David Burns is an adjunct professor emeritus in the Department of Psychiatry and Behavioral Sciences at the Stanford University.
Here is the full text of David’s talk titled “Feeling Good” at TEDxReno conference.
David Burns – TEDx Talk TRANSCRIPT
Well, my talk is on depression and anxiety.
Sometimes some of us fall into black holes of self doubt, anxiety, inferiority, feeling like we are not good enough, beating up on ourselves. How many of you sometimes feel that way? Put your hands up if you’ve ever struggled with depression or anxiety or self doubt?
It is one of the worst forms of human suffering.
I’ve had patients who told me that they pray to God at night, that they could develop cancer so they could die in dignity, without committing suicide. How many of you have ever felt maybe that your life was not worth living or have known a friend or loved one or a colleague who made a suicide attempt? Put your hands up if it had ever touched you. It’s one of the most horrible, horrible things.
I started out at University of Pennsylvania medical school, I finished my residency. And I did a research fellowship on depression, and I was always curious what makes us depressed, why do we fall into these black holes, what’s the cause of it, what can we do to turn these moods around?
And I started out like many young psychiatrists. It’s what you call a biological psychiatrist. I was doing research on brain chemistry, this idea that depression and anxiety are due to some kind of chemical imbalance in the brain. I was treating patients with antidepressants and other medications.
But there were only two problems from my point of view. The first is our own research — research we did, didn’t seem to confirm that depression or anxiety were actually due to a chemical imbalance in the brain. In fact, our research indicated that this probably is not the cause of depression and anxiety.
In addition, I was giving antidepressants by the bucketful to patients. I had hundreds of patients, only a few of them were being helped. Most of them were not. They were going on week after week, saying I want to die, I feel worthless.
And, I said, “Gosh, there’s got to be a better way.” If the pills had worked I would have been perfectly, perfectly happy. And I thought maybe there’s some type of psychotherapy I could combine with the medications, because I wanted people to be able to wake up and say “It’s great to be alive”, and “I have joy, and full of love, I am full of life” and I was rarely seeing that.
And I tried different kinds of psychotherapy. They didn’t seem to work, and then a colleague said “You know, there is something new, fellow here at Penn is developing, Aaron Beck, and he calls it cognitive therapy and it is kind of simple in its theory. And maybe you could try this out with some of your patients.”
And cognition is a thought, it is just a fancy word for a thought, and there is three basic ideas behind cognitive therapy.
The first, is that our thoughts create all of our moods. And that when you’re depressed and anxious, you’re giving yourself negative messages. You’re blaming yourself, you’re telling yourself something terrible is going to happen.
Now, this idea is not new. It goes back to the Greek philosopher Epictetus. Nearly 2000 years ago, he said people are disturbed not by things, in another words, not by the events of our life; but by the views we take of them. That, we create all of our emotions, positive and negative, at every moment of every day through our interpretations of what’s going on.
And that goes back even before Epictetus to the Buddha, who was saying the same thing 2500 years ago.
Well, the second idea is that when you’re depressed and anxious, those negative thoughts: I am no good, I am a loser, what’s wrong with me, I shouldn’t have screwed up, I should be better than I am — those thoughts are not realistic thoughts. They’re distorted. That depression and anxiety are the world’s oldest cause.
And that there is ten distortions that you always see in the negative thoughts of individuals who are depressed and anxious, like all or nothing thinking, if I am not a great success today, I will be a total failure. Shapes of gray don’t exist or over-generalization, seeing a negative event has a never ending pattern of defeat or should statements or self blame.
And the third idea was that you could train people to change the way they think, and then suddenly change the way they feel.
Well, I heard that theory and I said: “That sounds like so much bullshit.” I know my patients have negative thoughts. That’s certainly the case, but you can’t help serious suicidal, depression with some kind of power of positive thinking. And I told the colleague that.
He says, “Well, David, why don’t you go to Beck’s weekly seminar and as part of your research try this with a few of your toughest patients and then you can prove to yourself that it doesn’t work.”
And I said that’s, that’s a great idea. I think I will check it out.
Well, the first patient I tried it out was a woman, referred from the intensive care unit of the University hospital. She had made a nearly successful suicide attempt. An elderly Latvian immigrant. They referred her to me for a follow-up.
And I said “Martha, there is this new form of therapy and I am doing some investigating and would it be okay if I present your case at this weekly seminar? And then, I can tell you what they say and maybe we can find some new techniques. And she was fine with that, she gave me permission.
So I presented her case to Dr. Beck. I said: “How would you use this cognitive therapy with someone who is suicidal?”
And he said: “Well, our thoughts create all of our emotions, so just ask her what were you telling yourself the moment you try to commit suicide.”
So, I went back to her and I said to her. She said: “What did you find out at the seminar?”
I said “Well, I am suppose to ask what were you telling yourself the moment you attempted suicide, what were your negative thoughts.’
And she said “Oh, I was telling myself that I am a worthless human being, because I’ve never accomplished anything meaningful or significant in my life.”
And she said “What am I supposed to do about that?”
And I said: “I am not sure, you have to wait a week until I go back and ask at the seminar.”
So I went back and said: “Here’s what I found out and, what should I do?”
Dr. Beck said: “Well, one technique we use is called ‘examine the evidence, see if what you are telling yourself is true or not. Ask her to make a list of the several things she has accomplished.”
I thought, that makes sense, so I went back and I said.
She said: “What’d you find out at the seminar?”
I said: “Well, you are supposed to make a list of the several things you have accomplished.”
She said “That’s just the problem, I can’t think of anything.”
And I don’t know maybe some of you folks felt that way, sometimes looking back on your life and say ‘What have I done that was really meaningful, really significant, what did my life really amount to’.
So, I said: “Well, why don’t you take it as a homework assignment, maybe you can think of something.”
Well, the next week, I forgot I gave her homework assignment. I did my usual non-specific schmoozing, and how are you feeling, and do you need a refill on antidepressants and this type of things and halfway through the session, she said: “Well, are you going to ask me about my homework?”
And I said: “I forgot, did you come up with anything?” and she handled me a list of about, oh, seven or eight things that she had accomplished during her life.
And the first one she said: “I overlooked the fact that… I smuggled my children out of Nazi Germany, my husband died in the concentration camps. My… all of our relatives died at the concentration camps, but I got the children out and we made it to America, and I worked scrubbing floors and cleaning people’s houses to keep food on the table and to keep roof over her head. And this week, my son just graduated first in his class from Harvard Business School. So I thought maybe that’s an accomplishment.”
And then she said “I forgot that I speak five languages fluently.” And I’m a gourmet chef and she had all these amazing things, and I said: “Martha, how do you reconcile this with your claim that you are a worthless human being, who’s never accomplished anything meaningful.”
And she said: “Dr. Burns, it doesn’t compute. It doesn’t make any sense, I don’t know how I could have been thinking that.”
And I said: “How are you feeling now?”
She said : “I am feeling a lot better!” She said: “Do you have more techniques?”
I said: “No, that’s the only one I’ve learned so far, you have to wait until next week, you know, I’ll learn another technique.”
And so, that’s how it began to go. And I began to see patient after patient that I have been stuck with some patients who said they have been depressed, had failed therapy for more than 50 years, some who said they never had one moment of happiness in their entire lives, suddenly experienced joy and self-esteem.
And I said; “This is the thing I want to commit my life to.” I had just received the grant from the government, a five year grant to develop a brain chemistry research laboratory at the medical school. And I sent the money back. I said. ‘I don’t want to spend my life doing research on a theory that’s not going to bear fruit. This is what I want to do.”
And then the research began to come in. First, the pilot study at Penn that showed that this new form of therapy was as effective, if not more effective than the best anti-depressant drugs. And then study after study has come in and now it’s become the most researched form of psychotherapy in history.
We all got excited and Dr. Beck said: “David, would you like to co-author the manual that we’re writing for therapists so people can learn how to do this form of new therapy.”
And I said: “You know you got enough people, Brian Shaw, Gary Emery and others who can co-author that book for you. I think my calling is to write the manual for the patients and for the general public that show people, give them tools, to begin to use these tools in their own lives, or maybe patients could read the book between the sessions to accelerate their recovery.”
So then I wrote the book ‘Feeling Good‘.
Another research came along, a fellow at University of Alabama began to do some research on what is the fastest and most inexpensive way to treat people with depression. He did some research I was unaware of.
He took people coming to the University of Alabama asking for therapy for severe depression and said you’ve got to be on waiting list for four weeks before you can see the psychiatrist. Meanwhile, we want you to read this book: ‘Feeling Good‘. And then he did research on them every week to see would there be any change in mood, and he reported that 69% of the patients in four weeks were recovered and needed no additional therapy.
He’s repeated, he’s done at least 8 outcome studies with the older citizens, teenagers, people all ages in between and has continued to come to the same conclusion.
And I kind of knew that was true because I’ve gotten at least probably 50,000 e-mails and fan letters from people who said: “I read your book, and it changed my life.”
Now, my group at Stanford, my psychotherapy development group, it is getting even better and we are developing even newer and more powerful techniques.
I think there is a difference between a technician and a healer. And one of the differences is can you use your tools in your own life, can you practice what you preach. I kind of live in the idea of physicians heal thyself. And certainly I have known my own moments of anxiety, like when I was invited to come to speak here. And the despair, as well.
And I was put sorely to the test when our son was born. I was there at his birth, and then, after he was born the doctor said: “You’ve got a wonderful, healthy son here, but the only problem is he can’t breath.”
And I looked at him and he was bright blue. His lips were blue, and his fingernails were blue and he was struggling to get air. And he said: “We are going to put him in the intensive care unit.”
Oh my gosh, this is horrible and I… He was born, I think around 10 at night, and I went home and I was feeling anxious and depressed and terrified and I told myself: “Remember it is not the events, it’s your thoughts that upset you.” I said: “Oh no, that can’t be true, this is real.”
I said: “Well that’s how, what your patients say, why don’t you write your thoughts down and see if there is some distortions in them.”
And I said: “Okay, I will. Well, first thought is well my son needs oxygen for his brain and he is going to have brain damage, and then the second thought will be bringing him to clinics for the rest of his life, and then I did little thing called downward arrow, if that were true what would it mean to you and the third thought, “Well, then people would look down on me because I have a mentally retarded son.”
Then I said: “Are there any distortions here?” I said: “Well, gosh, here is fortunetelling, I don’t know that he is going to have brain damage. Doctor never said that. He just said ‘We’ll put him in the intensive care unit’, and then, are people going to look down on me because I have a son with brain damage?” That’s ridiculous, people will feel about me depending on how I treat them and if I love them and treat people with care and compassion, they will respond”, and suddenly all my anxiety disappeared.
And then I said: “You know, look at how self centered you’ve been. Your son needs you and he is suffering at the hospital and he needs you.” I said: “I am going to go and see him.” I was on this faculty, so I can get into the intensive care unit.
I went in there about 3:00 in the morning, and I said: “Can I see my son?” They said: “Yes, certainly doctor.”
And then he was in this incubator as… (Inhaling and exhaling intensely) His whole body was shaking to get a breath and he was still blue, it was so sad and I said: “Can I touch him?” They said: “Well, you have to put this glove on and put your hand through this hole in the incubator.”
So I put my hand and I put my head on it — my hand on his forehead and I said: “Eric, I want you to know that we love you. Your mommy and daddy love you, and we are going to be with you every step of the way.” And I felt better and I went home and felt with peace and the phone rang. It was intensive care unit nurse and she says, “You know Dr. Burns, the oddest thing happened. The moment you walked out of the intensive care unit, Eric calmed down and started breathing. And doctor discharged him, he is cuddling with his mommy for the first time.”
Well, that’s about it. Eric suggested I tell the story. I’ve never told it in public before. I said: “I’ll tell it if you come on up to Reno with me so I can introduce you to the group.”
Eric: Wow, I think if I had dry eyes right now, then I would not be your son. Um, I just want to — if in case you didn’t get the message I think is that you don’t have to be blue anymore! All right. We can all be happy, and I just want to say you dad for inviting me up here such an honor. I am so proud of you. I am so proud of this speech, it was just phenomenal. And I — and your life’s work, and I just want to say I’m so thankful you had enough faith in yourself, had faith in me to give my life, so, thank you.