What if the People Around Me are Not Real?

Hi Dr. Burns,

I have read your book, Feeling Good, and now I’m reading your more recent book, When Panic Attacks. I done a Cost-Benefit analysis for one of my negative thoughts and that helped me greatly. I also found some cognitive distortions in my negative thoughts as well.

I have a question. Sometimes I think that the people around me might not be real or are all doing stuff just to keep me happy, almost as if my life is a some kind of a simulation. Iif you watched the movie, ‘Truman Show,’ you will know what I mean!

I especially feel this way when some coincidence in my daily life occurs, like running into a friend who I hadn’t seen for a long time, at some random place, or when I learn that someone else had thoughts that were similar to my thoughts at the same time.

If you have some tips or could share some of your experiences with patients who had similar problems, I would appreciate it!


Hi Sal,

Thanks for your question! I enjoy answering questions, and hopefully others will be interested as well. However, I cannot safely or ethically give medical advice or treatment in this medium, so my comments will be quite general, and might not apply to you. Remember to consult with a licensed mental health professional or physician in person for any questions concerning your health.

Now that my disclaimer is out of the way, I will try to answer your excellent question. During my psychiatric residency, I learned about two of the more unusual symptoms of anxiety called depersonalization and derealization. Depersonalization is when you get the feeling that you are unreal, and derealization is when you get the feeling that the world is unreal. So it sounds like the feelings you described could just be symptoms of anxiety. And if so, you’re on the right track reading my book, When Panic Attacks, which, as you know, is all about anxiety.

Sometimes anxiety results from the hidden emotion phenomenon I talk about in the book. I don’t know if you’ve read that section yet. That’s when you’re upset about something or someone in your life, but you’re not aware of this due to excessive “niceness,” so you sweep your feelings under the rug, so to speak, and you kind of “forget” about the problem that’s bugging you. Then the feelings come out indirectly, as anxiety. Then you use all your energy ruminating about the anxiety, and don’t take the time to figure out what’s really bothering you.

So I always include the Hidden Emotion Technique in my arsenal when treating someone with anxiety, because it can sometimes be tremendously helpful to pinpoint what the problem is, and then do something about it. Essentially, you think about your life, and the people you know, and the things you’re doing, and ask yourself questions like this:

  • Is there something bothering me that I pushing out of my mind?
  • Am I mad at someone?
  • Do I have some feelings or emotions that I feel like I’m not “supposed” to have?
  • Do I feel tense or uncomfortable about something, or someone, in my life?

Any questions along these lines can help. Usually, the hidden problem or feeling is something recent, not something buried in the past. I have no idea if this is the cause of your symptoms, but it is often a useful tool in understanding and treating anxiety.

I’ve had a Feeling Good Podcast on the Hidden Emotion topic, and you can probably find it easily if you review the podcasts on my website. I’ve got them all organized together there now. I think it was an Ask David podcast on how to deal with an “identity crisis.” In fact, I found it for you, so CLICK HERE if interested.

To listen to a podcast gives an overview of the four models I use in treating anxiety, CLICK HERE.

Also, the most recent Feeling Good Podcasts cover the topic of anxiety, and there is an entire podcast devoted to the Hidden Emotion Technique as well. It is scheduled for Monday, March 13, 2017. I think all the podcasts on the treatment of anxiety might be of interest to you.

Thanks again!