Accessing Resources and Future Research

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 Today, we're tackling a question that's shaped therapy for more than a century Do you have to understand your past to heal Many of us assume that depression, anxiety and trauma are rooted in childhood experiences And that real recovery means digging deep into old wounds But Dr. Burns challenges that idea in a big way He recently published an article on psychology todayoday. com titled the moment you're in matters more than the one you remember. Early in his career, a patient asked Dr. Burns to explore his past to explain his depression Instead, Dr. Burns made an unusual proposal Let's cure the depression first Then if you still want to explore your history, we will What happened next changed the course of Dr. Burns's career Drawing on decades of clinical experience and new data from a large app based study He argues that once you account for how someone feels right now, Their emotional history may add almost nothing to predicting recovery In other words, the key to healing might not lie in revisiting the past but in transforming the present. This is a conversation about therapy Tuma. evidence and a radically hopeful idea that emotional suffering may be far more changeable than we've been led to believe Let's dive in David, it's great to talk to you again Likewise, Thank you I really enjoyed reading your article I have a question for you to begin I'm wondering if you'd be all right with just telling us the story, kind of set the scene for us of this client who was depressed So asked you to delve into his past in order for him to understand his depression Oh, yes. ye. Oh, that great thank you for reminding me about that. Kevin I was just starting out my clinical practice and I was just beginning to learn cognitive therapy and got very excited about it And I have been a psychiatric resident I was a medical student at Stanford and then I I did my residency at Highland Hospital up in Oakland and at the University of Pennsylvania in Philadelphia And the The training I got was just, you don't listen to patients sound I was always unhappy with that. It felt so terribly awkward Oh to give them techniques to use or to interact with them in a more natural in a more natural way And and I've never seen anybody get better to be honest from, you know, just My supervisors were presidents one year. I think I had the president of one of the Philadelphia Psycho Analytic Associations supervising me I never once saw a patient recover much less much less improved. And so when I learned from back There are methods we can teach patients to get over your depression and maybe fairly rapidly. I was just overjoyed you and that's why what I decided to to devote my career in my life too. But I remember one of my early patients was a student from an We in Philadelphia And I don't remember exactly what was wrong, but he had some probablyro perfectionism going on and maybe some insecurity in his relationships, but he was he was he was quite depressed And he'd had a lot of ineffective treatment as well. And so I told him how we'd be doing homework assignments at having a very active approach to teaching him how to change the way he thinks and see us. And he said,, well, yeah, but Dr. Berns can take S time before we do that to explore my past. some patterns there that would explain s why I'm having the problems I'm having And I was a little bit taken aback because I had just gotten over to, you know, several years of doing that We're trying to do that with no benefits ever that I noticed for anybody And and so, you know, I felt a little defensive and my back was up against the wall and then I kind of blurted out to him U D Jud Jam, I tell you what. The u If you want to spend some time exploring your past I would like to ask you If you would give me two or three or four or five sessions to cure your depression first. with these new techniques And then once you're cured then if you like, we can take all the time you want exploring your past And so he was okay. and I was kind of relieved too, because I didn't want to explore his past becausecause I didn't have any idea of what I was going to do that could possibly be helpful to him And and so he was a very rapid responder And after, you know, three, four, five sessions, his symptoms, you know went to zero and he was happy as can be And I said, Hey Great. Now the good news is we can take some time, you know, in schedule to explore your past and you know, we can do it for you know,, you know, a month or two or even a year or two if if you like And and and then he said And I was thinking, this is great. This will stabilize my practice. I have a new practice. I have a lot of empty slots and this will fill up my slots and that type of thing. And then he says, Ohh, Dr. Burns, I don't need that anymore to explore my past And so that and and that was and that was there And And then I remember another early patient I had was very different. but a colleague asked if I would see her in the Stanford Hospital And And she was a beloved administrator at our hospital sound Oh She was in her forties. and She lived in Upper Derby, Pennsylvania and had a big house there and she was helping to cure for Several relatives with disabilities And she had never, she had never married and And she went to her OBG YN for a routine six month evaluation And he said, I've noticed something in your pelvis there. And I want you to go into the hospital and You know, so we can do a biopsy and find out what it was And then they found out she had terminal ovarian cancer. Oh no. And I don't know if there's any c for it today, but there certainly wasn't in those days And told her that she had two years to live And this was a trauma. talkal about treating trauma. Well, this, you know, we all have different things that are traumatic for us, but she was This threw her into a severe depression colleagues said with this new cognitive therapy maybe Cany. help for her And I said, you know,, and they colleague said, would I be willing to stop by and at least talk to her by her bedsidees. and u And I said I'd be glad to do that. And I went and and spoke with her and we kind of hit it off and she hadn't spent a life being depressed so I didn't have a a big history to take. and and But I gave her the back depression inventory, which was the one I was using in those days And and she was severely depressed. And and then I just asked her And and I didn't know that much about The agenda setting techniques that we've developed in this modern era that you're so familiar with, Kevin Oh But that I asked her you know, I can't promise anything, but Would you want some help with your depression if I could offer that to you. And she said, Oh, absolutely. And I said, well, would you need it would you want it today? todayod? Like like how about right now U And she says, yes, I'm I'm ready. And I'd only known her for about fifteen minutes and and so I just went into the normal cognitive therapy thing is what are you thinking? What are your thoughts? becausecause that's always the key to change and as well as of course, the key to understanding. and and she had I thinkick Three or four thoughts Let's see So one I'm letting my family down is Oh that was one of her thoughts And she believed it a hundred percent. Mud I hope I'm not talking too long. I probably Im o well, I'm so old I don't care atm You're doing great. I love this story and this is super helpful Yeah. and and then, uh They can't survive without me So I'm writing these down. You folks who are listening can write them down too if you want the cap survive when I those at one hundred percent too Oh yeah. they were all three were percent And it's my fault that I got cancer H and And then I I thought, well, she's her Really No good hearted woman. She was would help the residents with their research projects and She was just a person who gave, who gave, a giving person a very loving, gentle person And I talked to you I had a feeling she was pretty religious also And So I just thought I wonder paradoxical cost benefit or a paradoxical double standard technique would be helpful to her and that kind of a reverse of the normal double standard or normal double standard is would you talk this way to to another person and if not, what would you say to someone else in the same circumstances And I used it in the opposite way. And I said, Anne Imagine that there's a woman And she had a single room there in the Penn Hospital, but magine, you have a roommate And she's just like you. She's in her forties and she unexpectedly got the, you know, cancer of the ovaries And she's got two years to live. And she has a big house in a upper Dby and she's taking care of several relatives who have disabilities And and I want you to turnurn to her right now and say to her, you know, u you're letting your family down ong and she was Like stunned. And and and she said she said nothing for fifteen, twenty seconds And so Dr. Burns, I can't say that I couldt say that to another woman. who is in the same circumstances as I'm in And and and and, uh And I said, Well, why not, Anne M. talking to yourself that way, whyy wouldn't you talk to another womoman that way she said, well it would be It would be cruel And I said to her, yes, but Anne, do you believe in telling the truth? Are you the kind of woman who tells the truth or the kind of woman who lies And she says, so, o, I always tell the truth. that's that that's that's a spiritual you know, I'm very,, very religious And I said, Okaykay, it says in the Bible, the truth shall set you free. and by your own admission, I'm letting my family down. You said that's one hundred percent true so if it's true of you, it would be true of this other woman who's like identical to you So go ahead and tell her you're letting your family down because that's the religious thing to do And she got quiet again and she saidays, No, no, Dr. Burnside I still can't say that to this other woman I said, Well, why why not And she said because It's not true And I said, Well, what do you mean? It's not true? And she says, Well, my family loves me and they appreciate what I've done for them for years. And they are extremely sad about my diagnosis and the fact that I'm going to be dying two years from now None of them ever gave any hint They think that I'm letting them down. that's absurd. And I said, Well, how much do you believe that thought right now? And she said, zero. That's not a true thought And then we went through the same process with they can't survive without any and it's my fault I got cancer and she saw firstirst of all, that those thoughts also were absolutely untrue And also they were just cruel And that's the whole key to depression. When you're depressed, you're beating up on yourself, but you don't realize it No and And it was then it was relatively easy for her to to all three thoughts And her belief in all three of them went down to zero And that about fifteen minutes Mm And and I said, you know, let How were you feeling? now she said a lot better. And I said, would you take this back to Press and inventory again. So we could say and her score had gone down to zero and her depression just had entirely vanished And it was by Oasand on present problem in her life I'mly U you know, I saw her because I was in the department of psychiatry and So our paths crossed town her depression never returned. she felt loved, she felt worth worthwhile And she sadly died two years later right on schedule, was rehospitalized with massive metastasities and a heart failure, and it was sad that that she died But she had then It' so easy to treat and I asked myself She's a trauma patient and I've been taught that they're very difficult to treat Why is she so easy to treat? And I couldn't figure it out for about thirty years to be honest with you. And I thought, well, maybe because she didn't have a long history of depression. she wasn't trying to discend her depression She wanted to spend her remaining time with joy and lagh. and like that Just recently it occurred to me You know, and this is going to sound arrogant and maybe I'm overstating it ice head Many, many trauma patients. I did a trauma workshop all around the U. S and Canada today workshop and I treated ave volunteer from the audience at every workshop right in front of the audience for a two hour live demo. and I treated volunteer trauma patient who attended the workshop. And they all recovered like she did in a single session And and then I did a from a conference at Stanford for the psychiatric resesidents becausecause I wanted them to learn Tam CBT and see it's possible to get dramatic changes in patients in a single two hour session And so we Faculty referred about five or ten. uh presumably, you know, very Svere trauma patients refractory Oh And and we I treated one of them in front of the residents at each of our It was a daytim a two hour this seminar And they all pretty much went to zero that in that two hours And u In the meanwhile, I hadn't been keeping up with the trauma literature or anything. I just noticed trauma patients are by far the easiest to treat And it's just always been my experience. And I just took it for granted. I never thought about what it might mean And then I started hearing about these people who call themselves trauma shreks or that's not what they call themsel, but, you know, they specialize in the treatment of trauma and they use EMDR and you know, act and this and that, the other thing. I'm And they emphasize that the treatment can be very long term and that with the depressed veterans with PTSD, they're often treated with prolonged exposure for You know, five years with no improvement And I began asking myself Why is my experience different And and I and and I still couldn't couldt couldn't figure it out. And I thought people might be interested. And then on a Sunday hike, this is a long winded answer. You'll learn not to ask me questions. be the end of every podcast because I expect can sh up, but And then you know I do a lot of statistical modeling of data And I had data from several hundred patients who would we've been traded withith my app, the feeling great app, where there was actually the prototype, the feeling good app and they had very very rapid improvements but I developed a mathematical model and we're just sending it now finally to the journal JMRI, the journal for Medical Internet Research to see if we can get it published there. The psychology today was a pop psychology version of it, which I think is good so the lay personerson can understand Pion I developed a mathematical model and and was able to predict And Analyze the rapid recovery and the patient you' se the feeling good, good at basased on how they were feeling at the intake evaluation. How do you feel right now in seven different emotions? How depressed are you How anxious are you hopeless are you? How angry are you? that type of thing and And then I had this variable From the intake evaluation, how you've been feeling over the past two years to see what kind of patient population we have. because they were all volunteering to try the app And it turned out that their main their depression level previous two years was exceptionally high, almost like hospitalized p And then I said, well, I've got to put this variable into the model. because it can probably add additional plananetory power becausecause our patients, you know, most of them pretty much recovered or got dramatic changes in the first three days using the app And I said, well, thoseose who have been really severe previous two years. probably don't improve as much And and maybe by bringing this this mathematical variable into my model I can learn more things And so I brought it into the model. I use something called structural equation modeling and it doesn't exactly talk to you, but it talks to you, but it does it in, you know, kind of a mathematical language And and it said and it was just shocked the hell hell out of me It said, David, I want you to get that new variable out of the model becausecause it does me doesn't do me a damn bit of good. It adds not one fret of new information that I didn't already have And then nothing to the understanding of change and nothing to the the prediction of who's going to change and And by how much it's a totally useless variable time. And I was hiking on a Sunday hike and I said God, I've never had a variable the model told me I don't want that in my model. I've already got the complete answer And and and I didn't understand what it meant And then it suddenly came to me in the middle of the night kind of like I woke up and said, Ohh, here's what that means But it means the reason my patients have been getting better so fast for the past forty years because I'm always focusing on the here and now And I don't dwell on the past unless someone's had a It's just like trauma that with intrusive fantasies that I might, you know, focus on an exposure technique like memory rescripting that that's pretty rare. but most of the time I have found that when I peopleople change the way they feel today When I treat trauma patients, I don't treat your trauma from twenty years ago I treat problem in your life today And And what I found is that All of your problems are encapsulated in any one moment when you're upset And so once We found out Why you're upset today? What are your distortions? What are your self defeating beliefs to all of your suffering Even the trauma that you had And and Change up And when we heal it today, we're actually healing healing the best. and that's why I wrote that article for psychology. Today And I'm hoping the world I've been pr kind of in an angry, elderly, irritable phase lately becausecause I'm pissed off that the world seems to be ignoring a lot of the discoveries that I've made. And I don't like it. I think they should att attend to it And I think the fact that I've had such spectacular results and the treatment of trauma is important and meaningful And that's what that article was all about and that there's a simple explanation for it, but people who have devoted their careers to doing all these techniques focusing on the past, they're not going to like it because their livelihood is is threatened perhaps. sure. of course. Well you'd have to learn a whole new way of treating people Yeah. David I love what you said. when you said you were happy to publish this in psychology today because the layperson understand what it is that you're talking about. And that's what I loved about that article when I read it becausecause it's a great way for you to get this word out to people. And in fact, right now, people listening. us as we're having this conversation. suffering right now They're struggling with depression and they found this podcast in hopes that they themselves feel better And I'm just struck by how much hope you give people in that situation with everything that you just said. and I'm going try to summarize a couple of things to bring it down to my not as intellectual as you level person just needs to look at how they're feeling right now today in order to overcome pression no matter how long been feeling depressed because present moment when you look at feelings and then look at the thoughts that caused those feelings You can see everything that you need to know about helping yourself feel better right now today Because as soon as a person proves that those thoughts aren't true, they get a relief from the deression that those thoughts were causing done It's such a beautiful and almost simple thing, isn't it Yeah to just look at what am I telling myself right now and is that true and I loved that story that you told about Anne. paradoxical double standard technique when She just couldn't say the words to another person who was exactly like her that she had been saying to herself and that Beautiful question Is the truth important to you? because isn't what you're saying true And she had to disagree and say it actually isn't true And that was the moment that she recovered from depression And what I love so much about what you teach therapists and patients is that's all we need. We just need prove to ourselves that what we're telling ourselves that causes our suffering isn't true. and in that instant We fully recover problems You're very generous on your website where you share with people who are listening to your podcast tools that they could even just download a news right there on the website, plus they could use your app And your daily mood log is available. It's right there on your website someomeone right now could just start filling it out They could ask themselves, what am I feeling right now? and what thoughts are causing my feelings? And There are some instructions on your website for how to do that and certainly in all of your books I'm mentioning all this because for the person who's listening to this I just encourage you to realize that you can help yourself to feel tremendously better right now and you could overcome your depression even today, while you're listening to this podcast, put it on pause and help yourself, right And that is such a beautiful message that you're right is very different than what other approaches to therapy are telling people. I get pissed off too when I think about how People are given this message that you have to go deep into your past and it's going to take you years Things like CBT are just surface level change What I want to ask you about David is I'm imaging that some people who are listening are asking a question Well, they felt better in that moment with you when they've crushed their belief from their thoughts. Aren't those thoughts going to come back? Aren't negative feelings going to come back again in the future? Doesn't that mean that their recovery is temporary? No, they never do. It's a one and done. Well what I offer is unlimited, you know, euphoria for the rest of your life and money back guarantee if you don't get that result. And but that's so important what you said because life is hard for for all of us and And after someone has had that initial breakthrough and has recovered. And by recovery, I don't mean just feelingless less depressed. I'm in G getting into joy, G getting to see what Malarkey And I don't mean this an insulting way When you are depressed, you're telling yourself things not only that are cruel, but they're just a lot of horse shit. When Anne was telling herself, it's by fault like outovarian cancer, it was just like P shit in the extreme. becausecause the cause of ovarian cancer wasn't known in those days So you couldn't give yourself cancer if you tried Mhm would have been impossible, but she's beating up on her her. selves like that And that and that is that is is the cause of her deressia But it's also one of the most beautiful things about her because her life was devoted to helping and other people. and her love for others who were suffering and that's taking responsibility. And her own depression was just a little bit of a too much of a good thing, a little too much responsibility And u Yeah and and and and and uh But but once you know what your pattern is, what are the cognitive distortions, the all or nothing thinking or the overgeralization or the self blame or the emotional reasoning or the should statements, whatever you get into After you've recovered, those thoughts will come back And that's that's a guarantee. Now in Anne's case, I don't think they did, but she only lived for for two years U But for most of us, those negative thoughts can come back, you know every week. I've been in hell myself the last couple of weeks because I've lost my computer and all my data. H And that was forty years of my life goodness. And it' I got my computer back, It's partially fixed. I haven't had time to turn it on to see what's there and what's missing You know Challenges come to all of us And when they come those negative thoughts can and will return. So once you've you've recovered Relapse prevention training is very vitally important And three parts to it part one is knowing that you're going to relapse. So I tell my patients, you know, the good news is The next three days will probably be the happiest days of your life. Recovery from depression is the one of the most rill in an extraordinary events patient can experience a human being can experience But number two, that those thoughts will return And you're going to have two kinds of thoughts when when they return. The first will be thoughts similar you had when you were when you were depressed like the retreating young man just just a week ago. Jill and I were in our Tuesday group who had in extreme approval addiction And he was telling himself, if someone I respect disapproves of me or is critical of me or anything I did, that means I'm a worthless. human van And there's so many ways to crush those thoughts which are so out and left out and left field. but he's blown them away compleomtely. We had a fantastic session and we'll have podcast so you can listen to those those sessions on the approval addiction His thoughts will come back. He'll again lapse into, o my God some of The authority figure is gonna to disapprove of me. And that's going to prove that I'm worthless, then he'll have to use the same techniques he learned from Jill Love it and David Burns The other kind of thoughts you're going to have when you relapse are the typical relapse thoughts that we all have when we relapse like you'll be thaninking. Oh, this relapse proves that the therapy didn't really work It wass just a superficial band aid Snakes weren' enough. I was just fooling myself when I was telling myself I was worthwhile and that type of thing. And so the the third part of the relapse prevention training is Once you've we've made a list of those thoughts you're going to have when you relapse in three weeks or whenver it is thenen we can use externalization of voices and I can challenge you with those thoughts and see if you approach them And if you can't crush one or more, we can do roll rehearsals and I'll show you how to crush it And I don't call any of my patients officially discharged until They can blow all of those relapse thoughts out of the water. You've got to do this ahead of time. You can't wait until you've relapsed sen it'll be too late and why No It's going to be very difficult to do it if you wit M And then after that I just tell my patients if you ever then we recorded them defeating those thoughts on their phone And then I just say, if you ever relapse, just listen to yourself def feeding those thoughts and if you can't defeat them call me and I often have cancellations at the last minute so I can fit you in for an emergency session And I'll give you unlimited free tune ups for the rest of your life I get my work for life. And I hope to hell that you do relapse. Because if you don't, I'll never see you again I just got to liking you and knowing you And so please try to relapse every few years so say say hello And I just have a few patients who have taken me me up on that and um So so I find that, you know the initial treatment is the hardest for therapists to learn how to do because each patient requires different techniques The relapse prevention is easier to learn how to do because it's pretty much the same with every patient Wonderful David. Well, I think Maybe we've come to the end of our podcast for today because I think you addressed all the beautiful points in your article and brought them to life with some great stories and I think we've given hope to people who are listening that there are practical things that they can do, mayaybe the last thing that I'd like to mention is Let's talk a little bit more again about the feeling Great app, which is at feelinggreat. com And it's available free And somebody could download that app to their phone right now and get some help from the beautiful app you've created. Is that right Yes, absolutely And also the I've published We've just talked about two of nine No, I think we just had our tenth article It's on memory scripting U and and there's a lot of I love pop psychology. I love writing for the lay personers. I try to write in a way that anyone can understand. And so If you like this show today, you might go how do they get there there? because I don't even know how to get there to myself. Yeah Yeah, to read the articles, it's really easy If you just go to psychologytoday. com And then there's a search feature right at the top of the web page. And I just put in your name, David Burns and it brought up your profile and all of the articles that you've ever published on that website.. And so and there's a bunch of them there and they're all great and very practical You people read them that it gives them things to do to help themselves Absolutely. and if there's an article you like and You have a question about it, Son Kevinor David a question and Yeah alsoso maybe we'll do a show on your favorite article from the Psychology todayoday series because there's a lot of really Cool ones like in one of those articles. we make the claim for better or worse that we've discovered the cause of depression H theoretically is it known to science is it a chemical imbalance? Is it a lack of love? Is it Is it poverty? Is it some dietary thing Well use statistical modeling and So if you want to find out, you know, my opinion and what our data has shown and that's the one that we just submitted to JM R JM I R. to get to get pe peer reviewed that phone It's a very exciting article, but there's many there's at least ten more coming down the pipeline. So I love that. I my book feeling goodood but it's all the latest scoop where is feeling good reflects the thinking of forty fifty years ago point out for anybody who's listening to this for the first time that if you look at David's website feeling goodood. com and look at the show notes for this episode. five hundred and four We'll make sure that in the show notes, it mentions how to contact us with those questions Also you'll be able to see David's website, which has tons of free resources on it You could Dive into that for weeks and get lots of fun free things to help yourself and your loved ones So David Thank you again for another great podcast. It's really great talking to you. Yeah. And our doorbell just rang. so I've got to make an unexpected fast exit, but I love talking to you. And thank you so much, Kevin 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 anytime. 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. therapist and clinical director of Fewing Good Institute Silicon Valley Thanks so much for listening, and we hope you'll join us next time for another episode of the Feeling Good podcast