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Stanford Psychiatrist Reveals How Cognitive Therapy Can Cure Your Depression and Anxiety

Stanford Psychiatrist Reveals How Cognitive Therapy Can Cure Your Depression and Anxiety
hey everybody welcome to another episode of impact theory i am here with someone who has a total legend for me this is david burns md david welcome to the show thanks for having me on i'm psyched dude i am so excited i encountered

your

um book feeling good about um 18 months ago and have since that point been desperate to get you on the show i think it's one of the most profound books if somebody is struggling with

anxiety

depression

any sort of mood disorder and so when you release the new book feeling great it was a perfect opportunity to get you on um i think the the two books together are really the most uh certainly the most effective thing i have ever encountered i think

cognitive

behavioral

therapy

in general is just beyond extraordinary um if if i do my job well because i know you have the information if i do my job well by the end of this somebody that's struggling with a mood disorder i think will be moved forward pretty profoundly if you don't mind let's start with the basics what is

cognitive

behavioral

therapy

and why do you think that it it works as rapidly as it does yeah and then after that we can add what's new and feeling great because there's a whole new dimension uh kind of one step beyond cognitive behavioral therapy but all of the cognitive stuff is still pure gold and it goes back to the teachings of epictetus the greek stoic philosopher who said roughly 2 000 years ago that people are disturbed not by things not by advance not by what happens to us but by our views of them and that idea is so simple and basic that most people can't grasp what it means we'll we'll come back to that in in in a minute now the second idea is that when you're depressed and anxious again it's not the events of

your

life that are upsetting you it's it's the messages you're giving yourself the way you're interpreting events and when you're depressed you're giving yourself messages like i'm not as good as i should be and there's a lot of people listening right now who are thinking that and uh or if you're shy you may be thinking you know why am i so shy i'm really screwed up there must be something wrong with me depressed people often feel discouraged or hopeless and then you're telling yourself things will never change this is my true self i really am a loser i'll be this way forever and now and the really uh amazing thing that that's been kind of known what i just said more or less for 2000 years but what's really kind of new and awesome is that the thoughts that trigger

depression

and

anxiety

are not valid thoughts depression and anxiety is the world's oldest con and you're you're fooling yourself but you don't you don't realize it and then the final message from cognitive behavioral therapy is the very moment you change the way you think in other words the moment you can you suddenly see that those distorted thoughts aren't true and you stop believing them in that instant you can change and so that that was revolutionary and when feeling good came out in 1980 uh that was the first book to really introduce these ideas to the world and at that time there were only about 12 cognitive therapists in the world and all of us were pretty much considered quacks because nobody everyone was saying it's a chemical imbalance in the brain i've been working on research on that defunct and fraudulent theory at the university of pennsylvania and we saw that that really wasn't a true theory and then like so many young

psychiatrist

s i've been trained in this endless talk just come and talk talk talk and and that didn't seem to do anything to my patients i gave them tons of pills that didn't seem to do anything for most of them and then this new drug-free idea came along and i first heard about i thought it was quackery too but then i started going to a weekly seminar by dr beck at penn he was kind of creating cognitive therapy i said i'll just try this with some of my patients to prove to myself that it isn't true and lo and behold they started recovering like popcorn i said man there must be something to this and i gave up my academic tenure track position at the medical school to go into private practice and help help develop it because it was so darn exciting but that that's the the cognitive piece and then what happened i started writing i wrote this book feeling good just because i was so excited i want people to know what was happening to my patients i could barely believe it myself people who had been suicidal suddenly suddenly recovering it was so so exciting and then feeling good finally caught on it and have sold more than three million copies the sequel feeling good handbook has sold another two million and cognitive therapy has become the most popular form of psychotherapy in human history it's it's it's practiced all over the world and it's the most researched form of psychotherapy in human history well that was the magic as of 1980 and the cool thing was if researchers discovered that if they simply handed my book feeling good to people going to a medical center for treatment for severe or moderate depression and just say well it's going to be four weeks before you can see your frank but in the meanwhile read this book they found that two-thirds of them recovered with with with no pills with no therapy within four weeks and and didn't even water need therapy and so great you you point out that if somebody had told you sort of where you've come to now in terms of how rapidly these disorders can be disrupted that you yourself would have said you know this guy is a quack they're a con artist yeah and right what i want to get to so going back to that first notion that you talked about that um nothing is either good or bad but thinking makes it so right the shakes are right yeah and i honestly when i first heard that i knew that it played a role like that seemed pretty self-evidently true to me but a 100 as a student of the brain i assumed that this was going to be a balancing act that was maybe you began a process with the thinking but ultimately it became a hardwiring neurochemical process and that was where the real problem lied but in feeling great you walk through a story that i think is so profound it's worth talking about here because this is probably the one people would be like but what about postpartum depression that's obviously hormonal obviously neurochemistry um yeah and honestly when you started the story in the book i thought actually yeah like how is it possible that that isn't hormonal and neurochemical yeah well um all your feelings result from your thoughts and um the we don't know how the brain creates uh depression and anxiety and these theories like of chemical imbalance is was just rubbish from the very start there was never any reason from a scientific point of view to to to link depression to a deficiency of brain serotonin that was a theory this is a neurotransmitter serotonin and you it's too low in depression and so if you raise up serotonin people will recover and we discovered that that theory was bunk when i was doing my research at the at the medical school because we had a award for depressed veterans in the va and and and we did research studies there and increasing their serotonin levels yeah yeah we we gave them uh half the veterans got milkshakes they all got milkshakes every day but half of them were at least with 20 grams of l-tryptophan which is 20 times the amount you you generally get in your diet and that's the thing that goes directly from the stomach to the blood diffuses into the brain and is converted into serotonin so we caused massive increases in serotonin in half of the veterans and kept them on this program for you know four or five weeks kept measuring their moods the whole the whole way no it was double blind no one knew who was getting this massive boost in brain serotonin and then we broke the code to see how the two groups did and there was absolutely no differences in the groups and neither of the groups improved whatsoever so we published that in the world's top psychiatry journal the archives of general psychiatry and everyone ignored it until about 15 years ago because it clearly ignored it well there's money that drives stuff um and yes big pharma yeah there's billions of dollars being made on on this theory that's that's that's part of it because drug companies can generate create a drug that has some effect on the serotonin system and then they can get approval from the food and drug administration to market it as an antidepressant but now all of the new research indicates that the chemicals called antidepressants actually are not antidepressants they're just placebos they're just chemicals with side effects so they don't outperform placebos so we don't know the cause of depression but the cool thing is is that there's a chapter in the new book by mark noble a a neuroscientist and uh his his his thinking is that the new team therapy which it's like cognitive therapy on steroids you might say actually selectively activate people aren't going to understand they're going to read team in lower case when it's actually an acronym just real fast break it down so cbt cognitive behavioral therapy team is t is testing we test patients at the start and end of every therapy session and the readers of the new book will actually take these tests too to trace changes in their mood while they're reading the book e is empathy empathy will probably never

cure

anyone of anything but you've got to have it if you're doing therapy and i try to create empathy in the book too by showing warmth and compassion for for the readers and a lot of the readers in my book first book feeling good have written me probably 50 000 and said you're the only one who understands me so i think you can get empathy out of a book sometimes better than from a person and then a is assessment of resistance and that's the new dimension i've created in the last 10 or 15 years of my work at

stanford

that that's different from cognitive therapy cognitive therapy is in the book and it's still as good as gold but in in addition we've i've developed new techniques to eliminate what i guess mental health professionals call resistance which might not make much sense to the general public but it seems like when it comes to change we're all ambivalent we we want to change and yet we have one shoot put in the water one foot on the shore and you can see it clearly likely take an example when i do workshops they say how many of you would like to to lose some weight and you know all the hands go up and i say you just made a mistake what it's not true that you want to lose some weight you you definitely don't want to lose weight there's only two things you can do to lose weight and they both suck one of them is you start eating carrots instead of that yummy cinnabon you love and the others you get out and exercise when it's like it is right now and the air is horrible or it might be raining or snowing you want to be thin and attractive but you don't want to lose weight you see and that it shows resistance i mean and it's huge and a it's also true in depression people are depressed people it's the worst form of suffering in the world and they say oh yeah i'd give anything to to get better and then i say to them and this is in the new book well let's say there's a magic button here you press this magic button and you'll instantly go into a state of euphoria with no effort will you press that button and everyone says oh yes i'll prep press it and then i say well we don't have a magic button but i have some magical techniques and i suspect by the end of today's session we probably can make it all your negative all your depression anxiety shame and guilt hopelessness and rage they're all disappear all right so let's take this back to the the post we'll definitely get to that very counter-intuitive punchline but i want to i want to put it in what i consider possibly the hardest example for people to get over postpartum depression obviously hormonal well yeah how is that just her thoughts yeah well um it's not only her thoughts but her motivation to to to be depressed but what she was telling herself is is i'm a failure as a mother she was having trouble with breastfeeding and i and i shouldn't have mixed feelings about having a baby because she wasn't even sure she she wanted to have have a baby and then she was telling herself i have the wrong emotions i should be better at breastfeeding i'm failing as a mother she she was beating up on herself and it's those thoughts not some presumed hormonal imbalance that's causing her depression now i can hear people at home screaming right now that you're blaming the mother for her postpartum depression well how do you respond to that it's never to to blame anyone self-blame is the cause of depression it's not the the

cure

for depression but it's actually very liberating to discover that your depression has resulted from messages you're giving yourself that are cruel and untrue and that in today's session i can show you how to crush those thoughts and and get rid of this depression so you can go into a state of joy not just feeling less depressed but but feeling feeling euphoric but uh the the goal is never to blame someone in fact the discovery that you're wrong when you're depressed that you're giving yourself unfair wrong messages is the greatest discovery a human being can make i can give you a personal example or we can stick with the with with the woman with the postpartum depression because she also has a person for example does it have anything to do with trains trains trains that was the one two punch of because my when i first heard you say that and i thought okay wait a second if this is true then i should be able to take somebody who was clinically depressed two to the nines and if they had amnesia that their depression would instantly go away and that's probably why electroconvulsive therapy works temporarily it's actually not a very good treatment but you get a memory loss so you kind of forget your thoughts for a few hours this is super interesting i think it would if you tell that the the train track story um it was pretty enlightening oh that's a great one yeah the after i wrote feeling good this this young man wrote me and said oh i read your book feeling good and i just love it but i can't believe that a thought you have to have a thought to have an emotion he said what if you were stuck on a railroad track with a train coming you'd feel terrified and you wouldn't have to put a thought in your mind and i had read that letter when i was coming home from the airport in a taxi and i put it in my briefcase and i was just reading this this letter and i thought my gosh i'm i must be a fraud this makes sense how you know obviously if something awful happens you're going to be terrified and you don't have to put a thought in your head and oddly enough as we were rounding a corner about a mile from my house it's it there's a railroad track and there was a car on the railroad track driving on the railroad track and i saw there there was a freight train about a mile and a half away coming like at 60 miles an hour on that track and they don't stop so i said to the taxi driver stop i i gotta i'll see if i can get that guy off the railroad track otherwise he'll he'll be smashed and so i ran up and you know it was gravel about you know the at the edge of the tracks you know it was kind of elevated a little bit off the ground and i went up there and knocked on the window and the car stopped he was only going three miles an hour or something he rolled down this window and he says oh um uh can you tell me the the way to city lion avenue he was an older gentleman and i said city line avenue you've got to be kidding me it's eight miles in the other direction but you're on a railroad track and there's a train coming you've got to back up back up so i can get you off the track cause i wanted to back up to the road so he could turn his car and then drive off before the train hit him and so he starts backing up and i got him to the road now that the train is about 30 seconds away and they starts honking its horn like get out of the way get off the darn track and he was just perpendicular to the train and and so i got in front of him and waved my hand said back up now back up you just gotta back up three or four feet and the train will miss you and the guy started going forward slowly and and then the train put on the whistle non-stop put on its brakes but it came skidding and it hit broadside at about 60 miles an hour and the the car was ripped in half and the front half went about 15 feet or so from where it had been from the from the impact and i rushed up to the driver's window again and all the windows were smashed and and i expected to see a bloody decapitated corpse but the train it hit just an inch behind his head and it was going so fast it was kind of like when you pull a uh uh like if there's a glass on a table and there's a cloth under you pull the cloth really fast the glass doesn't fall over and it was kind of like that and he looked perfectly normal but there was glass all over and he said what direction did you say for city line evidence and i says you've just been hit by a train and uh and he said i have not he says that's ridiculous i says oh no why where do you think all this glass came from he says you're right it looks like somebody broke all the windows in my car all of a sudden i said where's your back seat and he turned around he saw that half of the car was missing and then he looked at me and he says where is this train i said it's right there it's 15 feet from here and the engineers and they're running here right now and he says this is wonderful and i says wonderful what's wonderful about he says well maybe i can sue and then the the engineers came up the police came the ambulance came uh i gave my story to to the police and i went home and i couldn't understand what what had happened uh and the next day i was on my six mile jog and i saw this man looking through the rubble a younger guy and i stopped and and uh i said oh yeah what what are you doing and and he says well you know my father was almost killed yesterday uh he was hit by a train but somebody saved his life and and i said well that might have been me because i was here and and i was trying to get him off of the railroad track and i um i didn't understand why he was driving down the railroad track he was asking how to get to city line avenue and then the fella said well my dad's had uh dementia uh for quite a few years and he does he lost his driver's license five years ago but he forgot and after dinner he decided to take the family car for a drive and he snuck out and went went driving and and so that that explained what had happened but here you have the same situation and i had the thought my gosh this guy's going to get killed you see so i felt intense panic he had the thought oh this is great i'm going to earn a lot of money from a lawsuit so he was feeling happy same situation different thoughts radically different feelings yeah see that when you told that story i actually thought the punchline was going to be okay look i'm actually making this up but you know it illustrates a point and then to hear that it was really real um and then there's a it's interesting because it's really a two-way street right so you have your thought it triggers something biological in the brain so they did a study where they removed the amygdala on a bunch of chimpanzees released them back into the wild that an inability to feel fear and so within something like within 48 hours they were all dead because they they wouldn't have avoided a predator they wouldn't avoid limbs that were too small and so you when if you can disrupt that communication right because if you think something negatively you are going to get a physiological response it and nothing yeah you're not trying to say that right yeah to me is is super interesting so now going back to our woman with postpartum depression so she's having these thoughts um they're giving her a neurochemical cascade where she is having a physiological response to this she's confusing the physiological response with what's actually causing this how does she then begin to back out of that like how does she the what what is the process the mood journaling and all of that is going to help her get out well there's there's two phases to it now when i wrote feeling good it was just how to crush the negative thoughts but now i think it's worth walking us through that i think people understanding the the sort of gist of the 10 cognitive distortions well sure let's let's do that then maybe later we can talk about this amazing new thing that speeds recovery so much uh but but uh you know she what is she telling herself well she's telling herself it's my fault that that the baby isn't nursing i i'm a failure as a mother and also i shouldn't have mixed feelings about having a child mothers are supposed to just love their their children and uh and those thoughts have all of the classic cognitive distortions for example uh should statements i i i shouldn't have mixed mixed feelings um also self-blame it it's my fault that the baby is is having trouble uh nursing that that type of thing and she had about eight thoughts and they all had multiple distortions you know all or nothing thinking looking at things in black or white categories emotional reasoning is huge a lot of people are listening right now feel depressed and hopeless so that they feel like losers so they say i must be a loser i feel like a loser i must be hopeless i i feel hope hopeless she's also involved in mind reading thinking oh other mothers don't have mixed feelings other mothers are you know these ideal ideal mothers and and so that's the first step is to recognize that what you're telling yourself is not true it's it's distorted the second thing is to realize that it's it's kind of mean-spirited what what you're doing to yourself and i used a number of techniques with her that were all pretty darn effective but one very simple one is called the double standard technique like uh i don't remember what i called her i always disguise people's names and then i can't remember god i know her real name but whatever her name was in the in the book i said imagine that you were that i was a dear friend of yours and and i look a lot like you and i went to the same schools i got the same grades and i also have a new baby here and i'm not you i'm a dear friend of yours and then uh and she and i said could we do a little role play like this she said oh sure and and so i said let's let's give her a name let's call her martha and and i'm susan and and i said uh martha could i talk to you for a minute um i i uh i i don't know if you're aware of this i just have a new baby you know my my husband and i we we've tried for years and we pregnancy didn't happen and we were almost given up and then all of a sudden here came the pregnancy now we have this this beautiful little boy but he he's having trouble nursing and i i'm telling myself that uh that this is my fault and that i'm i'm a failure as a mother does that seem pretty valid and then my patient who was playing the role of of herself talking to a dear friend uh said oh my goodness uh that that doesn't make any sense at all you know quite a few mothers and babies have this this problem and and you know it's certainly not your fault if if your little boy is having trouble with with nursing and it certainly doesn't make you a bad mother and i said well that's cheering me up a little bit uh but but i want to make sure that that's totally true is that 100 true or are you just bsing me you just try to cheer me up and she says no what i'm saying is totally true 100 true so i said so if it's 100 true for me and i'm like a clone of you then that would be 100 true of you too is is that right she says yes so i said write that down we're doing this all in in writing and i said how much do you believe what you wrote down in the positive thought column she says 100 and now how much do you believe the negative thought that this is my fault and she said zero percent and that's kind of how it works but then i wanted to push it further and i said okay will you help me on that one but i have another negative thought and i want to see what you think see i'm not always excited about being a mother and and tell you the truth i i've had mixed feelings about pregnancy all the way along and sometimes i'm real excited about being a mother and other times i kind of yearn for my my work and for my career and and feel kind of burdened and and even a little resentful and surely that makes me a failure as a mother right i mean a mother is supposed to just have loving felines isn't that right and she says that's ridiculous you know all mothers have mixed feelings about everything nobody has pure feelings and if you have mixed feelings that that's makes you human it doesn't make you a failure and i said is that right you mean i'm entitled to have mixed feelings even resentment about being a mother i said she said absolutely that's human all mothers feel that way sometimes i said this are you bullshitting me you're just blowing smoke in my face and she says no that's a hundred percent true and i said write that down and then how much do you believe this negative thought i'm a failure as a mother because i don't always have you know excited feelings about being a mother and she said zero and that's the type of thing it's it's it's learning uh to treat yourself with compassion uh and kindness and realism rather than bullying yourself with these distorted negative thoughts and that that is really the essence of cognitive therapy and then there's this other huge discovery from my weekly training group at

stanford

i have a tuesday night training group that's free for community therapists because most of them aren't happy themselves and they know they're not getting great results so they can come to stanford every tuesday and get unlimited free psychotherapy training and unlimited free personal therapy for themselves if they want and out of that group has emerged another massive insight that's i think as as big and important as cognitive therapy i mean that changed the world of psychotherapy in the 1980s and i think this is going to cause another massive revolution in how psychotherapy is done because we've discovered i still use all those amazing cognitive therapy techniques but we've i've we've discovered a technique that makes them work uh even faster and uh that than than cognitive therapy work because you see in the old days when we just had cognitive therapy i i would think if i get somebody with severe depression better in 6 8 10 12 sessions that was fantastic and it was and that's about you know what it took now with the new techniques when i work with people i generally generally i'd say 90 95 percent of the time i see a complete elimination of symptoms the first time i sit down with them now that has to be a 90 or minute session or a two-hour session i can't do it in an hour but it but i can do it in two hours and then it generally one and done you know that it's a complete course of psychotherapy and then i do relapse prevention training and for the most part the person is is good to go was the key insight there that people are resistant that they have their talk about that talk about the two different types of resistance this this to me is that sort of no approach of like you know look this is working but there it could still be better and acknowledging that people put up roadblocks and that you found a way around them is is so powerful yeah yeah that it's been mind-boggling because i've never had so much fun doing psychotherapy because every almost everyone recovers just right the first time i meet with them when they get high i get high but the essence of it see freud called this thing resistance and people talk about resistance why do people want to be depressed why do they resist recovery because half of people have pretty strong resistance half of people do not but about half of people will yes but the therapist and they seem to fight against effective treatment and we used to think we were trained to think that oh something this is their identity uh they they see themselves as a negative person so they're afraid to let go of their identity or they they they get secondary gain they like attention that they get from being depressed and and things like that or they like people like feeling sorry for themselves and these interpretations of resistance are kind of uh put downs to the patient and i don't think they're true in most cases and they definitely never helped anyone but what we have found is realizing something negative about yourself is not going to help you yeah yeah yeah yeah if the therapist convinces you you're just feeling sorry for yourself you'll you'll feel more angry and more hurt it's not going to help you in in any way sometimes there's a little truth to it sometimes i get upset i want to feel sorry for myself for a little while but uh it's it's not the big thing that keeps people stuck in depression and and what what we've discovered let's take the postpartum woman that we talked about one of her core issues is perfectionism she's been a super high achiever her whole life and part of her success is that she's always criticized herself when she falls short and so when she's beating up on herself and saying i'm a failure as a mother and this is my fault it shows how how what a loving mother she she really is and and it shows that she has high standards and that she wants to do the very best for for her little boy and i don't i want to put this back in the context of something that you said at the beginning and i said we'll get to us and i want people to know we're we're now at this which is that notion of the magic button and getting people to uh positive reframing i believe is the term that you've given it yeah where you're taking something that you would perceive as negative and you're realizing there actually is something good so if you can go back to you know you present people with this they're just feeling absolutely horrendous and the most powerful example i think you have of this is the mother of the little girl who was shot in the face with a pellet gun and it explodes one of her or multiple of her teeth props and multiple surgeries and the mother had let her go out to play and so it's like oh man she's beating herself up over it i never should have let her go out i'm a terrible mother you know my daughter is suffering how could i ever allow myself to be happy again um how how did you help her realize that hitting the magic button and making all of that anxiety and all of that you know shame and guilt like how on earth did you make her see that guilt and shame and anxiety are actually positive well that's the really fun fun thing you see she'd been suffering for for nine years since your daughter had been shot at the age of 12 and she blamed herself that she said i shouldn't have let her go out to play that night uh so i'm a bad mother and just horrible nine years and so centaur af we empathized uh i was treating her in front of a live audience and i i said now if there's a magic button here i said well first of all what do you want out of this session if a miracle happens what miracle would you want she said well i feel better i'm so so tired of feeling 100 guilty 100 anxious and 100 ashamed 100 depressed and hopeless and angry and i said well let's imagine there's a magic button here and if you press it you'll be instantly cured with no effort and you'll go into a state of euphoria will you press that button just absolutely i'd press it in a heartbeat every everyone says that i say well we don't have a magic button but i've got some incredible techniques but i i don't think it would be such a good idea to use those techniques and i just said well why not you know this is what i need i've been trying for nine years to get over my my depression i said well before we use those techniques let's see what all your negative thoughts and feelings show about you that's positive and and also now now let's say your sadness and depression to start out with you've been horribly depressed because your 12 year old daughter for nine years has had surgeries and unsuccessful treatment for post-traumatic stress disorder and she's been pretty miserable so if you press the magic button you'll be joyous and happy so you're saying you want to be joyous and happy about the fact that your daughters are suffering for nine years she said oh no that doesn't sound right so i said what does your sadness show about you that's positive and awesome she says it shows how much i love my daughter so put that down is that real is that powerful is that important she said absolutely and then you you're you're telling yourself uh that the people here in the audience are judging you that was another one of her negative thoughts they think you're a bad mother you think you're a bad mother what does that thought show about you that's positive and awesome the fact that you're concerned that the people in the audience here may judge you she says i guess it shows that i want a positive loving relationships with with them and is that true she says absolutely i said is that important she says absolutely so put that down shows that i want loving relationships with with the people here in the group and then you're very self-critical you're beating up on yourself constantly i'm a bad mother i'm a failure i i shouldn't have done this i you know i should have done done that what what is that show about you that's positive and awesome she says well maybe that i have high standards i said absolutely is that true she says yes and i said have you have your high standards helped you she says oh yes i do everything i can to help my daughter and and i got a phd in clinical psychology i've achieved a lot and i said is that important and she says absolutely i said what else does all this self-criticism show about you that that's positive and and awesome and and she says well maybe humility i'm not like bragging about about myself i said is that important humility she says yes i'm a very religious person that's it's a spiritual principle to put down humility and then and you're anxious all the time if you press the magic button your anxiety will go away but what are some good things about your anxiety since it keeps me vigilant to protect my daughter daughter the last time i let down my my guard she got shot in the face so i guess you're saying your anxiety is is your love for your daughter she says absolutely so she puts that down and then you're angry is that valid uh what what are some beautiful things about your anger she says well the parents of those boys never should have let them go out and play with other children with a loaded rifle uh and so so what does your anger show about you karen that's awesome she said well i'm like an angry mother bear i'm gonna protect my daughter i'm not gonna let those parents get away with with that and i said is that important she says absolutely so we came up with a list of about 25 beautiful things about her depression and anxiety and shame and guilt and anger and hopelessness even the hopelessness is even a good thing because it prevents her from getting disappointed getting her hoops up like it doesn't make sense that you could sit down with dr burns for one session and be cured that's like a snake oil salesman so your hopelessness shows that you're a critical thinker and it prevents you from getting horribly uh getting your hopes up and they then get all disappointed at the end of the evening she said absolutely so then i said well look at given all these beautiful things about you we've listed 25 beautiful things about you that that that are all expressions you know of these these negative feelings that that you have these negative feelings because of these beautiful things about you and if you press that magic button they'll all go down the drain along with your negative feelings is that what you want she says no i i don't want to suffer but i don't want to give up all these positive core values that i have and then we said well maybe we can make a little compromise here maybe instead of pressing that magic button we'll have a magic dial and you can dial them down to a lower level but not to zero so so how sad would you want to be at the end of the evening it's a hundred right now she said oh ten percent is enough they said are you sure that's enough of you could i sell you on 20. now i'm in the position of trying to persuade her to be more upset you see rather than try to sell her on something which only would trigger resistance and then so she dialed them to zero she felt the shame she didn't need any shame and one of them she only needed two percent and some of them she wanted 10 and that type of thing and now i've made a deal with her subconscious mind with her resistance that will dial them down to these levels but no further and then i said now karen that i have to advise you about one thing the techniques we're going to use are so powerful that you might overshoot your goals like your depression may go all the way from 100 to zero rather than to 10 but don't worry because if it go if you got too happy i'll try to i'll help you work your depression up to 10 before the end of the evening and then she started laughing and at that point i knew i had her and then it was easy then it took about 15 minutes for her to talk back to the negative thoughts the same way we role played earlier using double standard identified the distortions and and she not only went to zero on everything she actually went beyond zero and went into a kind of state of euphoria and the neat thing is i have all of this on video and uh i'm going to be showing it in a couple of presentations for therapists and one for the general public coming up too so people have to actually be able to see these little uh snippets but that that's how it it works and uh i want to go a little bit deeper into the into the um the resistance so you talked about in the book how there's two types you've got outcome resistance you know process resistance oh yeah a little bit about that and then i'd also like to better understand is it that people are subconsciously identifying that these actually are good traits or is it that they don't want to confront something negative about themselves no it's just well um no no uh confronting something negative about yourself that that would not be true in depression and anxiety actually it might be true when people are angry and vengeful uh that were with habits and addictions but in depression and anxiety the resistance always results from things are really good and beautiful about you but this thing of outcome and process resistance is blowing my mind because you really got the new book which is kind of exciting to me but yes the there's eight kinds of resistance there's outcome and process resistance for four targets depression anxiety relationship problems and habits and addictions outcome resistance is what we just worked through with karen who who was uh depressed about her daughter it means you don't subconsciously you don't want a good outcome from the therapy and in this case because all of her negative thoughts were because of what's most loving and beautiful about about her but that that's outcome resistance um outcome resistance for anxiety is a little different uh the all anxious patients feel or people feel like my anxiety is protecting me from something terrible and if i was cured you know things with horrible things would happen so for example uh i treated a woman with obsessive-compulsive disorder who who was washing her hands 100 times a day thinking she's going to get contaminated and she wants treatment for that and then i said well suppose you i press this magic button and you'll be cured would you do that she says absolutely i don't want to see you i said okay so now you're cured uh and so you're not going to wash your hands 100 times a day what's going to happen she says my hands will get contaminated and then i said then what will happen she said well that'll touch my children. okay and then what's going to happen and then they'll get contaminated and that's what what's going to happen well then they're going to die of leukemia they'll get leukemia and die and then she started sobbing i said you still want to press that magic button she said oh no no i don't want to press it and that's the outcome resistance you see she thought that her anxiety was protecting her and her children now processed resistance is a little different process resistance means there's something you're going to have to do that you're not going to want to do to get better see it's once you've decided i want to get better that's half you're halfway there but now what's this thing you're going to have to do well the thing that the press patient is going to have to do is psychotherapy homework and practicing writing down negative thoughts doing the exercises in my books like and feeling good and then the new feeling great the crucial thing is to do these exercises because that's where you reprogram your brain that's where the change really really happens and and so when i work with people i i say this is a gentle ultimatum if you want to work with me you must agree to do the exercises if not i'm not the therapist you're looking for because all i could specialize is and is quick irreversible cares if you want to keep talking endlessly to somebody without you know changing your life then i'm not the person you're looking for and and i i lay down the law but in a loving way and then most people want to stick with the therapy and they do the homework and 100 of the patients who do homework between sessions recover 100 of patients who refuse to do homework do not improve or recover so it's a really a big deal in anxiety the the process resistance is exposure the anxious patient will have to face their fear their their worst fear and when it's happening it's going to be terrifying and if you want me to cure your anxiety you're going to have to confront your fears now in most cases i'll be there with you i'll go with you to confront your fear but you must do that just talking about your anxiety is not good it's not going to cure you and i know how important it is because i myself when i wrote my book when panic attacks was all on all the anxiety disorders i discovered that i've had 11 anxiety disorders when i was writing it i didn't realize this and then in the six months after it came out i thought of six more so i've had 17 anxiety disorders i've had fear of bees blood horses dogs i used to have incredible public speaking anxiety this something like this would have freaked me out how do you do it with speaking because if you're going to expose yourself to speaking the audience is not unconscious you're you're there you're exposed is it self-narrative um how do you how do you do more than just motivation is important i use a lot of techniques but i can tell you how i got over my own if you have time for another story yeah please the uh when i was doing my research on brain chemistry i was invited to go to a prestigious conference in england at oxford university sponsored by nato and it was called the advanced study institute for metabolic compartmentation in the brain and i was doing this computer simulation work on brain serotonin metabolism and uh so i was they invited the 80 the top scientists brain scientists in the world to go and then two younger people who were kind of just getting started and i was happy to get one of those two invitations and i was terrified because the work that i was doing was challenging the work coming out of the national institute of mental health the laboratory of pre-clinical psychopharmacology and i i could see that their their research wasn't being done properly they weren't analyzing the mathematics that they were using it wasn't correct and and they didn't have good data they were losing half they were injecting radioactivity into rat brains and then losing half of it and so i decided to redo those experiments properly and i came to the opposite conclusion and this was the first research study i'd ever done and but i heard that the head of that laboratory like to humiliate people in in conferences and that he was going to be at this conference and my talk was the last talk of the conference after four long days of hearing these brilliant people and i felt so outclassed and and then finally my turn came and the night before i was so anxious i couldn't sleep and i wandered around the oxford campus and owls were like hooting at me derisively i was in a panic and i had this fantasy that i would go up to the podium freak out read and mumble my talk and that he would sit right in front of the podium and at the end he would jump in the air and start screaming at me and i absolutely believed that that would happen and all day i waited for my turn and it was like death and saying i wish i wasn't here why did i come to this conference finally they introduced me and i went up to the podium with my papers and there he was right in front of me sitting in the front row kind of glaring at me exactly as i had fantasized and i got so scared i read and kind of mumbled my talk and then at the end there was this silence and the moderator said does anyone have any questions for the young doctor and this fellow jumped out of his chair and started shouting at me telling me my work was bs and i didn't know what i was talking about and it was just incredibly humiliating and then he sat down and the moderator said does anyone else have any questions for the young doctor nobody said a word they said this concludes our conference we're now going to walk two blocks to the blah blah blah restaurant for our celebratory you know banquet or something and when i walked there i felt lower than a piece of dirt and no one would walk next to me and when we got there no one would sit next to me and it was the most humiliating experience of my life and then when i flew back to the united states halfway across the atlantic ocean i was finally calmed down enough to think of what his criticisms were and i had to thought that guy doesn't know what the hell he's talking about that was a bunch of bs he was throwing at me and i and i went to talk to uh my collaborators who'd been helping me and and one of them was this fellow at pan a physiologist named martin prang and i had heard he was one of the top two mathematicians in the united states and he was helping me with the mathematics behind we were doing computer simulation of brain serotonin metabolism it was pretty groundbreaking what we were doing and i said i i don't think this guy knows what he's talking about and he says david you're exactly right um his criticisms are just they do not make sense so we did a few more simulations and i wrote up my article and submitted it to a journal and then i got a call this is a little long story but it has a good conclusion i got a call in about three weeks from the editor of the journal and i thought good gosh why are they recalling they usually don't they write rejection letters do they call you up and call you out and tell you how awful your article was and he called and he says listen dr burns we got your article and something unusual none of the reviewers had any suggestions for changing anything in it and they have unanimously uh agreed that it needs to be published it's going to be in our next issue but i'm wondering could we submit it for the ae bennett competition this is an annual competition for investigators under 35 years of age on brain research and it's the top of word in the world and you'll be competing with uh nimh the group that you're uh criticizing and and scientists from all over the world could we submit your paper i said you sure can i had no idea and then he called three weeks later and he says you're the first unanimous winner of the inventive and uh i i just couldn't believe my ears and and he said can you give a talk presentation to a thousand

psychiatrist

s in new york next month that are at our meeting to receive the award i said you bet i can absolutely and then every night before i went to bed i i would start to fantasize you know blowing it in front of a thousand psychiatrists then i forced myself to change the image and to say instead to imagine just talking the talk with no notes and telling the people how lucky i was to work with martin prang and dave brunswick and how howell herring and jack jack london the people on my research team and how fantastic the discoveries we made were and how grateful that i was and what a fantastic experience it was and i i told them i wouldn't accept the award unless they gave me my my other co-authors equal recipients which they said they wouldn't do and then i said i want that i won't accept the award and they say okay we'll do it and so so they came to and and and and i just forced and i imagine that at the end of my talk everyone would rush up with congratulations and stuff just the opposite deal and i didn't believe it but i kept forcing myself to think that way and then when the day came i i walked up to that podium my wife came with me to new york from philadelphia there were a thousand you know researchers in the audience and then i told them about about the research and it just the how excited i was how grateful i was to have people of unbelievable brilliance you know on my research team and what the implications of the research were the methods that we had developed to do this this this research and at the end everybody rushed up to the podium and just you know it was exactly as i had fantasized it so that that was you know how i got over another another fear and then the odd thing was that uh two or three weeks later this group from sloan kettering in new york called said can we come and meet with you and martin prank in philadelphia because we have an idea and we want to see if you think it's it's ridiculous or theoretically possible because you see we've been using mathematics uh and certain information to to figure out what's going on inside of the brain and they they said that they had wanted to create something called a cat scan that that could take images of the inside of the human brain using electromagnetic stuff and and did we think their mathematics was valid and they think this was possible did we think this was possible and i didn't have much to say because i didn't have the mathematical power of martin but martin looked at he says yeah he said this this this is definitely gonna gonna work and then they went and and developed the world's first uh cap scanner so there but anyway that was my uh my experience with public speaking anxiety and you know and then you know once you've had that that experience uh i i i've had very little public speaking anxiety since then and just like this like meeting with you to me it's just like what a great moment that says you know i'm old and i'll be 78 in a week and all i've got thank you all i've got is the experience do you see what i mean and what an experience this is to hang out with you and to share these stories that may touch people and change their lives david i am serious when i say i am so grateful for your work and you know what you've managed to put together in just those two books let alone the rest of your work um feeling good and feeling great is is transformational and it was given to me originally by one of my employees who had been struggling with anxiety and he had found this and he knew that i had struggled with anxiety so he gave me a copy oh yeah as i was reading it i was just like oh my god it's so step by step it's so usable it's something that you can deploy immediately and the more you interact with it the more sort of self-evident it becomes just how powerful it is and that last example that you gave of as you imagine something you are creating that body response to what you're thinking of and i said you know so many people rehearse failure and so few people rehearse success and because you've rehearsed failure you're beginning to associate this negative response with this otherwise neutral thing and so it's no surprise that you then go and perform exactly the way you thought you were going to perform so it's this really rudimentary thing that i think nobody has explained as clearly and simply as you and given the ways to unwind that and i think feeling great really is as breakthrough as you think it is in terms of dealing with that resistance and understanding that as a part of the process of overcoming whatever mood disorder it is you're struggling with so again thank you so much for coming on the show man i i am eager to to see people adopt the new material i'm sure it'll be as transformational as the old so thank you thank you so much this has been the best interview i've ever had because of all the effort you put in it i couldn't believe how on top of the stuff you you are and it makes it uh it's such a gift to the person you're interviewing and it takes a lot of work and i'm i'm very grateful that's very kind it is the least i can do to show my appreciation for what you've given the world um it's amazing all right everybody trust me when i say every word that i've said is absolutely true it is astonishing his books will change your life if you use them and speaking of things you can use if you haven't already be sure to subscribe and until next time my friends be legendary take care buddy says something out loud it's 10 times more powerful than if they think it and then as we started to study the data particularly data that was just reinforced by christine porath from georgetown and harvard that negativity is a multiple of four to seven times more powerful than positivity you
stanford psychiatrist reveals how cognitive therapy can cure your depression and anxiety

Source : Tom Bilyeu