What can shift anxiety, depression, overwhelm, or simply feeling “down” – into feeling good, or even great? What are the hidden obstacles that get in the way? When it comes to improving your inner world, there are some things that consistently work. And there are other things that might help, but that aren’t nearly as effective. With more than 40 years of experience, Dr. David Burns, author of Feeling Good, returns to the show to reveal how his new “TEAM” approach helps you feel good – no matter what’s happening in your world. With examples from how he’s treated severe depression, anxiety, and PTSD – you’ll get a sense of how to eradicate your negative thoughts – and any resistance that’s getting in the way. David Burns’s new book, Feeling Great, will be released this coming September.
If you want to listen to our first episode together, where David Burns and I spoke about how to apply his work in relationships (based on his book Feeling Good Together), here is a link to Episode 98: How to Stop Being a Victim – Feeling Good Together – with David Burns
If you want to listen to our second episode together, where David Burns and I spoke about how to recognize and deal with cognitive distortions, here is a link to Episode 133: Change Your Thoughts, Change Your Life – Cognitive Distortions with David Burns
And, as always, I’m looking forward to your thoughts on this episode and what revelations and questions it creates for you.
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David Burns: I had created – and we need to upgrade it a lot, an electronic version of my brief mood survey that patients can take at the start and end of every therapy session, plus rate the therapist: on empathy helpfulness, were there feelings that you were hiding, did you have trouble being honest? filling out the survey? And so we have before beginning and end of session, rating on relationship satisfaction, depression, anxiety, anger, happiness, suicidal urges – and although the tool needs to be improved a lot, they sent me the data from 9000 therapy sessions.
David Burns: And so I’ve always loved statistical modeling and the kind of modeling, I do – Analysis of moment structures or structural equation modeling – requires big “Ns”. And I’ve never had a database this big… It’s kind of overwhelming like being a kid in a candy store. So I was able to… First off, just to replicate a lot of findings from 10-20 years ago, when I was working with smaller databases like maybe 500 patients from my clinic in Philadelphia, 100 and 70 patients from the Stanford in-patient unit which are relatively small. But I was able to replicate almost everything and the data is just the cleanest data set that I’ve ever seen and it’s just full of correlational findings and potential causal findings as well. So I feel like we’re seeing for the first time kind of like the anatomy of psychotherapy that’s never been seen before. The veins, the arteries, the muscles, the tendons and how it works. So I can begin answering really, really basic questions, like, if you wanna have high patient satisfaction, what are the variables that cause that in the session, what do you need to attend to, or what goes into therapeutic empathy? I published an article that everyone has ignored actually in the top psychology journal about probably 20 years ago called intimacy and depression. Is there a causal connection?
Because the interpersonal therapists, make a big deal about the idea that depression is caused by problems in intimate relationships.
Maybe this should be our podcast. Maybe we could start broadcasting. And I never really bought it but it had never been tested. And it’s hard to test because you have to do something called non-recursive modeling which is the most difficult topic in statistics where things are circularly correlated.
Neil Sattin: Right, I think I heard in a recent podcast episode of yours. Testing – do thoughts cause feelings, or do the feelings cause thoughts?
David Burns: Chicken or the egg… exactly, that was just a little study I did with my Standford Data it had about an n of 100 but the findings were clear cut, so I did something like that with a much larger database, maybe a few hundred where we had depression, and relationship satisfaction scores at the start of therapy. I didn’t measure as intensely every session at the start and end. It was just once a session. But we had it at the intake and 12 weeks later. And intimacy and depression were correlated minus.4 at both time points, which was similar to what you see in the literature, using different scales everyone seems to come up with about that number. So high depression, low relationship satisfaction and high relationship satisfaction, low depression at both time points – and then changes in depression were associated with changes in relationship satisfaction.
And so, people interpret this, like the cognitive therapists say. Oh, that’s because when you’re depressed, it causes an impairment in love relationships because a variety of reasons – you feel worthless, you feel un-lovable, and you’re very sensitive to criticism, and you feel like I have a self that’s no good.
And then the interpersonal therapist says, “No, you know we need love, to feel happy” – But none of those people has ever bothered to check it out. People in our field in general, pretty much everything that’s said is false, ’cause people just talk, they say things that they wanna believe and came up with it themselves, so they think it must be true. And so in my study, we found that there are NO causal links in either direction, that have any particular meaning. There are tiny little causal links that are marginally statistically significant, but the magnitude of the causal link is so tiny that you couldn’t possibly improve depression by improving relationship satisfaction – even a great deal, and that itself, it’s almost impossible.
And in addition, you couldn’t possibly improve a troubled marriage by improving the depression or even curing both partners of depression.
I knew it already, because when my book 10 days to self-esteem came out. I did a bunch of studies all around – pilot studies. It’s a self-help thing for depression, and I had about 40 pilot studies. This should be, in your podcast, I think.
Neil Sattin: I’m recording right now.
David Burns: Oh, you are recording – Okay that’s great. And what we saw was that in all of these groups, people started with my book 10 days to self-esteem and they were in these groups – there were no therapists president. It was just a self-help thing I was trying to create.
And all the groups, people had dramatic improvements in their depression but… but in none of the groups did relationship satisfaction improve. At the beginning they were depressed with miserable marriages, and then at the end of the group, they were euphoric with miserable marriages.
It just proves that there’s no connection between these domains.
Well, I had a chance to try to confirm that now with 9000 therapy sessions where we’ve got relationship satisfaction or dissatisfaction is one variable, and depression or happiness. I measured happiness for the first time – as separate from depression. Happiness at the start and end of the session, depression at the start and end of the session. And the findings were exactly the same, and it was really thrilling. The correlation was similar, like -.3, which is a small correlation – ’cause the 3 times 3, is a 9, so there’s only 9% overlap in depression and relationships, and relationship satisfaction or happiness and relationship satisfaction.
I have to do that one. I could test that today. Does relationship satisfaction cause happiness or does happiness cause relationship satisfaction or both or either. After our call it’ll take me a minute to answer that question.
Neil Sattin: We can do a little footnote on this conversation with whatever you discover.
David Burns: Right, but at any rate, it came out exactly the same – there are no meaningful causal relationships between them, and that’s not a bad thing.
Neil Sattin: Yeah, so what it leaves me wondering is, where are the major leverage points for what does cause either of those things?
David Burns: Well, as I’ve said for years, all the causes of all psychological and interpersonal problems are totally unknown. And anyone who claims to know is just a con artist or a fool. It’s just like before we knew the cause of polio there were thousands of theories and treatments for the last two or three thousand years – and everyone was sure that they knew – and it came out to be a virus and we got the Salk vaccine. We had the true answer. We can say with certainty that depression is triggered by negative thoughts, and that if you have a negative thought and believe it like “I’m no good” or “I’m a loser”, then you’re gonna be very unhappy. But what we don’t know is why are some of us so prone to negative thinking and pessimism, and self-doubt, self-criticism. While others are maybe more outgoing and happy. And then there’s a bell-shaped curve.
Some of us, most of us are somewhere in between these extremes. That question we don’t know the answer to, all we can say with certain… Is that all current theories are false, like the psychiatrists claim it’s the chemical imbalance in the brain, and that’s been… We proved that was false in 1975 at our laboratory, in Philadelphia in our depression research unit. We flooded the brains of depressed veterans with like 30, 50, 100 times boost in brain seratonin. And that’s what the so-called chemical imbalance people fraudulently call seratonin the happy chemical. There’s nothing in the literature that ever said it should have anything to do with mood. Somebody just made up the theory and then there was no change in the mood of the veterans, none whatsoever. And we published that in the top psychiatry journal and it was ignored for 25 years. Because the drug company people didn’t wanna hear it. And recently, people are starting to quote it a lot. All these theories of causality. Nobody knows. You know, as Freud says, “Oh it’s anger turned inwards, or something in childhood” and certain psycho-analytic type therapists, they believe these theories that have no research to confirm them. But the great news is we CAN help people tremendously with depression.
My new book, I’ll give a pump for it, “Feeling Great” – it should be able to be ordered on Amazon soon – it’s coming out in September. We’ve got fantastic high speed techniques to cause depression to go away really fast. And that’s all I care about. And then, why do people have relationship problems? My research indicates that blame is the major factor. The problem is not that your partner is to blame, the problem is that you’re blaming them and not looking at your own role in the problem. And we’ve got ways if people want help with troubled relationships, which is generally not the case, we have tremendous techniques to help them. But anyway, that’s just kind of quick – where I’m at. The TEAM-CBT that I have created, and it’s now really out-performing cognitive therapy, at least in, in my hands, and those of a number of my colleagues. It emerged because of the research I was doing, a number of years ago when I was in practice. Why do some people get better fast, and others resist, or fail to improve?
And I found out why that was- it has do with motivation and resistance. Something I scorned early in my career, thinking it was not important, that turned out to be incredibly important. And once we saw that we developed new high speed ways to boost motivation, and that has, and reduce resistance.
The first time we meet with someone – and then that leads to amazingly rapid recovery.
Neil Sattin: There are all sorts of thoughts that I’m having at this moment, that are interweaving with things that you’ve mentioned already in this conversation.
So, I guess first… Well, I’m thinking about Emily Nagoski and her model for Human Sexuality, and what allows people to feel connected to who they are as a sexual being, and to their partner – and she talks about the dual control mechanism, which is basically what turns you on, and what turns you off, and being aware of those things. And so I’m hearing the parallel already in what you’re offering in terms of what motivates you to change, and what resistances you have to change – your accelerator and your brakes. And I’m curious to know, for you, does willpower enter into the conversation at all? I’ve been trying to get what’s his name, Roy, Baumeister on the show to talk about willpower. We’ve been in conversation for quite a while, but I’m wondering where you feel like willpower ends up as part of the equation?
David Burns: I don’t use the term willpower, but I created a term called willingness in the late 1980s when I was trying to find out why some people don’t recover quickly when treated for depression.
And over the years, I’ve come to see more of what this willingness is and what it isn’t. I developed a scale. And essentially, how willing are you to do stuff to help yourself like, psychotherapy homework for example.
And that was the only variable in the world literature that’s ever been shown to have a causal effect on depression or changes in depression, and the causal effect is massive. And then you can think about that as resistance, or motivation, which would be the opposite. And that variable – I tested all kinds of things that people were saying cause people to get better, like therapist empathy. Everyone was thinking, that was it. Therapist Empathy is important but it doesn’t have much of a causal effect on anything, surprisingly. But that variable was huge, and people doing homework had a huge causal effect on who got better.
Neil Sattin: So the variable was their willingness or the variable was their taking action? Because someone could begrudgingly take action.
David Burns: Yeah, yeah both. If you take action that’s meaningful, to help him reduce your negative thoughts – the actual homework had effects and the motivation that the homework reflected also had a massive causal effect on changes.
Recently I saw an article, somebody took this term willingness – I don’t think they attributed it to me, they should have – but they developed a willingness scale for anxiety disorders and reported that’s the first variable in the world literature that’s been shown have causal effects on recovery from obsessive compulsive disorder – OCD. That are you willing to use exposure to confront your fears…
Neil Sattin: So, willingness. So, that does intersect with the question of resistance and… So in your TEAM model, which is what you’ve added on and just to mention, for you listening, this conversation is, in some respects, giving you a brief synopsis of things that we went into a lot of depth into in our first two conversations together. So in our first conversation which was episode 98, we talked about your book “Feeling Good Together,” and it was this question of how to help relationships using your model.
We talked about that point that you just made a few moments ago that a lot of people actually don’t want to change their relationship even though they might say they want to change their relationship.
So we go into that question in a lot more depth in episode 98. And then in our last conversation, which was episode 133, we talked a lot about the ways that we work on our own feeling state.
So the first conversation we had was more focused on relationships, then we went through all the cognitive distortions, and we talked briefly about your TEAM model, but let’s just say what the TEAM stands for in this moment. Because that may be a good point for us to dive off into the other intersection that you brought up – the polio virus. And it’s impossible to have a conversation right now. I think without talking about the ways that SARS-CoV-2 or covid 19 or the novel Coronavirus whatever we’re gonna call it – that is impacting us.
And I’m seeing it have a huge impact on so many people, including myself, people who have been resolutely positive and optimistic, and it’s the way, the scale by which this seems to be affecting everyone in every walk of life – I feel like it would be great for us to bring our conversation back to that, and maybe we’ll weave in, maybe we’ll weave in all these things, like our resistance, and our blame, and we’ll put it all a nice bow around it before we’re done…
David Burns: That sounds great! We’re starting on my feeling good podcast series, Corona-casting and we’ve got two recorded and we’re gonna be doing maybe one or at least one or two more. But essentially, when you’re looking at the effects of the corona virus or both at intimacy relationship issuesm because we’re compressed closer together, and there’s more blow-ups and anger and tension being expressed. And so we’ve had a couple of those in my Tuesday training group at Stanford, where we sometimes do live work. It’s free training for therapists in the Bay Area or from anywhere. If they come consistently, they can get unlimited training and unlimited personal therapy for free, which is a pretty good deal.
And they have to come consistently, and do homework and use the brief mood survey to see how they’re doing with their patients. But in the last two weeks, we’ve had two people very upset. Both therapists – the therapists are human – no different from anyone else – due to intense family conflicts that have erupted because of of the coronavirus. And then I’ve also been working on the internal mood issues – the panic, the depression, and how we use TEAM to help with those things too – again with one live, or a real example. But what team is: T is testing, E is empathy is, A is – we used to call it paradoxical agenda setting, but that was too confusing to people. So now we call it assessment of resistance, and then M is methods. Now testing means that we test every patient at the start and end of every therapy session.
They do it in the waiting room.
And can do it now on their cell phone so it doesn’t waste any therapy time, but we find out exactly how depressed they are at the start of the session. How angry they are, how anxious they are, how happy they are, and what their relationship satisfaction is with the spouse or mother, whoever they want to be rating. And the reason we get those ratings at the start of the session is because therapists’ ability to know how patients feel is close to zero.
Research has proven this. And therapists don’t know this. Therapists think they know how patients are feeling, but if you stop and test it, you find out the therapist’s perceptions are way off base in most cases. In fact, it happened to me recently. I thought I was doing brilliantly. I’m not in practice, but I still treat a lot of people for free because I’m addicted to it. And on one of my Sunday hikes… I was working with a woman with certain issues, and I could just see that I was hitting it out of the park, and it was just an awesome hike… There were many hikers there, and afterwards, I was just congratulating myself for how outstanding I’d been in helping her, and then I discovered that she was enraged with me.
I mean she was livid.
I had totally totally missed the boat. And the listeners are maybe saying “Burnsie, he’s probably insensitive. That wouldn’t happen to me,” but it happens to all therapists all the time, and most therapists don’t know it. But if you get the assessments, the measurements, because then they rate you at the end on empathy, on helpfulness, on unexpressed anger, which was the case with my so-called patient, and a lot of other dimensions. And if you use the brief mood survey, it’s like having an X-ray machine. You see the truth for the first time. It is the platform for all effective therapy to my way of thinking. E is empathy, you know all about empathy. And so at the start of the session, we empathize with the patient without trying to help. That was my mistake with this patient – I just thought I knew what her problem was and jumped in to cure her. I didn’t bother to empathize or reduce her resistance – I violated my own rules. But fortunately, we had talked it over, and now we’re closer than ever. The failure turned into something just the opposite.
Neil Sattin: Right, and how often do we assume we know what’s going on with another person? And just jump in, yeah, with offering something and it can be with the best intention.
David Burns: That’s one of the things here with the coronavirus – people are often trying to help somebody or tell them what to do. Most people just want someone to listen, they don’t want someone to try to fix them, if they’re panicky, or upset, or angry about the coronavirus – good listening skills is is all that 95% of people are really, really looking for. But then after we’ve empathized, and that takes about 30 minutes generally, in my experience. I treat most people just with one session, I don’t have multiple sessions – I just treat people once and try to “cure” them or whatever that means in one two-hour session. One and done, is my approach. But if they need more, they can get more. But I rarely see people for more than one session. So you can empathize if you use what we call The Five Secrets of effective communication, which is I’m sure similar to approaches that you use. You can generally get an A or an A plus – you can form the deepest possible relationship with any person, you’ve never met in about 20 to 25 minutes. And then we do assessment of resistance. We say, “What do you want help with? Do you want help with anything?”
And once they say what they want help with – could be a relationship problem, it could be depression, it could be anxiety – we do what we call, fractal psychotherapy. I don’t know if we brought up that – fractal psychotherapy – a fractal is a little tiny formula that multiplies itself, and you can simulate almost anything in this way. This is like, how nature works.
Neil Sattin: The macro level is mirrored in the tiniest piece.
David Burns: Yeah, yeah, that’s it. I can take a little tiny equation that a third grader could understand, and have it multiply on your computer, and it will go infinitely to the size of the universe. You can’t see it all, you can only see a portion but you got it. It could create a gorgeous multi-color parrot, but the most beautiful little parrot, but if you zero in on the tiniest little piece of that, it will always be the same thing, that’s just repeating itself over again. And that’s how human suffering is. At any one moment in a relationship conflict, all the causes of the relationship conflict will be embedded. By one moment, I mean, what did the other person say to you, What did you say next?
And if you look at that interaction, you’ll see all the causes of that conflict between those two people. You don’t need their history. You don’t need their childhood – just one sentence from the other person, or two sentences – whatever – and exactly what you said next. That’s a fractal for a relationship problem. And you have a fractal for depression.
Tell me one moment you were depressed. What time of day was it, where were you, what were you feeling? Circle all of your emotions, how depressed were you? 90% okay, how anxious were you 80%? Okay, how guilty or ashamed were you? You get all of these emotions and 9 different dimensions, and you say, “What were you telling yourself, what were your negative thoughts?” And in that one moment when the person was depressed or anxious, you can find all the causes, and all the cures for all the upset they’ve ever had in their life. So we want the person to say, what’s one moment – if you want help, give me one moment that you want help. Where were you? What time of day was it?
What were you doing, who were you interacting with?
Yeah, and then I generally say to the person, Okay, you were all upset yesterday at [9:30] or whatever and you were feeling 100% depressed and angry and upset and all these emotions, but what kind of help would you be looking for? And generally it comes down to… Well, I want my negative thoughts and feelings to go away. With someone recently… We had a woman 95% depressed and 95% anxious and 65% feeling inadequate, and I think frustrated at 100, and jittery 100 because of the coronavirus. She just woke up and she’s trapped at home, and she’s thinking that she should be more active, but she feels like procrastinating and then she’s beating up on herself for not being productive. And…
Neil Sattin: it sounds really familiar, actually.
David Burns: Then we say, well if there’s a magic button – if you press that magic button all your negative thoughts and feelings will instantly disappear, or the person you’re upset with will instantly become your best friend in the whole world. With no effort, you gonna press that button? And everyone is “oh yeah, I’ll press that button.” And then we do what’s called positive reframing – we bring their subconscious resistance to conscious awareness.
This is the whole key to TEAM therapy to eliminate resistance before you try to help the person change, and that is what has opened the door to these phenomenal high-speed changes that I’m seeing. Now almost all the time when I work with people, they generally go from extreme or severe depression, not only to no depression – they go into a state of euphoria, mostly in a single two-hour session. People hearing this will get enraged, and they’ll think I’m a con artist, and think it’s impossible. If I’d heard this was possible 10 years ago I would have said it’s a con also – don’t believe that person. But I see it and I measure it, I have the data…
Neil Sattin: And you’re doing follow-up with those people as well?
David Burns: I do from time to time… I’m building an app now, a feeling great app, that will allow us to do follow-up forever, on everybody. Doing follow-up on humans is pretty time consuming. In my clinical practice, I did relapse prevention training.
I always do that before I’m done with somebody. Because we can guarantee that people will relapse. 100% of humans relapse pretty much every day. I define a relapse of one minute or more of feeling like crap.
We’re always relapsing all the time, but what I found is that if you do relapse prevention training, which takes about 20 or 25 minutes – relapse has not been a problem. And what I do is I just tell the person you are gonna relapse and here’s what you’re gonna be thinking when you relapsed, and here’s how to talk back to those thoughts. And then we practice it with a role play and they record it. Then I say, if you ever do relapse, play this recording and if you’re still stuck, give me a call because I offer unlimited lifetime guarantee of my work, and I’ll give you tune-ups for free, if you’re not satisfied.
Neil Sattin: It’s a pretty good deal.
David Burns: Yeah, in my whole career, I’ve had over 40000 hours of therapy sessions – I’ve only had eight or nine patients who ever took me up on that. And in all of them, it was one session or two sessions and then they’re on their way again. I only had one patient whoever relapsed and required intensive therapy again, to get out of her web. So I don’t think the relapse thing – the people that I’ve been working with – I worked with a woman four or five years ago, who thought she was a bad mother, because her daughter had been shot in the face, and she thought it was her fault. Her daughter was 12 and wanted to go out and play after dinner, and she says it’s a little late but I guess… Go ahead. She’d let her daughter go out every night for years, and then some neighborhood boys snuck up on her daughter and they had a high power pellet rifle – and aimed it at her face and pulled the trigger. And it hit her daughter’s tooth, which exploded in her mouth, and she ran inside, sobbing, blood coming out everywhere. And she required multiple, multiple surgeries. And in addition, by the time I saw the woman she had been beating up on herself for nine years. “I’ve ruined my daughter’s life.”
Her daughter was still struggling with PTSD and had failed therapy. So we did the TEAM therapy with her. I did it in a live workshop, and it took about an hour and a half, and her feelings went from extremely severe that she’d had every day for nine years. Just, “I shouldn’t have let her go out and play. I’m a bad mother I’ve ruined her life, I can never allow myself to be happy when she’s struggling. The people in the audience who are watching, they probably are judging me and thinking I’m a bad mother.”
And at the end, she was more than recovered – all her negative feelings went to zero, but she estimated one of them as minus a thousand and another one as minus a million an a score of zero to 100. She was in a state of euphoria. So I contacted her. I follow up with people from time to time just out of curiosity, and she sent me an email that she’s still in this amazing joy, and her negative thoughts have never returned it. And the thing is that after that session, when she recovered, I have a recording of it – which I gave her and she listened to it with her daughter, who had no idea that her mother was struggling like this.
And then her daughter recovered.
And so it’s infectious, when you’re recover. But at any rate, relapse prevention training is easy to learn – it isn’t easy to learn how to cause severe chronic feelings to disappear in a single session or a short period of time. It requires a lot of skill and training. But at any rate at the assessment of resistance, we bring the factors – see Anthony de Mello, maybe I said this in our last interview, he’s a Jesuit mystic from the early 1900s I think, or maybe the mid-1900s but he said “We yearn for change, but cling to the familiar.” And that’s resistance… We say, “Oh I would really wanna lose some weight.” But then when you… someone offers you a nice… like my wife made – we’re cooped up here at home – but she made some beautiful peanut butter cookies.
And they’re so good with a fresh, crisp apple. So you say, “Well I’ll lose weight next time.” We have ambivalence about change.
And so, we bring all the reasons to resist change to conscious awareness and patients haven’t thought of it before. And what we’ve seen is, for the most part, at least with depression and anxiety, the reasons people resist have do with really beautiful things about them, and once they see that, they don’t wanna press that magic button anymore, because then all these beautiful things will go down the drain. Like the woman who says I’m a bad mother. I hope we didn’t talk about her last time.
Neil Sattin: No, we haven’t spoken about her yet.
David Burns: I think – she’s saying “I’m a bad mother” – I told her, Well, gosh, if you press that magic button all your negative thoughts and feelings will go away. But before we do that, let’s say, What do they say about you that’s positive and awesome? When she’s telling herself I’m a bad mother what does that show about her that’s positive and awesome? And what are some benefits to her? What does that actually show about her, that’s beautiful and positive?
Neil Sattin: Well, it would show that she really cares about being a good mother.
David Burns: Yes, and that’s what she came up with. And I said, “Is that important?
Neil Sattin: Absolutely I would imagine so!
David Burns: Is it powerful? So if you press that magic button all your sadness and concern about your daughter will disappear and you’ll be euphoric, as happy as a lamb – is that what you want?
“Oh no, no, I see what you mean.” You see, and she’s intensely anxious. What does her anxiety show about her that’s positive and awesome?
Neil Sattin: Well, it would again be… I’m just imagining that she’s still really concerned for her daughter and wanting to ensure that she’s doing whatever she can to keep her safe.
David Burns: Absolutely, is that important?
Neil Sattin: Definitely.
David Burns: is it real?
Neil Sattin: for sure.
David Burns: Is it powerful?
Neil Sattin: Absolutely.
David Burns: Yeah. And so we went through all of her negative thoughts and feelings. And now you’re concerned that the people in the audience here are judging – gonna judge you.
What’s awesome about that, what does that show about you that’s beautiful?
You’re a bit afraid they’re gonna think you’re a bad mother.
Neil Sattin: Right… so she wants to be a positive role model in the world, for motherhood. She also probably wants people to know that she takes responsibility for being a good mom – that there’s something about if she were totally okay with it, then somehow she’s absolving herself of all responsibility.
David Burns: So does it show that she wants good close respectful relationships with the people in the audience?
Neil Sattin: Definitely.
David Burns: Is that a good thing?
Neil Sattin: absolutely.
David Burns: Is that powerful?
Neil Sattin: I would say, so, yeah.
David Burns: And so everything you see, we’ve been trained to tell patients – you have a mental disorder – you can look it up in DSM, you could qualify for probably three different mental disorders.
And that makes us ashamed of our suffering. Thinking. Oh, there’s something wrong with me.
And what we’re saying is there’s actually something right with you – a lot that’s right with you – your suffering comes from the part of you that’s most beautiful and awesome, at least with regard to depression and anxiety, not not so much relationship conflicts, although to a certain extent. But in depression and anxiety it’s something beautiful. And that’s called “assessment of resistance.” And then with her we came up with, I think, 22 beautiful things about her and benefits of her negative thoughts and feelings, and I said, well…
Why would you wanna press that magic button ’cause then all of this will go down the drain?
Why would you wanna do that?
And she said “I see what you mean, but still I I’m suffering so much, isn’t there something I could do?”
And then we used the Magic dial and say, “Well maybe instead of pressing the magic button we could dial them down. Your depression is 90… How much would you like to be at the end of the demonstration, today?”
Is there a lower level, that you could keep all these beautiful things about you and your shame, and your guilt? What would you like them to be? How anxious would you like them to be and she said “oh well 20% is enough on depression and maybe five would be enough anxiety, and shame – I’ll turn that one all the way down to zero.”
Her anger… She was very angry at the parents who let their boys out with a loaded rifle. And she wanted that one to go from 100 to maybe 20 or something. And then we say, “Okay well, we got powerful techniques and will lower them to those levels.” She had a gold she wrote down for each of her nine different negative emotions. They I say “we won’t lower them any further, but we’ll have to be careful ’cause the techniques I’m gonna use here are so powerful – we may overshoot.”
Your depression may go down to five or zero even – but don’t worry if you get too depression-free or too anger-free I’ll help you dial it up at the end of the session.
And she liked that, and now the resistance, is gone. And then we just went on and identified the distortions and her thoughts, and showed her techniques and roleplay techniques to talk back to them, and she just blew her negative thoughts out of the water. And then at the end I said now do you think these people in the audience are thinking you’re a bad mother and they’re judging you? Could we do an experiment to find out if that’s true?
And she got very anxious and he said, “You mean maybe I could ask them?” and I said, yeah, would you wanna do that? She says No no A… And I said “your fear shows us that it’s the thing to do” ’cause that’s exposure, right? Confronting your fear.
So she said, “Well maybe could some of you come up to the front,” because a friend of mine was doing is on his tiny little cam recorder, and so talk into the microphone – and then you can ask them if they’re judging you and how they feel about you. And then about 10 people came up and each one of them she said “How do you feel about me?” And they started – every one of them started crying and saying, “You’re my hero. Getting up in front of the group and doing this demonstration shows what a beautiful mother and beautiful human being you are, and I’m so deep in admiration.” And then she started sobbing – she couldn’t believe it. To see how off-base or negative, her thoughts had been… And that was kind of the end of the session – we did the end of session measurements and everything had gone to zero and below zero. So, that’s TEAM – testing, empathy, assessment of resistance, and the M is methods. That’s identifying the distortions in the thoughts and turning them around. Now it plays out radically different for relationship problems when we follow the same structure.
Neil Sattin: right, and I like when I’ve heard you talk about all the different methods that get combined, and how you work with people, that you’re quick to point out that they come from all of these different places that you’re sourcing all kinds of different therapy, therapeutic models and how you approach problems.
David Burns: yeah, yeah, TEAM is not a school of therapy, I’m against all schools of therapy. And think they could all be got rid of, just as when the Catholic church, when science and astronomy broke away from the Catholic church, it became a science – data driven science. So now you see how fantastic physics and astrophysics and all of that, has become… And I think that therapy you can draw from all the schools of therapy and the M equals methods. I use over 100 methods really that are on my list for therapists, and they come from all schools of therapy.
But then we should be focusing on basic research, to see how all of psychotherapy works. And then having a structure for therapy. TEAM is a structure for all of psychotherapy. That’s how therapy works – rather than schools of therapy, which are generally guru-driven rather than a science-driven, and are pushing some theory of some person who has a lot of followers.
Neil Sattin: And is the idea that you’re paying attention to what is actually working for the individual? ’cause I can see that some things might statistically look like they work more than other things, but if it’s not working for the person in front of you, then it doesn’t matter how statistically proven, it is to be effective.
David Burns: Yeah, like her thought – the first thought she wanted to work on from her daily mood log was “I never should have let my daughter go out and play.”
And in my mind or on paper, I generate what’s called a recovery circle. I imagine that thought’s in a circle that she’s trapped in – and then there’s arrows coming out of the circle. And each arrow is a different way of escape and at the end of each arrow would be one of these hundred methods that I use. Like a method could be identifying the distortions, or externalization of voices, or examine the evidence, or a downward interpersonal arrow, or the hidden emotion technique, or whatever techniques. And then I go through them one at a time, in my mind, until I find the “Aha!” one that just implodes the system and the patient suddenly recovers. This recovery generally happens in a matter of…
Oh, maybe a minute or something like that. When the patient suddenly sees that the negative thought is not true, at that very moment they will improve or recover.
Neil Sattin: Okay, I’m wondering if you’d be willing to do something that I’ve only done occasionally, here on the show, but what I’d love to maybe try if you’re up for it is… is to do a little work together.
Because I feel like one of the reasons that I reached out to you is that when I was thinking, Okay, we’re in the middle of a crisis, at least that’s what the thoughts tell us – and the news tells us – and most of us are living somewhat sheltered in place. We’re not leaving our homes… So the world is different in this moment.
I was thinking, Okay, who… Who do I know that I would most trust to show up in a moment like this? And you were the first person that came to mind for me and so it’s…
David Burns: So kind of you to say – thank you – you’re one of my heroes.
Neil Sattin: Thank you David, I appreciate that. And so what I’m hoping is that for everyone listening, that if they… I think it’s so instructive to hear you talk about the process and, as you know, witnessing the process might also be really helpful for people as they think like, Okay, how do I deal with everything that’s happening in the world right now?
[First we revisit the data set to see if we could find any more causal relationships or correlations]
David Burns: We’re looking at the relationship between relationship satisfaction, happiness or unhappiness on the one hand, and then a 10-item happiness scale. It’s things like “I feel worthwhile, I feel close to people. I feel productive,” and so forth. We’ll get on to our exciting personal work, which is gonna be way cooler than research for your listeners. But we did get some clear cut results here, with, I think the… N on this is 9000 sessions – and so we can now say…
Okay, let’s just, let’s look at the results, right? Okay, we’ve gotta just make one last adjustment.
Does happiness lead to better relationships? Or does better intimacy cause feelings of happiness? That seems like a reasonable question, don’t you think?
So, and I’m just, I’m setting this up in the software I have no idea of what these results are gonna show, but they do, they do show a fairly clear cut result here. The correlation between positive feelings and relationship satisfaction is about.38 – it’s a modest correlation – not huge – you take the square root of that which would be about 15 or – the square. The square of.38 is about.15. So there’s about 15% overlap between how satisfied you feel in your relationship with your spouse, or partner, and how happy you are. Now, in one of these models I declared that there was no causal effect of positive feelings on relationship satisfaction. In other words, that when you’re reporting how satisfied you are with your spouse or your partner, we’re testing the theory that… How happy or unhappy you are, has nothing to do with that.
Now do you think that’s a true or false theory?
Neil Sattin: I would say that that’s – intuitively I would say false. That your level of relationship satisfaction would impact how happy you say you are.
David Burns: Well, you’re, you’re right, you’re a genius. Because it has no causal effect whatsoever.
Now, how about the other hypothesis? Is your happiness, feeling of happiness, influenced by how satisfied you are in your relationship with your spouse or partner?
Neil Sattin: That was the one that I was saying, I thought would there would be a correlation.
David Burns: Well, we’re talking about causal effects not correlation…
Neil Sattin: Right, so, in other words, with the first one, does your inner state of happiness cause you to report more satisfaction in your relationships?
David Burns: Right, and, and you predicted “no”, and you were right…
Neil Sattin: But that was the one where it was 15% like that there was 15%…
David Burns: No – that’s just the correlation between them, but that doesn’t mean there’s a causal relationship.
Neil Sattin: Okay, got it, thank you for clarifying that.
David Burns: Yeah, but if you’re very unhappy and then you become very happy, that’s not gonna affect how you report your relationship satisfaction or dissatisfaction. And that’s kind of what I found in my pilot study too, that when we made people’s depression, disappear, it had no effect on their level of satisfaction with happiness or unhappiness in their marriage. Now we’re looking at the other direction.
Does how happy or unhappy you are, in your relationship, does that affect your feeling of depression?
Neil Sattin: I’m gonna go out on a limb and say Yes.
David Burns: Yeah, and again, you’re right, so you… I think you need to go into statistics. Good statistics should reflect common sense. It often gives surprises.
There is a causal effect there, and I can tell you how big the causal effect is. My relationship satisfaction scale, is highly accurate. It goes from zero to 30. So let’s say your relationship satisfaction increased by 10 points – that would be a huge improvement. And it’s hard to get that in a clinical situation when someone’s unhappy with their marriage. But if you can boost it by 10 points there would be four-tenths of a point increase in the positive feeling scale, which goes from zero to 40. So it’s the same result that I had in Philadelphia. There is a causal effect in the direction you mentioned, but it is so tiny as to be kind of theoretically and clinically, meaningless. And it’s kind of an interesting result, because it means that how happy or depressed you are, on the one hand, and then how close you feel to people in general or to your partner on the other hand – that they’re not related to each other – for the most part, there’s no connection. So, the tools that you would need to improve a relationship and the theory of what causes bad relationships is totally different from the tools you would need to treat depression or boost happiness and the things that cause depression or happiness. That they’re independent domains – they are not linked.
Neil Sattin: So, there you did see a causal effect, but it was pretty small.
David Burns: Yeah, it’s exactly what I reported in my original paper in the Journal of Consulting and Clinical Psychology in the mid-1990s or something like that – and no one’s ever attempted to replicate it. Today, I have the first replication studies of that.
And it is important because it means, let’s say you’re a therapist, and someone comes in with depression, and they’re lonely or they have a poor relationship. Clairman and Cole [sic] have this thing called Interpersonal therapy where they treat depression by improving people’s relationships, and then they think that that’s effective. And of course, the therapy, all therapies for depression have a placebo effect and not much more. And that’s true of theirs. And so while they do get people somewhat better. It’s not – the depression doesn’t improve because of improved relationships – improving relationships will not cause you to feel less depressed or happier.
Neil Sattin: It’s so interesting, it’s so interesting. And I guess this must be something that I’d account for, I’d have to account for it in a different way. At this point it makes sense to me… People often talk to me about their relationships, I think, because of what I do. But prior to what I did, I found people talking to me a lot about their relationships, and it always seems, it has always seemed as though that if something isn’t going well, that that weighs heavily on them and it does ripple out into the other aspects of how they perceive themselves to be doing.
So what that would suggest – what you just revealed – is that we may harbor this belief that there’s a connection there, when in fact those are two completely independent domains and should be treated as such. So, what someone says, “How are you doing” and you… You say like… Well, I’m okay, but my relationship is horrible or whatever. Then maybe the next response that should happen given what you just said, is like, “okay, that makes sense. Let’s separate those two, because they are a completely separate or almost completely separate.”
David Burns: Right, right, and because you don’t have a big ego, like probably your self is dead, so you’re open and can receive. But the problem with most mental health professionals is that they think they know things, and so it’s hard to accept new findings. I find these new findings that are so different from what I believe to be, in a way, kind of exciting, because what it means is that we have new understanding of how the world works, and then we can use that to refine our effectiveness as therapists. But sometimes it’s really hard to accept what research teaches us because it shuts down what we thought intuitively to be the case. But I found this also true, that when – I have treated thousands and thousands and thousands of hours of people with depression and now I have tools to cause depression to disappear most of the time, just really fast in a single two-hour session. And I never work on boosting relationships – I can cause depression to go away without any attention to how happy or unhappy a person is in their intimate relationships. And if they also want help with relationships, then I would use a completely different set of therapeutic tools from the ones I used to treat depression.
So it’s just kind of interesting and you always have to take it with a grain of salt, because you can fool yourself with research too. But I’ve seen this now with two huge databases exactly the same results.
Neil Sattin: I’d be interested to see how this… Not that we’re gonna do this right now, but how this would overlap with say all the research and modeling that John Gottman has done, and see where those datasets correlate with… Where they line up with each other, and where there might be disparities between the two.
David Burns: Yeah, absolutely, and if you review the literature too, if you want publish a paper, you have to say so-and-so found this and so and so found that… And so forth. But the kind of analysis that I’m doing here is-it’s difficult to do, it’s the most difficult topic in all of statistics when you have A and B – the kind of the chicken and egg thing. Most people don’t know how to do this. This kind of modeling. But it would be fun. Maybe he has never measured happiness at the same time that he’s measured relationship satisfaction – maybe he’s never measured depression at the same time he’s measuring relationship satisfaction.
That’s what you need to measure these things. at time A and then measure them again at time B later on – and then you can model the causal connections if any between the variables. But yes, it would be fun to find that out, but let’s do something cool and truly awesome now and get rid of statistics…