Posts About Cause of depression

Feeling Good

125: Ask David: How Do You Treat Chronic Laziness?

125: Ask David: How Do You Treat Chronic Laziness?

Answers to More Great Questions from Listeners Like YOU!

  1. Kevin asks: After your initial improvement from treatment or from reading your book, Feeling Good, what can one do moving forward to give yourself “booster shots?”
  2. Umatsagir asks a related question: I feel great right after reading your book, Feeling Good, but the effect diminishes over time. What should I do?
  3. Umatsagir also asks: Is there an anxiety masterpiece equivalent of your book, Feeling Good?
  4. Kyle asks: What can I do, as a therapist, about the passive patient who just shrugs when I ask what he wants to work on, and says, “My Mom thinks I should come to see you.” When I try to dig deeper to try to find out what patients like this want help with, I run into resistance and then they typically drop out of therapy. What should I do?
  5. Benjamin asks a somewhat related question: How do you treat chronic laziness? In your book, Feeling Good, you call this “Do-Nothingism,” which is a lack of motivation that you often see in depression. In your book, you talk about ten different types of procrastination, with a different approach for each. If the patient feels overwhelmed by many things he or she is procrastinating on, how can you help that person, since he or she probably can’t do the psychotherapy homework, either! It’s a Catch-22, since they cannot find the motivation to do anything, but have to do the homework to improve!
  6. Jim asks another related question: How about doing a podcast on psychotherapy homework? “What do you have your patients do for homework? This is particularly important since I have 45 minute sessions and can only see my patients for 45 minutes every two or three weeks.”


Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world via teletherapy. You can reach him at fabrice@life.net. You can reach Dr. Burns at David@feelinggood.com. If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

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TEAM-CBT Methods for Anxiety Disorders–

Step-by-Step Training for Therapists

by David D. Burns, MD and Jill Levitt, PhD

May 19, 2019

You can attend in person or from home via Live Streaming

Check it out now!


Coming Soon!

Act fast if you want to attend! The February 10 workshop habits and addictions sold out early.


And there will be two awesome summer intensives for you this year!


July 15 – 18, 2019
Calgary four-day intensive
Sponsored by Jack Hirose & Assoc.

July 29 – August 1, 2019
South San Francisco four-day intensive
Sponsored by Praxis

125: Ask David: How Do You Treat Chronic Laziness?

121: Ask David: Do You Believe in Freud’s Notion of Secondary Gain? Is Seasonal Affective Disorder (SAD) Real?

Answers to Great Questions from Listeners Like YOU!

  1. Dylan asks: Do you believe in Freud’s “secondary gain,” in which patients resist change because they benefit from their symptoms?
  2. Juleann asks: Is Seasonal Affective Disorder (SAD) a real thing?
  3. Ismail asks: Should I use the Daily Mood Log just when I’m upset, or at the end of the day, or when? Do I have to stop what I’m doing when I get negative thoughts so I can write them down and work on them?
  4. Abe asks: What about negative thoughts that are valid? For example, I was interested in astronomy and physics as a teenager, but my SAT scores showed I had no aptitude for a career in these areas.
  5. Kevin asks: Can positive flooding be used to change the object of our desires—for example, our sexual desires, like the man in one of your books who had lost sexual interest in his wife?
  6. Valentina asks: Where do cognitive distortions come from? Our parents? Our genes? Societal messages?


Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world via teletherapy (but not across U.S. state lines). You can reach him at fabrice@life.net. You can reach Dr. Burns at david@feelinggood.com. If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.

080: Ask David: Where Do Negative Thoughts Come From?

080: Ask David: Where Do Negative Thoughts Come From?

“I’m a loser. . . I’m a failure. . . Where do my negative thoughts come from? “

In this podcast, David and Fabrice answer several fascinating questions submitted by listeners:

  1. Jackie asks where our distorted thoughts come from, since they are so often irrational and distorted, and inconsistent with the facts. Why do we sometimes beat up on ourselves relentlessly with negative thoughts?
  2. Tyler asks if it possible to do TEAM-CBT in conventional, 45 minute sessions. And if so, how? It seems my patients are just warming up by the end of the session, and then we have to start all over again the next week.
  3. Jess asks if it is possible to use the Five Secrets of Effective Communication in non-therapy settings. For example, if you are in a position of authority, like a high school teacher, will your students lose respect for you if you use the Five Secrets? Could you use the Five Secrets if you are working with violent gang members?

Two Cool Upcoming Workshops for you!

March 22 and 23, 2018 Rapid Recovery from Trauma, (David D. Burns, MD) J&K Seminars, Lancaster, Pa 15 CE credits, includes live evening demonstration on the evening of day 1.
You can join in person or online from wherever you live! 

May 20th, 2018  Advanced, High-Speed CBT for the Treatment of Depression and Anxiety A one day workshop by Drs. David Burns and Jill Levitt. 6 CE Credits, $135
You can join in person or online from wherever you live!

Fabrice and I hope you like our Feeling Good Podcasts, and also hope you can leave some positive comments for us and five star ratings if you like what we’re doing!


At least one listener has had problems leaving an iTunes review from his i-phone, so Fabrice has created some simple to follow instructions if you need help.



125: Ask David: How Do You Treat Chronic Laziness?

Do Depression and Anxiety Result from a Chemical Imbalance in the Brain?

Another Great Question from Rob, an Enthusiastic and Thoughtful Fan

Hi David,

I’m listening to your old face book video.  You are describing bi-polar disorder which you mention is a biological disorder.

I’m curious, what is the difference between a biological disorder (which obviously exists) and a “chemical imbalance”? If I understood some of your previous talks, there is no evidence of any “chemical imbalances” in the brain?  Perhaps that is something you can address in a future podcast if you see fit?

As always, I appreciate all the wisdom you share!


Hi Rob,

Sure, I can address this in a podcast, but here’s a quick answer so you won’t have to wait.

The concept of “imbalances” was used for hundreds of years, unsuccessfully, to explain how nature works. For example, balances and imbalances in these four elements—earth, air, fire, and water—were thought to explain nature, but the theory just didn’t work. Nature cannot be explain by a hydraulic system of “balances” or “imbalances” of earth, air, fire, and water.

For example, the massive fires in Northern and Southern California right now are likely the result of global warming, and the lack of rain, and not by some kind of “imbalance” of earth, air, fire, and water. Well, I guess you COULD say the fires are due to too much fire and not enough water! But that’s not much of an explanation–because it’s just a tautology! It’s like saying “fire is the cause of fire.” Duh!

Global warming appears to be caused by burning fossil fuels and dumping millions of tons of hydrocarbons into the atmosphere, causing the “greenhouse effect.”

For two thousand years, medicine tried unsuccessfully to use the “balances” and “imbalances” model to explain medical illnesses, which were seen as due to an imbalance of four “humors”—black bile, yellow bile, blood, and phlegm. So when George Washington had a severe throat infection, his doctors thought it was the result of an “imbalance,” namely, too much blood, so they bled him. This so-called “treatment” contributed to his death. Again, the balance and imbalance theory did not explain anything in a valid way, and did nothing to advance medicine. It was not a sound or useful theory.

Very few medical illnesses are due to “chemical imbalances.” For example, a broken leg is not usually due to a “chemical imbalance” in the bones, but rather from a fall and the physical forces that cause the fracture. Similarly, a heart attack has a biological but it is not caused by a “chemical imbalance” in most cases, but rather from the narrowing or closure of one or more arteries that supply blood and oxygen to the heart, as well as other causes, such as electrical conduction disorders. A heart attack is not the result of a chemical imbalance, and cardiologists rarely talk about “chemical imbalances,” although in some cases electrolyte abnormalities can cause cardiac problems.

Hydraulic imbalances of basic elements or humors, as you can see, is a primitive way of thinking that goes back at least two thousand years, to the time of Hippocrates, an early physician. And hydraulic imbalances in brain chemicals do not explain most brain disorders, emotional upsets, or behavioral problems, either.

Still, psychiatrists have tried to use the “chemical imbalance” theory to explain psychiatric disturbances for the past 60 years or so; but this effort has not been helpful, in my opinion, because the brain is not a hydraulic system of balances and imbalances. The brain is some kind of super computer, an massively complex electronic system that we are just beginning to understand.

There are many biological abnormalities in the brain, but are rarely “chemical imbalances.” For example, Alzheimer’s Disease is a true biological brain disorder, but it is not due the result of a chemical imbalance. The same is true of brain tumors, as well as encephalitis (an infection of brain tissue) or meningitis. These are true biological problems, but they do not result from “chemical imbalances.”

Schizophrenia is a tragic and severe psychiatric disorder–it is not a variant of normal thinking or behavior, and it has a yet-unknown biological cause, which partially involves genetic causes. We will likely know the cause of schizophrenia fairly soon–but it likely will NOT be a “chemical imbalance.”

The brain can have all kinds of biological abnormalities that are not “chemical imbalances”—hemorrhages, strokes, malformations from genetic abnormalities, traumatic injuries from concussions, infections, and so forth, but these do not usually involve “chemical imbalances.” Neuropathology was one of the few courses I excelled in as a medical student at Stanford, and received one of the highest scores ever on the final exam, but I cannot recall using the term “chemical imbalance” in that class.

We do not yet know the cause of most (or arguably any) psychiatric / psychological “disorders.” I used to do full time research on the “chemical imbalance” theory of depression, but left biological psychiatry to focus on new forms of psychotherapy when I realized that the chemical imbalance theory was not a productive or valid.

The theory holds that depression is due to a deficiency of serotonin, one of the many neurotransmitter substances in the brain, and that mania is due to an excess of serotonin. But I am not aware of any consistent or convincing evidence for this theory.

The research my colleagues and I did on this theory, which we published in the top psychiatry journal, Archives of General Psychiatry, did not support this theory.

This is the article:

Mendels, J., Stinnett, J. L., Burns, D. D. & Frazer, A. (1975). Amine precursors and depression. Archives of General Psychiatry, 32: 22 – 30.

Essentially, we flooded the brains of depressed veterans with massive increases in serotonin–but there was no effect on their moods. The depression levels did not improve from the increases in serotonin. This was, to my way of thinking, a simple and direct test of the “chemical imbalance” theory, and the result were crystal clear.

That was a clinical study. I was also involved in basic brain research on the chemical imbalance theory. I won the A. E. Bennett Award from the Society for Biological Psychiatry for the next article:

Burns, D. D., London, J., Brunswick, D., Pring, M., Mendels, J., Garfinkel, D. & Rabinowitz, J. L. (1976). A kinetic analysis of 5 – hydroxyindoleacetic acid excretion from rat brain and CSF. Biological Psychiatry, 11(2): 125 – 147.

I mention this not to brag, but to emphasize that I was not an “outsider,” but someone working very successfully within the system of biological psychiatry. I also wrote chapters on the chemical imbalance theory for textbooks, such as this one, which was based on a review of the entire world literature on the chemical imbalance theory:

Burns, D. D., & Mendels, J. (1979). Serotonin and affective disorders. Chapter 3 in Current Developments in Psychopharmacology, Vol. 5 (Essman, W. B. and Valzelli, L., eds. ), New York: Spectrum Publications, Inc., pp. 293 – 360.

Much recent suggests that antidepressants–which boost brain serotonin systems, have very few true antidepressant effects above and beyond their placebo effects. Of course, a placebo effect can itself be fairly strong. That’s why some people do appear to improve when treated with antidepressants. In many cases, they attribute their improvement to the medication, when the improvement may actually be due to changes in their won behavior and thinking.

Everything about being human results from biological (genetic) and environmental influences—such as IQ, personality, height, hair color, and the proclivity to being naturally more negative in outlook (depression, anxiety, shyness, anger) or more naturally positive (happy, confident, outgoing). However, we do not yet have much understanding of the brain systems that are involved. To what extent is depression the result of problems with our hardware (tissue level brain abnormalities or damage) vs. software (learning, neural circuitry, etc.)? We just don’t know.

Here’s one final analogy that may work. The brain is an incredibly complex super computer, involving billions and billions of neurons. I suspect you’ve had many problems with your computer over the years. We all encounter this. The computer freezes up, crashes, won’t connect to the internet, or whatever. Were any of these problems ever due to a “chemical imbalance” in the chip?

I don’t think so! So, it is true that humans are biological, and that biological factors contribute to our emotions, positive or negative. But this does not mean that psychiatric problems are due to “chemical imbalances.”

Let me know if I’ve made this clear.

Finally, because I am sometimes misquoted by individuals who may not understand what I’m saying, I am NOT saying that medications should never be used for individuals with psychiatric problems. Far from, sometimes medications can be helpful, even lifesaving.

And I’m NOT saying that people who take any kind of psychiatric drugs should suddenly stop taking them. That can be dangerous or even a disaster in some cases. All drug decisions must be made on a personal basis, based on a dialogue with your physician.

Some people may feel that a wrong theory is better than no theory at all. This is not my thinking. I am an agnostic on the causes of depression and anxiety. Some day we will know much more about causes. For this day, I am simply grateful and excited that we have so many new and powerful treatments for depression and anxiety, including TEAM-CBT and other new treatment methods, and that so many people can now be treated quickly and effectively without any medication at all. And to me, that’s good news!

One last thing. I get tons of positive emails, which I deeply appreciate, but I occasionally get hostile emails from people who don’t like what I say or write about. They scold me! A therapist recently emailed me to let me know she would never again recommend any of my books to her patients because of my position that we have perhaps been oversold by drug companies on the safety and efficacy of the antidepressants.

Remember to take what I say with a grain of salt. Sometimes, in fact often, I am wrong. But I always try to convey my honest take on things, thinking “the truth shall make you free.” For years I suppressed my thinking, fearing it would hurt or anger some people. Now I’m being more open. If you ever want more scientific references, I’d be happy to send you tons of them.

I still struggle with this issue of how open to be with all of you, and I still don’t know the “correct” answer. I don’t want to hurt anyone’s feelings, and I think the prognosis for fast, effective treatment of depression and all of the anxiety disorders has never been brighter.

Let me know what YOU think!



How to Find My FB Broadcasts

Click on my Facebook tab on https://feelinggood.com/ if you’d like to watch me each week on my Live Facebook broadcast each Sunday afternoon around 3 p.m. PST. Make sure to “like” my Public Facebook page: https://www.facebook.com/DavidBurnsMD/ so you can watch it on my page or yours.

Join me as I answer mental health questions from viewers — therapists and non-therapists alike — from all over the world. Type your question in the Facebook feed and I’ll do my best to answer it.

If you miss the broadcast you can watch the saved videos on my Facebook page! Also, viewers can watch these Live Facebook broadcasts as well as other interesting TEAM-CBT videos on the Feeling Good Institute’s YouTube channel!

The David and Fabrice Feeling Good Podcasts

Fabrice and I hope you also enjoy our Feeling Good Podcasts, and also hope you can leave some positive comments for us and some five star ratings if you like what we’re doing! We are already enjoying 25,000 downloads per month from listeners like you. Thank you so much for your support of our podcasts!


At least one listener has had problems leaving an iTunes review from his i-phone, so Fabrice has created some simple to follow instructions if you need help.