Why Is Anxiety Increasing? Is it Poor Diet, Alienation from Technology, or Unemployment?

Why Is Anxiety Increasing? Is it Poor Diet, Alienation from Technology, or Unemployment?

Or is the answer, “none of the above”?

Hi Dr. Burns,

In your When Panic Attacks book you are saying that anxiety is mostly the problem of kind and nice people (or extremely kind and nice). So my question is what happened to the kind people in the last century?

We know anxiety disorders increased by that time, right? So is it the technology and increasing social withdrawal, is it increasing struggle for jobs, is it the decreasing quality of our diets (less vitamins, hormones and minerals).

Thanks for your kind answer.



Thanks, Kerem,

You always ask cool questions. How about “none of the above” for an answer. There are really two related questions: 1. Do we have any valid information that rates of depression or anxiety are changing? 2. Do we have any valid information about environmental or biological factors that might account these changes?

With regard to the first question, I do not know of any valid historical information on changes in the rate of depression or anxiety in the past 50 or 100 years or more. To study rates of change, you first have to have valid measurement devices. My own depression and anxiety inventories are brief and reasonably good, with reliability coefficients (accuracy) around 95%. But they were only developed recently. The Beck Depression Inventory was the first depression test, and it was published in 1964, I believe. It’s reliability coefficient is lower, around 80% or less, but it was important historically because it showed that mysterious concepts like anxiety or depression can, in fact, be measured with reasonably high precision.

So before we get too fancy about interpreting changes in rates of various emotional problems, such as anxiety, we first need to get the evidence that the rates are, in fact, changing! But I’ve never seen any evidence, and in fact, this would be impossible without the administration of accurate anxiety tests to large populations repeatedly over time. I am not aware of any studies of that type. And my hunch is that depression and anxiety have been human afflictions for a long time, and were probably just as common hundreds, thousands, or even tens of thousands of years ago.

With regard to the second question, you wondered whether anxiety results from changes in technology, unemployment, or by the quality of the food we eat. The causes of all psychiatric disorders are still pretty much unknown. I am not aware of any valid or convincing evidence linking anxiety to technology, employment, diet, hormones or minerals. However, this doesn’t stop people from assuming these factors are real and valid. I think the only thing we can say for sure is that all, or nearly all, current or historical theories about the psychological and biological causes of emotional distress can be shown to be false.

Probably the most we can say right now is that genetic factors are likely to be very important, along with environmental factors as well. But that’s not saying much!

I guess for many people, a wrong theory is better than none at all. or they assume that because something appeals to them, or seems to made sense, it must be true. Sometimes people believe what they want to believe, without much concern for critical, skeptical thinking, valid research, or truth. Before scientists discovered the causes of disorders like polio or epilepsy, there were dozens of false claims about the causes of these afflictions, and many quack treatments as well.

My focus is not so much on the causes of things, but simply on the development of high-speed techniques to help people recover, without waiting for the causes of depression and anxiety to be discovered! We can now measure changes in depression and anxiety across single therapy sessions, and this is historically really important, in my opinion, and represents a major treatment breakthrough. I love psychotherapy, and it never ceases to blow my mind when I see someone suddenly recover from years or even decades of suffering, right before my eyes during a therapy session!

The photo I sent with this blog if from a recent Sunday hike. On the Sunday hike this week, I worked with a young and extraordinarily dedicated and skillful physician who’d been experiencing intense depression, guilt, and inadequacy. He treats many patients with fatal and horrific illnesses that yet have no cure, and has been telling himself that he isn’t really helping his patients.

At the start of the hike, he looked like he was carrying the weight of the world on his shoulders, and he described individuals and families he’d gotten very attached to, and then had to tell the son or father that they had just a few years to live due to some horrible disease for which there is no cure or treatment.

i worked with him, using TEAM-CBT, and toward the end the hike, his symptoms had vanished, and he was flooded with feelings of joy and relief. That’s what I like to see, and what warms my heart and motivates me. It is, for me, the greatest experience of all, to help someone escape from the suffering of anxiety, depression, and self-doubt. if people are interested, contact me and I can ask his permission to describe what was so helpful for him.

So that’s my focus–I am trying to bring about a revolution in treatment. And I’m trying to learn how to get the word out, as best I can, through my blogs and podcasts and books.

I’m sure my answer might not be very satisfying to you, Kerem, but I deeply appreciate your questions and the dialogue, so keep your questions and comments coming! And keep in mind that I am only expressing my own opinions, and that lots of others–many very intelligent experts, in fact–will strongly disagree with lots of my thinking!


If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

50 Years of Psychotherapy! And it Finally Worked!

50 Years of Psychotherapy! And it Finally Worked!

Topics in this blog:

  • Can we be happy ALL the time? 
  • What causes depression and anxiety?
  • Can patients really recover from depression and anxiety in just a few sessions, or in a single, extended therapy session? 

Hi Dr. Burns,

Here’s a hypothesis that I’ve been working on. Both the Freudians and the Transactional Analysis (TA) schools divide the psyche into three parts. In the case of the Freudians the three parts are Id Ego and Superego. In the case of the TA school the three parts are PARENT, ADULT, CHILD. My hypothesis is this: “Under development of any one of the three parts is the cause of many types of mental disorders.”

In my particular case, an under development of the Parent part, caused by very inadequate parents for the most part caused me to never develop the Parent part. After nearly 50 years of psychotherapy, (I started in 1968), I finally realized what was wrong, that I hated all authority. Now, I have somehow magically transformed my psyche to have a parental part. I’ve been pretty “cool” ever since.

That was about three months ago. I wanted to share this with you as my current and best therapist is “sold on your book, Feeling Good,” and I even have a hardbound 1st edition.

What do you think?



Hi Gary,

Thanks for your note, and congratulations on finally achieving your goal after 50 years of hard work. Sometimes the sweetest victories come from the hardest fought battles! Your patience and persistence are amazing. Way to go!

Please thank your most recent, and best therapist, for supporting my work! I greatly appreciate that. And hey, the hardbound first editions of Feeling Good are pretty rare now! I hope I can sign it for you one day. The publisher predicted that the book would not be popular, so the initial hardbound printing was small.

You might be interested that with TEAM-CBT, we are trying to bring about the “magical” changes you described much more rapidly, sometime even in a single extended therapy session, although this is clearly not always possible. But most of the time, I pretty quickly see the sudden emergence of a compassionate, realistic, and wise voice from within an individual who has been struggling with issues involving low self-esteem, depression, and inferiority for a long time, often decades. The wise voice finds the power to crush the distorted negative thoughts that have been triggering the painful feelings and robbing the patient of joy, self-esteem, and intimacy.

I’m not sure how that would fit into your hypothesis, but I suspect there might be some overlap! Perhaps this “wise voice” that emerges so quickly in TEAM-CBT would be similar to the “adult” voice, or healthy self? Maybe that is the “adult” voice? You’ll have to teach me about this! I am thinking there might be a healthy and unhealthy version of the three voices?

Here are some links if you would like to read about the new developments in TEAM-CBT, and how and why they emerged. If you get the chance, let me know what you think! The first link is to my recent article in Psychotherapy Networker entitled, When Helping Doesn’t Help. The second is my recent blog asking whether some people can really be treated for depression and anxiety in a single, extended therapy session.

Incidentally, lots of people attribute their difficulties to their parents or childhood, and certainly most parents are flawed, and most of us have had painful experiences growing up. However, I am not convinced we yet know the causes of emotional problems. Most experts think depression and anxiety result from some combination of genetic and environmental causes, but beyond that, the specifics are still unclear. Sadly, the lack of scientific knowledge does not prevent many people from promoting this or that theory! I guess, some people believe that a wrong theory is better than none at all! I put my efforts more into developing fast, effective tools to help people change, regardless of the cause of our insecurities.

And if therapists begin to measure symptom severity at the start and end of every therapy session, as we do in TEAM, then we’ll know when we’re being effective, and when we’re not. I believe that data-driven, outcome-accountable psychotherapy will be the wave of the future. And I also believe that the future is NOW. We already have these tools, if therapists are brave enough to use them!

How important are childhood experiences in shaping how we think and feel as adults? About thirty years ago I read about an interesting research study from Sweden. They compared something like 500 children from the worst homes, in terms of stability, warmth, and so forth, with a similar number of children raised in the most loving homes, and studied them for twenty years in terms of emotional development, academic performance, and antisocial / criminal activities. Which group do you think did better? Think about it for a moment before you continue reading. You will find the answer at the bottom of this blog. Here are your choices:

a. the children from the worst homes did better.

b. the children from the most loving homes did better.

c. both groups of children did about the same.

Once I was on a morning television talk show in Philadelphia discussing my book, Feeling Good: The New Mood Therapy. A viewed called in when the show was live and asked if it was possible to be happy all the time. I said I didn’t know, but didn’t think so, but if anyone knew of anyone who’d been happy all the time, to have that person contact me because I’d love to talk to them and find out the secret of their success.

As I was leaving the show to go back to my office, the producer said there was a call for me from a man who claimed he’d been happy every minute of his life! I invited him to my office to tell me about it, and was curious to find out more about him.

The next day he arrived and explained that he’d been happy every minute of every day, in spite of numerous catastrophic events. I think he’d gone bankrupt once, had been betrayed by a loyal friend, and had successfully battle two forms of cancer. But no matter what happened, nothing got him down.

I asked him if he had any idea why? Had he had a particularly loving childhood, for example?

He said when he was about five or six years old both of his parents suddenly died, so he was adopted by his grandparents, who lived on a farm. The day he arrived, his grandfather told him that there was a tremendous amount of work to do to survive on a farm, and everyone had to pitch in and help. So he shouldn’t expect to get a lot of love because there wasn’t enough time for that type of thing. But his grandfather told him this: “Don’t ever let anyone put you down, and you’ll be fine.”

Apparently, that advice was all he needed!

Didn’t make a whole lot of sense to me, but his story was interesting, to say the least. Personally, I don’t aim for being happy all the time, for lots of reasons. First, I think the contrasts of emotions make for much of the joy in being human, including the many moments of self-doubt, anxiety, and despair, that most of us experience. Second, I think the down times provide us with enormous opportunities in terms of personal and spiritual growth. And third, I am convinced that negative emotions, such as sadness and grief, without distorted thoughts, can actually be a form of celebration, and one of the highest experiences a human being can have.

Answer to the question in the blog, Surprisingly, the correct answer is c. There were no statistically significant differences in the two groups of children! The children from the worst homes did just as well as the children from the best homes in all of the outcome variables. I wish I still had the reference to that article! if I can find it, or if a reader can find it, I will pass it on to all of you. I am recalling this from memory, and memory can be flawed, so take it with a grain of salt until we can get more confirmation. But I found the article to be mind-boggling, and it reminded me once again of how little we know about the causes of emotional distress!


If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and tons of resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

Why Are Relationship Problems So Tough?

Why Are Relationship Problems So Tough?

Hi David,

Thank you so much for your help and encouragement on the Sunday hike this week. I thought it was interesting how despite my initial sense that I didn’t need help so much with my feelings, once we got into the “Five Secrets” practice it was clear I had more work to do on my anxiety. I guess I couldn’t see that until I owned my role in the dynamic with my son and saw how much I was struggling with the Five Secrets in my interactions with him. Having the layers separated by the discipline of the TEAM-CBT method helped me start to untangle something that has been very confusing.

More musings. During the hike you were talking about how many people can now recover from depression and anxiety really quickly using TEAM-CBT, but that relationship and habit work generally take much more time.  I’d be very interested in hearing you say more about this, because relationship problems feel more complicated (in my case with son, at least). At least consciously, I’ve always felt like I wanted to be closer to my son. Today it’s clearer to me that I’m having a number of Self-Defeating Beliefs (SDBs) that cause me to act in ways that prevent closeness. For example, I’m telling myself that both he and I should be perfect achievers, that he and I should never be angry at each other, and so forth.

Maybe relationships are a place where “the rubber hits the road” so to speak, where our SDB’s display themselves with real world consequences. . . Hmm. I guess the point is that relationship work can be a rich but challenging entry into personal growth!



IMG_1737Hi H,

Thanks, we could brainstorm on this theme in emails or on a future hike, but to be honest I don’t entirely know why it can be so much harder, even for highly skilled therapists, to deal with our own relationship problems, with family and the people we care about.

However, there is one idea I have had for a long time that may represent a part of the answer. If I’m treating you for depression, you will discover that your painful negative thoughts about yourself (eg. “It’s all my fault,” or “I’m a loser,” or “my problems are hopeless” and so forth) are distorted and wrong. That discovery makes you happy, so it is a pretty easy sell. You discover you are way better than you thought. Not a bad deal! Although treatment resistance always has to be addressed early in the therapy, it is pretty appealing to learn how to let go of self-blame and feelings of depression, anxiety, inferiority, worthlessness, shame, hopelessness, and inferiority.

Relationship problems are quite different. That’s because most of the time, you will be blaming the other person, and thinking about him or her in a distorted manner. For example, you may tell yourself that it’s all his (or her) fault, that he (or she) is a loser, or wrong, and so forth. Then, in the course of treatment with TEAM-CBT, you will discover, when you’re working with the Relationship Journal,  that actually have a huge role in the problem and that you are probably triggering and reinforcing the very problem you have been complaining about. This insight can be incredibly empowering, but it can also feel pretty humiliating, shocking, and painful at the same time. In essence, you will discover that you are far worse than you thought, and that if you want the relationship to improve, you will have to stop blaming the other person and focus all of your energies on changing yourself.

For most of us, it is not particularly appealing to have to let go of other-blame and the feelings of moral superiority that go along with feeling certain that we are “right” and the other person is “wrong.” Pinpointing your own role in the problem when you were so happy blaming the other person is usually very painful. That’s just one reason why intimacy is not an easy sell. I address this in the chapter entitled, “Do We Secretly Love to Hate?” in my book, Feeling Good Together.

That’s a big part of why it’s so hard to deal with personal relationship problems, but I think there are other reasons, too. When I’m helping someone with a relationship conflict, there is usually an “inner problem” and an “outer problem” that need to be solved. The inner problem is all the intense negative feelings you have about your interaction with the other person. These feelings may involve anger, shame, anxiety, loneliness, depression, hopelessness, inadequacy and so forth, and they are usually triggered by your own negative thoughts about yourself as well as the other person, and those thoughts are nearly always distorted. For example, you may be telling yourself that the other person is a self-centered “jerk” who “shouldn’t” be that way, and you may be telling yourself that you “should” be a better partner, or mother, and so forth.

The outer problem involves the dysfunctional way you are probably communicating with the other person. For example, you may be trying to “help” when you need to listen, or you may be arguing defensively instead of finding truth in what the other person is saying, or you may be lashing out aggressively, trying to put the other person down, instead of sharing your anger in a respectful and loving way.

The tools for solving the “inner problem,” such as the Daily Mood Log, Cognitive Distortions, and “50 Ways to Untwist Your Thinking,” are tremendous, but they are radically different from the tools for solving the “outer problem,” which include the Relationship Journal, the Blame Cost Benefit Analysis, and Five Secrets of Effective Communication. So the task is twice as hard, with twice as much to teach the patient. Of course, there is tremendous potential for personal growth, as well, and for developing more satisfying and loving relationships with the people you care about.

Perhaps some who read my blog will have theories about why it can be so much harder to resolve personal relationship problems than to overcome anxiety and depression! Let me know what you think with a Comment if you are so-inclined!

Readers interested in learning more about the methods for combatting depression and anxiety may want to read my Feeling Good Handbook, or When Panic Attacks. Readers interested in learning about how to develop more rewarding personal relationships may want to read Feeling Good Together. But I have to warn you—doing the written exercises while you read will make all the difference in the world! Just reading simply won’t “cut it,” so to speak, especially if you are reading Feeling Good Together and want to get close to someone you are at odds with right now!


If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David

Yikes! The Feeling Good Podcast Cured 40 Years of Depression! What Happened?

Yikes! The Feeling Good Podcast Cured 40 Years of Depression! What Happened?

Comment: Dear David and Fabrice,

hke photo 3Thank you for the Feeling Good podcasts!

I am 63 years old and have had mild to moderate depression since my 20s. The lowest score I ever got on the BDI in your book, Feeling Good, was 12, when I was seeing a therapist. (David comment. The BDI is the old Beck Depression Inventory, and it goes from 0 to 63. A score of 12 indicates mild depression.) Usually, my depression score was in the 21-22 range. (David comment: moderate depression.)

Four weeks ago, I was having a very bad day, and thought I’d try one of your Feeling Good podcasts. I started listening to one that was a few episodes into the series about cognitive distortions, and it was information I knew, but I thought, “this is good, I’m starting from Episode 1, called “You Feel the Way You Think.” I was in a parking lot and I started to drive and listen to Episode 1. Halfway through the episode I thought, “I don’t think I’m depressed….at all.” It was such a different feeling, like David talks about, but I never believed him.

It’s four weeks later, and I’m still not depressed. I took the BDI and scored a 1. You tell *me* what happened. I don’t know!

I am a little concerned that I don’t really know what “relapse prevention” steps I should take, but I’m taking exercise classes (a miracle in itself), working every week on my novel, and other amazing things. Whatever happened, thank you, thank you, thank you!.
Deepest respect and regards,

Hi Arlene,

Thank you for your fantastic email. I really appreciate it. That is SO COOL!

I am about to fly to the east coast for three workshops, so can only give you a brief response now, but will write a more detailed blog for you on Relapse Prevention Training when I return home. Here are the high points of it, with more details later, I promise!

  1. You must know that we will all relapse forever. I define a relapse as one minute or more of feeling crappy. Give that definition, we all relapse all the time. No one is entitled to be happy all the time, and your negative thoughts will try to return over and over. But it does not have to be a problem if you are prepared and know what to do. In fact, bad moods are part of what makes us human, and they give us the potential for emotional (and, arguably, spiritual) growth.
  2. The technique that worked for you the first time will likely always work for you. Initially, when I work with some, I may have to try several techniques before I find the one that works. But after that, it is much easier, as you just use that same method or technique. For example, it might just be writing down one of your negative thoughts, pinpointing the distortions in it from my list of ten cognitive distortions, and then substituting a more positive and realistic thought, perhaps the way you might talk to a friend who was depressed and anxious.
  3. You need to write down the negative thoughts NOW that will almost definitely cross your mind, and every person’s mind during a relapse. they include thoughts like these:
  • a. This relapse proves I’m hopeless.
  • b. This relapse proves the therapy didn’t work. It was just a fluke that I got better.
  • c. I didn’t even really get better, I was just fooling myself.

If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David


Should Therapists Apologize? A Raging Debate!

Should Therapists Apologize? A Raging Debate!

Hi web visitors and friends on social media. Yesterday I got a really interesting email from my esteemed colleague, Angela Krumm, PhD, who created the certification program for TEAM-CBT. Angela’s clinical practice is located at the Feeling Good Institute in Mt. View, California. and they also offer training for therapists. I thought you might enjoy the question, as well as my answer. You will see that the information is relevant to everybody, and not just therapists.

If this topic of developing more loving and satisfying relationships interests you, you can read more about these techniques in my book, Feeling Good Together, available at Amazon and other book sellers.

IMG_1761Hi David,

The TEAM Certified list serve is having a colorful discussion about the use of apologies (specifically, saying “I’m sorry”) within the Five Secrets of Effective Communication. People are pretty engaged and arguing both for and against “I’m sorry.” Would you like me to share the comments with you?

If you’re interested, I’d love to post a response from you about whether you teach people to say “I’m sorry.” I think your general mode (if I remember from past training) is to avoid “I’m sorry” since it’s so generic and less specific than the Five Secrets.

Let me know if you want to see the comments and have a chance to respond.  I can send them to you!

Angela Krumm, PhD

Hi Angela,

To my way of thinking, “I’m sorry” can be effective or dysfunctional, depending on how it is used. In my experience observing clinicians in training, as well as troubled couples in treatment, it is nearly always dysfunctional, but it doesn’t have to be. Let me explain.

I recently treated a troubled couple from Los Angeles who had treated each other shabbily out of anger for many years. Without going into all the details, the husband had an affair with a woman they both knew from their church, and slept with her every night for six months. The affair appeared to be his way of getting back at her for something she had done that hurt him.

His affair was devastating to the wife, and she kept making up excuses for the children why Daddy can’t come home tonight. Every time she tried to express her feelings of being hurt, angry, anxious, humiliated, and betrayed, her husband would say, in a defensive tone of voice, “I’ve said I’m sorry! You have to put that behind you so we can move on! We’ve already talked about this!”

As you can see, he used “I’m sorry” as a way of avoiding listening and hearing how his wife felt. And although they’d bickered about their problems endlessly, he’d never really listened or giving her the chance to be heard.

I don’t want to scapegoat him—she gave the same dismissive and defensive answers when it was her turn to listen to his complaints and feelings. But it seems pretty clear to me that his use of “I’m sorry” was defensive and aggressive. It was his way of saying, “shut up, I don’t want to hear what you have to say.”

Therapists frequently do much the same thing in response to criticisms from patients. For example, a patient might say, “Last session you interrupted our session to take an emergency call, but I’m paying for the time!”

The well-meaning therapist might apologize and say, “I’m really sorry. I’ll remind my secretary to hold calls during our sessions unless it’s something super severe like an actively suicidal patient.”

It should be easy (I hope!) to see that this therapist is also using “I’m sorry” as a way of brushing the patient off, so the therapist doesn’t have to deal with the patient’s anger and hurt feelings. But those kinds of feelings may be a central problem in the patient’s life, and the therapist has missed a golden opportunity to deepen the relationship through the skillful use of the Five Secrets.

I have often said that no therapist in the United States or Canada is able to deal with or acknowledge a patient’s anger. Of course, this is an exaggeration to make a point, but it is SO TRUE most of the time! In my experience, it is very difficult for therapists to master the Five Secrets, for use in therapy, as well as in their personal lives, which can be even harder.

Of course, you can apologize skillfully. Apologies aren’t inherently dysfunctional. For example, you could respond to your patient’s criticism like my example below, which is based on the Five Secrets of Effective Communication. The abbreviations in parentheses at the end of each section indicate the communication technique(s) used in that sentence.

“I felt badly about interrupting the session, too. (IF) This is your time, and any interruption is unfair, and I want to apologize. (DT) The call was from an actively suicidal patient, but still my focus should be on you. (DT) I wouldn’t be surprised if you’re feeling hurt and ignored, and maybe even a bit angry with me, for good reason. (FE; DT) This is especially painful for me, because one of the themes you have described is that ever since you were a kid, the people you care about seem to ignore you, and don’t take you seriously. You said they gave your older brother all the attention, because he was a straight A student, so you end up feeling lonely and rejected most of the time. (IF; FE; DT) Now I’m in the role of ignoring you, and it’s especially painful for me because I respect you tremendously (IF; DT; ST) At the same time, I’m excited, because this is really important and can give us the chance to slay that dragon and deepen our relationship. (ST; Positive Reframing) Can you tell me more what that was like for you, as well as other times I’ve said or done things that hurt your feelings? (IN)”

I’m sure that can be improved upon, and is perhaps too long. But the important thing is that you are honoring your patient’s feelings, and encouraging him or her to open up. In this context, the apology is okay. However, notice that the phrase, “and I want to apologize” probably isn’t even needed.

I would also say that therapists, as well as patients, sometimes polarize things as “this way” vs. “that way,” so they can argue and feel like experts. Sorry if I sound a bit cynical here! Skillful and effective therapy is rarely “this way” vs “that way,” but exists on a higher plane. TEAM-CBT does not consist of simple formulas you can apply. It is an art form that is difficult to master, and simplistic approaches usually won’t be effective.

The bigger issue is that every one of the Five Secrets can be used in a skillful, compassionate, helpful way, or in a dysfunctional way. In fact, this is true of every method and technique in TEAM-CBT. For my two cents, I’d rather hear that people are asking for help in learning, rather than arguing about who is right and who is wrong, but I’m old and probably sound pompous or annoyed, so I will stop babbling!




If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients!

Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationshp conflicts.

Thanks! David


Self-Acceptance–Are We All Defective?

hike photo 9Hi everybody,

I’ve been getting lots of great emails with questions recently, and will try to get to as many as possible. Here is one from this morning.

Hi Dr. Burns,

I really hope you get to see this! I just wanted to say how I love your book and it has been helping me a lot I bought and read Feeling Good: The New Mood Therapy, and I’m currently reading your book on anxiety, When Panic Attacks.

But I did want to say one thing. On page 216, near the bottom, it says, ” … in fact, we’re all defective and you can view your ‘defectiveness’ as a reason for suicide or a cause for a celebration….”

I didn’t understand that. That we should view us being defective as a reason to kill ourselves?? It threw me off and I asked my friend to read it over. I just want to know what you meant!

It’s near the bottom second to last paragraph on page 216


Hi Nicole,

Sometimes I write things that may be hard to “get” at first, so I appreciate your question. First, let me emphasize that suicide is never appropriate or needed for someone who is feeling depressed and hopeless. However, was writing about something I call the Acceptance Paradox, where you achieve enlightenment by accepting your many shortcomings with a sense of inner peace, or even with a sense of humor. I call that “healthy acceptance.”

And when you “grasp” this notion that it is okay to be flawed and defective, or even wonderful, you can achieve liberation from feelings of depression, anxiety, shame and self-doubt. And it brings you a lot closer to other people, too, because, believe me, there are TONS of other defective people out there, so we can have a party and lots of folks will join us, and we can just hang out and not worry about having to impress each other.

But people who are depressed usually have what I call unhealthy acceptance. They wrongly believe that because they are defective, they should kill themselves.

If you CLICK HERE, you will find a chart that distinguishes healthy from unhealthy acceptance.  As you can see, healthy acceptance is characterized by joy, intimacy, laughter, and creativity. In contrast, unhealthy acceptance is characterized by cynicism, depression, hopelessness, and loneliness.

This is sometimes hard to “see” at first on an emotional level, especially if you are depressed, or prone to depression. But when you suddenly “get it,” it’s like seeing the grand canyon for the first time. It simply takes your breath away, and you discover that it’s only okay to be defective, it’s actually great–in fact, the very BEST way to be!

I am writing something more ambitious on this topic, and I’ll publish it here soon. This is just a beginning note intended to whet your appetite, hopefully at least! What I am writing about now are some of the more philosophical underpinnings of TEAM-CBT, although the notions are actually ancient, and go back at least 2500 years. I will try to address two questions:

  1. Is it possible to be worthwhile or to be worthless?
  2. Do we have a “self”?

Although these themes may seem abstract, they have powerful, practical, emotional consequences. Just one small example, let’s say you struggle with anxiety and shyness. You may have the fear that others will judge you because you are inferior, or not “good enough,” and this thought can cause tremendous suffering. But this thought is based on the notion that you have a “self” that can be evaluated or judged. When you see through this notion, you can experience liberation from your fears.

The Buddhists called this “The Great Death.” Of course, we all fear death, and struggle to keep our egos alive. But once you’ve “died,” so to speak, you can join the Grateful Dead, and then life suddenly opens up in unexpected ways. And for those who may misread me, or interpret my words literally, I am not referring to physical death, but death of the “self.”

So, stay tuned if this type of dialogue interests you! And thanks for reading this!

Doctor David

If you are reading this blog from Facebook or Twitter, I appreciate it! I would like to invite you to visit my websitehttp://www.feelinggood.com, and register there as well. You will find a wealth of free goodies, including my Feeling Good blogs, plus all my Feeling Good Podcasts to date, and the Ask Dr. David blogs as well, along tons of resources, including videos for mental health professionals as well as patients and the general public!

An Anxiety Question and a Blessing from Turkey for “David Uncle!”

An Anxiety Question and a Blessing from Turkey for “David Uncle!”

Hi Dr. Burns,

whenpanicattacks-sm  Thank you for your life-saving books and blogs. They really help. I have given your book, When Panic Attacks, to others. It is so good! What I admire the most is your empathy and your desire to seek the truth.

I have a simple request. Can you clarify the use of cognitive flooding and thought-disputing? I find these two methods to be quite useful but confusing at times. For example, it doesn’t seem logical to flood my mind with panic thoughts and then turn around and dispute them. Perhaps morning flooding and evening disputing?

I don’t know that a general answer is possible but any thoughts you have are sincerely appreciated. I understand you do not give personal advice and that if you do answer, it will be for the help of many others who follow your blogs and appreciate your insights.


Hi Bill, Thanks for your kind comments and question. I am embarrassed that I can’t give you a good clear answer. But I’ll try to babble briefly. Remember that there are four treatment models for anxiety, and I use all four with every anxious patient I treat.

  • The Motivational Model—where you bring the anxious patient’s Outcome and Process Resistance to conscious awareness and melt them away.
  • The Cognitive Model—where you challenge the distorted negative thoughts that trigger the anxiety, using a wide variety of techniques such as Identify the Distortions, Externalization of Voices, the Experimental Technique, and so forth. You call this “thought disputing,” but there are more than 50 ways of disputing and crushing negative thoughts.
  • The Hidden Emotion Model—often the overly “nice” anxious individual is sweeping some feeling, conflict, or problem under the rug and not dealing with it. When the patient brings the problem to conscious awareness and deals with it, the anxiety often disappears completely.
  • The Exposure Model—where you flood yourself with anxiety by facing your fears. If you stick with it, in most case the anxiety will diminish over time and then disappear. You call this “cognitive flooding,” although that’s just one of many exposure techniques.

I describe these four models and methods in my recent series of Feeling Good Podcasts on the treatment of anxiety (Podcasts 22 to 28). You might enjoy listening to them, and can link to the first one if you CLICK HERE. All four treatment methods are helpful, but they work in different ways. You never know which method or methods will be the most helpful to any individual.

But I have to confess I don’t “schedule” them as you have suggested. However, that’s not a bad idea! In my experience, depressed and anxious individuals who work with these techniques, and actually try them, including the written exercises, as opposed to just reading about them, nearly always have the best outcomes. So stick with it!

And of course, if you need help or guidance, it never hurts to check with a mental health professional. However, I would personally tend to avoid a psychiatrist as my first choice, as you are likely to get drugs, drugs, drugs. Although I am a psychiatrist, and have prescribed medications on occasion, I find that most depressed and anxious individuals can now be treated quickly and effectively without medications. In addition, research studies indicate that many people recover from depression anxiety on their own after reading one of my books, but if you need a little guidance from an expert, there’s no shame in that at all! Sometimes, we all need a little help from our friends!




Hi Dear David Burns,

feelinggood  Firstly, I want to say thanks a lot for you book, “Feeling Good: the New Mood Therapy”! This book has changed my life! Now I love life and enjoy everything in life.

My story started after reading your book second time! Thanks very much! God bless you David uncle!

Sedef (from Turkey)

Hi Sedef,

Thank you so much for your kind and incredible comments, and for your blessing! I am thrilled that you are now loving life and enjoying life! That is like a miracle and the greatest gift a human being can receive.

It is many years since I wrote Feeling Good as a young man, editing it while we were on summer vacation in California, at Lake Tahoe. You might not have even been alive at that time! It seems like a miracle that my words have now touched you, so many miles away. God bless you, too, Sedef!

All the best,

David Uncle