Final Thoughts on Rapid Emotional Relief

Welcome to the Feeling Good podcast Have you ever wondered why you keep feeling the same way Even when you're trying to change Anxiety, habits, relationship struggles sometometimes it can feel like nothing really sticks I'm therapist Kevin Cornelius, and each week I sit down with Dr. David Burns one of the world's greatest authorities on cognitive behavioral therapy and the creator of Team CBT This podcast is all about practical tools that actually work. Clear techniques you can use to overcome anxiety and depression Iprove your relationships and build real confidence No fluff. No vague advice just effective tools that can help you change the way you think The way you feel and the way you live Let's get started Welcome. In this episode, we're talking about something that affects millions of people but that most of us really question Psychiatric diagnosis deccades the diagnostic and Statistical Manual of Mental Dorders, the DSM has shaped how mental health is defined, treated, and even understood in the United States It lists nearly three hundred mental disorders and plays a central role in therapy, medication insurance coverage and research What if some of those categories don't reflect clear biological diseases What if many of them are better understood as variations of normal human emotions, like sadness, anxiety, or shame that exists on a spectrum For the listener today, you've joined us for a very special discussion Dr. Burns recently published an article on psychologyoday. com titled Is it time for a new approach to emotional suffering In this article, David argues that while diagnoses can reduce stigma and help people access care They can also unintentionally shape identity medicalize everyday suffering sometimes distract from what actually drives emotional pain He brings decades of research and clinical experience to this conversation includluding surprising findings that suggest many negative emotions may share a common root. This is a thoughtful, nuanced discussion about labels Measurement. therapy and what it really means to heal. I'm so excited you're here with us for this today. So let's dive in. Okay Kevin. Hey, thanks, David. I appreciate that. Hello to you. and it's great to have this discussion with you today. I really loved reading your article And it reminded me of some really important things I've learned from you in the past. And so I'm really excited for people who are listening to hear your take on this because I think it's very important And And let me officially welcome you again as the official host now of the feeleeling Good podcast. This is your third, but the first two Rhonda was here kind of babysitting on us and making sure everything's going okay. So this is our kind of like solo flight and I'm just I really love you and respect you tremendously And I'm excited to bring our dialogue to our audience And your introduction was just right on target. And I think the thing we want to address in today's the take home message for you folks who are listening is you do you have a mental disorder O are you just They inhumum And and also, if, you know, there are a few true mental disorders. there aren't many But if you have have one of those willll have a lot to offer you as well But let's dive in and why don't you start off by just telling them where they can go and access this article. I've been publishing a lot of articles in psychology today And they're partially based on research and Partially on the team CDT model Yeah But anyway, take it away and I'll respond to your questions, Kevin Yeah, thank you, David. And thank you so much for those kind words. I really appreciate that. and it's so wonderful to be here with you in this role. Is it time for a new approach to emotional suffering is the title of the article we're talking about today? And it's on psychologytoday. com and we'll put a link in the show notes that you can go directly to that article. And then you can see I think there's at least six if not more other articles that you have published on that same website that are Also wonderful. So it's a great thing to check out for everybody. And we'll be talking about more of your articles in the future too David, my first question for you M of our listeners probably don't know what the DSM is. For those who may not know, what is the DSM and how did it become so influential in American mental health care? I think it's conveniently you know and formally referred to as the Bible of the American Psychiatric Association And it's maybe by way of a very brief background. I'm a psychiatrist. you, first I went to medical school and then I did my psychiatric residency training And and The question is, you know, how much of emotional suffering should be under the care of physicians and how much maybe can respond better to a psychotherapeutic approach us Bobby here You know, I went into the field because I want to help people. I want to do psychotherapy and work with people And and then I found out that it's really totally medicalized. And I think the history of it is that I don't know if you are old enough to remember those psychiatric New Yorker cartoons that they always had some psychiatric theme like I remember once there was this feellllow he was hiking with his dog and he fell into quicksamp And he's sinking into quick at it. He tells his dog, G help And then in the next panel, it shows him the dog on a psychiatrist's couch And and I think that psychiatry has always been viewed as the weak link in medicine, the least credible old and there's jokes about how neurotic psychiatrists are. and I think there's you a lot of truth to toout And there's been an attempt to make it more like a medical field And so what they've done, the DSM, it's tried to convert everything into some kind of mental disorder. Now, there are a few mental disorders and I've and down the ones that I can think of. but a true mental disorder would be like schizophrenia Mm. So a tragic horrible disease. We don't know the cause of it Someday we will, someday we'll have a, you know, better treatment But it's just The symptoms are not a part of normal human experience. you hear auditory hallucinations, you know, voices coming from outside of your head and you get involved in, you know, paranoid conspiracies and U, you know, it's I remember I was treating a young man with schizophrenia at Highland Hospital where I started my internship and residency and He would see, you know, rocket ships flying through the officeall while during sessions. and it's really sad and tragic. It's a brain disease of some kind. Yeah. We don't know the the cause of they have some medications that can help Psychotherapy can help but it's for the most part tragic and I'm unfreatable. It's incurable for the most part But that' Mental disorder And then over one is certainly you know a mental disorder but it it doesn't have the tragic prognosis like schizophrenia, it's like a person might suddenly become manner And you know, go running naked through the streets, screaming that you have a new plan for world peace and you don't notice that you're doing something that others might think is not normal And and you can get into, you know, trouble end up arrested or in the hospital or whatever. and then you can swing into the low part of the cycle too were become extremely extremely depressed and bar does respond well, not so much in the manic phase, you have to have medications But in the depressed phase of the in between phasees responds really well to psychotherapy like Team CBT there's a few other true brain diseases, but they're mainly in the realm of neurology, like drug intoxication and withdrawal or drug toxicity, like Korsicooughs of people who are hardcore alcoholics and they start confabulating and you know, get really deranged brained tissue but And then there's dementia and, you know,, you know, you know, infectious diseases of the brain that can cause psychotic type conditions, but Though those are true. tissue abdnormal of the brain But what's in there, the hundreds of things they've taken normal U you know feelings, like most people do you say U these are Do you get anxious in social situations? And most people say, Ohh yeah. ye. Absolutely. do you have public speaking anxiety? Most people say, yes, and that's called social anxiety And psychiatrists have done is they want to turn that into and that's what I've had it myself, all kinds of social anxiety. I've had at least five kinds of social anxiety. and I love it. It's my favorite thing to treat. It's the easiest thing to treat But psychiatrists take something like The symptoms of social anxiety and they'll say to the patient You don't have shyness. you have social anxiety disorder M And that makes it sound like it's a mental disorder, which it's which it's not and that it needs to be treated with drugs and medication and there is some kind of long term thing. When I'm working with people with social anxiety, I would like to see a dramatic change in symptoms within a single two h therapy session or going out with them in public and approaching strangers. and overcoming it, you know, ra rapidly It's this attempt to medicalize things and it's it doesn't make sense from a philosophical or conceptual point of view, for example take do you ever worry about things Sure Okay. And do you know how many days of continuous worry you have to have before you have the mental disease of generalized anxiety disorder I think it might be something like six months. Yeah, midnight of Yeah of worin, you have something called Generalized anxiety disorder that you didn't have five months earlier Right. Well, why six months? Why not three months? Why not an hour and a half of we're end Right. But but the thing is if they can call it a disorder, which it's not then they say, okay, then we can start treating this with drugs and we don't have to Uh do psychotherapy or get to know the patient or learn how to how to treat uh, you know ric Rin, which is what it is. So they've got hundreds of these patterns And and sound I'll get my last Parting shot here is that it's it's really sad and irritating to me. because People with anxiety, for example, already feel ashamed and aective That's one of symptoms of anxiety And then when the doctor says, Ohh, you have a mental disorder That's simply adds add adds to that the offers are doing these days. is and what the model that's being taught in many medical schools, if not most is you see patients just for a five minute session to adjust the medications once a week And then theirir insurance companies will pay and asked a young psychiatrist, how much can income can you generate from that And she has said at depes on, you know two to five hundred dollars for the five minutes to pay a your self pay or insurance pay Well, you can imagine the temptation for young psychiatrists because you can learn how to prescribe antidepressants I used to be a full time psychopharmacologist and I could teach you everything you need to know to prescribe antidepressants in thirty minutes And and benzodiazepines I can teach you everything you need to know thirty seconds M And I will do that now H the Benzones are great anti anxiety drugs, but they're all addictive after two or three days I know I got hooked on them myself once the answer there is don't use the benzos they're very pleasant. if you have to have a colonoscopy and they offer to give you an intravenous Valley I ll go for it. you'll love the colonoscopy But's they're not an effective Treatment Yeah, It's all, you know, just, you know crank crank the patients out as fast as you can. And if you have ten Five minuteatients in an hour. for two hundred dollars, Well, that's two thousand an hour And then it can go double or triple that. And so the young psychiatrist can be making A million dollars or two million dollars a year by giving out these prescriptions. And the problem is that for anxiety disorders, the drugs are pretty much all addictive or not very effective. And for depression, we have drug free techniques that can work in less than a day you know, less in my experience, less than than two hours. So I think it's you know, it's a major Ehical Um issue and and and it angers me. ye. the to see this direction. And she said that they're also trained to say if the patient brings up a problem during the five minute drrunk you know, evaluation because I knew I used to do this with patients, they would come in and a like not five minutes, but one minute to hand handle their drugs then I spent the rest of the hour doing psychotherapy but they don't do that extra extra part. And if the patient has a problem, they're trying to say, Oh, I'm just your medication doctor. You have to go to your you therapist to talk about your deression or ar anxim or your marital issue or whatever Listen Well I can understand why that makes you angry Pople are being told that they're Normal human emotions are actually a mental disorder. It's a medical problem that can only be treated with medications and then they're only seen for five minutes. because you can crank out the money basically Yeah That's right. That is a huge ethical problem I'm imagining what a person who's looking for help thinks when they hear this, right Yeah, It's very discouraging. lead to some confusion and hopelessness. Yeah. You know and passassive rule. this person who's an act saying, o, you have a mental disorder Yeah. And then you're thinking they know something that you don't Right. N atet any special knowledge. All they have is a set of rules allows them to select people who are the most severe. say, o, you have generalized anxiety disorder major depressive disorder the criteria aren't based on someome wir in of the brand or some tissue level, it's just symptoms. and to have the diagnosis of say, major depressive episode or major deive disorder. How long do you have to be depressed for It's fourteen days een days, okay. just upset. And and it's so arbitrary, you know, more days than not, you know, Right for fifteen days. and then on midnight of the fourteenth day, you have this this mental disorder That's right. And well a fourth grader could make that diagnosis. It doesn't take a psychiatrist. just if you can count up to fourteen Yeah And there's something from your article that I wanted to make sure I asked you about if that's okay. Yeah which is there are some Benefits from the DSM, right? So when somebody is given a DSM diagnosis, for instance, there are some benefits. and I liked the way that you listed them. Can you talk to our listeners about that right now? How is it helpful To be told you've got a depression disorder or you've got an anxiety disorder, what's the benefit of that? Well, thanks for bringing that up because that slips my mind and makes for unbalanced discussion. So this is important Well, for one thing Oh who feel guilty about their symptoms feel relieved to be told you have a mental disorder and it reduces the stigma And others can increase the stigma Right But that that's a benefit. another one is it makes it easy to get paid by insurance companies if you carry one of these diagnoses. Another thing is sometimes you get kind of like disability type type considerations if you're told you have, you know, a learning disability or ADHD disorder or something or, you know, you can get on disability for depression and things of that of that nature And although that Yes sometometimes abused sometimes it may be tremendous lifeifesaver to at some What support for your emotional suffering I think I've worked with a number of people who were on a leave from work and they have to have a doctor sign off on that, right to say, well, this is the problem that this person has that makes them qualify for having this time off from work to address it. O And And there have been times when I have told patients, let's say university students who were struggling. I would recommend that you take this semester off or drop out of this course and lighten your load right now. I'm willing to support that with the the authorities here is is that one is that one What would help you E think And and sometimes, you know, it is very important to people to just get some support and from the tremendous pressure, hospitalization can sometimes satisfy that function as well Okay. No What are some that's Kevin I think you mentioned this before, but many people do feel relief when they get that diagnosis It's not that there's something wrong with me as a person. I don't have some kind of a moral failing Yeah O I'm not choosing this. I'm not choosing to let people down or something like that. right? Yeah. But it's something that's kind of outside of my control that I've got an actual disorder that's legitimate and I can get some help for it, right? If somebody knows, okay I recognize your symptoms. 've got the symptoms of depression. And I've got ways of helping you with that. Right Yeah. That could also maybe give them some hope. I think. Yeah H impro? Five minutes once a week and give you antidepressants that don't work That's right. Well, therapists also work under these diagnoses for psychotherapy too. R? because in order for a patient to be able to use their insurance in order to Oh yeah can get psychotherapy The DSM is used as well Yeah I've diagnosed you with generalized anxiety disorder. and here's the treatment plan for how we're going to help you with it. It's psychotherapy techniques instead of medications. It's teamwork and relief. and this is what's going on. Like my computer broke down yesterday, as I mentioned to you It's being diagnosed in the Hopefully a competent computer fixed place, but Once they tell me what their diagnosis is, you know, what the plan is, that'll be a definite relief for sure Yeah. I think it might be helpful to understand When did you first begin to question? the DSM that it may have these limitations Well, I started out at the end of my residency and psychiatry, that was all based on the DSM and assigning these diagnoses. so we had to understand you know, how to use the diagnostic system according to the rules in the diagnostic and statistical manual of Mental disorders, that's what the DSM Yeah. And We needed those diagnostic categories and their original purpose was valid and still is. and research you need to diagnose Hey population that can be reproduced by others who want to double check your findings And so they said, we'll how, you know for major depressive episode. It would be only people with a certain severity of depression for at least two weeks and certain others. it can't be due to alcoholism or all psychotic disorder and to get a kind of a purified diagnostic Oh value there being or a group and then we published and You know, scientific journals like archives of genereral psychiatry and biological psychiatry and , you know, that that that that type of thing and it was Perfect for that Okay, but where it doesn't work is is you see, we work diagnosing mental disorders, we were diagnosing you groups of patients that we could define the criteria in a scientific aper that we published in a pure refereed journals so then the people who read it could say here's the kind of patients they studied and they would be able better to understand You know what what we had done. Um the u But then when I went into practice, I began to to think, you know, well, we should do this with all new patients. I hated it because T do it properly, you see, we had to do these called structured diagnostic interviews. The SADS interviewed the skids interview, the interviews changed a little from year to year. But they were essentially you would sit down with a patient for one to two to three hours, sometimes more going through a long structured interview that was all yes, no questions. So have you ever struggled with, you know, anxiety Social anxiety, and excessive anxiety around other people? Yes or no uh or for alcohol, you know, you know, T y or no Questions in order to arrive at at a diagnosis And I got so sick of doing these things because I want to work with patients on their problems. And it was very boring to go through these diagnostic interviews. So in my clinic in Philadelphia, we actually hired somebody to give the diagnostic interviews to patients before we treated them And they'd give us a summary with all of the diagnoses according to the DSM criteria. And then I noticed that most patients had multiple diagnoses, not just one or two, as we had been trying to think about our patients but I was also developing my own mood tests my brief wood survey, but my brief depression test And I wrote my tests, How are you feeling right now rather than over the past two weeks, although you can word them like that But I want to know how much improvement patients were getting within sessions and so I then was curious the I was using the how you're feeling today How angry are you? How anxious are you? How depressed are you? How happy are you? How is your relationship satisfaction? And but then we had these lists of diagnoses. And so one of the articles once I went into private practice is I wanted to see how much information this three hour interview how valuable that was Once I knew See, I could As you know, you use the same test, I can find out how to press some on this in fifteen seconds And how that changes from the start to the end of the session I looked up the, you know, the changes in my patience in the first twelve weeks of therapy. you know, theseese days I treat people for two hours but are standard was, you know, twelve weeks of therapy and it was often more when I was in Philadelphia And so I found out the measures I had created had high predictability and were very valuable in knowing, you know how much people had improved or what was contributing to their improvement and this type of thing thenen I noticed when I added the DSM diagnosis They added N end is statistically. in other words, they didn't seem to have any causal effects on how fast or slow people got better whether they got got better, better. And I thought that that's interesting. That was the first kind of shocker that I'd had These things that we've put so many hours into learning these boring diagnostic surveys to be scientifically correct. acccording to the American Psychiatric Association was giving us information that didn't appear to be valuable. And so when I moved to Stanford from Philadelphia. and I gave a talk there in the Department of Psychiatry and I mentioned these this finding that we were surprised because I had the personality disorders, all the mood disorders, all the anxiety disorders You know, I had like You know twenty At least twenty or thirty diagnoses accurately done according to the diagnostic and st statistical manual And I found out that the information on how who was going to improve and how much they were going to improve and what I was going how much of it was relevant to what I did as a therapist. All of them had zero relevance that they had no value at all. All I needed was how depressed they were, how anxious they were. angry they were, how suicidal they were. those were the crucial Th And then what happened to me is that And I didn't present this in an aggressive way talk I said I was really surprised that these DSM criteria I can't see that they have any validity in terms of my work as a clinician, that they They didn't inform me of any of anything. Now if someone has schizophrenia, Sure, that's incredibly important to know or if someone is bipolar, that's incredibly important to know But aside from a few things like that, in terms of patients I was working with who were struggling with depression and anxiety and relationship issues They they had, you know, really no relevance. And I was saying This is something we should consider No. that these things that're worsihiping this Bible, the DS him and you know, the The emperor has no clues was what Wh Yeah, I find it was And then three days later I was called before the Stanford Ethhics Committee in department of psychiatry which was very terrifying to me because I had just moved out to Stanford and I was trying to make a good impression on people and show that even as a clinician, I've been doing research and finding some interesting things and they didn't take kindly to this at all and thought that I was challenging psychiatric diagnosis, which I was, in a sense that this was challenging their whole identity as, you know This is what the Department of Psychiatry is is founded ond. It's kind of like the Catholic church it's saying that holy water Maybe isn't as holy as you think it is Maybe just tap water but Everyone isn't ye You know eager to get that interpretation So, you know, I explained myself and fortortunately wasn't kicked off of the faculty, but I felt ashamed and angry and anxious and frightened Oh and shocked because I have been trained in statistical modeling and ter research when I was at An and We were publishing in the world's top scientific Journals Oh And then I did a similar study When I was at Stanford I had developed an easy diagnostic system or entusted in they could purchase it in the shop on my website feelinggood. com And it's something that patients can fill out a survey And so you don't have to do that three hour interview and they patients can fill it out in an hour on their own time and then They showed to me at the start of a session and I could review them in five or ten minutes and see you know, all the various symptoms they're struggling with. I call them cl symptom cluster diagnoses. I'm not trying to do mental disorders And then I wanted to validate my easy diagnostic system against the DSM. So on about one hundred consecutively admitted patients to the Stanford inpatient unit I had graduate students who were trained to give this kids interview to a hundred patients I could see how those diagnoses compared with my easy diagnostic system, which was quick, cheap, and easy and high reliability this official system that has low reliability, low validity. I don't know to see if I could kind of validate it. And the study worked out pretty well. but what I did I was curious I and the interviewers and the patients didn't know I was going to do this after they had done this two hour interview with these newly admitted patients And they went through all of the diagnoses and they talked to them for two or three hours according to these yes no categories. M. And I said now, I want you to turn your backs to each other And then I wanted the patients to I ask them to fill out my brief mood survey, which just takes a minute And how are you feeling at this moment? How depressed, how suicidal, how angry, how anxious, that type of thing alsoso rate this interviewer for warmth and empathy on my five item empathy scale And then I told the the experts who had energiewed them to rate how they thought they were feeling right now H you were just p it twow or three hours talking to this patient only about their feelings. So How are they feeling right at this moment You know, I was trying to make it as easy for them as possible. If you ask them, how were you feeling two weeks ago? That's kind of an unfair quest job But how are they feeling right now? So guess how they're going to answer it And then I was able to take these two sets of data and find out how accurate these experts were, how much had they learned about how these patients were feeling And it was shocking because the the accuracy the of knowing how depressed the patients were was three percent on the Soto hundred. Wow. their accuracy knowing suicidal urges was zero percent theirir accuracy on anger was zero percent. Anxiety was something like five for South And then therapeutic empathy was was was nine percent that the The therapists were ninety one percent inaccurate and knowing how theyd come across And I thought, my gosh, that's pretty condemning the DSM doesn't give us information that's even valuable Fifteen seconds after we were done using the DSM It doesn't tell us how our patients are feeling and that's the thing Patients care about Yeah to change my depression, to get rid of my panic attacks, my social anxiety And David, I want to Really make sure I'm understanding a couple of important points here. Is it okay if I ask a coupleions Qions here I heard you say that The DSM has its helpfulness when it comes to research giving criteria of what you need a set of patients who fit a certain cria of symptoms in order to test things and do research order their best just in order to have a study that can be replicated by independent stigators. Yeah. And to make that study valid Yeah. that Is that right? Yeah. I' treating social anxiety. claim to have treatment for social anxiety 's my patient group, here' our intervention, here's how much it helped them. And then try it yourself and see if you get the same result The reason why that DSM diagnosis is helpful in that case is because it helps you make sure that everybody that you studied certain criteria that were the same. Yes And then the problem is switching that around and saying Okay, if you meet These specific criteria, you now have this disorder? Yes. And the problem with that as you know, Kelvin We work We treat humans. We don't treat aners Right. And the problem is if you say, oh, this, I have a patient with you know major depressive disorder Uhm. or okay, then I'm going to give them My five minutes an hour antidepressants Right. I can I talk to them about what's going on? and The whole action is on the patient's thoughts, the negative automatic thoughts. I'm a loser I'm not smart enough If someone I respect criticizes me, it means I'm worthless. That's one that came up just this past past week. Oh And the problem is Those are individual. See the thoughts that upset Kevin aren't the same as the thoughts that upset David or Sarah or you know, Habib or whoever We're working with And so you've put people in a boonx rather than treating them individually based on their own suffering. And that's the thing about it that I hate the most is it gives a therapist or psychiatrist or whoever an excuse not to talk. Pave shuts And that's the thing that angers me the most because we've proven Finally, after two thousand years in another article that we mentioned there in psychology today and we have a scientific version of it. felt ready to submit to one of the scientific journals Those negative thoughts are the cause of your depression and anxiety. and that's where all the emphasis should they like to ask the patient, what are you thinking? what are you telling yourself But even a lot of therapists don't do that. They rely on some kind of magical putting people in boxes and So you need EMDR or you need ACP therapy or you need psycham dynamic insight oriented therapy. just people in a box and then throw schoolool of theraapy at them without finding out what How they're suffering? What are they telling themselves? What are their negative thoughts? The people listening right now, what are your negative thoughts explains all of your emotions right now, like you might be thinking Burn sounds like a total S Thankking you wouldn't be that off track And if you're thinking that you're feeling kind of angry and pissed off and you know, judging burnts or you might be thinking, this is really cool and important information. And if you're thinking that, then you're feeling kind of excited. and interest it Oh Oh, I will shut up now I'd love everything that you're saying, David. and I've got a couple of questions that I think might provides some hope for the person who's listening who maybe has been given a diagnosis or is suffering and is seeking help David, what would you say to someone who feels defined or maybe even trapped by their diagnosis. I've got generalized anxiety disorder, and that's defined who they are and they feel trapped in this What could you say to that person that could be helpful to them? Well, I never treat people on a general level like that as you know, Kevin, and I was ye don't either But as I would say, can you I like do what's called fractal psychotherapy, and you mentioned it earlier You know, what time of day were you upset G me a specific example of one moment that you fellt trapped because you might be referring to a pattern in your romantic relationship where you feel trapped because you're not being assert of O I mean, things have a hundred different meanings to a hundred different people. So I would want to know what what is a specific moment that that person was suffering? And what were their negative thoughts at that moment And what kind of help are they looking for What wouldnt it be worth it to you if I agreed to work with you and show you how to overcome that site possibly even in today's in a session And then I would also be looking at their resistance to change because all of us say, well, I really want to get over my trapped feeling or my anxious feeling I' my depressed feeling but we also have kind of subconscious resistance to change sometimes. And if you bring that into the equation and deal with that and lower that resistance to change That's when you can get really rapid rapid changes. And that's what I want to see with as many of my patients as possible city rellease and recovery Today, not next week, not next month, not next year Yeah, so if somebody has been given a diagnosis and they're feeling upset by that or stuck in this diagnosis. What I'm hearing you say is There are real practical methods that are individualized to each person that can help them break free from this problem by looking at one moment in time what they're feeling And what are they telling themselves in that moment that causeed those feelings there's real hope that even in one session with you, right, one, two hour session They could overcome this problem They don't have to be stuck And I'm a person with major depressive disorder or I've got this generalized anxiety disorder that I need to get rid of. I work with people using your model. so I see them doing this every day where they ome these problems and they're not trapped in in a diagnosis. know, right. It breaks my heart to hear people who have been You' suffering I've had a little more than fifty thousand hours. of therapy people struggling with pretty severe depression and anxiety And in the early days, I mean And just what on and on and on, we never measured anything when I was a resident We didn't have any methods for people and we just assumed treatment was going to take forever and it did And my dream has always been to develop really rapid methods for helping a person Today, not, you know, if possible, therapists can't do that. I can't always do that, but I can usually do that And nothing gives me greater joy than see a patient go from tears and sobbing and intense panic and anxiety at the stir of the session and joy and laughter at the end of the session And and then when I say that this is possible, a lot of people Tust me, they hate it. They think I'm a con artist A But I'm not folks. this is this is something that can can happen. And I'm ussually amazed at how simple the solution is. It doesn't mean it's easy or that anybody can make it happen. It takes a lot of skill to figure out why somebody is trapped deression or anxiety or guilt or shame or inadequacy Oh. And but but when you find the solution, it's usually surprisingly surprisingly simple like that the woman I've talked about on a number of occasions my first talk toive therapy patient really was this elderly woman from had escaped from Nazi Germany with her u to little boys And her husband and everyone else died in the concentration camps and she came to the US and managed to get a job you know, cleaning people's houses. So they they'd have a roof over their heads and , you know, food on the table and she did that for her whole life. And then she was referred to me from the intensive care unit of our hospital She made a nearly successful suicide attempt or a nearly completed suicide attempt. It was very serious, but she survived And then they referred to me and I didn't know how to you know, stuff like that with cognitive therapy. I mean, all I knew was the lan things I'd been trained in give antidepressants do general talk, and I knew that almost never was effect of hand out And so I went to Beck's seminar. U, you know, I was sure cognitive therapy was a crock of shit Oh, it just I'm too much like pop psychology And I decided to try it and prove to myself that it wouldn't work. And I said, Well, Dr. Pack, here, I have this suicidal Willen, you know, how would I use cognitive therapy And he said, Well, ask her what she was telling herself at the very moment she tried to kill herself. I thought, Well, that's cool. And I still to this day don't know many therapists who know to do that to find out what was the person thinking? He said, it's all in your thoughts And she said, oh, my thought was I'm a worthless human being because I've never accomplished anything meaningful. were significant in my life. All I've done is clean people's houses. I clean their toilets, I wash their windows, I vacuum their carpets. But that's all my life is has amounted to And And so I feel worthless. and she was kind of into this whole achievement addiction that a lot of us are or into my worth depends on my So my cheeseing buts Um, and u And it so You know, I told her this is what I found out from doctor back and she told me, well, here's my negative thought. What can I knew about it And I said, I have no idea. I'm just a beginner and wait another week and I'll go back to his weekly seminar tell you what he says and he said, Well'll just ask her to write down a few things she has accomplished And I thought well And That's logical. how cool is that? And that sounds like it's going to be simple. So she I went back, Sorry the next week. She said, What did dor. Beck say? And she said, Wellll just ask you to write down two or three things you have accomplished And she said, Well, that's just it. Dr. Burns, I've never accomplished anything And that's why I feel like a worthless human being and that's why I decided to kill myself. And and that's it's always trickier than than what you think Russia is is like playing chesss against a world class player And they're not going to fall for your easiest easiest moves so she should so what should I do And I was stymed U and and And this this s went in early days and I said, well, why don't you take it as a homework assignment? Maybe you'll think of something you can draw it down And between sessions and then we could look at it next week And and so that we went ahead and completed the session. And when I went in to see her the next week, I didn't even remember the homework assignment And I was felt really stuck And I was kind of hypnotized by her. I was thinking, yeah, like sounds like she has end of not achieving anything and feels kind of worthless and I can't see a solution to this either. What I was saying is that the solution is always right under your nose Oh It's hard to see that at the time And and so u At any rate, I just reverted to my normal Do you need any more antidepressant Do you have any side effects and how have things been going? Halfway through the session, she said, Well, Dr. Burns Didn't you want to see my homework And I said, well,, I I forgot about your homework. Were you able to think of anything If she had it be a list and there were about six or eight things written there And she said I numberumber one was was, you know I managed to sluggle two little boys out of Nazi Germany, Nazi territories. and make it to the United States and save our lives And when I think about it, That seemed like a an accomplishment of sorts. And when I read that, tears started going down my cheeks and then she said, And then and then I work cleaning people's houses. so we could survive And and that seems actually pretty darn Manans full And my son just graduated number one in his class from the Harvard Business School And you know, maybe I can get a little credit for that. And then she also had on her list I speak three, four languages fluently And then all another one was I'm a gourmet chef And she had all of this stuff. and I said, Elise, how do you reconcile this with your belief that you've never accomplished anything? U meaneingful And, you know, I was crying and And she' said talk Dr. Burnsite I can't reconcile it. It makes no sense out And I said, how much you now believe that you know, I'm a worthless human being because I've never accomplished anything? because she had believed that thought one hundred percent And she said it just I don't believe it. it just went down to zero and I said, how were you feeling Oh, because that's the theory. When you change your belief and these negative thoughts, your feelings will change And And and she said Gsh that doctor Burns My depression just here just when I'm not depressed all of a sudden And then she said this is so cool. Do You have some more of those ool techniques to teach me And I said, No, this is the only one I've learned so far. examamine the evidence but I'll go back to the seminar this week and I'll try to learn a new technique each week But she only lasted for two more sessions because she was totally upressed at that point not saved her was very simple And it was just seeing things in a little different way And and when you're depressed, you don't believe this is possible It's like being in a hypnotic France And you believe for all the world, like you're worthless and your world is worthless And I think Ive looked at your one of your websites mayaybe have experienced some of that at certain point in your life as well And and then When people suddenly see how we've been deceiving ourselves with all these self critical Brutal But little in thoughts And you suddenly see that that's not valid. It's like enlightenment and a whole new world suddenly suddenly opens up And that's what I offer, what I want to offer to every all of our listeners this is possible Yeah I believe for everyone who's Wh who who's suffering That's such a beautiful story, David. and such an important point for us to todayoday's episode on to understand that there is this hope people to get better by using specific methods and addressing what is causing the suffering that when we change our thinking, we really can change the way that we feel But then But it's not easy. rightight. It takes a lot of skill. You know, I've developed well over a hundred probably one hundred and fifty now techniques for crushing distorted negative thoughts and so There aren't You know, there's also a lot of people out there promoting some kind of quick fixes of psychotherapy You know and this thing and your life will be transformed and do this thing, your life will be transformed and I hate that pretty much almost as much as the DSM and the idea that Now medication is going to solve everything for for people, but there are new approaches and if you want to try it out and if you move fast, you can try or are feeling great am. We're revise it with a whole new version, but the current version works pretty well and you know, I can't treat everybody myself the Fing G app, it's free of charge And how long it's going to be around, I can't say, but if you would like to try these things out for yourself Check it out. you just go I believe to feelinggate. com and then you can download it and have your first your first session today and most people get quite a bit of emotional relief within the first hour and a half of using No It's not a quick fix. If you're looking for a quick fix, this is that you're in the wrong town But if you're willing to spend an hour and a half of your life, identifying your negative thoughts and learning to challenge and crush them you might be ' shocked and surprised at You know, how rapidly these things can change for you as well Thank you so much, David. You know, we're gonna make sure we put in the show notes the link. feeling great at And then also to read the articles that we've been referring to that you published recently and For therapists who are listening here today too, you're always offering training And if people want to learn how to do what it is that you're describing, it takes a lot of work But it's so valuable that work I think that You can also include some information in the show notes about upcoming training that you're doing. Thank you, David Let's wrap this up here today That's it for this week's episode of the Feeling Good podcast. For more information, head over to Dr. Burns's website at feelinggood. com where you'll find show notes on the podcast page Plus past episodes and lots of helpful resources for therapists and non therapists alike We'd love to hear from you Send us your comments or questions anyt timeime And if you enjoyed the show, please share it with someone who might benefit You can also support us by leaving a five star rating on iTunes I'm your host, Kevin Cornelius thepist and clinical director of Feling Good Institute Silicom Valley. Thanks so much for listening, and we hope you'll join us next time for another episode of the Feeling Good podcast