281: Ask David: “Wants” vs “Needs,” Threats of Nuclear War, and purely obsessive OCD, with Special Guest, Dr. Matthew May

281: Ask David, Featuring Matt May, MD

“Wants” vs “Needs,” Threats of Nuclear War, and Purely Obsessive OCD

  1. Sanjay asks: How can we convert our “needs” into “wants?”
  2. Vanessa asks: How can we think upon the threat of a nuclear war, or the thought of America becoming a totalitarian state, or the loss of voting rights, without becoming anxious or depressed?
  3. Cliff asks: I have pure obsessive OCD and get stuck on intrusive thoughts. What should I do?

Upcoming Questions in Ask David podcasts

  1. William asks: How would the T.E.A.M. model look with addiction and procrastination?
  2. Caroline asks: I’ve done Cost Benefit Analyses (CBAs) for many of my SDBs (Self-Defeating Beliefs), and the disadvantages greatly outweigh the advantages? What’s the next step?
  3. Al asks: Can you help me with fear?
  4. Khoi asks: How do you deal with colleagues who gossip about your boss?
  5. Matt asks: How do we help patients who don’t “get” the Acceptance Paradox?
  6. Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness!
  7. Al asks: Can you help me with worrying and fear of symptoms?
  8. Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives?  I’m in that boat


  1.  Sanjay asks: How can we convert our “needs” into “wants?”

Dear Dr. Burns

I thank you for pointing out “dramatic shift” in the foot notes and it has given me immense satisfaction .

So my learning from this is that ‘Low Level Solution’ remains just a “first aid” only because it is still in the category of “NEED” has not yet moved into the category of “WANT”.

A further question comes to mind So what is the process / formula to keep the deepest desires of ours from not entering into NEEDs and remain in the WANT zone. and yet we can work with highest passion and love to achieve them . OR in other words , how do you keep your biggest desire of your APP in the WANT zone and still maintains the highest level passion to achieve it . what is he process to reach that stage?

You have already given us the answer to this and shown us the way towards Enlightenment via FOUR GREAT DEATHS of the “self.” Still if you would like to say something more that will help us to grasp the process of keeping the desires in WANT only.

warm regards



David’s reply

In reply to Sanjay Gulati.

You can also do two Cost-Benefit Analyses CBA. For example, the first might be a CBA on the Adv and Disadv of Needing love, achievement, or approval, for example, and the second would be a CBA on the Adv and Dis of Wanting the same.

You could also use the semantic Technique. What could you tell yourself instead of “I NEED great achievement (or love or approval or whatever) to feel happy and fulfilled.”

A third could be to do an experiment and see if it is really true that happiness always or only comes from achievement, love, approval, etc.

A fourth strategy would be to do a Feared Fantasy and have a conversation, in imagination or in role play with a therapist, with someone who has achieved tremendously. That person would have to explain that she or he looks down on most other people because they haven’t achieved as much, so s/he feels they are less worthwhile.

You might suddenly discover that such a person doesn’t actually seem especially “worthwhile,” but more of an egotistical type.

With regard to the app, I’m just having fun with it, and making all kinds of amazing discoveries. Parts of it are really effective. Other parts are ineffective and need to be changed. But it is all an adventure.

I can’t control the outcome—will it be popular? Will we develop a business model that allows us to pay our bills? Maybe yes, maybe no, maybe partially. But to be honest, I don’t really care!

And not “caring” or “needing” frees me up to care way more effectively, and more creatively, and more lovingly. And with inner peace along the way.

Here is something else. You begin to realize that there is no such thing as “failure,” only information. For example, if people don’t like some lesson, or some word I have used, I just change it and make it better. Most of the negative and positive feedback is totally unexpected and surprising, which is really fun!

I feel privileged, not pressured. These feelings are quite rewarding and addictive.

I realize, too, that most people don’t really care how “successful” I am, including you. Most people do appreciate it when I treat them well, however.

Same with our cat that we adopted at the local humane society after her owner died.

Might make this an Ask David if it is okay!

Thanks, david

By the way, you subsequently emailed me and asked me to comment on “intense wants” vs. “needs,” so here’s a little more.

When I was a young man, I used to collect antique paper money from around the world as a hobby. I can vividly recall seeing a rare uncut sheet of banknotes at a trade show that I feel in love with instantly.

It was from the US Virgin Islands from the 1850s, if I recall correctly, and it consisted of a one thousand dollar bill and three five hundred dollar bills. It was gorgeous and I was instantly hypnotized, thinking it was one of the rarest and most desirable things in the world!

But sadly, I was a poor graduate student and could not afford it, and I’m not sure the dealer, a really nice guy from New Mexico named Larry Parker, was willing to sell it. Finally, I gave up on it and stopped thinking about it.

Years later, that exact same item came up in an auction in Los Angeles, and I was starting my clinical practice in Philadelphia. So I called the auctioneer, who I knew, just an hour or so before the end of the auction, and asked how much I should bid in order to be sure that I would win that intensely coveted item. At the time, the bidding was around $2,000, and I thought I could likely get a loan from the bank to buy it.

The auctioneer told me that no matter how much I bid, there was no chance I could win it.

I asked why. He said the wealthiest man in Caribbean was bidding on it and would pay any amount of money to get it, no matter what.

I was devastated and felt my chance for true happiness and worthwhileness had just evaporated! My “intense want” was not fulfilled!

Years later, similar notes started appearing in auctions, and I was able to figure out they were all reprints, including that original uncut sheet. Although they had some modest value, they were easy to obtain, and . . . suddenly I had no desire at all to own them!

And it also dawned on me that all those years when I couldn’t have that “fabulous” (or so I thought) uncut sheet, I’d been absolutely happy.

So much for our so-called “needs!”

  1. Vanessa asks: How can we think upon the threat of a nuclear war, or the thought of America becoming a totalitarian state, or the loss of voting rights, without becoming anxious or depressed?

Hi Dr. Burns,

First off thank you so much for your podcast and books. They’ve helped me immensely grow and I am forever appreciative!

Recently, I’ve been hearing statements like “American democracy may not be around in 10-15 years”, “America is becoming a totalitarian state”, and “We’re heading to nuclear war” from both sides of the political spectrum. All of these statements make me very anxious to hear.

I know that thoughts create feelings, so even if something is true (like the threat of nuclear war, or that voting rights are being infringed upon, etc.), is there a way we can think upon these issues without becoming anxious or depressed over them?

Thank you so much,

Vanessa B.

David’s reply

Hi Vanessa, Thanks. I’m sure many people have similar concerns. However, this is a very general question, and you have not given me any specific examples of your own negative thoughts.

So, I can only give you an equally vague and general response, which is guaranteed not to be helpful. That’s because general questions and answers tend to be little more than babbling.

All that being said, I will say that there is a healthy and an unhealthy version of every negative feeling. So, some alarm and concern is probably totally appropriate and healthy, but getting crippled with excessive anxiety and depression is perhaps not useful.

Healthy negative feelings result from valid negative thoughts; unhealthy negative feelings always result from distorted negative thoughts.

But, as I pointed out, without a single example of your negative thoughts, all of the “good stuff” will remain unseen!



PS I will make this an Ask David for an upcoming podcast.


  1. I have pure obsessive OCD and get stuck on intrusive thoughts. What should I do?

Hey Doc!

Very glad I ran into your work. Started with a video and have been reading and listening to your stuff for a couple days now.

I’ve been diagnosed with OCD (PURE O). I struggle with intrusive thoughts. I have had a lot of trouble exposing myself to the thoughts in order to face them. I’ve tried a writing a narrative of my fears etc…. I just can’t seem to get the right exposure.

A couple examples: I get stuck on… I don’t believe in God, or don’t believe enough or that maybe there isn’t a God?

I get stuck on… what if I go crazy?

I wish there was a dirty sink I could go touch or something tangible I could face.

Any suggestions?

Cliff (name disguised)

David’s reply

Hi Cliff,

Sure, and sorry you’ve been struggling, and fortunately, the prognosis is very positive.

But I have a few questions so I’ll know what you’ve done already. First, which of my books have you read, and did you do the written exercises while reading? For example, When Panic Attacks is all about techniques for anxiety.

Second, have you done a search for OCD as well as anxiety on my website? You will find many resources.

Third, have you completed the free anxiety test and class on my website?

Fourth, sometimes a therapist with expertise in exposure can help with exposure, although that is one of a great many powerful techniques for treating anxiety. Trying to treat OCD or any form of anxiety with exposure alone is a huge mistake.

Fifth, have you used the Hidden Emotion Technique?

Let me know, and thanks.


Rhonda, Matt, and David

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