Avoiding Narrow Minded Therapeutic Approaches

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's conversation challenges one of the most deeply held assumptions in therapy that in order to heal trauma We have to go back and relive it In his recent article, a new model for treating trauma. Burns presents a provocative idea One that suggests healing may not require digging into the past at all. Instead, David argues that powerful change can happen by focusing on the present moment By identifying and transforming the thoughts, beliefs, and fears that are active right now Drawing on real clinical work He describes cases where even severe, lifelong trauma began to shift rapidly when therapy targeted what patients were telling themselves in the here and now rather than what happened years ago It's a perspective that raises big questions Do we really need to relive painful memories to heal What if trauma persists not because of the past itself but because of how it's still being experienced today In this episode, we'll explore the science, the skepticism, and the promise behind this new model. and what it could mean for the future of therapy It. Kevin, wow, I'm been looking forward to seeing you today and recording this this podcast that I'm very excited about actually. Thanks, David. It's great to be here with you. and I'm excited about it too As usual, I loved reading your article in psychology today And not only did it give me some great training as a therapist, but also I love the way that you make this 's so easy for everyone to understand, even if they're not a therapist. That's a real gift that you have There are so many important ideas that your article touched on And I've got a question for you about it if that's okay to dive in. Y. First of all, you're challenging a core assumption in trauma therapy that healing requires revisiting the past. Yes. I'm wondering what led you to question that idea. Yeah. Well, well, there were two two things. so that that And they dawned on me over time. in the first place I've always loved treating trauma patients Since the when I was just first learning how to do cognitive therapy, I had a dear colleague from Pan who was told that she had terminal ovarian cancer with two years to live. colleagues asked if I would see her at the bedside because she was very depressed. She just found out two weeks or a week or earlier. that she had two years to live. The whole diagnosis of ovarian cancer came on suddenly, she was in her I don't know low fifties or mid forties. she was not that old of a person And all I knew was cognitive therapy And she I had about a forty five minute session with her at the bedside in the hospital of the University of Pennsylvania And I just asked her, you know, well,, you know, I formed a connection with her and and gave her the back depression inventory and saw that she was severely depressed and you know, and asked if she wanted help so as to set an agenda and then say, would you like help today right now? if I could deliver it? And she was real open to that. And then I just had her I didn't have daily mood logs. I just had pieces of paper and I brought a clipboard along so I could kind of write out a, you know, a daily mood log and let her do it on the bedstin stand, you know, that goes over the bed And she had three highly distorted thoughts and it was pretty easy. just took you know, a couple of Lakes to bring her to the point where she saw how distorted and unrealistic these thoughts were and her depression more or less immediately disappeared Mm And and so I never saw her again as a patient T night interacted with her over the next two years because we were in the same circle there in the Department of Psychiatry and her depression did not come back. She felt loved and and productive and kept working and helping the residents and the way she'd always done And then sadly, right on schedule She develop massive metastases and had to be rehospitalized and died from the complications of her of foramcer But I at the time It didn't dawn on me that I had treated a severe cancer patient, a severe trauma patient, a cancer patient also and just a single session. and measured her depression and it went from, you know a severe level to pretty much zero and that didn't mean she wasn't sad about her diagnosis But but she wasn't beating up on herself like, this is all my fault that I got ovarian cancer and I'm letting my family down and things like that were that were just obviously untrue, but I never thought much of it except that it was just wonderful to have these new cognitive therapy tools that work so well And and then I remember saying to people, I wonder why trauma is so easy to treat, at least so far in my experience And my hypothesis was like in Anne's case She was always a happy woman And and then this sudden Terminal cancer diagnosis came like a lightning bolt. and struck her down, but she wasn't committed to being miserable or om roll or depressed roll And so she she was she believed her distorted thoughts and then was shocked and pleasantly surprised to see they weren't valid at all And and then she was, you know, happy to be not depressed anymore. And so I thought the reason was that You know, she she wasn't a chronic person with depression were to become a part of her identity. and so it was fairly easy to treat her But then over the years, that was early in my career and then I saw From that point on over forty thousand hours of therapy I did with people with severe depression and anxiety and there were tons of trauma patients in that group And I even went around the United States and Canada doing a trauma workshop, a two day for mental health professionals And at every workshop I would ask for a volunteer from the audience who had head severe traumas and so I could do a live demo and in the workshops I did a two hour live demonstration And every patient that I worked with U all of their symptoms disappeared. her during the the live demonstration and again, I didn't think anything of it except that I just thought, well, trauma is just it's the easiest thing of all to treat. And I was just speaking from my own my own personal experience And then I started noticing that these A lot of people were specializing in the treatment of trauma And I wasn't aware of any trauma patient I'd ever had who took more than one session for treatment M And and then I started hearing that they're doing all these fancy things and There's that fellow I'm trying to think of his name Ven, something or other He was nder. Yeah, yeah, Vandor Coke or something like that.. Yeah And and many others with their trauma focused therapy and hearing them say to patients that Sometimes it takes a long time to treat trauma You know, depending on the the kind of trauma, is it complex trauma or simple trauma? And I was puzzled because I thought, gosh, simple trauma, complex trauma, it's all been the same to me. and and they're all really easy to treat. And what's going on here And I realized over time I was a slow learner. But the data was there in front of me that I'm always focused on the here and now, you know, even with a trauma patient to sur. with Anne, it was she was upset about feeling that she was letting her family down. She was taking care of a lot of disabled relatives and was blaming herself for, you know, the fact she was she was gonna to die And that's what she wanted to work on. And I've always asked trauma patients, what would you like help with? And one hundred percent of the time, it's been something in their life in the here and now. because you know, we all have things that are upsetting. I had something upsetting earlier today, for example. And And you had something upsetting with your son last week. Yeah. and And But I've always treated people with what they want help with. I let the patient set the agenda. And then I noticed that the trauma people have their own agendas you know, that you and they tell people, you have to unpack your trauma or you have to do EMDR or you need this or that technique or this or that series of sessions and procedures And I thought, b gee, gee, that's o they're doing a completely different treatment from the way I work and they don't know how to do what I do, so they're probably doing the best they can, the best they know how the it seems to me like I've got a much better faster treatment for for trauma. That was the first thing and this is too long an answer, I suspect. But then the second thing is You know, I lost my computer a while back and I lost my statistical modeling programs that I have to download them again and reinstall them. But in general, throughout my career for at least the last twenty, thirty years I've done statistical modeling of my data And I have one submitted now to a Journal of Medical Internet reesearch. you know what technical article. I used to publish a lot of not a lot, but a fair number of technical articles based on that data And and I had been analyzing data from our app or feeling great at And I was St in changes in, you know, emotions in the here and now and then I had data on emotions from the past two years. I may have said this on a previous podcast. Oh, well, I'm elderly repeating myself probably, but at any rate, I developed a mathematical model, which I've now submitted to JMIR, which is really pretty fantastic and accounts for just a high amount of the variability and and reveals the causal effects in recovery from depression and anxiety And and one of the things is that I never used that variable. of past depression over the past two years because my are my group was our group was very, very depressed and had been moderately the severely depressed on average over the previous two years, most of the time And so I said, my gosh, I forgot to include that variable in the model the mathematical model And so I Ined it in the model And and I love structural equation modeling because the computer kind of talks to you and tells you things. It does it through its mathematical results. It doesn't speak in words But it's telling you things. and what it told me, it says David that variable is a pain in the ass. I don't want it in the model. I don't need it in the model. I've got complete explanatory power I know exactly what happens in these patients and Wh improves and why and the causal effects And this variable notot only doesn't make the model better, it makes the model worse Well this tast emotional Dan And I said, o, well, gosh, that's interesting, but I was thinking mathematically, like that's a surprising mathematical result. And then I got to thinking how w This reflects absolutely my own clinical Experience. that I'm always working on the here and now peopleople change the way they feel in the here and now They are no longer concerned about past trauma. And that's because the past is embedded in the present moment And So when you change the present moment you're actually changing your past And so that's the thing. and som I'm saying that the field might be u really miss missing the boat and pushing a lot of mythology that, you know, I'm getting kind of old now and people say I'm getting irritable and hard to get along with. It's kind of shameful to hear and shocking True that I get impatient with gurus who proclaim things without numerical U you know, research to And u All these people are telling trauma. If you tell a trauma patient, you're gonna have to be in therapy for months or now It's a guarantee they'll be in therapy for months or more, but you're the one that's causing them to be in therapy by using an ineffective treatment So let me I like that you get bothered by that, David. I think that it's against your own values and morals for someone to do something that doesn't have any data to back it up Yes, ye, yes, exactly. Yeah Exactly. know. I want to make sure I'm following everything gave so many golden points here that I want to make sure I'm hearing right. Is it okay if I reflect back a couple things to make sure that I I'm going do it anyway because that's the kind of guy I am. Let's do. I'm dying to hear your questions Yes, well, I'm just it's standing out to me First of all, I know that since you first started working patients. I'm thinking eararly to mid seventies. T out You were using testing before and after every patient. Oh yeah A at each session An session over time I evolved into these new scales, how are you feeling at this moment And then I could measure at the start and end of every session been collecting this information from the beginning of your career. Oh ye of working with patients And so it makes sense then when you worked with the patient early on and that you describeed Yeah. And in one forty minute session with her while she was lying in a hospital bed, You helped her completely overcome this traumatic experience of receiving her cancer diagnosis so that even though she still did die two years later from a horrible disease She was not depressed wasn't experiencing symptoms of trauma anymore after the two of you work together. and maybe you didn't notice it in that one experperience But over time, you realized that When you focus just on the present moment, what is this person feeling right here and right now? What is it that's bothering them now? What are their negative feelings? What are the thoughts that are causing those feelings? they can overcome trauma even from along a way past. Yeah. The math doesn't lie when you use your structural equation modeling all of the information that you had from your patients, what the results were telling you was knowing about patiententss past was not only not helpful information, was unnecessary, but it actually would make the treatment worse rather than more effective. Yeah, in the stistical modeling. Yes, Yeah. and then it was all based on the cognitive model because I like to see things kind of a unified field theory for psychiatry and psychology And the idea that, you know, Ellis claim Epicet dis claimed Be claimed It's not the events of our lives, It's not the traumas. they don't affect us its own thoughts And so I've always focused on patients' thoughts. and do you see an an She wasn't them upset about her diagnosis. she was sad She would have preferred not to have had a two year life expectancy. But then then it wasn't why she was feeling guilty and ashamed and inadequate and worthless It was because she thought she was letting her family down Mhm. and, um And and those thoughts were quite distorted and in her case, fairly easy to crush And the moment she stopped believing those thoughts, her depression disappeared. And this also raises an important distinction between Healthy negative feelelings and unhealthy negative feelelings. And it's, you know, if you've had a traumatic event, like one of the people came to the workshops was very athletic, a young mental health professional And it was the most important thing for her to get in shape and to stay in physical shape. And she was a runner and then in her work, she worked with children. She was a therapist And then The u She was rear ended three times on freeways Yeah, roughly one year intervals And and in each of the times her car was totaled And she had, you know, flashbacks of, you know, flying through the air after being, you know, smashed by somebody behind her at sixty miles an hour And and then then she had some physical issues to work through and just about the time she was getting in good condition again. she was in a second similar freeway. rear ran thing and hit at high speed from behind and then, um when she came to the workshop and it just happened for a third time But um, the, uh what she wanted help with Do you see, I just did the typical Cgnitive therapy thing. Are you upset? Is there something bothering you What's bothering you? what are your negative thoughts She was really very angry people in her clinic because they had sent notices to her patients that their therapist had been in a severe you know, highway accident And she thought it was insensitive that the children would worry unnecessarily And she had that and a number of related concerns that we work throughuring during the workshop. And you know,, and this was the evening of day one of the workshop And you know, I measure symptoms at the start and end of every session and her symptoms went from, you know, intense anxiety and anger and depression and shame and inadequacy and hopelessness to Zoero And then and another thing by the way that I learned I almost never used exposure techniques They, you know, because they tell patients, you have to use exposure and re experperience this this trauma Yeah, you're reading my mind, David. That was actually my next question for. Have you used exposure with trauma patients because so many people do think that's necessary. Yeah Yeah. When I started measuring symptoms, I learned that the trauma patients like the DSM is just so screwed up I'd say nft up, but I don't say afterft up And I didn't just say it But you know, it says that, you know, trauma patients have fl fl flashbacks. Well,, you know, very few of the trauma patients I've seen have had flashbacks or any of the other classic symptoms. all you know, a lot of them didn't even have any anxiety you know, they had depression or guilt or shame It was interesting. But at any rate, this woman came back the next day to the to the workshop and said the I'm just still on a high It's just that I still have severe like back pain or something like that. and we didn't address that during the workshop. And so I thought, well maybe I could use a little exposure with her. And I said, when you think about the accident, what you know, what comes to mind? And she says, Oh, I can see myself flying through the air in the car And that's terrifying to me. And I said, okay, and this was just a few minutes before the workshop began. And I said, I want you to fantasize that right now and make yourself as anxious as possible And you know, and she got it up to like ninety five percent. and I said, I want you get up to one hundred. I want you to be as anxious as possible. And that's one of the things about exposure you, the therapist have to be not afraid of it at all and encourage the patient, that has a paradoxical effect. When you say, I want you to be as anxious as possible. patient gets the mess say, Gsh, I guess this anxiety isn't very dangerous But she closed her eyes and she got up to one hundred percent and then after it faded after within two minutes. it went down to zero. And I said, how are you feeling now? And she said Change just disappeared, went to zero The same So that was one time. The only time in I did like forty demonstrations for trauma patients in that workshop. That's the only time I used exposure. So Iy, I've never been against exposure. In our next podcast, next week, I'm going to show a very extreme form of exposure. Okay This is so interesting to me because I know that you have incorporated exposure so much when helping people with an anxiety problem Yeah So it's not like you donon't find exposure to be effective, it's essential. I hear you knowolutely. You've taught me that for sure I also heard you say that not everyone who has experienced a trauma is reliving the trauma or having flashbacks. Yeah. with those symptoms that are lia. The media publicizes because it's kind of sexy. not based so much on what actual from a patient's experience I really love Everything you're sharing today, the thing that stands out to me is This whole theory of the cognitive model that events don't cause our negative feelings, it's our thoughts that do Yeah and we have more power than we think we do. We can change the way that we feel by changing the way that we think Yeah. Eactly. And I repeat that back simply in that way to you because I think for somebody who's listening to this and is being introduced to these concepts for the first time. envy them in a way because they've got this opportunity to use methods that you've developed to help themselves even their own trauma or depression or anxiety And so for somebody who's listening, who's finding this intriguing this idea that I could use cognitive therapy tools to very rapidly overcome horrific traumatic experiences in my life. I would encourage that person who would like to get that kind of help to pick up one of your books or listen to more podcast episodes and consider using a Daily Mood log and using these techniques because I think that part of your message that's so important and powerful is That people can help themselves with these tools too. That's what the book Feeling Good is all about, right? when panic attacks right. Yeah And so maybe even the book feeling great since you do have that whole chapter ks about those forty or forty two cases of trauma that were successfully treated in one two to three hour session in a workshop two two hour. twoo hour session. Yeah, it could be a great thing for someone to get that book and if they want to get help for themselves even right now today, you can just I'm a big proponent of Just downloading it right now off of Amazon and get to work because it's such powerful tool and I'm not trying to sell anything here right now, but I just think that it's such an awesome thing that somebody could be busy I'll go ahead and sell All right, shameless a salesperson. I'll try to sell our feeling great app because that's which is toally free. Yeah, it's free of charge. so you can' hang me for being greedy there, but it'll give you an experience very similar to working with a therapist or even working with me in particular but yeah, pick up feeling great or feeling good in any of my books And I can give you two examples. quick examples of how it works so you can see what the cognitive model is because we're claiming it happens really fast you're thinking, well, what is this thing they do with disturbed thoughts. And going back to Let's see, Amy, is that what we're calling her? Anne? Oh yeah, Anne. Yeah, Anne Uh, like she had a couple a couple of thoughts One is it's my fault. I got cancer I'm letting my family down and they can't exist without me And they can't exist without me. She was helping them. She had a big old house in Upper Derby outside of Philadelphia And she was letting them stay there and, you know, and helping them And so she was thinking without my help, they'll end up homeless and die or something like that. And then the technique that work for her and I'll just make it really quick is I said imagine there's another woman here. If she was in a single room at the University of Pennsylvania Hospital, But I said imagine this's a double room and you have a roommate Wh has your exact Problem Oh you know, ovarian cancer and What I want you to do is talk to her right now. in the same way you're talking to yourself. Just turn to her and say, you're letting your family down It's your fault, you got cancer Your family will never survive without you And when you hear that You imagine saying those words to someone else, talking to another person the way you're talking to yourself It absolutely shocked her and stunned her And she said, I would never say those things to another human being. And I said, but aren't you a human being And you're saying those things to a human being. I'd say, what would you talk to say to this other woman? He said, I would tell her It's not your fault. you got cancer or you got ovarian cancer. We don't know the cause of ovarian cancer. So you wouldn't know how give yourself cancer. That's impossible And the fact that you're letting your family down They don't feel let down. they love you They appreciate all the things you've done for them over the years And finally that they can't exist without you. I would say to her, Oh, that's rubbish.re you've helped them, but you're not as big as you think you are. And and they will they're resourceful. they will survive And I said, how How much do you believe these thoughts? And she said, one hundred percent. I said how much do you believe these negative thoughts? And she said zero And that was the moment when her negative feelings went to zero. The very moment you start believing the distorted messages you're giving yourself Your feelings will change It's not easy because we all have different thoughts, so requires different strategies, different techniques So the kind of therapy that we're talking about, team CBT, has a lot of techniques So that what whatever is going on with I've developed over a, you know over a hundred, over one hundred and fifty really these techniques for challenging negative thoughts. I haven't developed all of them. Most of the ones I use I've developed, but some I've learned Like that one I learned from Maxie Molzby. I modified it and made it a roleplay technique, but he was one of the early cognitive therapists and a great fan of Albert Ellis But that would be a simple example And at the moment that you see that what you're telling yourself is rubbish. At that very moment, your negative feelings will change It's such a beautiful story, David and it brings cognitive therapy till I think, in a really powerful way. And I think you said you had one other that you wanted to tell. Well, another of my early, even earlier, one of my very first cognitive therapy patients was referred to me from the University of Pennsylvania Hospital An elderly woman from I think Latfvia who had attempted suicide and it was very serious and they sent her to me for for follow up for follow up care and then I didn't know how to do cognitive therapy at the time. And so I went to Dr. Beck's weekly seminar and With her permission, I presented her case and said You know, how how could you work with somebody Who's suicidal you know, but how do the thoughts come in there and Dr. Beck said, Well, that's easy, David. You know all of our thoughts and feelings come from our thoughts where all of our feeleelings come from our thoughts and urges and motivations And so just ask her what she was thinking at the moment she decided to commit suicide Now this was a woman who had had trauma. She had escaped from Nazi Germany and lost her husband and all her relatives in the concentration camps So she'd had horrific trauma but the thought that was upsetting her had nothing to do with any of that trauma. when when she got to the United States with her her two little boys who she smuggled out of Nazi territory She she had to get a job and she she took a job cleaning houses And she said that she had been doing that for thirty years or thirty five five years and and I said and what was your thought The moment you decided to kill yourself, and she said, I told myself I was a worthless person because I've never accomplished anything worthwhile in my life And And it was it was just so sad to hear her say that to say that. She says, All I've done is clean people's houses I've never you know, done anything impressive or Yeah, I'm just a cleaningian woman. I clean people's toilets. That's what I do And som I'm worthless and that But then I won't go into the full story. I've told it elsewhere and But you know, it took two or three sessions for her to see Theog too, was rubbish and the very moment she stopped believing it. Her negative feelings disappeared and she was able to terminate therapy. and then she sent her children and grandchildren to me for treatment, which was pretty cool. Oh wow But that would just be some examples but it takes a while to You have to learn how to identify your negative thoughts And then you have to learn how to challenge them and crush them Thank you so much for telling that story, David. and both of those stories are so powerful and beautiful And they really bring to life this idea that We don't need to relive the past in order to break free from our traumas. Yeah, hopefully I'm hearing that right. That we should never, you know examine the past or that there's no value in that Mhm think about that D, I must have treated See I mentioned O forty severe trauma patients in that chapter and feeling great. And that was just a small percentage of what I've treated in my in my career And in virtually all cases, I was just working on what's something in your life in the here and now that you were upset about See, when I'm upset, I'm upset about something right now today And I bet that's the same as you with your son last week And when you T turnurn that around It's kind of an aha experience Ver much so and I think, David, we may be coming To the end of this particular podcast about this article And there's a really interesting bridge here to the next conversation that we're going to have about another article about trauma Yeah It looks at it from a different perspective. Yeah. And then in a different method that you used. Yes. And this was a young woman where we did, I felt it was a good idea to go into the past and revisit the trauma and do some kind of fancy footwork. so we'll tell you' all about that next Next week. Yeah, And what's so cool about that to me is that One of the things that makes teams so effective is that you don't see one technique as the answer for Proms Yeah, I think that one of the problems that therapists can get into is to get narrow minded in Oh, this is the approach that has all the answers for this problem. Oh, if you have trauma, then you need EMDR or you have OCD, then you need ERP. Yeah And you do the opposite of that actually. you have a whole tool box of tools at your fingertips and you have the attitude of failing as quickly as possible at methods until you get to the one that's right for that particular person for that problem. Eactly But that's one of my pet peeves for in our field. And I'm just working with a young woman from Switzerland Who is I guess Adelyrian therapy is big there now Okay. so to get certified, she has to get certified in Adlarian therapy. And the basis of it is that you had some traumatic event in childhood explains all of your problems as an adult And so the therapist helps you figure out what that traumatic event was And then you work it through, I guess, with all of these add Lyan U, you know, methods And she she's very frustrated because she's seen how rapidly team can work in and her personal life is as as as well But yes, people want one thing that I can use to treat all of my patients And that would be like a doctor who just wants one technique likeike you could, you know, learn to use penicillin. Or you could learn to put casts on people's arms or legs. And whatever patient comes to you, you could just prescribe penicillin and then the patient could say, well, I've got a broken arm here. Why are you prescribing penicillin? And the doctor says, Ohh, well, I'm in the penicillin movement Yeah. that type of thing. It sounds so ridiculous when we describe it that way, but that's what is happening with a lot of psychotherapy No. Yeah.'s like ye. Yeah. I want to dangle that carrot again of what the next episode is going to be about, which is pretty exciting, a beautiful technique that you're going to teeach us about using memory rescripting And so how about if we say goodbye for today? And we'll get on to our get people looking forward to next week Okay, great. And by the way, I think we've got this system that we're setting up where you can provide feedback now on podcasts And it's abs you liked and what you didn't like and rating it from zero to four, zero to five and then I'll Kevin and I will be able to look at these reviews you submit. and learn from you and modify our podcast to be more fun for you and more interesting Yeah, I love that you mentioned that. and I'll point out that the link for that survey is in the show notes. And there is a unique link for each episode. Today's episode, which is five hundred and eight. if you wanted to give us a brief review of what this episode was like for you you would click on the link that's in the show notes for this episode and then you could give us that specific thatertainly super short. There's only four super quick questions so you can answer almost instantly Great Well, until next time, David Yeah, thanks. Thankk you, K that was great Thank you. Bye bye R Bona. That's it for this week's episode of The Feeling Good podcast For more information, head over to Dr. Burns's website at feelingg goodood. 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 pist and clinical director of Feling Good Institute Silicong Valley. Thanks so much for listening, and we hope you'll join us next time for another episode of the Feeling Good podcast