024: Scared Stiff — The Cognitive Model (Part 3)

In this Podcast, David and Fabrice describe cognitive model of anxiety, which is based on three powerful ideas:

  1. Anxiety always results from negative thought (NTs) that involve the prediction of danger. For example, if you have public speaking anxiety, you are probably telling yourself something like this: “I just know I’m going to blow it. My voice will tremble. People will know I’m anxious. My mind will go blank. I’ll mumble and make a total fool of myself.” Or, if you struggle with panic attacks, you probably have thoughts like this: “I think I’m about to die. I can’t breathe properly. I’m about to pass out!” Or, “I’m about to lose control and go crazy.”
  2. The NTs that trigger anxiety are always distorted and illogical. In contrast, valid NTs cause healthy fear.
  3. When you put the lie to the distorted NTs, the anxiety will disappear. This can sometimes happen in an instant.

Dr. Burns describes his treatment of a woman named Terry who had suffered from ten years of incapacitating panic attacks and severe depression prior to contacting Dr. Burns. During each panic attack, Terry would experience tightness in her chest and tingling skin and tell herself she was about to pass out, suffocate, or die of a heart attack. Multiple emergency room visits, medical tests, and reassurances from doctors did not help. In addition, years of medication and psychotherapy were not at all helpful.

After trying a number of cognitive techniques that did not help, Dr. Burns persuaded her to let him induce an actual panic attack during an office visit so he could use the Experimental Technique, which is arguably the most powerful technique ever developed for the treatment of anxiety, and he televised the session. What happened next will blow your mind!

In the next podcast, Drs. Burns and Nye will describe the Exposure Model of treatment, and Dr. Burns will describe his personal struggles with his fear of blood during medical school.


→ Click here to download Terri’s Recovery Circle

10 thoughts on “024: Scared Stiff — The Cognitive Model (Part 3)

  1. Hi Dr. Burns. I enjoyed yours’ and Fabrices’ podcast this week. I’ve read your book “When Panic Attacks” and “Feeling Good” and I have a question, since listening to this podcast. If the techniques that were developed over the years, require extensive training, then why would you put out these self-help books? I’m not trying to sound critical, although I have been a bit discouraged as I have probably been using the techniques incorrectly. I look forward to hearing back from you!

    • Thanks, Eric.

      Thanks for the kind comments on the Feeling Good podcasts, and for your question about why I write books,

      I write books for several reasons. First, research studies have indicated that quite a few people who read my books do experience significant improvements in their moods, including moderate to severe depression, even without therapy or antidepressants, and that is very encouraging. The books are inexpensive and totally free of side effects! Of course, its not true that everyone can do it on their own, just from reading a book, and some people will definitely need some additional help from a skillful and compassionate therapist.

      Second, I sometimes think that in some cases, patients can actually learn these things more rapidly than therapists, as strange as that may seem. Training therapists can be very difficult, especially if they have previous training. It can sometimes be hard to unlearn bad habits. And often therapists have strong beliefs that simply are not true, based on some school of therapy they identify with. It seems like when someone is a true believer, all the facts in the world won’t dislodge them from their beliefs. To be honest, I see an enormous amount of superstitious, non-critical thinking in our field, which is disheartening. Of course, I’ve also had many fabulous individuals come for training in TEAM-CBT, and they’ve been a joy to work with. And I want to apologize if I sound overly critical of my fellow mental health professionals.

      And third, my original motive in writing Feeling Good was the idea that my patients could read chapters between therapy sessions, and this would accelerate their recovery. In addition, I thought it would make the treatment easier for me, as they could read all the standard things, and then I could use the therapy time individualizing the methods for each patient’s specific and unique problems.

      I never actually intended Feeling Good to be a self-help book, and never imagined it would have antidepressant effects until I read about some surprising research on my book in the New York Times. The research was conducted by a psychologist at the University of Alabama, Dr. Forrest Scogin. He conducted a series of well-controlled outcome studies on Feeling Good. When depressed patients came to the medical center requesting treatment for depression, he told them they would have to wait four weeks before meeting the psychiatrist and starting therapy. In the meantime, he gave each patient a copy of my book, Feeling Good, and suggested they might read it while waiting for treatment. Half the patients received no book, and were siply put on the waiting list, so he’d have a “control group” for comparison.

      Dr. Scogin reported that 65% of the patients receiving a copy of Feeling Good improved so much within four weeks that they no longer needed treatment with psychotherapy or medications. In contrast, the patients in the control group did not improve.

      Then he told the patients in the control group that they would have to wait four more weeks, but gave them Feeling Good and encouraged them to read it while they waiting. The same thing happened. 65% of them improved so much during the four weeks that they no longer needed treatment. He called the new treatment “bibliotherapy,” or “reading therapy.” He also did three year follow-up studies on the “bibliotherapy” patients and reported they did not relapse, but continued to improve. They said that whenever they got upset, they would re-read the sections of the book that had been the most helpful, and then they felt better again. Dr. Scogin did additional studies with similar results, and published much of his research in a top psychology journal–The Journal of Consulting and Clinical Psychology.

      And finally, I greatly enjoy writing and editing, especially if I can find a good editor, which is not easy. Most of us tend to do the things we enjoy, and writing is something that I find rewarding. In fact, that’s why I have been publishing quite a lot on my website lately, and why I’m answering your excellent question!

      All the best,


  2. hi dr burns i ve been suffering from anxiety mainly having panic attacks or ocd as my therapist recently confirmed. i have fear of fainting, the difference is that i actually do faint some of the times which seems to be strange according to the norm .it used to happen when i was standing and i would sit down to avoid fainting, but now it s happening even when im seated. it has become an obsession for me because im all the time thinking about it and im always afraid that it will happen everywhere like grocer,caffe shops ,walk etc. im afraid to go out by myself even though im a very independent person. i tried medication and psychotherapy which im currently still doing. i feel helpless and not understood by anyone. my therapist told me to ignore the thought but it s not that easy. im pregnant which makes it even worse cos i can t take any medication and my anxiety is huge and im afraid it will have negative effects on my baby and that the obsession will increase once he is born. i lost interest in everything and terrified to do things i like such as my work. my main concern is people’s judgements.

    • It would be a good idea to get a medical workup for your frequent fainting, because a variety of medical problems can cause this. For example, a sudden fall in blood pressure will cause fainting, as well as various cardiac rhythm changes. A good cardiologist or internal medicine doctor should be able to diagnose this. If you get a complete bill of health, then you can look for psychological causes. But I would have to say that in my clinical experience treating depression and anxiety, frequent fainting, including when you are sitting down, is not common. This is just a suggestion, as I cannot give medical advice in this medium, but in all issues concerning your health, it is wise to consult with a physician.

      All the best,


      • Already consulted a physician. It s all related to the obsession and fear of fainting . It does not happen all the time. Mostly I am petrified that I will faint ,at times it happens and at others it does not happen. It s like there is no cure for it. Can you suggest ways to fight it apart from exposing myself to it?

      • Hi Ella, Thanks! I have an unpublished chapter that was intended for my When Panic Attacks book, but the publisher rejected lots of chapters as they wanted it short, which I thought was a mistake, but then again, what do I know! At any rate, it is on the fear of fainting, so i will look for it and see if I can add it as a blog or link of some kind. All the best, david

  3. Hi Dr. Burns,

    I really appreciate all of your podcasts and your insights – listened to your TED talk and you are one of the first therapists I’ve heard say that anxiety and depression aren’t unsolvable without medication.

    I haven’t seen a therapist specifically because I don’t want to go on medication or anything like that – I would like to do it myself. My question is that I get anxiety and the OCD guilt complex over thoughts rather than specific things (for example, thinking that I am a horrible person for flirting with someone while I’m in a relationship even though my significant other has specified that it is okay and to move on). I get anxiety about things in the past and then ruminate over and over, thinking that if I think about it I can get every detail that will let me know if I’m in the wrong. Then when I finally convince myself that what I’m anxious about is okay, it revisits me in a few days and the cycle starts over…it’s creating tension in my relationships. This creates anxiety and overwhelming guilt. My question is how do you use cognitive therapy or exposure therapy for things that have happened in the past that are triggered by thoughts? (for example, being triggered when my boyfriend wants to take me out for dinner because I feel like I don’t deserve it because there is a chance that I’ve wronged him). I just wonder because it’s not a specific action that I can expose myself to (like inducing a panic attack or stepping on cracks like the man in the other podcast did).

    Thank you for everything – I’m purchasing your book Feeling Good today!

    • Thanks, DS. I think reading Feeling Good is a good first step. It is on depression, and if you want something with a focus on anxiety, try the Feeling Good Handbook or my When Panic Attacks. They will show you more of the step-by-step methods, as well as the four basic strategies for challenging any type of anxiety, including OCD: the Hidden Emotion Model, the Motivational Model, the Cognitive Model, and the Exposure Model. These four models were also covered in the introductory podcasts on anxiety, and we will undoubtedly have more on that topic as well. Also, several therapists trained in the new TEAM-CBT therapy offer Skype-type sessions, and working with a therapist is always something to consider when you need a little boost! There are likely some good therapists in your area as well, as some folks prefer face to face treatment. All the best, david

      • You really are the best – I went right to the chapter on the hidden emotion model and honestly it opened something up that made a flood of information come and things to make sense.

        Can’t tell you how fortunate I am to have stumbled on your talk and now your books. You’ve touched my life in ways I can’t put into words.

        THANKS AGAIN!!!

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