Here’s the short version of today’s Ask David questions.
Do depression and anxiety result from medical illnesses, like thyroid problems?
Do we REALLY create our own interpersonal reality? What if you’re being raped? Are you saying that’s your fault? How can that be?
I struggle with anxiety. Why is it a mistake to try to “calm down?”
How do you deal with entitlement? I think my patients should do what I tell them to do! After all, I’m a highly trained professional!
How do you deal with racism, sexism, and other societal barriers? What if the injustice is real and it isn’t “all in your head?”
And here are the longer versions. Fabrice and I hope you enjoy these thoughtful questions submitted by listeners like you!
1. Barbara asks: 1) How are hypothyroidism, depression, anxiety, and bipolar disorder related, and (2) how are heart disease, depression, and anxiety related?
2. Mark asks: I’m one of your most avid listeners to your podcasts. I’ve listened to most of Feeling Good Podcasts as well as the recordings of your Facebook live broadcasts with Jill. I absolutely love your content and extremely grateful for your insights and the material you put out for free. I’ve heard you say numerous times how in interpersonal relationship problems we create the poor behavior we see in the other.
At what point though, is a threshold crossed and you acknowledge the other in the relationship is creating problems? For example, if your client is being raped by their partner and is being threatened with violence if they dare leave, you wouldn’t say to your client you’re creating that kind of treatment from your partner.
Obviously the above is a very extreme example, but what if its scaled back in terms of severity of abuse, stopping short of physical attacks and threats? Where does a line in the sand get drawn where you acknowledge the client is not creating the problems themselves? I’d deeply appreciate your reply!
3. Angela asks: I was intrigued by your comment in your podcast #88 on Role-Playing Techniques that “trying to calm down is a big mistake. . . then your emotions become your enemies,” but then you said, “that’s a good topic for another podcast.” I hope you do a podcast on that topic!!! I’m eagerly waiting to hear more about that!
4. Julio asks: I’d like to share my experience. I am a therapist and I suffered from, and am still working on, feeling inadequate. I frequently questioned “am I good enough to be a therapist?” “How can I help others if I have issues of my own?”
After reading Feeling Good I realized I frequently jump to conclusions, engage in mind reading, and labeling whenever there is some uncertainty with my clients. At times I might even have blamed them when things didn’t go the way I thought they should go.
I believe I do that to protect my ego, and I might have developed some cognitive distortions related to entitlement such as
“I’m a therapist, people are supposed to do what I say”
“I worked too hard and too long and potential employers better give me what I deserve”
“Because I practice evidence-based therapy, I’m better than 99% of all therapists.”
These entitled thoughts led me to become irate whenever someone didn’t act according to my expectations. I would vacillate between feeling angry and feeling depressed.
I guess when I initially emailed Fabrice I was confused as to how my entitlement develops, but now I’m realizing that it comes from the same distortions that can cause depression. I didn’t know that distortions could produce depression and entitlement.
I’m curious what you and Fabrice think about this. I thoroughly what you and Fabrice think about this. I thoroughly enjoy your podcast and often find myself re-listening to earlier episodes.
5. Holly asks: “ Burns: I have found tremendous value in your books and podcast. I have noticed that you discuss some emails/letters/etc. on your podcast and I have one I’d like to hear you discuss. What are your thoughts on dealing with racism, sexism, and other societal barriers?
For example, it is not uncommon for people with dominant identities (white, male, physically able) to tell women, people of color, or those with physical challenges that their issues are all in their minds and that if they thought differently, then they would have different outcomes.
I am an African-American woman and I don’t believe this (the statistics on access to education, employment, and justice all suggest otherwise). What are you saying (if anything) in your writing, practice about thoughts related to injustice?
So there you have it! Great questions, and keep them coming!
By the way, one of our podcast fans has written an outstanding and thoughtful article asking if there is a causal link between Donald Trump’s Twitter tweets and anti-Muslim hate crimes for the prestigious journal, Scientific American. Here’s the link.
Thanks, David and Fabrice
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 email@example.com. You can reach Dr. Burns at firstname.lastname@example.org. If you like our jingle music and would like to support the composer Brett Van Donsel, you may download it here.
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.
THERE WILL BE MANY EXPERT TRAINERS TO GUIDE THE ONLINE PARTICIPANTS DURING THE SMALL GROUP EXERCISES
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.
HOW MUCH DOES IT COST? $135,
WILL I GET CE CREDITS? YES! 7 CE hours available
WILL I GET CREDIT IN THE TEAM LICENSURE PROGRAM? YES! 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.
WILL I HAVE FUN? Yes!
WILL I HAVE GET TO HANG OUT WITH SOME COOL COLLEAGUES? Yes!
WILL I GET AN AWESOME FREE BREAKFAST AND LUNCH? Yes!
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.
Fabrice and David address several challenging questions submitted by individuals who listen to the Feeling Good Podcasts.
Richard: Do you have to get along with everybody? How do you deal with a sociopath?
Dave: Positive distortions can trigger mania, addictions, narcissism, and violence–but how can you get rid of them?
Julia: What can you do if you’ve been depressed all of your life and wake up every morning with your mind flooded with negative thoughts? I spend two hours trying to dispute them, but they just keep coming back the next day.
Omhur: How would you treat “Reading OCD?” I feel compelled to read every sentence and paragraph carefully and repeatedly so I won’t miss anything!
Unnamed fan (who left a negative review on iTunes): Isn’t your concept of the death of the ego potentially dangerous to people with low self-esteem who are being abused?
Thank you for your terrific questions, your frequent praise, and your occasional criticisms and challenges. They keep us on our toes, and we deeply appreciate all of you. So keep your comments coming, as well as your suggestions for shows and topics you want to hear more about!
We are receiving more than 50,000 downloads a month. Please tell your friends about us so we can continue to build our audience.
Thanks! We really enjoy doing these shows for you.
David and Fabrice
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October / November / December 2018– Cool Workshops for You!
Sunday October 28th, 2018 (8:30 am to 4:30 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.
The in person version is now sold out, but limited spaces are still available if you would like to join online. There will be experts to assist the online participants with small group exercises in break out rooms, so you will have the same experience as those who attend in person. But act fast it you want to be included!
November 29 and 30, 2018–San Francisco, CA (in person only)
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!
I am confused about the idea that depression and anxiety result from distorted thoughts. For example, you say that anxiety always results from the distortion called Fortune Telling—making unrealistic negative predictions that something terrible is about to happen.
If anxiety is results from telling yourself that something bad is about to happen, feeling alive and euphoric must result from predicting that you’ll have a good future—is that right? But isn’t that also a distortion?
Why should I believe that everything is going to be fine? Isn’t that equally ridiculous as believing something bad is going to happen?
Have a Nice Day!
Thank you for the thought-provoking question. I have edited your question to make it a bit more focused and understandable, and I hope that is okay. And here is the short answer if you don’t like to read too much of my babbling—it probably isn’t a good idea to tell yourself everything is going to fine, because it isn’t!
Bad things happen to all of us. For example, you’ll make mistakes, you’ll fail at some things, you’ll lose people and things you love, and you’ll experience illness and eventually, death. Good things will probably happen to us, too! For example, you seem to be interested in my work, and you ask good questions. That’s cool! I am honored by that, and consider myself fortunate.
But these events do not cause you to feel the way you do. Your thoughts create all of your feelings, positive and negative. That’s been known for at least 2,000 years, since the time of the Greek philosophers, like Epictetus, who said that humans are not disturbed by events, but rather by our views of them. In my opinion, the most important issue is whether your thoughts about these events are realistic or distorted.
In my two podcasts on my list of ten cognitive distortions, first published in Feeling Good: The New Mood Therapy, I emphasized that negative and positive distortions can both cause problems. Let’s focus on negative distortions first. The negative thoughts that trigger depression and anxiety will practically always have many of the distortions I’ve described, such as Jumping to Conclusions, All-or-Nothing Thinking, Overgeneralization, Should Statements, Self-Blame, Magnification and Minimization, Labeling, and more.
That’s why I’ve said that depression and anxiety are the world’s oldest cons—because you’re telling yourself things that simply aren’t true, but you don’t realize it. For example, depressed patients often feel worthless because they tell themselves that they are “losers” (All-or-Nothing Thinking). They may also feel hopeless because they tell themselves that they’ll be depressed forever and their problems will never be solved (Fortune-Telling).
As you so wisely pointed out, you see the exact same distortions in anxiety. For example, a woman with an intense fear of flying told herself, “Oh, I just know that the plane is going to run into turbulence and crash!” This is an example of Fortune-Telling–making an unrealistic prediction. It’s also an example of Magnification–blowing any real danger way out of proportion. And it’s an example of Emotional Reasoning as well–she’s reasoning from her feelings, telling herself that she feels frightened, so she must be in danger.
Cognitive therapists use many powerful techniques to help individuals struggling with depression and anxiety put the lie to the distorted thoughts that trigger their distress. In fact, I use more than 75 different techniques. And the very moment you stop believing the negative thoughts that trigger your depression and anxiety, you will immediately experience a profound improvement in your mood. However, this type of therapy is extremely sophisticated and requires a high degree of therapeutic skill and training. You can’t just tell someone to cheer, or feed them a line of positive baloney! People are not that stupid!
It would be wrong to conclude that all negative thoughts are distorted. In fact, many negative thoughts are valid, and not distorted. Realistic negative thoughts trigger healthy negative emotions, such as healthy sadness or healthy fear. For example, if you are walking in a dangerous part of town at night, you may be feeling frightened because you are telling yourself that you are in danger of being mugged or murdered. You don’t need to treat your fear with a pill or psychotherapy. You WANT the fear because it may keep you alive!
The same is true for the thoughts that trigger healthy sadness. For example, I recently lost my beloved cat, Obie, who was likely eaten by a predator in the middle of the night a couple months ago. I loved him tremendously, and he was the joy of my life. We were very close. In fact, I often described him as my best friend in the whole world, and one of my best teachers, too. Now I am grieving his loss, and will miss him for a long time! My grief is an expression of the intense love I felt for him, and does not need treatment. Nor do I need or want anyone to try to cheer me up. I’m fine with my sadness.
There are also ten positive distortions that are the mirror images of the ten negative distortions. For example, depressed patients are into the “nothing” of All-or-Nothing Thinking, but patients with mania are often into the “all” of All-or-Nothing Thinking when they tell themselves, “I am a winner! I’m the greatest!”
Politicians sometimes try to control people by combining negative and positive distortions. Hitler told the German people they were the superior race (the positive distortion) and that the Jews were inferior and to blame for Germany’s economic problems (the negative distortions). These positive distortions led, as we all know, to murder, sadism, and war. Some politicians today appear to be using similar strategies, and gaining a frightening amount of power.It is shocking and disturbing to me that so many people are gullible and cannot see through them!
Positive distortions not only trigger mania—which you can see in the crowds who were listening to Hitler’s speeches in a frenzy of manic excitement—but play a central role in narcissism, relationship conflicts, violence and addictions as well. Much of the world’s suffering results from negative distortions, but a great deal results from positive distortions as well.
Positive distortions are never the antidote to depression, in my opinion, and telling yourself nonsensical positive things that are not realistic will rarely or never be helpful to anyone, in my experience. But if you believe positive distortions, you will likely feel temporarily high, overly confident, and even euphoric.
Healthy joy results from positive thoughts that are realistic, just as healthy sadness results from negative thoughts that are realistic. I hope this helps to clarifies the difference between distorted and realistic thoughts.
For more information on how to overcome the thinking patterns that trigger depression and negative, I would guide you to any of my books, like The Feeling Good Handbook.
Do you believe that addictions can be healed without a support group? And if so, why is there no book by Dr. Burns specifically on addiction recovery?
Dr. David’s Response
Thanks for your question. I have a new workshop on addictions and habits for next year, so I have been thinking about this topic. Also, some of my students and colleagues in my weekly training group at Stanford treat habits and addictions, including eating disorders, drug and alcohol abuse, and so forth. So we spend quite a bit of time developing new treatment techniques.
I think that support groups, like AA or Smart Recovery, can be helpful for many people with addictions, and support groups like Recovery International (formerly Recovery, Inc) can be helpful to people with mood or relationship problems. However, some people can conquer habits and addictions without a support group. Partly, it depends on the severity of the problem and the motivation of the individual.
Many people believe that people overeat or use drugs or alcohol to self-medicate their own depression, loneliness, or low self-esteem. While this may be partially true in some cases, I believe that habits and addictions are primarily motivational problems, and not emotional problems. My recent research on approximately 160 patients admitted to the Stanford Hospital’s psychiatric inpatient unit did not seem to support the notion that depression and anxiety trigger addictions. In fact, individuals who were depressed actually tended to binge less, on average, than individuals who were not depressed. I have not published this finding, as the main focus of the research was different–but the negative correlation between overeating and depression was consistent with conventional psychiatric thinking that a loss of appetite can be a symptom of depression and low self-esteem.
In addition, I could not validate the idea that depression and low self-esteem have a causal effect on alcohol or drug abuse, either. But a brief assessment test I developed called the “Urges to Use Scale” was massively correlated with drug and alcohol use. This seems to indicate that positive, seductive temptations are the driving force behind most, if not all, addictions.
In other words, my findings suggested that people drink or overeat or use drugs primarily because it feels darn good to overeat or get high. So why do we overeat? I believe that we overeat because of the abundance of good food in our society, and because eating is immediately reinforcing. Of course, alcohol and drugs are also widely available in our culture, and TV ads provide powerful temptations to drink.
While distortions are involved in addictions, they are mainly positive distortions, such as “Oh, that beer would taste SO GOOD!” Or “I deserve some dark chocolate right now. I’ve had such a hard day.” I have created a list of ten positive distortions that correspond to the ten negative distortions in my books, such as Feeling Good. They positive distortions are mirror images of the negative distortions, and I will post them soon on my website.
Of course, negative distortions also play a role in addictions, along with positive distortions. After giving in to the temptation to drink or overeat, we may scold ourselves with negative distortions: “I SHOULDN’T have eaten that chocolate. I’m just a fat pig. I’ll NEVER lose weight!” These thoughts can trigger feelings of shame and hopelessness, which can trigger more addictive behavior, such as overeating or compulsive drinking.
Unlike negative distortions, positive distortions create immediate positive consequences if you give in to them. That’s why habits and addictions can be challenging to treat, and why motivational techniques are of tremendous importance. Traditional cognitive therapy techniques can be helpful for the negative distortions, but new and different kinds of techniques are needed to combat the positive distortions, such as Paradoxical Agenda Setting, the Decision-Making Form, and the Devil’s Advocate Technique, to name just a few. Of course, Empathy and respect for the patient are also extremely important.