131: Ask David–How Can I Develop Greater Joy and Happiness? Does “Neuroticism” Exist?

131: Ask David–How Can I Develop Greater Joy and Happiness? Does “Neuroticism” Exist?

We are getting some fascinating questions from our listeners. Thanks! In today’s podcast, we will answer six of them.

Debbie asks: Can you use TEAM-CBT to help people with medical disorders, such as Parkinsonism or Cancer?

Here is the promised link to Stirling Moorey’s book on Cognitive Therapy for cancer patients.

Here is the link the first episode of live therapy with Marilyn, a woman who was diagnosed with Stage 4 lung cancer a couple days before her session with David and Dr. Matthew May.  You may also want to listen to podcasts 50 to 52 and 59, which also feature David and Matt working with Marilyn. Marilyn described these inspiring podcasts as mind-blowing!

Mark asks: How can I help a depressed family member or friend who is passive and doesn’t want to do anything?

Paul asks: How can I get over death anxiety?

Sune asks: If you’re super-shy, does this mean you have “Avoidant Personality Disorder?” What’s the difference between garden variety shyness and a personality disorder?

Sly asks: “Do you believe in the big five personality traits model? And will your therapy tools change these big five traits? I got a score of 67 on neuroticism, which means I am more prone to anger, depression, anxiety, and vulnerability, and tend to think about things in a pessimistic way. If I do the exercises in your books, and develop a more realistic outlook on myself and others, does it follow that my “personality traits” will get more or less changed?”

According to Wikipedia, the “Big Five” are O = Openness to experience, C = Conscientiousness, E = Extraversion, A = Agreeableness, and N = Neuroticism, often represented by the acronym, OCEAN.

Here’s an important point I forgot to make on the podcast. According to Wikipedia, here’s  the definition of “Neuroticism:” People with high neuroticism indexes are at risk for the development and onset of common mental disorders. . .  such as mood disordersanxiety disorders, and substance use disorder, symptoms of which had traditionally been called neuroses.”

Can you see that this is a tautology? In other words, they ask you if you tend to have these kinds of symptoms, then they tell you this is “due to” some “trait” you have called “neuroticism.” But they are defining “neuroticism” as people who tend to have more of these kinds of symptoms! It’s circular reasoning. 

I hope you can “see” this! The reason I mention this is they make it sound like they discovered some “trait” you have which causes you to have depression, or anxiety, and so forth. But they haven’t! It’s just a word game. In fact, scientists don’t yet know the causes of any of these problems, and “traits” do not actually “exist.” 

Haike asks: What if you’ve battled your negative thoughts and self-defeating beliefs and still don’t feel happy? An absence of depression and anxiety does not necessarily mean more joy in life. How can you help people find out where they want to go in life, who they want to be, and what it is that brings them happiness?”

Here is the promised link to the first of the five podcasts on Five Simple Ways to Boost Your Happiness.


Dr. Fabrice Nye currently practices in Redwood City, California and treats individuals throughout the world (but not across U.S. state lines) 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.

* * *


TEAM-CBT Methods for Anxiety Disorders–

Step-by-Step Training for Therapists

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


Dr. Jill Levitt and I are offering what I think will be an outstanding workshop on the treatment of anxiety disorders on Sunday, May 19, 2019. Our Sunday workshops are tremendously fun, so consider attending if you are interested. 

The last Sunday workshop in February sold out quickly so register soon if you are interested. You can join in Palo Alto in person or online from anywhere in the world.


WHEN: May 19, 2019, 8:30 am – 4:30 pm PST
(11:30 am-7:30 pm EST)

WHERE: Join us live online or in person at the Creekside Inn, Palo Alto, CA.


WILL I GET CE CREDITS? YES! 7 CE hours available

Completion of this workshop also counts towards TEAM-CBT Level 1, 2 or 3 Certification

WHO CAN ATTEND? Therapists of all levels are welcome

CAN I REGISTER IF I’M NOT A THERAPIST? Although the workshop is geared for therapists, it will be taught in a clear and basic way that anyone can benefit from.




You will love this lively, amusing, and immensely useful day of training with Drs. Burns, Levitt and the Feeling Good Institute Staff. The trainers will use a combination of didactic teaching, live demonstrations, video, and breakout group practice to enhance skill-building.


Act fast if you want to attend!

* * * 

Check out the two awesome summer intensives 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


092: Feeling Good Now

092: Feeling Good Now

David and Stephanie James, part 1

Hi everybody!

I recently did the first of three interviews with Stephanie James on her superb radio show and podcast, The Spark.  Here’s how Stephanie described the interview (with minor changes):

We have amazing power within us to change our thoughts, our feelings, our actions, and our lives.

This episode is an inspirational way to take control of your automatic negative thoughts today and transform them in order to create a more joyful present and a more fulling future.

Join us as we talk with the legendary Dr. David Burns about how we can break through the old thinking habits that bind us and begin to live a more happy, harmonious life where we can feel good now.

Stephanie is a superb therapist and dynamic radio personality from Colorado. It was an honor to be on her show. She is co-authoring a book on how to live a “spark-filled life.” It should be completed soon, so you’ll likely be hearing from Stephanie a lot next year!

Following the interview, Stephanie visited my Tuesday training group at Stanford and participated in one of our Feeling Good Podcasts with some students in the group. She suggested we might want to broadcast the Tuesday group live so that therapists from all over the world could join us. We are thinking about that, but will have to check with the powers that be to see if we could get permission to broadcast from Stanford, as well as our Tuesday group members who may have mixed feelings, due to the intensely personal nature of the training.

Let me know what you think about this idea!

My second interview with Stephanie was on the evolution of traditional Cognitive Behavioral Therapy (CBT) into the new TEAM-CBT. Fabrice and I will publish it for you shortly. My third interview with Stephanie will be on the interpersonal TEAM model—how to convert conflicted relationships into loving, rewarding ones.

* Copyright © 2018 by David D. Burns, MD


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!


Attend a Summer Intensive!

This year, I am offering a July summer intensive in Whistler, Canada, and one in August at the South San Francisco Conference center. The intensives are almost always my most exciting and fun workshops of the year. Hope you can join us at one of these locations.

Here are some details:

Advanced Cognitive Behavioral Therapy: 

A Four-Day Intensive Training in TEAM-CBT

July 3 – 6, 2018 Whistler, BC, Canada

For more information, contact Jack Hirose & Associates Inc.
Phone: 604.924.0296, Toll-free: 1.800.456.5424

* * *

High Speed, Drug Free Treatment of Depression and Anxiety Disorders–

A Four-Day

Advanced TEAM-CBT Intensive

August 6 – 9, 2018, South San Francisco Conference Center, California

For more information, click here, or call IAHB.org at 800-258-8411

If you can only attend one of my workshops, consider attending one of these intensives!




075: Five Simple Ways to Boost Your Happiness–#2: Do Something You’ve Been Putting Off

075: Five Simple Ways to Boost Your Happiness–#2: Do Something You’ve Been Putting Off

Note: I am republishing this because I published it in the wrong category last time. You have likely already received it, and if so, ignore this new version, as it is the same. I apologize for my error! david

Use the Anti-Procrastination Sheet!

This the second of five Feeling Good Podcasts on simple things you can do to boost your happiness. Procrastination is one of the most common causes of unhappiness, and this bad habit is almost universal. We all put off the tasks we dread because they make us anxious, and because we’re tempted to do other things that are way more rewarding. But the longer you procrastinate, the worse you feel, and this robs you of motivation. As a result, you fall into a vicious cycle where procrastination triggers negative feelings like depression, anxiety, and guilt, and your negative feelings, in turn, reduce your motivation and trigger more procrastination. A vicious cycle.

Fabrice and I are going to show you how to break the cycle and boost your happiness. To get started, please think of ONE thing you’ve been procrastinating on. It could be anything, such as working on your taxes, cleaning your garage, filing papers, working on a paper or presentation you’ve been avoiding, reading something you have to read for school or work–anything at all.

Now I want to ask you a question. Would you like to overcome the procrastination so you can get started on that task? If your answer is no, you can come back and listen later when you do want to solve this problem.

If the answer is yes, then I have a second question for you. WHEN would you like to overcome your procrastination and get started? Today? Or later on?

If your answer is today, then we’re ready to rumble. If you say, “tomorrow,” or some later time, then I’d encourage you to come back to this podcast when you are ready to solve the problem. I can ONLY help you overcome your procrastination today! NOT tomorrow.

Finally, I want to know if you’d be willing to devote a very small amount of time to getting started TODAY. I’m asking you to invest something like five minutes, and I’m also asking you to agree to limit your work this small amount of time. This is crucial, because if you tell yourself you have to do the entire job, that may take hours, and you’ll probably feel so overwhelmed that you won’t do a thing!

Finally, I want to know if you’d be willing to get started for five minutes even if you’re not “in the mood,” and even if you’re completely unmotivated, and EVEN if the very thought of the task makes you anxious and guilty. If the answer is YES, then we’ve got a deal. But if you want to wait for the motivation, I urge you to turn off the podcast and come back to it at some later time.

One philosophical principle is the approach we’re going to teach you is NOT to wait for motivation. Most procrastinators think that motivation comes first, followed by productive action, but this is an illusion, because you’ll probably NEVER feel motivated to do some awful task you’ve been putting off. If you’re waiting for motivation, you’ll be waiting forever!

As I wrote in my first book, Feeling Good: The New Mood Therapy,  highly productive people know that ACTION comes first, followed by motivation. In other words, you have to get started on some task before you’ll feel motivated. You’re not entitled to feel motivated until you’ve start accomplishing something! Waiting for motivation is the trap that keeps your procrastination alive and prospering.

I’m going to make things simple for you using a tool I created years ago called the Anti-Procrastination Sheet! To make this podcast experiential, think about the specific task you’ve been putting off, like filing papers, preparing your taxes, cleaning the garage, a paper or report you have to prepare–anything at all.

Now take a look at the Anti-Procrastination Sheet. As you can see, it has five vertical columns, but they’re different from the columns on the Pleasure Predicting Sheet that we discussed in last week’s podcast. In the first column you break the task into small, or even tiny, steps, and number them. Make sure that each step can be completed quickly and easily–for example 30 seconds, or a minute or two.

You don’t have to outline the entire task, just the first four or five steps. And make sure the steps are small enough so you can complete all or most of them in five minutes or so. The philosophy behind this is called “little steps for big feats!” If you aim to do just a little, you may end up doing a great deal. But if you aim to do it all at once, the odds are high that you’ll just end up procrastinating, because the task will seem overwhelming.

After you’ve outlined the first few steps, predict how satisfying or rewarding each step will be in the second and third columns, on a scale from 0% (not at all satisfying) to 100% (tremendously satisfying.) Make sure you complete this column before you do the activity. And make sure you do it on paper, and not just in your head!

Now complete the first step, and indicate how satisfying and rewarding it turned out to be on the same scale, from 0% to 100% in the fourth and fifth columns. That’s all there is to it! Now do the same thing for the second step of the task.

You are welcome to print the attached copy and use it personally, but distribution or reproduction electronically is not permitted. Therapists who want to use this and hundreds of other assessment and treatment tools can purchase my Therapist’s Toolkit–you’ll find the order form on my website, www.feellinggood.com.

Now I’ll show you how the Anti-Procrastination Sheet works using a personal example of a task I hate and typically put off–and since this is something that I’m procrastinating on right now, we’ll see if the method works!

The task I’ve selected is listing my business expenses for our annual meeting with the accountant who prepares our taxes. This is something I always put off because it seems hard, boring, and anxiety-provoking.

Throughout the year, I save my receipts in file folders for various types of expenses–mailing expenses, professional entertainment expenses, software expenses, and so forth. So I have to list and total up all the expenses in each category, which involves a lot of busy work. I also have to do some complicated things like downloading our yearly charge card business expenses so I can list them as well, and I also have to download my PayPal receipts for sales of Therapist’s Toolkits and other things I sell on my website. And I nearly always have to call the help lines to figure out how to do the downloading, since I find it a bit complicated and confusing.

Yuck! No fun!

Take a look at my Anti-Procrastination Sheet. As you can see, I listed the first five steps of this task, beginning with something really simple–turning on the computer.  I made sure the next four steps were reasonably quick and easy, too.

Then I predicted how difficult and satisfying the first step would be, on a scale from 0 (not at all difficult or satisfying) to 100 (extremely difficult or satisfying. As you can see,  I did not expect it to be especially difficult or satisfying, since I turn on my computer all the time. But I thought it might be slightly satisfying because I could tell myself, “hey, I just got started!”

Next, I made my difficulty and satisfying predictions for the next four steps. Again, my estimates for the difficulty of each step were fairly low, as were my expectations of satisfaction, as you can see.

Once you’ve listed the first few steps and predicted how difficult and satisfying each step will be, go ahead and complete the first step, and record how satisfying and difficult it turned out to be in the third and fourth columns, on the same scale from 0 to 100. As you can see, my predictions for the first step were fairly accurate. It wasn’t at all difficult, but it was twice as satisfying as I had anticipated.

Then, I got a little boost in my mood–since I was facing the task I’d been putting off–and completed the next four steps, which were surprisingly easy, and somewhat more satisfying than I had predicted, as you can see. I’m sure you’ve heard the old Buddhist proverb that the longest journey begins with a single step–or, if you’re using the Anti-Procrastination Sheet, three or four small steps!

That’s all there is to it! Give it a try and email us to tell us how it worked for you!

Now let’s just suppose you’re not sold on what Fabrice and I have been teaching you in this podcast, and you’re telling yourself, “Oh, this is too hard for me, I just can’t get myself to outline the task on the Anti-Procrastination Sheet.” What should you do then?

Well, I have a suggestion for you, and another cool tool you can use. My suggestion is to stop telling yourself, “I can’t,” because this is not a valid statement. It isn’t true that you CAN’T get yourself to use the Anti-Procrastination Sheet. For example, if I held a gun to your head and told you to outline a task you’ve been putting off, you’d suddenly discover that you CAN do it!

But what is at issue here is that you may not WANT to do get started–for a whole variety of reasons! If that’s where you’re at, I would suggest that you list all the really GOOD reasons NOT to use the Anti-Procrastination Sheet today.

In fact, you may not even want to do that, so Fabrice will do it for you, and you can just look at this list that he and I came up with:

Really GOOD Reasons to Keep Procrastinating

  • Tomorrow will be a better day
  • I need more sleep
  • There’s something really good on TV right now
  • I’m not in the mood
  • I’ve done enough work for the day
  • I need some time to relax
  • It’s not necessary to do it right now
  • It will take too much time
  • It will be too hard
  • It will be too upsetting
  • I have other more important things to do.

Once you’ve complete your lists, or simply reviewed the list that Fabrice and I created for you, I would like to ask you this question: “Given all those many wonderful  advantages and benefits of procrastination, and all the really good reasons NOT to get started right now, why in the world would you want to get started? Your procrastination makes all the sense in the world!”

Oh, I forgot to tell you how my own Anti-Procrastination Sheet worked out for me. Doing the first few steps got me into a flow, and over the next several days, I completed the entire task fairly easily, working a couple hours a day, even without having to outline any more steps on my Anti-Procrastination Sheet. I’m ready for the meeting with our accountant, and my wife informed me that I’m actually a month ahead of schedule. The whole secret was getting started, taking that first small step.

And DID it boost my happiness? Absolutely! I feel relieved, proud,and happy with what I’ve accomplished. That awful chore is no longer a heavy stone I have to carry around on my shoulders all day long! No guilt, either!

Next week, we’ll have another cool and simple tool you can use to boost your happiness–by confronting a fear. You may have a phobia, like the fear of cats or dogs, or heights. Or perhaps you’re shy and fear opening up in groups of people, or maybe you have public speaking anxiety. Since I’ve had and defeated tons of fears in my life, and since I’ve had thousands of therapy sessions with individuals struggling with every conceivable form of anxiety, this is one my favorite topics. I can’t wait to see you at next week’s Feeling Good Podcast!

Fabrice and I hope you 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!


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.


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

Is it Possible to be Happy All the Time?

Is it Possible to be Happy All the Time?

A frequent web visitor commented on a blogger who said that the propensity to feel depressed or anxious never really leaves a person. He asked if I agreed with this.

Here’s the answer. I am convinced that being flawed and having moments of irritability, depression, anxiety, and so forth is an inherent part of the human condition, at least for most of us, and probably everybody. It is not possible to be happy all the time, nor is this a realistic or useful goal–at least that’s my take on it.

We all fall into these black holes of self-doubt or anger from time to time. What I do is to create a ladder for each patient, so you can quickly climb out of the black hole whenever you fall in. That’s why the psychotherapy homework is so vital—so you can practice and learn these tools, so you can use them in the future whenever you need them. It is like riding a bicycle. The skill never really leaves you once you’ve learned how, but you won’t develop the right “brain muscles” without the written practice between sessions, using tools like the Daily Mood Log, the Relationship Journal, and so forth.

There are two goals in TEAM-CBT: Feeling better and getting better. Feeling better is the initial recovery, when the symptoms of depression and anxiety completely disappear, and you feel fantastic. This is a tremendous experience for the patient and for the therapist as well. The recovery usually happens suddenly during a session, and with the new TEAM-CBT techniques, if often happens very early in the treatment.In my experience, it often happens in the first session, assuming I can work with the patient for two hours or so if needed.

Getting better means that you have the tools to deal with the inevitable “relapses” that affect all human beings. To me, I define a “relapse” as one minute or more of feeling lousy. Given that definitions, we all “relapse” all the time! But it does not have to be a problem if you know exactly how to deal with it.

One minute of feeling upset is okay. Or an hour, a day, or a week. But I don’t want my patients to have to struggle with weeks, months, years or decades of misery.

I always tell my patients that we are all entitled to five happy days per week. If you aren’t having your five happy days, you need a little mental “tune-up!” But if you’re having more than five happy days per week, that could be a problem, and we may have to put you on lithium!

I will edit and post a partially completed blog on Relapse Prevention Training (RPT) before too long. RPT is fairly easy and only takes about 30 minutes in most cases. However, if the therapist fails to do RPT, the patient may be shocked, overwhelmed and devastated when the negative thoughts and feelings return. But if you have prepared the patient properly, he or she will know exactly what to do, and the “relapse” will be short-lived.

As an aside, my thinking is consistent with the thinking of the late Dr. Albert Ellis, the New York psychologist who founded a school of therapy call REBT (Rational Emotive Behavior Therapy). Dr. Ellis once wrote a paper on “The Impossibility of Maintaining Consistently Good Mental Healthy,” or some such title. He was making the same point, that we are flawed, and cannot achieve perfection.

Dr. Ellis pioneered much of the thinking that triggered the development  of CBT (Cognitive Behavior Therapy), and now TEAM-CBT, although he approached treatment in a radially different manner. Those who still remember him, and attended one or more of his wild workshops or talks, or his $5 admission fee Friday night live therapy demonstrations at his center in NY, will know what I mean!

Dr. Ellis was quite the character, very controversial, but his contributions were tremendous, and he had a great sense of integrity. He did not steal from others, as some in our profession have done, but always gave credit where credit was due. That was one of the main reasons I became a fan of his!


Is Love an Adult Human Need?

Is Love an Adult Human Need?

Hi Dr. Burns,

Hope you have time for another question. Maybe you can post this on your site.

In your Intimate Connections book you say that many people believe that they need a romantic partner to be happy (which you think is a false belief). Doesn’t this imply that people are either happy or unhappy, which is, or course, all or nothing thinking? Doesn’t happiness exist on a spectrum, from say 1 to 10?

Shouldn’t the question be, “Do people need a romantic relationship to achieve a certain level of happiness?”

To achieve a happiness level of 10, do people need a partner? If they could achieve a 10 without one, why would they bother attempting to then obtain one. Why bother trying to find a girlfriend if you’re not going to be any happier? How happy can one be without one?

Shouldn’t you change your statement to: people assume they can only achieve a happiness level of about a 2 without a partner when in actuality they can achieve a level of about a 7?

What are your thoughts?


Hi Richard,

Happiness, like all emotions, exists on a continuum, and you could measure it on a scale of 0 to 100, for example. So sometimes we are not happy at all, and other times we may be extraordinarily happy. The same is true of sadness, anxiety, anger, discouragement, shame, and so forth. Emotions do not exist in an All-or-Nothing way.

Our culture definitely teaches us that we need love to feel happy and fulfilled. In one of her famous songs, Barbara Streisand’s sings that “people who need people are the luckiest people in the world!” So most people naturally assume that we “need” love to feel a high level of happiness and fulfillment.

When I first heard Dr. Aaron Beck assert that love is not an adult human need in one of the weekly seminars I was attending during my research fellowship at the Penn Medical School, I had the thought, “My gosh, he must be a sociopath to say such a thing!”

But I decided to test what he was saying, spending more and more time alone, just to see what would happen. I did it as a series of experiments, using my Pleasure Predicting Sheet. It consists of several columns, and in the first column you schedule a variety of activities with the potential for pleasure, satisfaction, learning, personal growth, and so forth. In the second column, you record who you plan to do each activity with. Make sure you schedule some activities that you will do on your own, as well as activities you will do with others. In the third column, you predict how satisfying or enjoyable each activity will be, from 0 to 100.

Now you are ready for your experiment. Go ahead and do each activity, and after you’re done, write down how satisfying it turned out to be, between 0 and 100, in the fourth column.

When I did this, I was shocked to discover that I could be maximally happy when doing things by myself. This was a revelation to me, and at first it was hard to accept. These experiences definitely changed my thinking. But the conclusion was absolutely consistent with the basic premise of cognitive therapy, that our thoughts, and not external events, create all of our feelings, positive and negative. I have treated large numbers of people who were extremely depressed, even suicidal, who were very loved; but their minds were loaded with negative and distorted thoughts about themselves and their lives.

I am only touching on this topic in a superficial way here. You can read more about this notion in the first section of Intimate Connections, which is all about learning that you can be happy when you are alone. You can also read more about this in the chapter on “The Love Addiction” in my first book, Feeling Good: The New Mood Therapy. And you might want to watch the reality TV show, “Alone,” which just completed its third season. It’s all about being stranded in the wilderness alone for prolonged periods of time, to see how long you can survive. The winner receives $500,000.

The topic is extremely controversial, like so many topics in mental health / psychology. And everyone is pretty sure they are an expert who knows “the truth.” So the post might fire up some controversy.

At any rate, you asked why anyone would want to have a boyfriend or girlfriend, or friends at all, if you can be completely happy when you are alone. Well, there is a difference between “needing” something and “wanting” something. For example, I might want a fancy new sports car, but I don’t “need” one to be completely happy.

From a practical point of view, I have treated large numbers of single men and women who were having a terrible time in the dating world, and usually they were telling themselves that they “needed” love to feel happy. This made them come across as “needy,” and their neediness forced people to reject them. That’s because of the “Burns Rule,” which states that “people only want what they can’t get, and never want what they can get.” So if you need someone, you become what they can get, and they won’t want you.

So I always encouraged these single individuals to overcome their fears of being alone before I would teach them how to get people chasing after them. And this was nearly always effective. Once they no longer “needed” people, but had learned how to love themselves first, then they were far more successful in the dating world.

So that’s why all the chapters on flirting and such in Intimate Connections follow the initial section on learning to be happy when you’re lone.

Personally, I love to be alone! And many of the happiest moments in my life where moments when I was lone.

And I also love to hang out with others, and I love to give and receive love from those I’m close to as well. And that includes my family, students, friends, and even, or especially, our beloved cats!

Well, there my answer, Richard, but I’m sure we’ll get a ton of comments from folks who, like yourself, are hooked on the idea that we “need” love to feel maximally happy! I have created dozens of techniques to help folks overcome the fear of being alone, but that is perhaps for another day.

Oh, one last thing. If you have a firm belief that you cannot be happy when you are alone, it may function as a self-fulfilling prophecy. For example, I once treated a woman who’d been rejected by her husband, who was having an affair with his secretary. She told me she had proof she couldn’t be happy when she was alone, because she was alone and constantly miserable, for example when eating dinner.

I asked her what she had for dinner the night before. She said she sat in a chair facing the wall and ate a peanut butter sandwich.

I said, “Well, maybe that’s why you were feelings miserable. What would you have for dinner if you had invited your favorite person in the world for dinner? For example, some celebrity you intensely admire?”

She said she’s buy the best food at the grocery store and prepare a gourmet meal, with candles, music, etc. I suggested she might try doing that for herself, as an experiment, using the Pleasure Predicting Sheet. She predicted that shopping, cooking, eating would be 0% to 5%, a scale from 0% to 100%, because she’d be alone.

She also had a luncheon scheduled with her husband later in the week, and had predicted it would be 95%, since she wouldn’t be alone. She fantasized they’d talk about getting back together.

But she was shocked by the results of her experiments. Shopping and cooking a gourmet meal for herself were 95% satisfying. And then she sat down with herself, with music and candles, and ate the dinner, and it was 100%. She said she got so high—no drugs or alcohol, mind you—that she took herself out dancing (in the living room), and just loved being with herself. This blew her mind.

The luncheon with her husband was also mind-bending. He spent the entire lunch talking about what a wonderful lover his secretary was, and how they’d divide up their belongings for the divorce. And of course, he was an attorney, and his suggestions involved pretty much everything for him and nothing for her.

In the Outcome column of her Pleasure Predicting Sheet she recorded 0%. The data were simply not consistent with her belief that she “needed” her husband’s love to feel happy and fulfilled.

Then she asked me what she should do next. I told her that now that she no longer “needed” love, it would be pretty easy for her to do some flirting with attractive men she met, and I told her that as soon as she found someone she really liked, and she no longer even wanted her husband back, I promised her that her husband would then come crawling back to her.

And that’s exactly what happened. She met a handsome hunk of a guy who was also recently divorced, and they fell madly in love. That very day her Ex called and said he’d changed his mind, and begged for her to accept him back. But she didn’t. She told him she was far happier without him, and wanted the divorce to be accelerate.

Her husband called me in a rage. He’d referred his wife to me initially, because he was afraid she was suicidal, and he’d asked me take care of her. He shouted in the phone, “I told you to take care of her!”

I replied, “I did, I did!”

If you’re interested, you can read more about the story in Feeling Good. She was one of the first people I treated with cognitive therapy, way back in the early days! But I’ll never forget!



Hi Dr. Burns,

Thanks for your response. Here is mine.

You keep drawing a distinction between needing and wanting.

I don’t see the importance of that. You say you don’t need a sport car to be completely happy, but you may still want one. If you could be completely happy without one, why would you want one?

Also, in order to be completely happy (long-term, not just for a few seconds) what does one need? Do you agree with many psychologists that to live the happiest life you need four basic things:

1. enjoyable work

2. good friends

3. good hobbies

4. good romantic relationship


Thanks, Richard!

Excellent response! Can I post your response, and my email on my website, as part of the post, with or without your name? Beyond this exchange, that would be the end of the posting of exchanges, however, as it gets too long, perhaps.

Personally, my answer to your excellent question is no, but that’s just my take on it, and not some absolute truth. I don’t see these as “needs.” But you can set it up like that if you want, and think of these things like enjoyable work, hobbies, love, and friends as basic human “needs,” and this might not be a problem for you. As a “shrink,” I don’t try to teach people about some “right” or “wrong” way to believe or think about things. I simply try to help individuals with problems they are having.

Lots of people do not have enjoyable work, and yet they are quite happy. They see their work as a way to earn money, and they do things that are more interesting to them when they are not at work. There is no rule that says everyone “must” find enjoyable work.

When I was in college, I did construction labor in Phoenix for two summers. It was pretty demanding work, with pick and shovel, and also lots of sweeping with a big broom, and it was hot that summer, with little no shade on the construction sites. The temperature in the shade was usually 105 degrees, and the temperature in the sun where we were working was typically 135 degrees. One of the laborers I worked with was named Carmen, and he was constantly telling me I did not use the shovel or broom correctly, and he would show me better ways to dig or sweep.

I would not say that the work was “enjoyable,” but I was very grateful to have a job and the chance to earn some money. The hourly wage, due to the union, was $3.10 per hour (Local 383 of the AFL), which seemed like a fortune to me, since we did not have much money. Another summer I had a job filing checks in a bank, which was boring, but tolerable, but definitely not “enjoyable.” I did try to make it interesting, however. For example, I tried to learn about the lives of the other construction laborers I worked with, since in my upbringing I did not have the chance to meet lots of people who were doing construction labor for a living. I felt a bit intimidated, but they were all really kind to me, and I worked as hard as I could.

Many people, and perhaps most, do not have jobs that are especially enjoyable. Now, if they tell themselves, “Oh, an enjoyable job is a ‘need,’” then they might feel unhappy and pressure themselves a great deal, thinking they have somehow fallen short of some basic human need.” If they wanted help with their negative feelings, and only if they wanted help, we could use a great many of the TEAM-CBT skills to help them, and this would likely be a really easy problem to solve. But if they were not asking for help, then I would simply “Sit with Open Hands,” since I have no special expertise in what people in general “should” or “shouldn’t” think or believe. My task is to help individuals who are struggling with depression, anxiety disorders, relationship problems, or habit and addictions, assuming they want help.

The most fundamental error in psychotherapy, in my opinion, is trying to help someone who is not asking for help, as this nearly always triggers resistance and a kind of log jam between the patient and therapist may develop. Of course, if someone is ambivalent, and wants to dialogue about that, it can be very productive, and there are tons of TEAM-CBT tools we could use—Empathy, Paradoxical Agenda Setting, and Methods. For example, we could do a Cost-Benefit Analysis (CBA) and balance the Advantages against the Disadvantages of viewing an enjoyable job as a “need.” Then we could balance the advantages against the disadvantages on a hundred point scale. For example, is it 50-50? 60-40? 35-65?

Then we could do a second CBA, balancing the advantages against the disadvantages of thinking of an enjoyable job as a “want,” and balance the advantages against the disadvantages on a hundred point scale.

The way you use language is a personal decision. It is not so much the idea that one approach is inherently more “correct.”

Similarly, when you goof up at something, the way your think and use language will impact your feelings. For example, you can beat up on your “self,” telling yourself “I am a bad teacher,” or a “failure as a father,” or some such thing. These kinds of thoughts contain multiple cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, Labeling, Self-Blame, Emotional Reasoning, Mental Filtering, and Discounting the Positive, and they are hidden Should Statements as well. These distortions will probably trigger feelings of depression, shame, anxiety, inadequacy, loneliness, and hopelessness, because the negative thoughts sound so absolute and permanent.

Or instead, you can focus on the specific error you made as a teacher, or as a father, or whatever, and make a plan to correct it. These two approaches are a matter of personal choice, but they can have massive implications in terms of how we feel.

The idea that our thoughts create our feelings is also a spiritual notion, embedded in Buddhism and nearly all religious traditions. Buddha emphasized the importance of focusing on specifics, rather than thinking about our errors and shortcomings in global terms. He was one of the first to teach that our thoughts, and not our external circumstance or the events in our lives, cause all of our feelings, positive and negative. We are creating our own emotional reality at every moment of every day. This notion is some basic, obvious, and fundamental, that many people simply cannot “see” it, or grasp it. Understanding this notion is one form of enlightenment.

Many people with enjoyable work, good friends, wonderful hobbies, and great romantic relationships are depressed and suicidal—I have treated many of them in my career—and many people who lack these things are very happy. But again, it is a matter of choice how you want to think about your life. If you ruminate about things you don’t have, and you tell yourself that these are “needs,” how will you feel?

I go on Sunday hikes with members of my training groups at Stanford. The hikes are not a basic human “need.” I spent most of my life not going on Sunday hikes. So if the hikes are not a “need,” why do I go on them? That is the type of question you are asking. I go on the Sunday hikes because they are a lot of fun. It gives me the chance to do personal work with students and colleagues, and to get to know people on a deeper level. In addition, it is a nice way to get some exercise.

To me, wants and needs are very different. Why do we do anything? For me, I do things because I am alive, and grateful that life offers so many opportunities and experiences. We have a new kitten—sadly, my beloved Obie disappeared two months ago. He was my best friend and likely killed by a predator in the middle of the night, in the woods behind our house. I will grieve his loss for a long time. I still shout out his name when I am out jogging, thinking he might hear me and suddenly appear, even though I know he is gone. A neighbor kindly gifted my wife and me an adorable kitten they found abandoned by the side of Moody Road, near a trail I hike on. She was three weeks old and it was a rain storm. They took her home and gave her a loving home for several months. But they traveled a lot, and did not like to leave her alone, so they gave us this beloved kitten, Miss Misty, who is now 4 ½ months old. And what a joy she is! So cute and full of life, and love. But I do not think of Miss Misty as a “need,” but rather as a gift, or as a little miracle of sorts.

Dr. Beck once told an interesting story in our weekly training group when I was first learning cognitive therapy. He said he and his wife went to a night club to hear some jazz performance, and the man sitting alone at the table next to them seemed like he was having an extraordinarily good time, even though he was alone, Dr. Beck asked the man why he was so happy. The fellow said he was incredibly happy because he’d just gotten an extremely important promotion at work. Dr. Beck asked him what work he did, and what promotion he’d received. The man said he’d been working in a local bakery for 25 years, and he had the job of making the donuts in the kitchen in the back area of the bakery. But he said that earlier in the day, the manager said that he could actually arrange the donuts in the display area, and gave him a 10% raise, and thanked him for the excellent work he’d been doing for so many years. The man was beside himself with happiness! Dr. Beck talked to him a bit more and learned that the man was living alone and could not read or write, and had not graduated from fifth grade.

I guess the point Dr. Beck was making is that our thoughts, and not the facts of our lives, create our feelings. You can be miserable in the midst of abundance—like many of the depressed individuals I treated—or joyous in the midst of very little. It all depends on how you think about things.

Still, none of this is meant as persuasion, just examples to illustrate my own very different way of thinking about wants vs, needs. In my opinion, we “need” oxygen, food, and water to survive. The new reality TV show, “Alone,” illustrates this very well! But I do not believe that we “need” enjoyable work, love, hobbies, or friends, although all of these can be sources of pleasure and joy.

But that’s just my way of looking at things. Ultimately, we are all free to think about things in whatever way we want. And lots of therapists do like to emphasize the “needs” we have as human beings. And I would say this line of thinking is “politically correct,” too. Your point of view, Richard, is quite popular, and if it is working for you, then there is no real need to change!


Hi Dr. Burns,

Yes you can use my first name if you publish our emails. We could go on forever so i will respond briefly.

As far as four things people need for happiness, maybe we could add a fifth which would be good health (depression being bad health).

Also, there are people who are happy who have bad jobs but are they really a 10 on the happiness scale or more like an 8?

Thanks for your thorough response.


Hi Richard,

You are most welcome! And thanks for the good dialogue which will likely interest a few people. However, this blog may make some people mad (at me, not you), since my thinking is somewhat politically incorrect.

But once again, my answer is no. Good health is wonderful, but not a requirement for happiness, and certainly not a guarantee for happiness, either.

In addition, my hunch is that there is no “cap” on happiness one way or the other. I have had many patients test this theory with the Pleasure Predicting Sheet that I described earlier in the blog. An experiment can be a nice way to check these beliefs out, sometimes.

I’ve treated or known many people with severe illnesses who were tremendously happy and content with their lives. And I’ve treated many, of course, who were in great health, but miserably unhappy.

I had a pretty severe problem with my right hand years ago (reflex sympathetic dystrophy), and had to do hand exercises 18 hours a day for 6 months to get my hand back to normal, or close to normal. I also had to go for hand therapy several times a week in a gym designed for people with serious hand injuries.

I was always amazed at the cheerfulness and friendliness of many patients in that gym who had the most grotesque and horrible hand injuries you can imagine. One was a woman with extremely advanced arthritis in both hands, and her profession was restoring rare paintings. She could barely move her fingers! And I can remember a professional skier whose hand had been crushed by a truck, and it was as flat as a pancake, making it nearly impossible to hold onto those things that skiers hold while skiing. But they weren’t complaining, and had the most positive outlook on life.

And I can remember an African America high school student who was doing some kind of exercise on one of the hand machines next to me, so I struck up a conversation and asked him what he planned to do with his life when he finished his schooling. He said he was hoping to become a professional basketball player. Then I asked him about his hand injury—what had happened?

He explained that he was injured when using a saw in his shop class at his high school, and that both of his hands had been cut off. He explained that they tossed his hands into a bucket of ice water and rushed him to the University of Pennsylvania Hospital Emergency room, and that Dr. Osterman (who was also my doctor) had sewn his hands back on. And he told me he wasn’t giving up on his dream!

But there were usually one or two patients in the hand gym who were miserable complainers, nasty, demanding, and hard to be around—and usually their hand injuries were mild. So once again, it is our thoughts, and not the external circumstances, that create our emotions, positive and negative. But that’s just my mind-set, and others will have different ideas for sure!

I remember diagnosing terminal lung cancer in a woman I treated in our hospital in Philadelphia before I moved back to California years ago. I had been making rounds with the residents to prepare for my medical board examination when we moved to California, since I had let me medical license in that state run out and was pretty rusty on my memory of medicine.

The woman was very cheerful, and the residents who I made rounds with kept telling me that she “should” be more upset, as if her reaction to her diagnosis was somehow wrong, or involved denial, or some such thinking. But she told me that she was a deeply religious woman, and that she was extremely grateful that she’d had a good life, with two daughters who she loved and who loved her a great deal. She told me that she had nothing to worry about, and nothing to be upset about, because if it was God’s time to take her home to heaven, then she was ready to make the trip!