114: David on “The Upgrade”

114: David on “The Upgrade”

Hi everybody!

Today we rebroadcast a fabulous interview David did recently for “The Upgrade” Podcast (sponsored by the popular Life Hacker website with hosts Melissa Kirsch and Alice Bradley on a range of topics, including:

  1. Why did you write Feeling Good: The New Mood Therapy?
  2. Is depression caused by a chemical imbalance in the brain?
  3. What’s your experience with electro-convulsive therapy (ECT)?
  4. Why did you give up your research career in biological psychiatry?
  5. How can you tease out your negative thoughts when you know you’re depressed but you just can’t think of any thoughts?
  6. How does TEAM-CBT differ from conventional CBT?
  7. Can you use TEAM-CBT with severe problems, or is it only for individuals with mild mood disturbances?

Thanks for listening to our Feeling Good Podcasts. Please tell your friends about us or forward this to them so our numbers can continue to grow. We are now in the range of 60,000 downloads per month, thanks to all of you! Fabrice and I greatly appreciate your support!

David and Fabrice

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Dr. Fabrice Nye currently practices in Redwood City, California and works with 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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A Cool Upcoming Workshop for YOU!

Coming Really Soon!

Act fast if you want to attend.

 

TREAT ANXIETY FAST–

Powerful, Fast-Acting, Drug-Free Techniques 
to Defeat Anxiety & Worry

a 2-day workshop by David D. Burns, MD

November 29 and 30, 2018: San Francisco, CA
(in person only)

and

December 3 and 4, 2018: Portland, Oregon
(in person and live streaming)

PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.

In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.

Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…

  • How to integrate four powerful treatment models to eliminate symptoms.
  • How to enhance your client’s engagement in therapy.
  • How to develop a treatment plan that specifically targets each client’s unique problems and needs.
  • …and so much more!

David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!

Don’t miss this opportunity to learn from one of America’s most highly acclaimed teachers!

Sponsored by PESI

To register, or for more information, call: 800-844-8260

 

109: David’s Top 10 List!

109: David’s Top 10 List!

A fan named Tanuj asked:

“I’ve heard Dr. Burns mention that he is most proud of a few of the techniques he’s developed, and he mentioned that the Disarming Technique would be near the top of the list. I believe he said there were three or five of them. I was wondering what the others were. Does he have a top 5?”

Thank you, Tanuj. I got to thinking and actually came up with 10. Fabrice and I will briefly discuss each one on today’s podcast. So here they are!

  1. The list of Ten Cognitive Distortions that I created for my first book, Feeling Good: The New Mood Therapy. This list has been reproduced enormous numbers of times in the media and has been translated into more than 30 languages.
  2. The Disarming Technique and Law of Opposites. This means that you can nearly always put the lie to a criticism by finding the truth in it. However, this can be difficult because it requires the death of the ego, or self, the so-called “Great Death” that the Buddhists have emphasized as a key to enlightenment. This method has transformed my clinical practice and personal life and has been very helpful to many of my patients as well. However, it is not easy to learn, in part because it does involve the death of the “self.”
  3. The Externalization of Voices plus Acceptance Paradox. This was one of the first cognitive therapy techniques I developed, and I have used it more than any other technique during my career. It’s totally mind-blowing.
  4. The two classic Uncovering Techniques: the Individual and Interpersonal Downward Arrow. You can use these techniques to quickly pinpoint the Self-Defeating Beliefs that trigger painful mood swings, such as Perfectionism, Perceived Perfectionism, the Love Addiction, and Brushfire Fallacy, and more.
  5. The Feared Fantasy and Acceptance Paradox. This is a powerful and innovative exposure technique that can help people overcome the fear of being judged or rejected. It can also help people modify Self-Defeating Beliefs like Perfectionism and the Achievement Addiction, and the Approval Addiction.
  6. The Experimental Technique for extremely rapid treatment of patients with Panic Attacks. With this technique, you can sometimes—often—cure Panic Disorder in a single session. But this requires great courage on the part of the therapist and patient, and a great therapeutic alliance with lots of trust.
  7. My published research with colleagues in the mid-1970s did not support the popular notion that depression results from a chemical imbalance in the brain. In other words, we found that depression probably does NOT result from a deficient of the neurotransmitter, serotonin. Although we published this research in the top psychiatric journal, it was largely ignored for 25 years because people were so hooked on the “chemical imbalance” theory of depression. Now the study has been quoted frequently, and most neuro-scientists no longer give that theory a great deal of credibility.
  8. Brief Mood Survey. I believe I was the first, or one of the first, therapists in the world to require testing of every patient at every treatment session. I started with the Beck Depression Inventory, but have since developed briefer and more accurate scales that patients can complete in the waiting room before and after every sessions. These scales indicate the severity of symptoms such as depression, anxiety, anger, suicidal urges, positive feelings, and relationship satisfaction or conflict. Patients also rate therapist empathy and helpfulness after each session. This simple procedure has revolutionized treatment, because therapists can now see, for the first time, how effective, or ineffective, they are in every single therapy session. The testing has also made data-driven, science-based psychotherapy possible. However, it requires courage on the part of the therapist because the information will often be surprising to the therapist, and disturbing!
  9. Positive Reframing, and all of the new, paradoxical Agenda Setting techniques have made super-high-speed TEAM-CBT treatment methods possible. I now see recovery at speeds I would have thought impossible 20 years ago.
  1. The use of extended, two-hour therapy sessions rather than weekly 50-minute sessions has also been huge. That’s because I often see a complete elimination of symptoms of depression and anxiety in a single extended session of TEAM-CBT, as opposed to months or even years of conventional treatment. Many of my students are reporting similar results. This,  I think, is truly revolutionary!

Well, that’s it. That’s what I’m the most proud of! I suppose I could also include my first book, Feeling Good: The New Mood Therapy, which has sold more than 5 million copies worldwide, and has helped many people recover, as well as the development of TEAM-CBT.
Thank you again for your question, and please accept my apology if I am bragging too much, which can be really offensive. However, my mother once said, “If you don’t toot your own horn, no one else is going to toot it for you,” so hopefully the podcast and write-up will be okay.

David

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Coming Soon!
October / November / December 2018–
Cool Workshops for You!

TEAM-CBT Methods for the Treatment of Relationship Difficulties

Step by Step Training for Therapists

by David Burns, MD and Jill Levitt, PhD

Sunday October 28th, 2018 (9 am-4 pm PST)

Live in Palo Alto plus online streaming

Learn how to reduce patient resistance and boost motivation to change. Master skills that will enhance communication skills and increase intimacy with loved ones. This workshop will be highly interactive with many case examples and opportunities for practice using role plays.

Join us for a day of fun and inspiring learning on site in Palo Alto
OR online from anywhere in the world.

Learn from David and Jill–a dynamic teaching duo!

6 CE*s. $135

To register, go to the Feeling Good Institute

or call  650-353-6544

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Rapid Recovery from Trauma

a two-day workshop

by David D. Burns, MD

October 4-5, 2018–Pasadena, CA

and

November 1-2, 2018–Woodland Hills, CA

The November workshop includes Live Streaming
if you cannot attend in person)

For further information, go to www.IAHB.org
or call 1-800-258-8411

Register Now!

* * *

TREAT ANXIETY FAST–
Powerful, Fast-Acting, Drug-Free Treatment Techniques
that Defeat Anxiety & Worry

a 2-day workshop by David D. Burns, MD

November 29 and 30, 2018–San Francisco, CA (in person only)

and

December 3 and 4, Portland, Oregon (in person and live streaming)

PESI is proud to offer an exciting workshop by David Burns, M.D., a pioneer in the development of cognitive behavior therapy (CBT). Achieve rapid and lasting recovery with all your anxious clients, just as Dr. Burns has done in over 35,000 therapy sessions with severely troubled clients. Become skilled at treating every type of anxiety without drugs.

In this unique 2-day certificate course you’ll master more than 20 treatment techniques to help your clients eliminate the symptoms of anxiety quickly – even your most challenging, resistant clients.

Dr. Burns will illustrate concrete strategies that provide rapid, complete recovery and lasting change for your patients. You’ll learn…

  • How to integrate four powerful treatment models to eliminate symptoms.
  • How to enhance your client’s engagement in therapy.
  • How to develop a treatment plan that specifically targets each client’s unique problems and needs.
  • …and so much more!

David will provide you with guided instruction and share powerful video sessions that capture the actual moment of recovery. You will take away practical strategies to use immediately with any anxious client. Leave this certificate course armed with tools you can use in your very next session!

Don’t miss this opportunity to learn from one of America’s most highly acclaimed psychiatrists and teachers!

Sponsored by PESI

To register, or for more information, call: 800-844-8260

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

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!

Rob

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!

david

 

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!

Subscribe

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.

 

David’s Fear Not Podcast!

David’s Fear Not Podcast!

Defeating Your Fears

Hi folks,

Here’s a link I did recently on Billy Atwell’s Fear Not Podcast. You might enjoy it!

David

 

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 forward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.

Thanks! David