Full PreFrontal

Ep. 120: Dr. David Burns - Feeling Good Yet?

August 20, 2020 Sucheta Kamath Season 1 Episode 120
Full PreFrontal
Ep. 120: Dr. David Burns - Feeling Good Yet?
Show Notes Transcript

Emotions are the heartbeat of human existence and the human drama that is full of anxiety, sadness, anger, fury, joy, or love feels like we are either riding a roller-coaster or floating gently in a boat that’s in a calm and placid lake. Emotions that disrupt our relationship with the world require regulation, but conventional wisdom approaches might get us off track as we might train ourselves to either not feel the feelings or not react to them. 

On this podcast episode, father of the CBT-TEAM approach, author of the best seller “Feeling Good”, and host of the Feeling Good Podcasts, Dr. David Burns talks about why it is important to understand that all feelings are caused by thoughts and focusing on grouping emotions into positive and negative emotions may not serve us well, but rather redirecting unhealthy negative as well as unhealthy positive emotions can and will allow us to live our human experience to its fullest. 


About Dr. David Burns
David D. Burns, MD is an Adjunct Clinical Professor Emeritus at the Stanford University Department of Psychiatry and Behavioral Sciences. His best-selling book, Feeling Good: The New Mood Therapy, has sold more than five million copies worldwide. Many published research studies have indicated that 65% of individuals with moderate to severe depression who are given a copy of his book improve dramatically within four weeks with no other treatment. 

Dr. Burns has won many awards for his research and teaching. His weekly Feeling Good Podcasts will hit three million downloads this year. His latest book, Feeling Great, is now listed on Amazon.com and will be published in September 2020. He is also working on a new Feeling Great App that will feature two powerful new mood-changing technologies to show people how to break out of severe and mild mood slumps quickly.

About Host, Sucheta Kamath
Sucheta Kamath, is an award-winning speech-language pathologist, a TEDx speaker, a celebrated community leader, and the founder and CEO of ExQ®. As an EdTech entrepreneur, Sucheta has designed ExQ's personalized digital learning curriculum/tool that empowers middle and high school students to develop self-awareness and strategic thinking skills through the mastery of Executive Function and social-emotional competence.

Support the show

Sucheta Kamath: Welcome back to Full PreFrontal where we expose the mysteries of executive function. I am your host Sucheta Kamath, you will notice several changes. First of all, we have had a makeover. Check out our new logo. Secondly, I'm also going at it alone. You will notice that we don't have producer Todd here. I will miss him terribly. But he has coached me well. So, I feel very confident. And lastly, if you have you haven't done already, be sure to follow us on our social media, as well as share this podcast with your friends and subscribe to us. Now, it's a great pleasure to welcome our guest today, one of the things that we talk about here is executive function, in essence, a set of mental skills that allow us to manage our thoughts, feelings, attitudes, mindsets, and actions. But we cannot be productive, successful without talking about role of emotions. And our guest today has all the expertise in the world to not only understand the role of emotions, but how to successfully manage so I'm very curious to frame this from that point of view. So, it gives me a great pleasure and honor to welcome Dr. David Burns. He is an adjunct clinical professor emeritus at Stanford University Department of Psychiatry and Behavioral Science. He has many, many accomplishments under his belt, but I'll mention a few. One of the favorite things of mine is I think he published his First Book in 18 1989,

Dr. David Burns: No 1890. I'm actually 153 years old.

Sucheta Kamath: Just about to say that I got a hold of it in 1999. So, I was a little bit slow to start, but I caught up. That has been my personal playbook in managing my emotions as a clinician, you know, as a speech and language pathologist. We don't get any training in counseling, but counseling is an essential aspect of managing patient's needs and families. Secondly, I will say he's a highly published researcher and he also has a very, very successful podcast and if you haven't heard, I are just telling him that I have heard only hundred and 43 podcasts so far, but I think he has crossed over 185 so it's called Feeling Good podcast. All this will be in your show notes. So please read that and follow up. And finally, the most amazing thing I'm waiting. I've ordered it, but he has a new book coming out called Feeling Great. And I'm hoping that he will give us the 2.0 version of Dr. Burns wisdom. So welcome to the podcast.

Dr. David Burns: Thanks for having me on. It's great an honor and a great pleasure. Thanks.

Sucheta Kamath: Thank you. So, I asked this of all my guests. So, my first question to you is, since we talked about executive function, the adaptive flexibility, goal management, intentional focus. I like to ask my guests what was what were you like as a child? How were your executive function skills? And when did you become since you specialize in emotions and emotional management? When did you become aware of your own emotional sense of being an emotional person? A person with emotions?

Dr. David Burns: Oh, those are pretty big words. For me. I don't even know what executive function is to be honest with you, but I do love the topic about when I was a kid. Well, I think I was a little maybe someone alone as a kid, the I had several siblings, older siblings who had been adopted. And I then my folks thought they wouldn't be able to have children and then you know, so they adopted and then I, I came along, and I think they might have kind of resented a little bit maybe in the natural born child and maybe thought I was getting favoritism, which I could well have been I didn't understand about this, but they were they were a little bit hard on me, I think. So. But I had a my mother's father, my grandfather for a while when I was like in grammar school in Denver, lived in the basement, and he kind of befriended me and he taught me how to do somersaults and he said some someday you know, things will turn around for you. So, I really appreciated that. And then I had a friend named Vance Aandahl who lived about a block and a half away. And he seemed to me to be incredibly smart and it was always fun, and we go out looking for ghosts or something like that. And, and once we were walking down the street, and he said, I have something in mind, we weren't we were kind of, you know, this was not a well to do neighborhood. And but he said, I have something in my hand that's, that's worth millions and millions of dollars. And I just couldn't believe so what do you How could you have something in your hand worth that much. And then he opened up his hand and said, See, these are seeds, like for apple trees, and things like that, and you can plant these, and you know, you can just grow food for four generations, and he was very creative. He eventually ended up as a science fiction author.

Sucheta Kamath: Wow.

Dr. David Burns: But I did a lot of things I think kind of maybe on my own but I have certain happy memories of childhood and vacant lot next door and there was a vacant lot across the street and we called Spencer's Forest because it was all overgrown and you could kind of Tunnel through it was just the size of a lot but yeah, but I think I was you know, loved academic things but my, my interpersonal skills probably weren't quite as, as developed. I, one of my memories was I that's probably not what you want to talk about on the podcast. But I remember in fourth grade, you know, my, I think my mother said, you know, are you going to go to a Halloween party, and I said, I haven't been invited to any. And, and then she said, Well, why don't you have one? And I said, Yeah, maybe I can invite the kids who weren't invited to other parties and then we'll have a Halloween party. So, I stood up in class and said, if you haven't been invited to a Halloween party, you can come to my Halloween party. And then almost every kid in the class showed up and we just Halloween party. But those are some miscellaneous ramblings from childhood.

Sucheta Kamath: Well, what's so striking about it with and this is something and I was going to ask you this question, but one thing that stands out for me is incredible capacity to love people you know, your compassion is just exudes through your words, your stance, I mean, I don't even see you in the podcast, but I can feel that if I was with you, you would just accept me the way I am. And I think sounds like a lot of seeds. You we can hear this in your stories that you're showing those signs of deep compassion for people. So that brings me to this question about emotions and maybe you can also So to frame it from your interest in this subject, but you know, I have this a little bit complex set of questions like a three questions, but what is the role of emotions in living a full human experience? And is it right for us to think that or to group emotions into positive and negative emotions? And can there be healthy negative emotions and unhealthy negative emotions? Yeah, how should we think about all this?

Dr. David Burns: Yeah, well, one way that I think about it is that every negative emotion has a healthy and an unhealthy version.

Sucheta Kamath: Oh, I see.

Dr. David Burns: So that, I know when chapter three of my first book feeling good, I talked about sadness is not depression, I think was the title of that chapter. Do you have it there? Oh, yeah. There. You've got it in your hand. Thanks. And the you know, I talked in that chapter about when an elderly man died. When I was a medical student and how his family had gathered around him and asked if he was dying and I was not a good medical student at all, but I remember telling them that Yeah, he's not going to be with you much longer and this is your chance to say goodbye and the tears started rolling down my cheeks because he reminded me actually of my grandfather, little bit and then they all started, you know, crying and I went down to the place where the residents about I was just a medical student and where they do their chart notes and, you know, cried, cried a little bit there. But that those kinds of tears are a beautiful thing. And I think that was very helpful to that family to be encouraged to be emotional because they started crying and stroking his head He was slipping into a coma. But he could still hear them, and they got a chance to say goodbye. But depression is a radically different thing that's kind of the unhealthy version of it because when you're depressed, you're giving yourself distorted messages telling yourself things that really are not true. Like I'm, I'm worthless, and I should be better than I am and I'm a hopeless case and things will never change. And, and so in general, all of our feelings result from thoughts an event cannot create emotions and a human being you have to interpret that event think about it in a particular way. And so, all feelings are caused by thoughts, but healthy, negative feelings are caused by valid thoughts. Like I loved him, and he was so beautiful man and I will miss him. And you know he'll be gone and that that that grief is a beautiful connection with life but unhealthy negative emotions result from thoughts that are distorted depression and anxiety are the world's oldest cons and those feelings get you out of touch with life and you stop functioning effectively you feel miserable and they rob you of joy. Similarly, with every emotion there's a healthy and unhealthy version you know, healthy fear. It keeps us keeps us alive and we want some fear to keep us alert to avoid the you know the pandemic

Sucheta Kamath: Putting ourselves at risk

Dr. David Burns: Yeah, yeah, that that's right. But unhealthy anxiety, anxiety disorders like obsessive compulsive disorder, panic attacks. generalized you know, chronic worrying phobias are caused by thoughts that are not good valid their distorted and illogical and we can talk about some of those 10 distortions but that

Sucheta Kamath: I would love to

Dr. David Burns: yeah that's true of every emotion. Healthy anger is radically different from unhealthy anger. Healthy remorse is radically different from neurotic guilt and so that's very helpful and then we probably don't have time to go into this, but positive emotions have a healthy and an unhealthy side too. You see,

Sucheta Kamath: That I never thought about Yeah,

Dr. David Burns: yeah, well see positive emotions cause violence and hatred and war and murder. The distortions like oh, we're better than they are

Sucheta Kamath: Like, righteousness.

Dr. David Burns: Yeah, yeah. Like I'm we're morally superior and those people are they probably smell a lot and they don't look very intelligent and our religion is better than theirs. And, and, and so, one unhealthy politics. emotion is that kind of moral superiority, superiority that leads to leads to racial hatred and religious hatred. And then also happiness is not the same as mania. You know, mania is a severe illness as a psychotic thing from bipolar, manic depressive illness and the pure joy, enlightenment feel a sense of ecstasy that then that's a healthy thing. So that's the quick overview on my view and interpretation at least of healthy versus unhealthy feelings.

Sucheta Kamath: Thank you. So, I had a question as you were speaking, that emotions, all emotions, our thoughts, I guess the foundation of the CBT cognitive behavior therapy or any intervention we offer is rooted in this idea that you can guide and direct your thoughts. Is that a good way to think about it?

Dr. David Burns: No, not really a new idea and direct and negative thoughts. It's not one of I've developed or learned more than 200 techniques to help people who are depressed and anxious and using the old cognitive therapy and the new team therapy I've developed in the last 10-15 years at Stanford, we can now see really rapid changes in people sometimes recovery in just a single two hour therapy session to complete a course of therapy now, but the techniques are much more sophisticated than guiding and directing your thoughts that would not be helpful to someone who's having a panic attack or someone who's suicidal or something like that. But I can give you some great examples. So, you can see how the new techniques as well as the older techniques work too. Because the very moment you stop believing in a negative thought in that instant, your feelings will change. But you need pretty powerful techniques to help someone most the time change these distorted negative thoughts They've often been thinking that way for years thinking I'm no good. I'm a loser. I'm a failure. I'm not a real man, as a fellow was telling me recently and I'm a weirdo, and people just be beat up on themselves a terribly and, and you need really, really powerful, pretty amazing techniques to get help somebody get let go of that of that mind mindset. One of the problems just when you give yourself these negative messages, say I'm a loser, I'm a failure. I'm hopeless, you feel worthless, you feel hopeless. And then you say, well, gosh, I feel so hopeless. I must be hopeless, depression and anxiety. Those are total body experience and you're just absolutely certain that these distorted thoughts are valid when, what when they're not.

Sucheta Kamath: So, you know, or one of the striking things that when I attended your training that you mentioned, now

Dr. David Burns: Which one did you do? Which one did you attend?

Sucheta Kamath: I did three weeks ago, I did distortion distortions or

Dr. David Burns: Yes. Oh, Isn't she amazing?

Sucheta Kamath: Oh, yes, yes. with Jill. It was she was amazing. Yeah, of course, I little. It was a Sunday workshop, and it was a full day workshop. And I misunderstood the 4:30pm ending to be Eastern Standard Time. It was Pacific Standard Time. So, my family got a little worried. They're like you have not stepped out of your room what's going on Sunday? Because I told them I'll be done but then it went beyond that 4:30

Dr. David Burns: I'm so glad you heard that. And if any listeners are interested on my website, Feeling Good.com. There's a resources page with workshops there. There's not a lot of them these days. But if you look there from time to time, Jill and I are going to do one on depression in October, and from time to time I do, you know, virtual things. But we taught last night at Stanford, Jill and I did we had,

Sucheta Kamath: Oh, you did?

Dr. David Burns: We have 40 minutes. There.

Sucheta Kamath: I'm so glad you went virtual, because you can now access you more readily. Well, when you came to Atlanta a couple of like, a no, in November, or December, I was traveling, and I couldn't attend. So, it was a real great treat. Yes.

Dr. David Burns: Yeah.

Sucheta Kamath: So, what you mentioned there that like this, the impact of the actual thought changes is now measurable in the body changes and vice versa.

Dr. David Burns: Right.

Sucheta Kamath: So before you get into these 10 distortions, can you just tell us a little bit about how young does one begin to develop distortions, cognitive distortions, and do we need to have a diagnosable disability or challenge or disorder or is it a normal phenomenon to have distortions when you are filtering words through a personal lens.

Dr. David Burns: I think it's a normal phenomenon. I am not sure it's productive, like the American Psychiatric Association has like three or 700 mental disorders in the Diagnostic and Statistical Manual, but most of them aren't disorders. It's just most people feel shy and socially anxious. And then what they're trying to say is, if that's severe, you have something called Social Anxiety Disorder, but there's no such thing as social anxiety disorder. There's no such thing as generalized anxiety disorder, but they make up these criteria. So, they can give pills and diagnosed you with like a mental disorder. We all worry and but then the way they have it set up if you worry about two or more things more days than not for six months, then you have generalized anxiety disorder. So that means at midnight on the six months a day, that's the six month you'd have brain disorder you didn't have an hour earlier. It's just nonsensical. Like worrying is something that human beings do. We all worry at times, and, but it's not a brain disorder, it's easily treatable. You can if it's getting in your way, tons of techniques to cause that worrying to disappear and quickly. But thinking about these things is as mental disorders is not very effective. That's my phone ringing. I'll just unplugged out there. So, we're not,

Sucheta Kamath: You know, the other if I can say one more thing about having done with in a clinical working for 20 years, and as a speech language pathologist, I see developmental delays, you know, diagnosed a disability such as ADHD, Asperger's, other sort of spectrum disorder, and they all have this underlying a difficulty in managing their own capacities to be a productive person. Whether it's on social context, or in an academic context, but then to me, it is completely possible to become anxious when you know you're not effective. And you know, or it's completely possible to feel ashamed of yourself when you know, you're smart. But you're still doing beginner's math when your friends have moved on to Calculus because they're more organized, and they're turning their homework in. So sometimes I feel the complaints or the disorders that get labeled on top of that are result from not learning how to manage their own thinking feelings and their relationship to their words.

Dr. David Burns: Sure, I think it starts as a child and then what you just mentioned is one of the two most common reasons people get depressed and anxious is you know, I'm not good enough. I'm not smart enough, is one or I have this difficulty therefore, you know, I'm inferior as a human being, or I'm not lovable. It's another common one and I think the these things start in childhood and you get the like, by the way, I have a speech pathology problem too is I remember as a child Yeah, I they sent me to speech pathology because I couldn't pronounce my Rs.

Sucheta Kamath: Oh, you well, that got treated, but that could have been just developmental achievement.

Dr. David Burns: Right, right.

Sucheta Kamath: Oh, my goodness.

Dr. David Burns: It was fun. I went to this speech

Sucheta Kamath: Articulation therapy. Yes,

Dr. David Burns: Yeah. But yeah, I think it starts in childhood and you pick it up from your parents too, because, you know, most people have the systems of belief that give rise to depression and anxiety where you're basing your self-esteem on how popular you are, how attractive you are, how successful you are. That and part of the recovery from depression is to change your value system. So, you you're not trying to become special. You're not trying to rate yourself as a human, as a human being. Real recovery is not only changing these distorted thoughts, but changing your value system and at a deeper level,

Sucheta Kamath: Which can have profound, long lasting results you see, because you can be otherwise therapist dependent, make me feel good. If that's the approach to therapy, then you need your therapist for a lifetime. And that's not what you're all about

Dr. David Burns: Exactly, exactly. Yeah, that kind of irritates me to. Ever since I was a psychiatric resident, I started fantasizing I wonder if really rapid recovery would be even theoretically possible. And I used to fantasize about it now it now it's a reality. I've spent my life trying to do that. But I thought the first thing we'd have to do start measuring things. So, you could see how much change there wasn't a therapy session from the start to the end of each session. Now, we do that all the time. Because without that information, the therapist skills can't grow And when I was a resident, it was all about you just sit around with people and to get them to express their feelings. And you're not supposed to say much as a therapist. And then something good is supposed to come out at that and in my experience, nothing good ever came out of it. The patients would come and cry and sob and say they're worthless and their marriage is falling apart and I'm not helping them and my supervisors who were psycho analysts said just tell them say tell me tell me more and leave so you can move your hands like this. That means Tell me more. Because I said you should only say tell me more twice in the session. If you've run out of your do-tell-me-more’s, then you jiggle your hands. My patients said that you never helped me, and you jiggle your hands and then I jiggle my hands because I'd use that might do-tell-me-more. And then I would ask my supinating that the supervisor said, Oh, this is such a great session. Your patient is sobbing and angry all the session long ago. Not all this repressed anger? And then I would say, but when do they recover? will this help them? And they would never answer that question. I never saw any of my patients recover. It's just this endless emptying and talking and I said there's got to be a better way.

Sucheta Kamath: So, I know we have to cover these 10 patterns. Do you mind then before that, talking to us about what is constitute CBT cognitive behavior therapy that you are referring to, which is effective way are transforming the patient? Yeah,

Dr. David Burns: yeah. Cognitive Therapy is what I wrote about in my book, Feeling Good, the new mood therapy. And it has to do with the idea that goes back to the Greek philosopher Epictetus that we're disturbed not by the events of our lives, but by the thoughts that we have about them. And the second idea is that the thoughts when you're depressed and anxious, or distorted depression and anxiety are calm. you're counting yourself, but you don't realize it. And the third idea is the moment you stop believing those negative thoughts in that very instant, your emotions will change, and you'll recover. And when I wrote that book, there was only maybe probably 10 or 15 cognitive therapists in the world. It had been developed by Albert Ellis in New York and Aaron back at Pam and most people thought we were rework quacks. And because they were so committed, and many still are to this endless talking, that kind of kind of therapy. But that book started out slow, but it's sold now over 5 million copies. It's still number one on the Amazon bestseller list, in fact, has three of the top five positions on the in the depression category and one of the reasons it's sold so much is because research studies have on the book itself showed that 50 to 65% of people who are depressed if you just give them a copy of that book, they'll be recovered in four weeks without treatment. And that's why it has caught on. And now cognitive therapy has become the most popular form of therapy in the world and the most researched form of therapy ever developed. But the new thing I've done at Stanford, I still use all those powerful cognitive therapy techniques, but now we have new techniques to melt away resistance to change. And then that's, that's as powerful as the cognitive therapy techniques were. And so, the new package has cognitive therapy, plus these new resistance busting or resistance smelting techniques. And that's why we can get so much faster recovery now.

Sucheta Kamath: So tell our listeners a little bit about the resistance what you're referring to, because it's interesting, and this has always been the case, at least in my work that people bring their children or adults come or college kids come to me and then they want change, but they don't want to do the work. And so, for example, I'm disorganized, I procrastinate. And then these are the steps you need to take. And then I always find that they, they're like, No, I don't have a buying into this, or I don't like it. So, this technique that the team technique, if you can tell us a little bit about that psychological underpinning of resistance, and then why you conceptualize this added portion, or, you know, leveling up that cognitive therapy, that'd be great.

Dr. David Burns: Yeah, well, there's eight forms of resistance to forms for depression, two forms for anxiety, two forms for relationship problems and two forms for habit and addictions. And for depression. There's something that it's called outcome resistance and process resistance. Outcome resistance means you say you want a good outcome you want to get over your depression, but there's a part of you that clings to the freshmen fights against change. The same is true in anxiety you want to get over your anxiety, but a part of you fights against letting go of the anxiety that's called outcome resistance. Process resistance means you might want to get over your depression or anxiety, but you don't want to do the work. Like to make it real obvious with anxiety, outcome resistance. Let's say someone's having panic attacks or performance things anxiety, or whatever. They want to get over their anxiety. But at the same time, they think something terrible will happen if they get over their anxiety. They think their anxiety is protecting them from some awful thing. Like a woman I treated with obsessive compulsive disorder was washing our hands 50 times a day, and she wanted treatment over Okay, fine, but suppose we press this magic button and you be cured. So, you'll stop washing your hands 50 times a day you'll wash them maybe twice or you know, some average normal minimal number of handwashing. What do you think what happened? Then she said, Oh, well, then my hands will get contaminated. Okay, and let's, let's assume your hands get contaminated. What then? And she says, well, then I'll touch my children. Okay, and then what are you afraid of? Well, then they'll get contaminated. And then what's going to happen? Then they'll get leukemia and die. I say, okay, so you want to press this magic button and then have your children get leukemia and die? Is that what you're telling me? You've seen this. She said, Oh, no. So that is the outcome resistance. You've got to bring that to conscious awareness that on the one hand, the person wants help, but there are these powerful forces. Keep keeping them that keeping them stuck. And the same with depression. Most depressed people are saying, I am not good enough and they beat up on themselves relentlessly. Do you see and so okay, well If you press this magic button, you'll be cured in today's session and you'll go out in the state of euphoria, do you want that? And they say, Oh yeah, I'll press that magic button. And then I say, okay, but you're telling me you've got all this fault and you're not good at this. You're not good at that. And you're kind of mediocre human being. And if you press this magic button, nothing will change except for your mood. You'll be a euphoric, mediocre human being. Is that what you want? Isn't it Oh, no, I don't want to press that magic button. You can see the resistance comes from what's beautiful and most beautiful and awesome about a person and you have to deal with that first or they'll yes but you and fight you went when you when you try to help them change. And so that's been the huge breakthroughs we've I've developed a pretty powerful new technique. Yeah, it just it makes sense. And then once you get rid of that resistance, people work with you and they, they recover, you know, with incredible speed, often in just 10 or 15 minutes once that resistance has gone whereas in the old days, I used to fight with people about their distorted thoughts now I don't have to do that anymore because we can totally antidote people's resistance really quickly now, but that that's just the tip of the iceberg. There's a lot more to it. I know we have to get to the distortions.

Sucheta Kamath: Yes. So let's talk about distortions and here's what I'm going to say to the audience member: Dr. Burns website is so in depth his work and and what's so fascinating and your generosity you know, you have shared this information again and again and again in various forms simplified ways. You bring experts in, or you banter you model. So that has been really helpful because some of these, I will tell from my personal experience, this was my second workshop, but I had already heard hundred episodes, I'd read all your book, but when it comes to applying as a clinician, for example, or even in whatever capacity or serving in helping people that practice needs, a lot of routes you know, you need lots of practice to be efficient. To recognize even signs of what how people are behaving. Yeah, but I do think that that can have incredible impact on your interpersonal relationships in all aspects of life, which is so exciting. So, let's start with the first cognitive. So, you described 10 most common cognitive distortions. And first one is all or nothing.

Dr. David Burns: Yeah, but that's where you look at things. Yeah, you look at things in black and white categories. If I'm not a complete success, I'm a total failure. And this you see with almost all people who are depressed and most people who are anxious and you see it in relationship problem problems as well. I when I was a psychiatric resident, Dr. Back, who was one of the founders of cognitive therapy, criticized the way I had handled the patient who was behind in his payments at the clinic. And I instantly felt devastated and I had the thought, My gosh, I'm I have They're going to take my medical license away. I'm a failure. I have no aptitude for psychotherapy, it was the all or nothing thinking, you see, because I made a mistake. I was seeing myself as a total failure. And, and it seemed very real to me. And I went home at night and thought, Well gosh, this was when that silly endorphin theory was around this wrongheaded belief that somehow you have to boost your endorphins through exercise. So, I ran six miles on a very steep hilly course a pretty high speed. And and I had the farther I ran, the more worthless I felt it didn't do me any good whatsoever, never has running. I've never had that runner's high never even once and I just thought my gosh took me so long to realize what Failure I was and then I said, well write down your thoughts on a piece of paper, maybe they're distorted. That's what you tell your patients to do. And they said, I don't want to do that my thoughts are real. I know that I'm a failure. And I told yourself, now you're whining, like your patients, fine. Write them down on a piece of paper and look at what you're telling yourself. So, I wrote it down and say, I'm a terrible therapist, I'm a failure as a human being, I'm going to lose my medical license. And I looked at that, and they said, these thoughts are preposterous. It's just black and white thinking. And that said, Why don't I tell myself instead, I'm a beginner. I have the right to make mistakes and I can correct them and learn and grow and tomorrow I'm going to see this patient again and I can tell him I screwed up and tell him he probably feels hurt and angry and we can talk it over and that might depression instantly vanished. And then I saw the patient the next morning is that I feel I owe you an apology. I I'm so ashamed because I really like you and I screwed up in our last session. And then tell me what that was like we just had the best session ever. He just gave me the highest possible rating, but that's a perfect example of all or nothing thinking. And yet, from the point of view of resistance, a lot of people who are into all or nothing thinking are perfectionists, and they won't want to give it up because they think with some truth that their perfectionism drives them to achieve more. So that's why with a new approach I've developed we work also with motivation and, and distortion simultaneously.

Sucheta Kamath: So, it sounds to me it's like a self-flogging to propel yourself in motion, which is completely defeating. Yeah, because it won't take you for a long distance. Right?

Dr. David Burns: Yeah, but you do get some short term gains out of it. You know, I used to tell myself, I have to be able to help every single patient. Other therapists shouldn't try because they're not that good. But I have to try because I should be that good. You know, and it did help in a way Because I created dozens of new psychotherapy techniques, when I was stuck with patients, I'd start creating more and more techniques, figuring out why I'm stuck. And it did allow me to develop psychotherapy techniques. But it was a great upgrade cost because life became like a roller coaster when I thought I was doing well; I would get euphoric. And then when a patient said, you're not helping, it was so painful to me, until I finally learned to let go of my perfectionism. And then when patients said you're not helping me I started saying you know, I agree totally. And it's sad because I really like you tell me how I'm screwing up you're probably angry and hurt. I want to hear about this and that all of a sudden, the heavens opened up and patience I had been stuck with started to recover but it's not easy for people to let go of that that perfectionism and all or nothing thinking.

Sucheta Kamath: And you know, in the in, in with executive with respect to executive function, there are three pillars that support the framework of executive function. One is inhibition or impulse control. Second is working memory. And third is mental flexibility, affective and cognitive flexibility. So that being able to take a perspective of the other as well as be able to think from many points of view is to have a, a way of thinking creatively or even just getting out of that black and white thinking. And I find that a lot of my interactions with those who are struggling, struggle a lot with this mental flexibility. They just don't, they don't have this ability to separate self from self and take a perspective on self from somewhere, someone else's point of view. So, this particular I think cognitive distortion really speaks to me. I'm, of course, subjected to that myself many times. Sure. But but I really like us to be aware of As you're saying, because and one technique I think you already mentioned, which I have not tried so prolifically, but write it down is what you're saying. And look at yourself, which is a creating that perspective. Yeah.

Dr. David Burns: Go ahead. Yeah. All right. We'll go on to overgeneralization. Yeah, I was going to say it's probably impossible to change your thinking without writing the thoughts down. And patience.

Sucheta Kamath: Tell us about that?

Dr. David Burns: Well, because on a mental level, your thoughts feed each other, and they create negative emotion. So you think that thoughts are valid when you write them down with short sentences and number them and you can examine them one at a time and look at my list of 10 cognitive distortions you can say, Oh, this is all or nothing thinking this is an overgeneralization. This is a hidden food statement. And then you can start to attack them one at a time. And in my clinical practice, I finally got to the point where if patients said they didn't want to do the homework, they didn't want to do the written exercises. I refused But instead, I refer you to people, people in the community who love to sit and talk endlessly. But I've never had a patient who recovered with that kind of therapy. You know, don't get me wrong. I'm not trying to get rid of you. But you should know that if you want to work with me, the written homework is as mandatory. It's not negotiable.

Sucheta Kamath: That's great. So yes, that does bring us to overgeneralization. How would you describe that?

Dr. David Burns: Overgeneralization is when you see a negative event as a never-ending pattern of defeat. So, a young woman broke up with her boyfriend of two years. And then she got upset and said I am telling myself I'm unlovable. I'll be alone forever. Do you see? So, she's taking relationships break up all the time for everybody and but she's saying well, because this broke up, then I am unlovable. She's generalized into herself. Do you see effect of self and fees generalizing to the future? And overgeneralization you can tell because there's usually, you know, a label you're attaching to yourself, I am a failure, or you're using words like always, or never, this is always happening to me, I'll never be loved that type of flag.

Sucheta Kamath: And so, this is kind of again, get an anecdote an antidote to this is, I am not my thoughts. I am separate from my thoughts, like so she's saying, No, no, I have a failure than I'm a failure.

Dr. David Burns: Well, yeah, that's, that's what did that that's what she's doing. But there are no simple antidotes. I have, you know, over 100 techniques I've developed to work with a motivator. It's not a formula where Okay, here's the formula for that we're teaching. We're treating human beings. But yes, you Yeah, on some level. You see, we there is no such thing as a cell if humans don't have a self that's just a kind of a mythical construct. But all Suffering 100% of depression comes from thinking you have a self that's inferior or defective. But that insight is after you recover, you see that? Just saying that to people, it tends not to be helpful to them you have to show them how to crush the what they're telling themselves crush that those distorted thoughts.

Sucheta Kamath: And you know, this part particularly the way you explained to me sounds like that in at least in Hindu and Buddhist principle, the self-actualization process to kind of really discovering the truth that you are not this or that.

Dr. David Burns: Yeah, yeah

Sucheta Kamath: Right?

Dr. David Burns: Yeah. Yeah. Right.

Sucheta Kamath: And really not again, and also another thing that I have heard you talk about this as well, but that witnessing that the innocence when you bring that innocence basically has no judgment attached to it.

Dr. David Burns: Yeah,

Sucheta Kamath: You observe yourself. doing all these things experiencing all these things, and you allow them to be, and I'm simplifying this too much. But Is that a fair way to think about it?

Dr. David Burns: Yeah, that's right. I sometimes say human is like a river, a river has no particular shape. We take it ourselves,

Sucheta Kamath: I love that.

Dr. David Burns: So many things that that we can do. And attaching to an identity thinking you'll have an identity or self is just puts you It puts you in a box. I can remember at one point in my career when I was little, the one thing I was good at was ping pong. And then, at one point in my career, you know, and I always had the fantasy, if I could only have had coaching, I could have been a tremendous table tennis player. And because I wasn't very good at anything else, athletically. And so, at one point, I said to myself, I realized when I was jogging, you know, I'm not a psychiatrist. I have the training of a psychiatrist. I have the degree. I'm certified by the National Board of neurology and psychiatry, but I'm not a psychiatrist. There's no such thing as a psychiatrist. Say, I'm just a person who's doing psychiatry among other things.

Sucheta Kamath: I love that, you liberated yourself.

Dr. David Burns: Yeah, as I said, I don't have to even be doing this anymore if I don't want, I said, I've, I think I've always wanted to become an Olympic table tennis player. So, I gave up psychiatry for a time. Yes. For about a about a year.

Sucheta Kamath: And you actually tried table tennis.

Dr. David Burns: Yes, I hired a coach. He was the Caribbean champion, named Ernie called himself, the Black Pearl of the Caribbean. He was a top world table tennis player. And I hired him he had moved to Philadelphia; he was very poor. So, he gave me a good deal. And I hired him for 20 hours a week of table tennis training. And we set up an Olympic table in my garage. We have a TV going We had a ball machine. And he it would be four intense hours a day of just pounding the ball and shouting and when you hit a learning all these things, and it was just so much. It was really, really fun. And after about six months of this, I talked myself and my son into getting into this Olympic Training Program in Bethesda, Maryland for table tennis players. And we did this four-day table tennis camp, and we thought they were going to be the US Olympic team, but they were the little children. It was to camp for little children.

Sucheta Kamath: Oh, my goodness.

Dr. David Burns: It was so embarrassing. And they match me against this 11-year-old boy. And I had all this training I've been doing I thought it was some really hot shot table tennis player and I was going to crush this little boy and he beat me 21 to 0 5 games in a row.

Sucheta Kamath: That is hilarious.

Dr. David Burns: It turns out he was one of the highest ranked players in the United States, but he was only 11. He just killed it every time he hit the ball. So, I decided I think I'd better go back to psychiatry something a little better. But it was a fun adventure, you know, and not realize I didn't have a self, or an identity gave me gave me freedom really to do something fun.

Sucheta Kamath: Oh, my goodness, what a great adventurous way to experiment with life giving choices and creating some.

Dr. David Burns: Yeah.

Sucheta Kamath: I love that story. Well, that I think we are coming to the end. So, I want to do two more distortions, if possible.

Dr. David Burns: Sure, I’ll do the quick version.

Sucheta Kamath: Yes, please. Or maybe you can do it. quick version of all of them, let's see,

Dr. David Burns: like, yeah, we could do that just a quick version of all run through them. The next one is a mental filter. That's when you're depressed you, you just focus on all the negatives about yourself, and then you think you're a total loser, you'll filter out anything that's positive. And that's goes on automatically with depression. It goes on with anxiety and with anger to you, when you're angry, you filter out anything good about the person that you're, you're annoyed with discounting the positive, is like, saying that the good things don't even count. You know, someone compliments you and you say, oh, they're just saying that to be nice. They didn't really mean it. The jumping to conclusions is for you jump to conclusions that aren't warranted by it by the facts and there's two common forms mind reading and fortune telling. Fortune telling is when you tell yourself something terrible is about to happen. That is always the cause of anxiety when I got on that plane, I just know it'll run into turbulence and crash, for example, or fortune telling causes hopelessness. When you're depressed, you predict that you'll be depressed forever. And you believe that, and you'll feel hopeless. But it's always a distortion, it's never valid. And then mind reading is when you think you know how others are, are feeling about you. And you may think that they're being very critical of you or judgmental when they're not social anxiety results from mind reading, you get into a party and you say, I'm the only one who feels anxious people wouldn't be interested in what I have to say, you know, think things of that nature.

Sucheta Kamath: That's number four, so

Dr. David Burns: That's five. We've done five.

Sucheta Kamath: Yes. Jumping to conclusions. Yeah.

Dr. David Burns: Right. And then number six would be magnification and minimization where you blow through things out of proportion. You see this in panic attacks, people get anxious and then they say, Oh, I'm about to go crazy. Or I'm about to have a heart attack. And they really believe that and then they panic for about 20 minutes and then the panic attack disappears. The next one would be emotional reasoning. We've mentioned that earlier. That's a term I coined when I created the list of 10 distortions for my book, Feeling Good. Emotional reasoning is reasoning from how you feel. I feel like I feel worthless, so I must be a loser. I feel

Sucheta Kamath: Yeah, going into reverse direction.

Dr. David Burns: Yeah. And that's a distortion because your thoughts create your emotions and your emotions are often no more realistic than those curved mirrors and an amusement park. So, you have to start at thoughts create the emotions and the emotions you have may not be reflecting reality. Then we've got "shoulds" labeling, that's where you that's like overgeneralization when you say I'm a bad father, I'm a bad husband or wife or I'm a loser, I'm a failure. And then you can label other people you can say he is a jerk. That type of thing. And then you've got should statements. That's

Sucheta Kamath:  Number 9. Yes.

Dr. David Burns: Yeah, I shouldn't be so screwed up. I shouldn't have made that mistake; I should be better than I am. Those are self-directed shoulds because guilt and shame and depression, and then other directed shoulds you shouldn't be that way. You've got no right to say that you shouldn't feel that way. You shouldn't say that. You shouldn't believe that. You shouldn't support Trump; you shouldn't be against Trump. You know, all these shoulds that we direct at others and that creates rage and anger or in traffic you know, that person shouldn't drive in front of me and then you go into road rage. And then the last two are self-blame and other blame the two forms of blame, self-blame, as you're beating up on yourself and blaming yourself and putting yourself down. And other blame you think someone you're in conflict with is the entire cause of the problem. And you're not looking at your own role and the way you interact with that person and are probably you're actually contributing to or triggering the other person.

Sucheta Kamath: Wow. Well, thank you for doing a great overview. You know, what's remarkably assuring about this is, one is this this abstract notion that I'm not feeling good or I'm feeling depressed or feeling stressed. But now once you at least create some framework and organize them, or they can be categorized, so your entire treatment can be also directed in that it gives me so much assurance that we're not crazy, like these are all understandable processes that are happening to us. And the second, right,

Dr. David Burns: Yeah and more than that they the negative your negative feelings result from Negative thoughts from the part of you that's most beautiful and awesome. We didn't go too deeply into that. But if you're depressed and anxious, and angry, not because you have a mental disorder or a chemical imbalance in your brain, but these are expressions of your core values and the things that are about you that are most beautiful and awesome, and they're also there's many benefits to all of your negative thoughts and feelings. And the moment you see this, I try to sell my patients on continue with your negative feelings continue with your negative thoughts are showing beautiful things about you. And if I can really sell you on not giving up your negative thoughts and feelings, your resistance paradoxically will disappear. And recovery will just be a stone's throw away.

Sucheta Kamath: Wow. Well, thank you so much for walking us through this giving us hope, and most importantly, giving us very specific techniques, because this is what had had been missing before. Your work came on board. As you said this laying down on a couch and the traditional view of therapy is ongoing, talking and dumping your thoughts outward, which is one more way to continue to stay thinking about your emotions or creating more emotions by thinking.

Dr. David Burns: Yes, all you do when you do that you practice the brain circuits. Yeah, that caused the depression. So, you're actually training yourself to be more depressed.

Sucheta Kamath: So, with that, so alright, listeners. That's all the time we have for today. As you can see, these are important conversations we are having with knowledgeable, incredibly qualified and passionate experts with unique perspective. And this particularly perspective Dr. Burns brought us helps us think about executive function and management because every individual we're working with has these responses. And particularly if you have roadblocks in your own capacity to facilitate success, then you're going to have some major work to do ahead of you. So, and as we end this podcast, I have a request for you. There are three asks, If you love what you're hearing, do share it with the share this episode with your friends and colleagues and loved ones. Secondly, if you have a moment, please take a take the time to give us a review. And finally, be sure to subscribe to the Full PreFrontal podcast as well as the newsletter. So, I really look forward to seeing you all again during our next episode next week. And meanwhile, let me thank Dr. David Burns once again for being here and being fabulous.

Dr. David Burns: Thanks so much. I just loved talking to you. I'm shooting the breeze and I wish everyone the very best.

Sucheta Kamath: Thank you very much. Have a great one.

Dr. David Burns: You too. Bye bye.