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David Burns on the Clearerthinking Podcast

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This is a transcript of the Clearerthinking podcast with David Burns. The transcript is preceded by a summary:

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Hello and welcome to Clearer Thinking with Spencer Greenberg, the podcast about ideas that matter. I'm Josh Castle, the producer of the podcast, and I'm so glad you joined us today. In this episode, Spencer speaks with David Burns about cognitive behavioral therapy and the team technique. Before we get into the episode, we wanted to let you know that EA New York City is hosting Spencer for a live recording of the Clearer Thinking podcast on January 30th, 2024. The event is titled The Moral Status of Insects and AI Systems and other thorny questions in global priorities research with Jeff, Sebo, and Spencer Greenberg. If you'd like to attend in-person, you can register either by clicking the link in the show notes or by visiting effective altruism.nyc slash events. David, welcome. Thank you. I'm excited to be on your show and honored. Well, I'm so excited to have you on. You probably don't realize this, but you were such a huge influence on me because I read your classic book Feeling Good about cognitive behavioral therapy when I was a young man. And it just had a profound impact on my life. It really got me to think differently about my own thoughts and my own emotions. I found it incredibly useful. I ended up going to a CBT therapist after reading the book because I was so, I was like, wow, this is amazing. And it also started my journey really thinking about psychology and getting really excited about it. So, yeah, it's just very exciting to be talking to you for the first time. Well, that's great. It was my pleasure. I'm just thrilled. And for the audience members that have not heard your name, you were really one of the people that popularized cognitive behavioral therapy, also known as CBT. I mean, before that, it was kind of a fringe thing. So, why don't we start there? What was, what was therapy like back in the day when you published Feeling Good? Well, yeah, I had been doing cognitive therapy for a few years. I had left my full-time position at the university after my residency. I was supposed to stay on at the medical school and I got a grant from the federal government to develop a kind of a brain chemistry research laboratory because everyone was saying that, you know, depressions due to some chemical imbalance in the brain. And our research gave powerful evidence that that was absolutely not true. And clinically, I saw that, you know, what I was doing wasn't helping people. Well, I was giving out antidepressants by the bushel fall. I would just say to people, tell me more. And we were just supposed to encourage people to talk and give them pills. And I almost never saw anyone really recover from depression. And then I heard about Aaron Beck's cognitive therapy. And the department chairman says, why don't you check this out? He says that depression is due to negative thinking. And I said, that sounds really stupid. He sounds like Norman Vincent Peel's power of positive thinking. And he said, well, why don't you just go to his weekly seminar and then you can try it with your patients and prove to yourself that it doesn't work. And I said, yeah, that would be kind of cool. So I started going to his weekly seminar and there were only about seven of us or five of us that maybe want a big week. We'd have 12 people there. And I would take my most difficult patients and present them. And I say, here's this, I have this woman just referred to me from the intensive care unit. And she's an elderly woman who attempted suicide. And she survived that they've sent her to me for follow-up care. What should I do? And then I'd get input from back and we'll try this and I'd go and I'd try it. And usually it was very effective. And I became amazed and I said, wow, this is for real. So I said, I don't want to do that brain chemistry research and hand out Peel's, Peel's, Peel's. I want to do something that will help people change their lives and go from despair to joy. And so that's what it was like in the early days was kind of helping people identify these distortions and their thoughts and make them aware that your thoughts create all of your emotions and you can change the way you feel. And it was just a very exciting, giddy time and then after feeling good came out, it began to spread. And as you know, it's now the most widespread cognitive therapy form of therapy in the world. And so we were successful in popularizing cognitive therapy. Now I'm trying to get people to think in new dimensions because we've kind of gone further ahead that therapy is morphed quite dramatically. But I still use the early cognitive therapy techniques I learned from back and developed and continue to develop this very day. And for those who don't know, Aaron Beck is considered one of the fathers of cognitive therapy. So David was working directly with the originators of the method, which is so cool. But you know, one thing you mentioned this idea of the power and positive thinking. And I think people can confuse that with CBT. So maybe you could break down. How does what cognitive therapy tells you to do differ from just say thinking possibly? Well, thinking, telling people to think positively is never helpful. It's not a technique I've used. I've learned or developed, you know, over a hundred techniques to help people crush the distorted thoughts that cause the misery that we all have. But what you have to do is is get someone to the point where they suddenly see that what they were telling themselves is actually not true. And in that very moment, the person's feelings will suddenly change. And you know, the first idea of it is you think the way you feel and that goes back to epictetus 2,000 years ago said he's a stoic philosopher, a Greek guy. And he said people are not disturbed by things or events, but by our views we have of them. In other words, your thoughts create all of your feelings. And that's been controversial for 2,000 years. And we've just recently got some data that helped us test that scientifically with data from an app I've been developing. But to make it simple for the listeners, you can probably recognize these negative thinking patterns in yourself. Maybe I've had that thought, you know, I'm not good enough. I'm not smart enough. What's wrong with me? Or maybe you're shy and anxious around other people? I had that problem for an awful long time. And a lot of times people were shy and anxious. They're also ashamed saying, what's wrong with me? I shouldn't be so anxious. Other people don't have this problem. Or you have public speaking anxiety. And you're saying, I'm just going to blow it when I get in front of the audience. So my mind will go blank. Or when you're feeling down, you tell yourself, I'm a hopeless case. I'm inferior human being. There's nothing special about me. And the first thing is to help people identify the thinking errors or cognitive distortions in those thoughts and then help them smash the thought. But you know, prove to yourself that they're that they're not valid. That was the original cognitive therapy. We're like like that. And maybe I can think of an example. I have my weekly teaching group at Stanford. And it's free to clinicians from all over the world. If any of them want to join our group, you can. We meet for two hours every Tuesday night and teach clinicians these new techniques. But one of the first patients I presented to back was this woman. And it was sad. She'd attempted suicide. And she survived the suicide attempt. And so I said to Dr. Beck, well, what, what, how can I help a suicidal patient? She's pretty serious. And I told her I presented her case in the, in the weekly training group that you've got here. And, you know, and I'd tell her what you said. And, and Dr. Beck said, well, ask her how she was thinking the moment she tried to kill herself because thoughts create all of our emotions, all our positive and negative emotions. So what was she telling herself? So I said, ah, that makes perfect sense. So I so eager to see her the next week. And she said, what did you learn in the seminar? And I said, oh, Dr. Beck said that I was supposed to ask you what you were telling yourself when you tried to kill yourself because your thoughts create all of your feelings. And she said, oh, I was telling myself that that I'm a worthless human being because I've never accomplished anything in my life. And all I've done is clean people's houses and scrub their, their floors. And, you know, and there's just nothing, nothing special about me. And, you know, I just feel like a kind of a failure as a human being and worthless. I feel worthless. And that's that's why I tried to kill myself. So what should I do about it? And I said, oh gosh, I don't know. You'll have to wait another week. I'll go back to this house. I'll ask Dr. Beck. And I'll tell you what it tells me. So I went went back and, and Dr. Beck said, well, tell her to make a list of things she has accomplished in her life. And I said, ah, that makes perfect sense. So I went back to her and she said, what, what did Dr. Beck say? And I said, well, he said to ask you about some of the things you have accomplished in your life. And she said, well, see, that's my problem. I haven't accomplished anything except, you know, scrubbing people's floors and cleaning their houses. That's all I've done. A cleaning lady. And she said, so what should I do? And I, you know, I knew so little about this new cognitive therapy at the time. And so I said, well, maybe you can take it as a homework as sign, but because that was another thing we were assigning homework to our patients to do between sessions. I said, maybe, maybe you can think of something you've accomplished and then put it on a list and you can bring it to our next session. So she agreed to do that. The next session I went back and I forgot to ask her about her list. And I, you know, asked her about her antidepressant because I was still prescribing antidepressants and kind of foolishly hoping they'd do a lot for people, which they rarely did. And getting them to talk. And so we were halfway through the session. And I was listening and she was talking. And then she said, well, didn't you want to ask me about my homework? And I said, oh, I forgot all about it. Did you, were you able to list anything? And she handed me a piece of paper with about 10 things on it that she listed. And the first one, she said, I, I forgot that I almost all of our family died in the in the concentration camps in Germany. But I managed to escape with my children and I got them to the United States and saved their lives. My husband died in the concentration camps and everyone else died. And she said, so I thought maybe that was an accomplishment of sorts. And then I thought, well, and once we got to the United States, I started working cleaning people's houses and scrubbing floors. And I was able to get a roof over our heads and food for my, my boys and, you know, placed to sleep at night. And so I thought, well, maybe I could get myself credit for that. And then she said, my son just graduated first in his class at Harvard Business School. And so that seems like a good thing too. And then she wrote down and I forgot that I speak five foreign languages fluently. And then she wrote down and I'm a gourmet chef. And there was this tears going down. My cheeks, I said, well, how did you, how do you reconcile that with the idea that you were worthless human being? And she says, doctor, it doesn't make any sense what I was telling myself. It just, it doesn't compute at all. And I said, well, how are you feeling now? She says, I'm suddenly feeling a lot, a lot better. Do you have any more of these techniques? I said, well, you have to wait another week. I'll ask Dr. Beck and I'll learn another one. I've been learning one technique each week. And that's the first one I've learned. But it was, so that, that was the story of how, how it all all started. And suddenly I saw people going from tears, tears to joy. And I wanted to spend my life like that, not handing people pills and seeing few or no changes. But it was, it was, it was very, very exciting. But over the years, it had, like everything, there were strengths in the early cognitive therapy. There were weaknesses. And it's evolved. And you know, I've done a lot of research. I've had over 40,000 hours with treating people with severe depression and anxiety for all over the world. And, and it's been a tremendous adventure to evolve psychotherapy. Where now it's, it's even vastly more powerful and effective than the techniques we had in the early days of cognitive therapy. I might say that just to illustrate her point though, that you see, she was involved in thinking errors. And one would be called mental filtering. Like she's focusing on the negatives in her life. And then discounting the positives, so overlooking what was beautiful about her and her, and, and, and her life. She was also involved in a distortion called emotional reasoning, reasoning from her feelings. She she felt worthless. So she thought, I must be worthless because I feel worthless. And she was also thinking, I feel hopeless. So I must be hopeless. And then she thought of suicide as the only escape from her pain. But there's 10 or 12 of those of those thinking errors. And I just found it philosophically mind blowing that depression results is a lie. And anxiety, you know, is based on lies too, that you're telling yourself things that are not true. But you don't realize you're fooling yourself because the those, you know, thinking errors are very subtle. And so people are as sure as a fact that they're skin on their hands, that they're worthless and hopeless, human beings. And when they discover that that's all a hoax, it's not true. It's one of the greatest feelings in the world being flooded from tears and worthlessness to joy. It's it's it's incredible. And it's incredible for the therapist to to give people that experience. One thing that really impressed me about CBT when I first learned about it was that I could search and notice it in my own mind, right? So yes, there were the studies and those were very impressive. But there additionally, I could start paying attention to what's going on in my mind. And I could search and notice, hey, you know, when I'm feeling emotional, I'll believe something. And then later when I'm feeling better, I'm like, that have of course, I was not true, right? Yeah, it's amazing, isn't it? It really is. And if you start being mindful about your own thoughts, you start seeing these tricks your mind plays on you. Yeah. Oh, yeah, it's it's really incredible. It's enlightening. A lot of people don't believe it. They don't they don't grasp it. They they they fight against this idea. But I saw it in myself. My wife is a clinical psychologist. She's the brains in our family. And she saw it in herself too. And we use these ideas in our own lives and the lives of our our children. And you know, I never would have committed my life in this direction if it hadn't been for that. I remember once I presented a patient to Dr. Beck in one of the seminars, his patient was coming to the clinic at the University of Pennsylvania Hospital. And I think he wasn't he was behind in his bill or something like that. And I said something about it. And you know, he the patient got upset. And so I told Dr. Beck and he said that, you know, you didn't handle that properly at all. And what you said probably hurt your patient's feelings. And you gave me some other idea how I should have handled it. And I panicked. And here's this great man telling me that I'm just, you know, out of my residency and I'm screwing up with the patient. And I began to I went home on the train going to to Brynmore from the Philadelphia, the 30th Street train station there. And I was just started feeling worthless. And I was telling myself I'm a terrible human being. I'm a horrible therapist. They'll probably take away my medical license. I won't be able to practice in Pennsylvania. You know, I have no future in psychiatry. And those thoughts seemed absolutely true. And then I told myself, well, you know, there must be some distortions in those thoughts. And I said, Oh, no, this is the truth. I've seen the truth about myself for the first time. And it was just horrible. And I got home. And these were the days where they were talking about exercise helps and boost your brain endorphins. That all turned out to be a lot of bullshit, by the way. But we were kind of thinking it was true. So I went on this severe six mile run with real steep hills. I thought that'll get my brain endorphins up and I'll feel better. But the farther I ran, the faster I ran, the more negative my thinking became. And it was like an absolute truth that I was a worthless human being. It was like it was seen at the first time. And I was thinking, how could I have spent my whole life not realizing how horrible I am? And of course, I was involved in all or nothing thinking. That's another common thinking error. You know, like one mistake and the whole is ruined. But I didn't see it as a thinking error. But it's how I was thinking. And hidden should statements. I should never screw up. I should be perfect. I should always do the right thing for patients. And then emotional reasoning again, I feel worthless. So I must be worthless. And self blame beating up on myself instead of treating myself with compassion or understanding. And you know, magnification and minimization is another one magnifying how awful this error I made with the patient. And so when I got home from the run, I was even worse depression than when I started. And then I told myself, well, David, why don't you tell your patients, write your thoughts on a piece of damn paper and look at them and see if there's any thinking errors. And then I thought, oh, no, no, this is true. I'm really am a horrible human being. It's just a fact. And then I said, no, David, write it down on a piece of paper and see if there's any thinking errors. So I say, okay, I'll write it down, but this is bullshit. And so I wrote down my, you know, three or four thoughts. I'm a worthless human being. I screwed up. They're going to take away my medical license. I have no future. And then I said, now are there any thinking errors here? I have no future. Well, got just kind of fortune tell. And isn't it? Yeah, how do I know I have no future? And then I'm a horrible human being. Well, that's kind of all or nothing thinking there. How horrible can you be? I mean, you're asking the guy to pay his bill and you didn't do it properly, but it's not like you killed him or something. And then I started asking my, I found all these thinking errors in my thoughts. And then I said, is there any other way to think about it? And I said, well, maybe I could just tell myself I'm a beginner. I'm a young man. And I have the right to make mistakes. And to create, create the correct those mistakes and learn from my mistakes. And and to, I can be kind to, to myself. And, and I'm going to see the patient again tomorrow. And I can tell him, hey, Mac, I feel having terrible week because I screwed up with you last week. And I really hurt your feelings. And I said the wrong thing. And my supervisor scolded me. And I, I'm just so glad that you came back for another session. And I can imagine how hurt and angry you feel and disappointed. Let, let's talk about it. And he just started crying and he opened up. And we had the best session ever. And then at the end of the session, he gave me perfect score on the empathy scale and the helpfulness. Scaly said it was a tremendous session. But it was just the same thing that you said, Spencer, that when you experience these things yourself, you, you suddenly see something that that you never saw before. And, and it's, it's an amazing experience. Now, that's a great example. I've found that one common thing that bothers people about CBT sometimes is they, they think that they're being invalidated, right? Like, they have some really bad thing happen to them, right? Like a legitimately really bad thing. They, let's say they discover their spouse is cheating on them. They're like, feel horrible, right? And then they say, well, what are you talking about? It's not just my thoughts. Like this really bad thing happened to me. You don't invalidate my emotion by telling me it's just my thinking, right? Yeah. And that's one of the why I started evolving and changing cognitive therapy and morphing it into what, what we know called team CBT. But that's just one of many, many errors that therapists make cognitive therapists and probably other therapists as well. But it's irritating. When you see people make such stupid interpretations of, you know, of a new development and using it in a corrosive way. But the first thing, you know, that you have to do when somebody's upset is to empathize and say that's a horrible thing that happened to you. And I feel sad too. And I can imagine how angry and hurt you must be feeling and let tell me more about that. And getting on the same page with with with your patient in a kind and compassionate way and kindness and compassion will never cure anyone of anything. But if you don't have it, you know, you're going to lose that patient and look like a stupid jerk right off the bat. But I've spent my life. I've trained over 50,000 therapists with my workshops in the United States and Canada, evident two day workshops for therapists and four or five day workshops for therapists. I've, you know, been teaching at Stanford two ever since we we came back to California. And therapists make all kinds of horrible, horrible mistakes. And it's it's it's sad. I make mistakes myself still. But I get scales from my patients that they rape me at the end of every session. How empathic that that I was. And the scales are very sensitive to the slightest therapeutic failures. And how helpful was the session. And again, the the scale is very sensitive to therapeutic errors. So when I'm making errors, I find out right away. So I can correct them at the next session with with the patient. I had a patient I saw in the Stanford inpatient unit. And I give I developed a daily cognitive therapy program for the Stanford inpatient unit because all they were doing was electroconvulsive therapy and medications. And once I got the program, I did it for my volunteer work. I'm on the volunteer faculty at Stanford. I'm unpaid unpaid faculty. But I love I love the teaching. So I just do it for free. But I developed this program. And and once I got it going, I went in once a week to kind of run the inpatient group, although it was daily and and teach the nurses would come and see how how how to do it, how to to work with cognitive therapy with these very severe patients. And I remember one day I was working with a woman who had had two horrible blows in the same week. And she was admitted for severe depression and and suicidal urges. And one her husband told her that he was leaving her. And and the same day she she was fired from her job. And she had that thought, you know, I'm a worthless human being and I I should end my life. And at the beginning of the groups, I have all the the patients take this brief mood survey that I've developed. And they can fill it out in 30 seconds. And then I could look at their score and see exactly how depressed they are, how suicidal they are, how angry they are, how anxious they are. And you know, measures like that. So I can see right away, even I don't know the patients, I can see exactly how upset everyone was. And so this woman had was very high on the depression and suicidal urges were high and the anxiety was high and the anger was was was was extreme. And she she said, could I help her work with her during this session. And I was so proud of how I was doing. And I used a powerful technique called externalization of voices and showed her how to blow her negative thoughts out of the water. And at the end of the at the end, I said, well, here's boy, I've done such brilliant work today. This is someone I could talk about in a workshop or a podcast someday with Spencer Greenberg. I could talk about the magic I did even with the most severe in patients in a single hour really. And at the end, I have all the patients fell out their scores again and and had them in to me as they're walking out of the the room for the cognitive therapy group, the hour and a half group. And when she had it, her her piece of paper to me and I looked at it, I was shocked because I thought all of her scores would be zero on the on the depression and anxiety. Instead, they had gone to the other extreme indicating the most severe depression a human being could have, the worst suicidal urges a human being can have, the worst anxiety, the worst anger she was enraged. And that I turned the piece of paper over to over to see my empathy ratings. And on the empathy scale goes from zero to 20. And a score of 12 would be like what Hitler could get. Like that's a bet, that would be a horrible score. Unbelievably bad. Well, I think she gave me a zero on empathy and a zero on healthfulness. And I couldn't believe it. I took her aside and I said, Margaret, this is part of a research study and it's easy to get confused when you take these scales on the mood scores. The good ones are good answers are on the left, the zeros and on the empathy and healthfulness, the good ones are on the right, the four, four, make could you correct it because we don't want to mess up the database. And she looked at her, because I couldn't believe that those were valid scores. And because she'd, I thought she'd done so great. And she said, no, there's no mistake here, doctor. And I said, what are you talking about? I thought it was a fantastic session that we had. And she said, well, good for you, maybe. And I said, what are you talking about? What, what happened? And she said, well, when you said that I'd had a double whammy, that really hurt my feelings and I thought you were making fun of me. Well, I had, I had used that expression. You've lost your husband and your work, the two sources of self-esteem. I said, that's like a double whammy, but she thought I was making fun of her. And I had no idea. And I said, let's sit down and talk about this. I'm, this is just devastating. And I can imagine how hurt and angry you feel. And took maybe five minutes to work that through and develop that warmth and trust. But therapeutic failures, therapists don't even know when they're acting lame. And that, but if you, if you use these kinds of scales, the patients will be honest with you and you'll find out right, right away. And if you have the courage to do it, your patients can become your greatest teachers of all. So for those who might have had a sort of not very good introduction to CBT or worked with a not excellent therapist who kind of had this idea that CBT does invalidate your feelings. Could you help them understand the distinction between when CBT is saying that your thoughts create your feelings, how is that different than invalidating the fact that you know, the event really was a bad thing that happened? Yeah, the, well, I had a colleague and come come to me for, for emergency treatment. And she allowed me to record it. And she actually published her sessions as a podcast. Marilyn coffee was her name, clinical psychologist and Sumanud had a kind of pretty hard life. But she had had just beautiful empathy skills and worked with the most severe people. And, and was very kind and giving. But if you said, David, I went to my doctor yesterday and he said, I have stage four lung cancer and devastated. And because I've never smoked and I feel in perfect health. And so we, I did a live session with her. And then part of it was, you know, first empathized and how horrible this is and how much, you know, we all love her and care for her. And this is, she feels devastated and 100% angry and 100% anxious and 100%, you know, lonely and abandoned. And just awful. And, and, and I don't move on in this session and tell the patient gives me an A or an A plus on empathy. And I say, you know, after 20 minutes or so, maybe 30 minutes, what grade would you give me on empathy in terms of understanding how you're thinking, understanding how you're feeling and accepting you and giving you a sense of acceptance. And, and, and if you can get an A or an A plus, then you can go on. But if you don't get an A, if you get an A minus or B plus, then you still have an understood the patient. You say, well, tell me the part, the part that I missed. But at any rate, and I had a co therapist, Matt, Matt May, one of my former students at Stanford, and now a superb local clinician, one of the, I think probably one of the finest psychiatrists in the world. And I'm certainly he is, but we did co therapy and recorded it. And, and, and then we say, now, you know, what, what, what would you like, like help with today? Is there something you want help with? And she said, well, gee, all these negative feelings and, you know, I'm just, I'm feeling ashamed. I'm, I'm feeling devastated. I'm, I'm feeling hopeless. All of her negative feelings were at 100. She had nine different categories of negative feelings at 100 and said, well, now what, what would you like if we could work a miracle here today? What miracle would, would you be hoping for? And, and she said, oh, you know, she said, it's impossible because something real happened, you know, the cancer is not a cognitive distortion. And I'm going to die. Then what would you want in the session? She said, well, if there's some way that I could, I could at least be not feeling so down and, and, and, and horrible. And then before we try to bring about that, I said, suppose, suppose we have a magic button. If you pressed it, all of your negative thoughts and feelings would instantly disappear with no effort. And you'd go into a state of, of, of euphoria. Would you press that magic button and just like every patient, she said, oh, I press it in a heartbeat. And I said, well, we don't have a magic button, but I do have some pretty magical techniques and probably could give you a tremendous, tremendous relief today. Maybe make all of your negative feelings disappear, but I don't think that would be such a good idea. And she said, well, why not? Because that's what I need, David. And I said, well, but, but you see, maybe these negative feelings are actually showing something beautiful and awesome about you. And your core values as a human being, and maybe they're, they're helpful to you in, in some way. And why don't we take a look at that before we try to make them disappear? And then what, what is your sadness show, Maryland about you? That's beautiful and awesome. And she said, well, maybe it, it shows my love of life. Never married or found a partner, a loving partner in her life, but she had a very close contact with, you know, with her, with her dog, with, with people who were struggling, who, who, she would help. She was a devout Catholic. And used to go to Masses every day and, all was given and she'd go to meditation retreats. She says, it shows my, my, my love for, for life. And I said, is that true? She said, absolutely. I said, is that important? She said, absolutely. And then you're, you're very angry. What, what, what, what is your anger show about you that's positive and, you know, awesome. And one of her negative thoughts was, I think I've been duped by some of my spiritual mentors. I think they were frauds. That's some of these Catholic priests. And I said, well, you're 100% angry. What, what does that show about you? And she said, well, maybe it shows my sense of integrity, my sense of fairness and the fact that, that I'm willing to, to stick up for myself. And on and on. And what, what's great about your, your anxiety or 100% anxious if you press the magic button, it'll disappear. And she said, well, maybe my anxiety is going to keep me on my toes. So I'll, I'll go to doctors. I'll get the best treatment I can. I'll stay alive as long as, as long as I can. And I said, at, you know, absolutely what a beautiful thing that is. And what is your gailton shame show about you? Well, shows I have a moral compass. What, what is your loneliness show? She said, well, my loneliness shows my love for, for people. And suddenly we had a list of 20 beautiful things that her negative feelings showed about her. And they were real powerful, big things. You see, so we weren't telling her her negative feelings were, were rubbish, but quite the opposite that her depression, her anxiety, her anger, her guilt, her shame, her loneliness and hopelessness were showing beautiful things about her. And then said, well, gosh, Marilyn, why would you want to press that magic button? Because you'll, you'll go into a state of euphoria. But then all these, and all your negative feelings will go down the toilet. But all these beautiful qualities will go down the toilet. Is that what you want? She said, oh, no, no, that wouldn't be right. And I should feel sad. This is a appropriate to feel, sad. It would be ridiculous if I didn't feel sad. I just found out I'm going to die of cancer. And so, say, I was supposed we had a magic dial and we could dial these feelings down, instead of making them disappear. And how, how sad would you want to feel? She said, well, maybe 15 out of 100 instead of 100 out of 100 would be enough. And it's great. Well, I put that down. That's your goal for, for sadness and depression, 15%. How anxious do you want to feel? She said, well, maybe 10% would be enough. And she re-rated her goal for all of these negative feelings. And most of them, she wants a little bit of that feeling, but not 100%. And that's a technique I've developed called positive reframing. And it honors the patient's negative feelings, rather than telling the patient, you know, you shouldn't feel that way or this shows what's wrong with you. See, strengths have been trained to tell therapists your depression is because of what's wrong with you. But with the new approach that I've developed in the last 10, 15, 20 years, we're going in the opposite direction. And before we take the negative feelings away, we actually argue for the patient to maintain those negative feelings. They're beautiful. It's not because of what's wrong with you. It's because of what's right with you. And paradoxically, that opens up the door for rapid change. And that was a long way of saying it, but a grain with you that you never want to be interacting with the patient to make them feel like they're foolish or that there's something wrong with them, but go in the opposite direction. And then we ask, now, what are you telling yourself? What are the thoughts? You see, it's not this event. Even cancer is not the cause of your depression. It's what you're telling yourself. What are you telling yourself, Marilyn? And she said, well, I'm telling myself that I'm a failure as a human being because I never found a life partner. And there must be something wrong with me because I lost a wasted a lot of my time being an alcoholic and drinking. And also, I'm a failure because I'm beginning to doubt the existence of God. And she had all these negative thoughts. And they were at the same damn distortions that I had when I was upset or that you had when you're upset. And then we were able to work on them. I said, now, you're calling yourself, you're a failure because you never found a loving partner. And would you say that to someone else, Marilyn, who you were counseling? Would you say, oh, you're a failure because you never found a loving partner? She said, no, I'd never say that to somebody that that would be cruel. I say, say, but you're saying that to yourself. What would you say to someone else who's just like you? She said, I would tell them that it's sad that you never found a life partner that doesn't make you a failure. You were gay. You were abused when you were little. You've had a hard life. And you've given a lot of love to people. You have a lot to be proud of. You've got a master's degree in theology. You've gotten five master's degrees. And you've also gotten a PhD in clinical psychology. You've been involved in environmental movements. You've gone to South America to help indigenous people who were struggling. You have a lot to be proud of. And I say, yeah, and are those things true of you, Marilyn? She says, yeah, I'm talking about myself. And then Tears came to her eyes because she was being kind to herself. And she suddenly saw it that it was her thoughts. The cancer is something that's bad enough. But your suffering is because you're beating up on yourself. You're being mean to yourself. And she said, wow, I'm feeling better. And she said, well, how can I talk back to this thought, Dr. Burns, that I'm a failure religiously, because I'm losing my belief in the afterlife. I don't know if there's going to be an afterlife. And I'm supposed to believe that. What could I talk to myself? And I said, well, Marilyn, I'll tell you, I've never told you this before. But once when I was jogging home from the strange station in Philadelphia, God came to me in a vision. And God said, David, if you believe in me, I'm going to be God damn disappointed in you. And I said, don't worry, big guy. I've got your back. Marilyn caught the joke and started laughing. And it was just a great moment to share with her. Again, she was just being so ridiculous. I said, Mother Teresa lost her belief in God through much of her career. And any religious person who believes in God all the time is a fraud or a fool. God would never want us to be doing that. And she saw it. At the end of this session, all of her scores went to zero. And this happened. This really happened. I'm just not bullshit. And it's recorded on one of my feeling good podcasts, one of the earliest ones we had. And it was a beautiful thing. And she outlived her prognosis. You know, by quite a few years, she used to come down to Stanford from Oakland, California for a chemotherapy because they had the best, best at Stanford. And then we'd go out to lunch and stuff like that. And we finally lost her about a year ago. She never died of the cancer. She died of the stroke. But she was a beautiful person. It's a gift to be able to give her the gift of self-love and joy. And every day when I go out on my jog or my walk from my exercise, I talk to her, tell her I still love her and think about her. I talked to my cat, Obie, who died, who I love to. He changed my life also. He was one of the best friends I ever had. Obie. But anyway, that's how it works. You have to honor people. And you have to be a technician with clever techniques. And we've developed many techniques to help people crush these thoughts that make our lives miserable. But you have to have kindness and compassion too. And so that's this kind of new team CBT that I've developed. And I wrote about that in my last book, Feeling Great, if anyone wants, they could look it up on Amazon. But has all of this new positive reframing stuff that has made the treatment even way more powerful than the early versions of cognitive therapy. Now I've got the job of trying to convince the world, well, cognitive therapy was good in its day, but there's something way better now. And so that's my latest, latest campaign. It's not an easy campaign. By the way, it's hard to get people to change their minds about an approach that the problem, for the reason you mentioned, were limitations with cognitive therapy that were very real. Yeah, you're a victim of your own success. You helped spread CBT so successfully. But you know, one thing that really comes across talking to you is just that you are a person of tremendous empathy and compassion. And I wonder if, you know, yes, you have all these technical things you bring to this table, all these techniques you learn that help people. But also you just bring this incredible compassion. I wonder if that just gives you a competitive advantage. Yeah, it does. And I had to learn it, because I didn't come naturally to me. And I've learned it a lot from some of my students who now work with me. Yeah, I have, I teach, I have a co-teacher with the Stanford or free Stanford training. If any of you were a therapist and you want training, you just, you know, contact me and you'd be welcome to join our weekly training group. But she'll love it. She's a clinical psychologist. She's the one I told you I hiked with this morning, because we hadn't working virtually. And so it was fun to see her in person. But she, she's a, you know, a brilliant clinical psychologist. Her dad was one of my classmates at Amherst. So she's a generation behind me, but really, really brilliant. And but also compassionate. And so I do a lot of co-therapy with her. And so I kind of model the kindness and the words that she uses that can convey that. But the, if you have, if you convey compassion and warmth to a patient that you're, that's 90% of the battle, but you have to have more than just, just that. You could be the kind as person in the world. And your patients could give you a perfect empathy scores. But if you didn't have the techniques to help them identify the distorted thoughts and techniques to change those thoughts. And also to give them the motivation to crush those thoughts, you won't get very far. You have to bring many, many skills to the table. And that's kind of why I've been working on this feeling good app, because I've, I've realized that probably of the 50,000 people I've trained, you know, with, I mean, trained, I'd say someone who spent at least two days in one of my full day, you know, two full days with me and learning cognitive airpire, the new team CBT. There's probably only been 10 or 15 who have been able to learn it. I've illustrated it on this program. We only 10 or 15 out of many thousands, have been able to learn it. They have developed the same, the same level of skill. Yeah. Yeah. Yeah. It means, you know, a lot of people are doing it. There's a feeling, there's a feeling good institute in Mount Vucalifornia. And they probably have 40 or 50 therapists associated with them. But there are, why range of skill levels and the ones like may or the ones when I work with people, I think you should be able to complete a course of treatment for depression in a single therapy session. It has to be two, it takes me two hours to do it, but it happens. That's a pretty amazing claim, right, that you could treat someone in two hours. I mean, yeah, yeah. And when I was young, I would have thought it was impossible. And I used to dream about it and say, would there be some way to get really good at psychotherapy? And I said, we'd have to measure things and nobody's measuring anything because athletes, when they practice like for basketball, every time they throw the ball up, they can see whether or not it goes through the hoop. So they learn really fast, but we weren't measuring anything. And I did a research study at Stanford inpatient unit to see how accurate therapists are and understanding how their patients feel. I gave you an example where my judgment of the patient was way off, but I had the scales that told me that immediately at the end of the session so I could correct the error. And that's how my own skill has developed so rapidly because I've ever since 1980, I've never had a single patient that I didn't measure their depression level and other things at every single therapy session and that information. And I wanted to get better and better. And so I've changed the methods and change the methods and changed my approach until now the my skill level has become massively beyond what it was when I was a young man doing, you know, psychiatric residency training at one of the top training centers in the world, but we weren't taught anything that had value that I was aware of. And I learned it along the road, you know, working with people and the measurements, I measure things at the start and end of every single therapy session. So I can see how are you feeling right now at the start of the session? How are you feeling right now? How depressed? How anxious? How angry at the end of the session? And that's how I first began to see that it's possible with some patients to get almost a complete elimination of their feelings, negative feelings in a single session. Then you've got to do relapse prevention training because the negative feelings will certainly come back. So you teach the patient how to deal with them when they come back. That's pretty easy. But then once I saw that I could get this occasionally, then I learned how to get it, you know, most of the time. It's not 100% of the time, but I would say it's 90, 90% of the time. And that's why I'm so excited about this innovation in the therapy that we've been developing and at my group, with my group at Stanford. Have you ever found yourself struggling to remember an interesting takeaway from a podcast you listened to last month? Have you ever considered how much valuable information you've consumed and then forgotten in the past year? We tend to think we've learned something as soon as we've seen it once, but the harsh truth is that we forget pretty much everything unless we use it repeatedly. ThoughtSaver is a free tool that was created to solve this exact problem. Every day, ThoughtSaver emails you a quick flashcard quiz designed to help you remember the things you care about. If you're not sure where to start, ThoughtSaver has some ready-made decks of flashcards across a wide range of topics that can get you started learning many interesting and important concepts. Or if you've already got ideas in mind, you can dive right in and start making your own decks of cards. Just start using this powerful free tool and begin strengthening your recall of important ideas head to ThoughtSaver.com. So could you break down how it works? You already talked about the positive reframing aspect where you think about your emotions as reflecting your values and you think about what level do you really want that emotion? And you also talked about the feedback loop, making sure to collect the data at every session of how they're doing. What are the other aspects to team that you think are innovations on top? Yeah, well it's a real simple thing. T is testing E is empathy, A is called either agenda setting or assessment of resistance, whatever you want to call it, and M is methods. And that's the linear order that we do things. So we started the beginning of the session before the session begins. The patient takes my brief mood survey, which is how are you feeling at this moment? And it takes them about 30 seconds to fill it out. And then I see their scores at the beginning of the session and I can see how depressed they are on a zero to 100 scale, how suicidal they are, how anxious they are, how angry they are. And these scales are like 95 to 98 percent accurate. They're amazingly precise and correct. And if it's a voluntary patient, they give you the true information. I empathize. And I gave you an example of how I did that with with Maryland coffee. And we train patients in the Tuesday group. I mean therapists, we have very rigorous empathy training techniques so that therapists can learn to get to perfect empathy with almost any patient within 30 minutes of the first time you meet with the patient. So what that means to the patient gives you an A. And not that you give yourself an A. Because your way you grade yourself will rarely be similar to the way the patient grades you. So it's how does the patient feel, how you're doing? How do you teach people the empathy? That might surprise the listener. How do you actually learn that? Well, the way I do, it's pretty challenging. I would say for the therapist and they don't all have the courage to do this type of thing. But in the Tuesday group, I might say, what is the most critical challenging, threatening, patient, imaginable? What would that person say to you or what have patients said to you? And they listen to things like, oh, patients tell them things like, oh, you don't really care about me. You're not really helping me. You don't really understand how I feel inside things of that nature. And then we teach the therapist what sounds easy, but it isn't. It's something called the five secrets of effective communication. And these are five communication techniques you can use in response to anything a patient says or a spouse says, if you don't remember anybody, I train them on the worst things that someone might say to them because if you can handle that, you can handle anything. And the techniques are, it's EAR, empathy assertiveness in respect. There's three empathy techniques. That's the disarming technique, which means finding truth in what the patient says, even if it seems unfair or exaggerated. And it's based on what I call the law of opposites. And the law of opposites is, if you agree with a hostile criticism and you genuinely agree that it's totally correct, the person will instantly stop believing that. And that's a paradox. So let me repeat it. If someone gives you a horrible criticism, like let's say it's someone on the inpatient unit who's been involuntarily hospitalized and say a teenager who's trying to get out of the hospital to kill some honor, to kill themselves. And they might shout at you, you're a jerk. You don't care about me. You're like a probation officer, something like that. And you know, what could the inpatient doctors say? How could you agree with that? Did you see? Because if you agree with it, the person will stop believing it. So you might say to something, you know, I feel the same way you do. I absolutely haven't been helpful to you. I haven't been understanding how you're feeling inside. And I really am kind of like in the role of a probation officer. And I hated as much as you do. It's not the way I want to relate to you. And I can imagine you're mad at me and pissed at me and pissed at the inpatient unit. You're here involuntarily. And you want me to let you out. And yet, I understand you told the nurses this morning you want to get out so you can kill yourself. Get out of the hospital. And I can tell you that I care about you. And if I let you out and you killed yourself, I don't think I could live with myself. But at the same time, I'm feeling pretty stupid like I really haven't done a good job with you. And you have every right to be pissed off at me. That would be like the disarming technique. And when you say something like that, the patient melts in your hands. Here is somebody's finally listening, finally hearing me. But that's the disarming technique. And it's like a magical technique. But it's hard to learn because it requires the death of the therapist's ego or a normal person can do it. You don't have to be a therapist, but it requires the death of the self. That's one of the four great self, great deaths that the Buddha talked about. Well, he just talked about the great death, but there's actually four great deaths. And this is the death of your ego to hear the anger that's being directed at you. Another thought in feeling epithetia paraphrasing the patient's words, acknowledging how the patient is probably feeling based on the words you're saying I don't understand you. And you're right, I've done a shitty job of that. And I can imagine how angry you might be feeling and hurt and kind of disillusioned. Tell me more about that. Am I on the right page? Am I reading you right right now? And that would be like thought empathy, repeating their words, feeling empathy, acknowledging their feelings and inquiry. Am I getting it right? Those would be the three empathy techniques disarming, thought and feeling empathy and inquiry. And then there's, I feel statements would be assertiveness, sharing your own feelings. Like I feel really sad and a bit ashamed to realize that I've failed you so badly, but you're right. And at the same time, I'm thinking that this could be a chance for us to develop the kind of relationship you want, the kind of relationship I want. And so with that in mind, tell me how you're feeling and tell me all the things I've been saying and doing that have been turning you off and not working for you. And problems I haven't been helping you with. That's the way we train the therapist, but you see, so they pair off in groups of two or three, and one plays the angry patient and attacks the therapist and the therapist has to respond with the five secrets. And then we give them a grade right away. Was it an A, a B, a C, a D? And they always do terrible. And they say, well, and then we say, well, your grade was, you know, maybe a B minus and that's out of kindness. We'll give you that grade. But you did some things right. Here's what you did right. But when you said blah, blah, blah, that's not going to work at all. Let's try a role reversal. Try it again. We go, it's called deliberate practice and we do role reversals until the therapist gets an A. That's how I teach empathy. And it's hard because they have to be willing to fail in front of other therapists. And they're all thinking that they're the only one who's in an app. They're all pretty darn inept to be honest. And if you have humility, then you can grow and learn. And so we use the philosophy of joyous failure. What I'm teaching in the in the Tuesday group, you have to set your ego, check your ego at the door and do these very challenging exercises that you're going to point out your weaknesses instantly. And if you're willing to fail, you can learn tremendously. That's so interesting. It's a cool way of teaching empathy because when you think about it, it seems like such a difficult thing to teach, but it seems like you've broken it down systematically and you have a training program where they can actually practice it. It actually reminds me of an experience I've had online where sometimes when people will write really harsh criticisms of things I've written in a really obnoxious way, what I've actually found the most effective is just acknowledging any part of what they said that's true. Yeah, that's right. And then very calmly just explaining why I think that they may be mistaken in other points, but in a very polite, gentle way. And I find that their belligerence usually goes way down. They'll start really belligerent, but then when they're almost like take it off guard by the kind of gentleness of my reply, and then they tend to lower the temperature down to the level I'm at, which works really well for me. It just reminds me of some of the things you're teaching. Yeah, that you're so right in what you're saying. It's an amazing phenomenon. I had a podcast with a woman that I treated for what Howard Hughes had, a contamination phobia, kind of obsessive compulsive disorder. And she'd had 25 years of washing her hands and spending two hours in the shower. It was just dominating her life. She was afraid of doorknobs because people would touch them and she thought she'd get germs. And I treated her live in one of my the Tuesday groups, my Stanford Tuesday groups, so the student is what we do live treatment. Some people can watch and ask questions. And it was an amazing experience in the woman at the end of the session. Well, first we went in the women's bathroom and touched all the toilets and it's totally freaked her out. You may have to explain that a little more. This is who's not familiar. She's afraid of contamination. And I use a lot of techniques with her, but one of the keys is to confront your fear. And so so she'd have to touch germs where germs are instead of avoiding the way she's been doing. And then after we got out of the band, I had 30 Stanford students there, you know, in the women's bathroom, watching us touch the inside of the toilet. And so that was freaking her out. I said, how anxious are you? She said 120 on a zero to 100. I said, well, that's not high enough. So let's walk out to the front of the building, touch all the doorknobs on the way. And that was freaking her out. But I said, you have to do this. And she was forcing herself to confront her fear. And we got out that the worst thing for her was the glass door at the behavioral sciences building at Stanford, because we'd have all these people's hands on there. And so I made her open the door. And then we went out. And there was a trash barrel that was empty, but it was like maybe an eighth of an inch of grime all over on the inside of it, like black gooey stuff. And I said, here's the last thing I want you to put your hands in here and get them all gooey and dirty and then rub them on your face. And she said, no, I can't do that. And I said, oh, you can do that. You're going to do that now. And this is where the epithet comes in, because I knew this woman loved me that like we had, she really trusted me. Because you can't do this stuff if the patient doesn't trust you. But she says, no, all vomit if I do that. And I said, all the better, you can just put your hands in there and get them all grimy and vomit all over yourself. And then she says, no, no, you do it first. And I said, no problem. So I stuck my hands in and then pulled them out and rubbed them all over my face. So it was all this black stuff all over my face. And then I said, okay, you're turn. So she says, I guess I have to do this. So she stuck her hands in there, pulled them out and rubbed them on her face. And all the students started cheering. It was so cool. And one of them had his got out his iPhone and photographed that. I made a 30 second video of it. We went back into the behavioral sciences building and back to the seminar room. And we all sat down. And I said, how are you feeling? She started sobbing. I said, why are you crying? She says, because I'm cured, I'm not afraid of it was like a miracle that happened here tonight. So it was so it was so moving. But at any rate, I had her on a podcast and to say, you know, rapid recovery is possible for most people. Even when you think you're a hopeless case, which she had thought. And then I got an email from somebody, a two word email. And coming back to your point about when people are hostile to you, it said, F you, as all it said. And it kind of pissed me off, to be honest. Apparently this guy didn't like the idea that people could recover rapidly and thought I was some kind of a fraud, a con artist, a liar and probably someone who had struggled. So I wrote back to him. And I said, sometimes my critics are my best teachers. And obviously I must have done or said something that really angered you. And I know you have important information to share with me. And I would appreciate it if you'd be my teacher and tell and teach me. And then I just got the kindness, kindness, imaginable email back from this fellow. And he became a huge, a huge fan. But it was just, was just what you were saying that, but it's hard to do that sometimes because we want to lash out at other people. We want to defend ourselves and get back at people who say things that hurt, that hurt our feelings. And it's hard for me sometimes too. To say the truth, I'm human. Sometimes I, I blow it. I'm not always acting saintly. But if you even can act saintly part of the time, it's pretty, pretty damn awesome. Well, yeah. I mean, a therapist goes to such intense pressure, you know, in the heat of the moment where they're being challenged by patient. And to do that in a real time, I imagine is very, very challenging. Yeah. But once you get at it, it's so much fun. You know, and because it's such a joy to be able to respond by finding the truth and what some, someone's critical of you, to find the truth and what they're saying and to honor them, it just blows their mind as you pointed out a few moments ago. You're going back to the story of the exposure therapy of the, of the woman who would obsessively clean herself. You know, some people I've heard, who talking about exposure therapy, think of it as almost cruel. And I remember you reading an article called like the cruelest cure or something. And, and some people listening to this might think, wow, that sounds like torture. Like you were putting this way through. You were making you do this. So how do you think about that? How do you think about it? You know, when is it pushing someone too hard? You know? Well, that's why I've developed an app because therapists, I don't think you're going to get it. And we've incorporated AI into our app now. And the cool thing, AI is the student I was, I always dreamed about because it learns fast and does exactly what I tell it to do. But, but therapists can, the school of psychotherapy or the field of psychotherapies made up of cults with cult leaders. They're called, you know, like your air and backs or your Carl Young's or the, you know, Fritz Pearls or these various famous people. And they're, they're often just, you know, narcissistically trying to promote themselves. And I guess you don't mind controversy on your program. Albert Ellis was someone I really admired and he was the first one to point that out that most nearly all of the great people in psychiatry and psychology are kind of sick puppies. The sociopathic or narcissistic exploitative people. So people get these ideas that they know the answer. But exposure therapy, 80% of therapists in the United States refuse to use exposure therapy for the reason that you mentioned. They think it's some form of insensitivity and cruelty. And of course, any powerful technique has the potential to hurt as much as the potential to heal. And so you've got to have courage as a therapist and you have to combine compassion with powerful techniques. Take the woman that I just described to you. The few minutes of intense anxiety ended 25 years of daily all day long misery. What a good deal is that. And she's been great ever since that session. She she's followed me to workshop. She came all away from California just to attend a workshop. I did in Atlanta. And so she could go up on the stage and have people watch her rubbing her heads on the floor and rubbing them on her face and telling people how great it was to be liberating. But exposure therapy is is is just one technique of maybe a hundred, a hundred and twenty five techniques I use. And but it has its its place. I've myself had probably 17 anxiety disorders myself starting from childhood. And so I know you know, I've had phobia of blood when I was young. I was afraid of bees, horses, dogs, heights. I've had crippling public speaking anxiety, all kinds of social anxiety. And anything that anxious patient has, I can say, Oh, I've had that too. I know how much that sucks. And what a joy it's going to be to show you how to overcome that anxiety. Because I've I've been there myself and I know I know how to solve that. And patients love love hearing that. But there's a lot of ways to to treat anxiety. A lot of techniques, but exposure has to be a part of the solution. But for example, let's say you're you're trying to treat someone with social anxiety without having them talk to strangers. Is there a afraid of doing that? Well, how could you say they're cured if they won't talk to strangers? I go out with them and say, Let's go talk to strangers together. I'll do it with you. Let's get over this fear today. Let's make it happen now. But it takes courage and and compassion. But it kind of frosts me when therapists take these highly opinionated positions on things. Oh, that's awful. That's a cruel cure. You know, well, you don't know what the hell you're talking about, buddy. And now I sound opinionated, but it's kind of like opinionated. When I was younger, I went to CBT therapist or guys, I think I was just saying cognitive behavioral therapist who had me go to bars at night completely alone. And he would give me homework like, okay, you're going to introduce yourself to five strangers. Oh, yeah. This was terrifying for me. Like my heart would pound in my chest. I felt like I was going to die. But I believed him. This was that, you know, it's sort of pushing through the fear was I believe deep down that that was going to get me to the other side. So I would force myself to do it. And it was incredibly powerful for me. Like after doing this a bunch, I now feel like I'm at the point where I'm less afraid than the average person. Oh, yeah. Well, look at you've got a fantastic podcast with thousands of people listening to you every week. It's really, it really is transformative sometimes, but also terrifying. And I think on a broader level, I feel like one of the most powerful heuristics in my whole life that I've ever developed was that I'm going to always try not to let fear hold me back from doing something valuable. Right? Like of course, of course, there are times when you should be afraid of things, right? It's dangerous or whatever. But it's really about understanding when, okay, I'm afraid, but this thing is worthwhile. And so I'm not going to let the fear stop the worthwhile thing, right? So I'm totally sold on BBCNC, but I also get why people are scared to do it, and why, you know, and also if done badly, how could I back consequences? Like I suspect if halfway through with that patient, you know, she'd run out of the of the building screaming and then never called you. Yeah, that would have been very bad, right? Yeah, I didn't tell you the first part of the story, but yes, you you've got to have an agenda with the patient and you've got to have the trust of the patient. You've got to do it collaboratively. But before I took her out to confront her fear, I told her a little summary of my favorite Rod Serling Twilight Zone in the group. I did you ever watch that TV show? I see a few episodes. There was this one about, it's my favorite episode and it had an elderly woman in an apartment building. And this supervisor comes in and says, listen, lady, we're tearing this building down. All the other people here have left. And you're the only one left and we've got to tear it down today and so you've got to get out of here. And she says, no, no, I'm not going to leave this this apartment building. And you know, they kind of she explains to him why she says, ever since I've been a little girl, I've been able to see Mr. Death. Other people can't see him. I don't know why, but I saw him once as a little girl. And when he touches you, you die. And I saw him on a bus once and no one else could see him and he went up and he touched a fellow who immediately died. And ever since I've been determined, I'm not going to let Mr. Death touch me because I can recognize him. And if I go outside of this building, and I haven't left this building for years and years, and if I go outside, I know he's going to come and touch me and I'm going to die. And that's why I'm not going to leave the building and this construction superintendent gets discussed and says, listen, lady, I'll be coming back. We're coming back this afternoon. We're going to tear down this building. You've got to get out of here. And he's kind of storms off angrily. And then she hears this wailing sound outside her door, help, help. And she opens the door, but there's a chain on it to look out. And it's this police officer in the snow, fallen in the snow. And he says, help, I've been shot, help. And she says, oh, no, no, you're not going to trick me. I think you're probably missed Mr. Death. And he says, no, no, please help me. I'm in pain. I'm cold. Please help me. So she consents. It's Robert Redford. That was the actor, maybe no one. And your fans won't remember. But he's like, ultra-handsome guys. And so she says, oh, okay, I'll let you in if you're not Mr. Death. And he's, oh, oh, no, I've just I've been hurt. And he has her lie down on her bed in this little tiny apartment. And she makes some tea for him. And she's comforted. And she's helping this police officer. And then the superintendent comes back in. And she doesn't want to open the door. She gets thinking, maybe he's Mr. Death. But finally, he rips the door open and comes in. And says, lady, we're tearing it down now. And you've got to go. And then she says, no, I can't because this police officer on my bed is is injured. And I can't leave him here. And then the superintendent says, what what police officer? I don't see any police officer. You get out of here. And he storms off angrily. And then she looks in the mirror and she sees her bed reflected in the mirror. And there's no one on it. And she realizes that police officer is actually Mr. Death. And then she says, you tricked me. You tricked me. And she says, am I am I going to die now? You know, and he reaches out his hand to her. And he says, there's no loud sounds. There's no pain involved. And in fact, it's already happened. And he takes her hand and she looks on the bed. And she sees her dead body on the bed. And he says, our adventure has just begun. And they and he takes her hand and they walk out kind of in a romantic way. This elderly woman and this young Robert Redford to type a guy. And the story, the meaning of the story is that, you know, she confronts this fear she's had at the fear of death. And she discovers there's nothing there even to fear. And she's going to have this beautiful, beautiful experience. And I told her this story before we went out and I said, now, are you ready to die? Because you have to die to be cured of your OCD and your contamination phobia. So I she said, and then I reached out my hand to her. I said, are you ready now? She took my hand. And then I I knew that she trusted me. And it was it was the time to do it. But you have to have that that love and a connection with your patient. And if you just go and start throwing exposure techniques at patients, sure they'll freak out. But it's not because the exposure is dangerous. It's just because you're a crappy therapist. And you didn't know how to develop a warm trusting relationship. I've never run into any resistance with exposure or a bad outcome. But I've never done exposure without a clear agenda with the patient and the trust that this this is what we're going to do. And this is how we're going to change your life. I'm actually finished going through all the letters of team and how they so I think we talked about empathy testing empathy and the agenda setting. In other words, the the elimination of the resistance, the patient's resistance, where we see that they're what you thought was your symptoms is actually symptoms of a mental disorder is actually what's beautiful and awesome about you. Your core values. And then once the patient sees that and dials down their goal for their negative feelings, then we go into methods and I take a negative thought like I'm not as good as I should be. Or I'm a loser or whatever it happens to be. I'm a hopeless I'm a hopeless case. And then I just use techniques one after another to crush that thought we start out identifying the distortions in the thought explaining the distortions maybe use a technique called the experimental technique or externalization of voices or the double standard technique. Just techniques like would you say this to someone else? Yeah, like that's the one I used with Maryland coffee. And it just worked really beautifully to her. And in the early days of cognitive therapy before we had these techniques to eliminate resistance or reduce resistance, I used to have to try 10, 15, 20 techniques before I could find the one that worked for a patient. Now with the the the new elimination of resistance techniques, generally three or four or five or six techniques at most that that when we get to that methods phase and the patient can smash their first negative thought, just blow it out of the water, reduce the belief in it to zero. And once they've crushed one negative thought, they might have written down on their daily mood log, you know, eight or 10 negative thoughts, then I go into something called externalization of voices where I become their negative self and attack them with their permission, with their negative thoughts. And they can generally just then blew them all out of the water if they get stuck on one, we do a role reversal. And that part of the session usually only takes 15, 20 minutes and then their symptoms are gone. I say now how do you feel? How how depressed are you? You wanted to go from 120. How are you? How depressed are you at this moment? And they jump zero. It's completely gone. And how anxious are you? Oh zero. How guilty and ashamed are you? Five out of 100. How inattentant? What worthless do you feel? Oh, you know zero. They're they're their feelings just fall pretty much down into the basement at that point. They go beyond what goals that they had and bring most of them down to zero or very small levels. And that's it. And then I do relapse prevention training, which takes about 20 minutes. It could be at the next session or at the end of the first, you know, session. I just sometimes I wait a day or two and then do the brief relapse prevention training. And then they're done. And that's how it works. And what do you teach during the relapse prevention? Well, there's three things. First, I say it's a hundred percent certainty that you're going to relapse. No one is entitled to be happy all the time. All your entitled to us five happy days per week and two miserable days. And if you don't have your five happy days, you need a tune up. So you better call me and come back for a little mental tune up. But if you don't have your two miserable days, you're getting too happy. So that's a concern also. But they went I say when when when you relapse, it could be tomorrow. It could be three weeks from now. It could be anytime. But everyone has the same exact thoughts. You'll tell yourself my improvement was just a fluke. The treatment wasn't wasn't real. Burns is a fraud. I'm a hopeless case after all. I'm worthless after all. This proves that the therapy didn't work. And I have them write those thoughts down on a piece of paper, then identify the distortions in them because right now they're feeling happy. So it's easy for them to crush those thoughts. For example, instead of telling yourself, this proves that the therapy didn't work. You can they might come up with a thought. No, the therapy was amazingly helpful. But last night I had a fight with my partner, went to bed angry. And I woke up today feeling worthless and miserable and hurt and alone. And maybe it's time for me to pick up the tools again and use them. And then I say, how how is that? Well, they say, oh, that's tremendous. You know, and they can easily crush these thoughts when they're in a good mood before it comes. And I roleplay the thoughts with them and say, no, I'm your negative self. And I want you to know that you know, that the treatment didn't work because you're so depressed today. The treatment was was superficial. It wasn't deep enough. And then see if they can crush it. Maybe they can say, no, the treatment was fantastic. My only mistake is listening to your bullshit right now. It's I'm upset. I have a right to be upset. And I'm going to see what I can do to deal with this situation. And I have plenty of tools to deal with that. I have one thing I can tell my my partner that I love them and that I felt badly about our argument. And let's let's talk it over. And and I can also talk back to these ridiculous distorted thoughts I'm having right right now. So that that that's how that's how it goes. And it's there. It's easy for them to do that. And I have them record that on the cell phone as the easiest way and say now when when you relapse, make sure you have this recording available so you can listen to it. And if you have any trouble, just call me and you can come in for a tune up. I give I give lifetime guarantees on my work. I'll give you three unlimited tune ups for the rest of your life if you ever need me again. And I hope you will because if you don't relapse and need me, I'll never see you again. And I've really come to like you and feel very proud of you and affection towards you. And I'm sad to lose you now, but I wouldn't have it any other way because you're feeling joy now. And that's that's the greatest greatest thing for me to have you recover really rapidly. And the 40,000 hours of patience I had, I don't think more than eight or ten ever contacted me for for tune ups. So it it seemed it seemed very effective. And when they did, I remembered them. It was just like I had, you know, a guy called me not long ago who I had seen for 35 years. He also had severe OCD. But he called me not not not for a tune up, but because he wanted to use my anxiety, failing his research. He'd become this very famous researcher from the National Institute of Health. But I, you know, I miss my patience. And the ones that were the toughest to treat that were the most critical of me and who then turned their lives around, you know, I miss them. Sometimes they wish I could call them and say hello. Do you remember me? Especially like if they treated them when they were a suicidal teenager or something like that, who really tough. You know, I grew so fond of all the patience that I ever had. But you have to let them go. You can't be, you know, calling them on the telephone. It would be like unethical or something. Was the average number of sessions that you find you needed the patient to help with depression or anxiety? Well, for me, it's just one, one, two hour session. My colleagues, my some of my students who are the real, have developed tremendous expertise, say that they'll typically see patients for three or four or maybe five sessions. And it's a problem for them economically because their patients get better so fast. So it's hard to keep their practice full. If you have the old-fashioned thing where people just come and talk to you for hours and months and years or even a decade or more, you don't need to get new patients. But the, you have to get a lot of new patients with these new techniques because they work so rapidly. But it generally works out because the word gets around that so and so has these phenomenal, phenomenal skills. So they get it start building, you know, a tremendous following after, you know, a year or two and the word get gets around. With our feeling good app, which we hope to be releasing probably in October or November and through there. And we're doing beta tests. If any listeners want a beta test, you know, it's free and it'll always be free if people can't afford it. We see pretty tremendous improvements in people with the, with the feeling good app and roughly two days. We see like a 50 to 60 percent reduction in seven negative feelings, feelings of depression, anxiety, guilt, shame, loneliness, hopelessness, anger. But that was, it are pre-artificial intelligence phase with the app. We're now creating artificial intelligence David in the app. And it's hard to say, to tell the difference between being treated by me live and being treated by the app that we're training because it's learned to do kind of exactly what I do. It just works faster than I do. And so we're, we haven't beta tested it yet. We'll be beta testing it within the next few weeks. But that I think could be a real game changer for the for psychotherapy, for people all over the world because the app is going to be inexpensive, very inexpensive and scalable. Now we're not allowed to say that it's a treatment for depression and it's not. It's just a self-help tool at the current time. It seems to have a tremendous promise in helping people with negative feelings. And we're just trying to help people. We're not trying to treat metal disorders with the app. We're just trying to help people reduce and eliminate negative feelings and boost positive feelings. But we'll see because it's hard to get therapists up to the level that I've gotten to over 40 or 50 years of constant feedback from patients. It's been a road for me to learn how to how to do this. And it's hard for human therapists to learn how to do it. Some have learned it somewhat and some have learned it very, very well. But the the app I think is going to be able to do extraordinarily well and opens up a new road, a new highway for the future of mankind if we survive, if the human race survives. And my dream is always to be able to bring this kind of rapid dramatic changes to people all over the world who care to afford therapy and even if you could afford it, you can't find anyone who can help you. And that's kind of what my life's goal has been. Science is built on replication. Our confidence that a particular hypothesis is true increases. The more times we can conduct experiments and get results that are consistent with the original research. Unfortunately, psychology and other social science fields have been undergoing a replication crisis for the past several years, meaning that researchers have tried but failed to replicate experimental results from the past few decades. And this is deeply troubling because it calls into question many of the things we thought we knew about how humans work. To help solve this replication crisis in psychology, the team at Clearer Thinking has launched a project called Transparent Replications that seeks to celebrate high quality research while also shifting incentives toward more replicable, reliable methods. They accomplished this by conducting rapid replications of recently published psychology and human behavior studies in prominent academic journals, with the aims of celebrating the use of open science best practices, improving reliability, and promoting clarity. Once the Transparent Replications team has completed a replication, they make their results freely available on their website for anyone to read. To read those results and other essays by the team, visit replications.clearthinking.org. What do you think the role is for SSRIs in treating depression? I think they have no effects other than the placebo effect. That's based on Irving Kirsch's analysis of all the data in the Food and Drug Administration, where patients were randomly assigned to SSRIs or to placebo. Irving Kirsch is the associate director of the placebo research institute at Harvard, and he has a wonderful book on that topic called The Emperor's New Drugs. It's an easy read, popular science, you can get it on Amazon. It's highly recommended. People hate it when I say this, but I've been a researcher in my life. I review articles for scientific journals. I'm one of the peer people that they get to point out problems in articles. It's Kirsch's research is stone solid. The SSRIs, I haven't prescribed them for 25 years. I haven't used an anti-depressant. Before that, I gave them out 16,000 times to patients, just because patients demanded them. They've heard that they're so good, and I didn't want to get sued. If they wanted them, I prescribed them. I never saw much from them, and I've never used them in the last 25 years. Do you see any role for physical exercise in mental health? Do you think it's, you mentioned earlier that maybe it's not affected from your point of view? It's not affected from my point of view, but it also has a placebo effect. If you exercise, and you're telling yourself, I'm really doing something for my health, then you're going to be feeling good. It's the thoughts, not the physical exercise. The research on endorphins has shown that the whole endorphin thing was a scam. They administered it a study I saw recently. It really did the proof of this fact that I've been claiming for years, and people get antagonistic when I say this, because a lot of people like exercise, and if you like exercise, God bless you, do it, and enjoy it. But they gave a drug, randomly assigned people to two groups, and gave half of them a drug that blocked endorphins in the brain, and then had both groups exercise and tracked changes in their mood, and there was absolutely no difference in the two groups, which proved that the endorphins had no role in any improvement in exercise. I once had a man who I worked with in the early days when people were touting exercise. He also had escaped from Nazi Germany, and he went to New York, started Chinese shoes on the streets of New York City, and he was alone as a teenager, and he eventually became a multi-millionaire, and he owned several city blocks in downtown New York, yet a manufacturing company, but he came to me as an elderly man. He said he'd never had one minute of happiness in his life. He felt like a worthless human being. And so I said, well, your problem was you've got to boost your brain endorphins, and through exercise, so I got him to running, and I got him running 12 miles a day. He was in his late 70s, and I said, Ezekiel, how did you feel at the start of your 12-mile run? He said, I felt like a worthless human being, and I said, how did you feel at the end of your 12-mile run? He said, I felt like a totally exhausted worthless human being. It didn't do a thing. He could have run from New York to Los Angeles, and he would have felt as bad. And finally, I asked him, because he'd been to psychiatrist his whole life, and he could afford the best, and no, he said, he'd been able to help him. And I said, well, Ezekiel, why do you feel like a worthless human being? And then tears came to his eyes, and he says, well, I've been hiding this from everybody, but I feel worthless because ever since I've been a little boy, I've had the fear of the dark and claustrophobia. And I said, ah, no wonder, you know, this guy could run for the rest of his life, and he would still feel worthless. The exercise isn't going to cure that, but I told him to, that the cure would be to go into his basement in the middle of the night, wake up, set his alarm for 2 a.m. when it was dark, and go into his basement, and roll himself up in a carpet. And so it's pitch black, don't have the lights on, but have a tape, have a recording device, and then just stay there until you're cured. And he fired me. He said, that's stupid. That's horrible. I could never do that, and stormed out of the office. And then he called me several weeks later, and he said, Dr. Burns, I went to another psychiatrist in New York, and to find out if you were crazy, the psychiatrist says, no, Burns is not crazy, and you should do what he told you to do. So could I come back, and you can tell me, you know, exactly what you want me to do, and I'll do it. So I told him to do it, and then he came back the next week, and he had gone into his basement in New York City, and in the middle of the night, rolled himself up in the blanket, and I said, then speak out loud so we can hear what you're so afraid of, you know, in the dark, and with claustrophobia. And he said, he thought that a ghost would come out of the darkness and sit on his chest and suffocate him. And he was 100% out of 0 to 100 with that thought, and he kept thinking that for 20 minutes, and he was still 100% panicky, and then he said, I suddenly said out loud, ghost, if you're going to come and sit on my chest, do it now and get it over with, I'm sick of waiting for you. And he says, no ghost appeared, and he suddenly started laughing, and he said he had no fear of claustrophobia, no fear of the dark, and no longer felt like a worthless human being. So everyone is different, and you have to target the treatment to the exact problem, and the thoughts that the person has, and just throwing, you know, exercise is great. You know, I try to exercise every day, but I hate every minute of it. It's never given me a runner's high, or even a tiny mood boost, but I do it for my health. But I like to individualize the therapy to each person's specific problem. And everyone is different, and everyone has something unique and challenging, and requires unique creative techniques to show a person how to get out of the trap they're in. Okay, next question for you. What do you think of the so-called dodo bird hypothesis? This is a claim that if you do randomized control trials, hitting different therapeutic techniques against each other, that they all kind of perform similarly. That's absolutely true, that's why I've developed team therapy because in all of the outcome studies for different forms of psychotherapy, how much do they reduce the Beck Depression inventory score? And all these studies are unimpressive. The most that they show is maybe 50% of the patients that are treated for months, maybe half of them get a 50% reduction in the Beck Depression inventory score, and that's pathetic. That's terrible. That means the other half didn't even get a 50% reduction in the Depression score. Now, I'm not allowed to talk about our app as having anti-depressant properties, and we're not treating depression, but I can tell you that in two days, people with the app get 60% reduction in seven different negative emotions. So you can conclude what you like, but you'll get a 30% with a placebo effect. And that's in most schools of therapy, they don't get any more than a placebo effect, and they don't like to admit it. All these schools of therapy want to think they're the cast pajamas for the treatment of depression or for the treatment of anxiety disorders, but the data does not support that, and that's why I've been trying to develop powerful fast-acting treatments that have effects massively beyond placebo effects. So does that mean you don't think that talking to people about therapy, which you taught in your original classic book, Feeling Good, is better than let's say psychodynamic therapy in terms of outcomes? When administered by humans, now, when people read my book, Feeling Good, there's been 10 outcomes studies on that book that are fairly encouraging. I think the Forest Gogan and research scientist in the University of Alabama, clinical psychology researcher, many outcomes studies just handy in my book, Feeling Good, to people. Any reported that 50 to 60, that said before you can see your doctor for your appointment for your depression, just read this book. And for it in four weeks, then you can see your psychiatrist for medications, your psychotherapy, or whatever. And then at the end of the four weeks, 50 to 65 percent of them had improved so much that they no longer wanted or needed any professional treatment or any medications. And that's one of the reasons I've created the app, because I thought, wow, if the book can do that, the app could certainly do better. And that's what our beta testing has shown. But you've got to be directing at your interventions at the level of motivation, as well as cognitions, if you want to get really fast results to melt away the person's resistance and help the person see that their negative symptoms are not the result of what's wrong with them, but what's right with them. And that's the technique that seems to open the door to improvement that seems to be vastly beyond the effects of placebo. A placebo confuses people because if I told patients, I've got this new ear tugging therapy. And all you have to do is tug your ears three times a day, and it'll get those imbalanced gases out of your ear and your depression will go away. And a patient will leave that and did that, you know, 35% of them would be cured of their depression in three or four or five weeks. But it's not ear tugging. It's just their belief that something good is going to happen. And that's how most schools of therapy operate. They have a little, maybe a little punch above and beyond the placebo effect, but not much. And that's why I've been trying to develop something much more powerful than that. And that's been my goal with my work on the feeling good enough to see if we can make that happen. Maybe a device can deliver to people what all these schools of therapy have tried hard, but the human therapists are pretty limited even when supposedly highly trained. And don't, to my way of thinking out of perform placebo by much, just as the so-called anti-depressants don't outperform placebo by much either. So just to clarify, make sure I understand what you're saying. It sounds like you think that cognitive therapy, as taught in your book, does significantly be placebo, but cognitive and does beat, let's say, psychodynamic therapy. But cognitive therapy, as practiced by an average practitioner, doesn't, is that what you're saying? No, I think that the cognitive therapy practiced by the average clinician has placebo effect and a bit more and is probably on par with reading the book, feeling good and doing some of the exercises in there. But neither is even the people that read feeling good, well, what happened to the 50% who didn't improve by reading feeling good? What was, why didn't they improve? You see, that's the question I've been trying to answer from my, and by research and in my clinical work. And the answer seems to be that, that, see, in feeling good, I didn't deal with resistance. And most therapists do not know how to deal with, with resistance. They keep trying to throw help at patients, and that paradoxically makes quite a high percentage of patients resist because people don't like it when people throw help at them or try to cheerlead them, just as you gave some dramatic examples of that earlier. So then something like seconded, anemic therapy or act or, you know, my philosophy stress should actually, et cetera. Do you think there's also without performed placebo? No, no, they won't. But maybe a little bit, but all of these, the best that they can do, is just how perform placebo by a little bit. And so I guess it's good if you've got some improvement in some patients, but to me, people who are depressed, they want to wake up in the morning and say it's great to be alive. They don't want to be feeling like 30% less depressed. One question that I wondered about just for myself is that I found some of my beliefs have been very affected by kind of reframing and things like that. But I find other beliefs in mind when I've tried to use techniques like that, the same thought will keep coming back. So I'll feel better in the moment. I'll feel, oh, okay, I've done reframing around that thought, but then, maybe a day later or a week later, it comes back again. How do you think about that? Do you think that the reframing just wasn't effective enough or what would you say to that? Well, I think that happens to everybody. I think that's what it needs to be a human being. And that's why you've got to be prepared to pump out of those relapses, but it's not in the cards to not have that happen. I think if you get really good at crushing the negative thought that causes your relapse, like whatever it is, the thing that's bugging you, if you can reduce it all the way to zero and get really good at it, then you can get pretty good at pumping out of those negative moods when they, I think the Buddha said, or somebody said, you can't stop the birds from landing on your head, but you can prevent them from building an nest in your hair. I don't think the Buddha said that, but somebody said that. But you have to work at it. If you tell me what your thought is, we can work on it at this moment, make it a little bit more specific. Oh, sure. I think for me, one of the most common recurring kinds of thoughts I'll have is that I might have said something that upset someone or bothered someone, and I especially get triggered if a friend starts acting unusually. Usually they reply right away, but then they don't reply for three days, and I'll start thinking, how did I say something wrong? Did I upset them in some way? I tend to have a lot of recurring thoughts like that. Oh, yeah. I can't kind of an obsession thing, type of deal. Yeah, I don't know. I'm not sure how you would define an obsession exactly. But it's sort of like, I think I'm very worried that I will hurt someone or upset someone. Yeah. Yeah. And then if I hurt, well, I can identify that for sure, because people used to tell me, how can you stand to see depressed people all day long? When I was in private practice, I used to see 17 depressed patients in a row for full sessions on my last days. To me, it was like the longer the day went on the higher I got. I loved being with depressed people, because I had something to give them. But if I said I heard or upset somebody during a session, it was like being shot in the stomach with a bowling ball. So it's very painful, and then I'd get very exhausted and kind of down on myself. And if you said something that upset or hurt someone, what would that mean to you? Why would that be upsetting to you? And I'm doing something now called a downward arrow technique, and I'm doing it on paper. I wrote, I upset or hurt them, and I put, wrote it through a downward arrow under, and that means, you know, it was, suppose that had happened, what would that mean? Why is that upsetting to me? Well, two things come to mind. One is that I've had a bunch of occurrences in my life, where I've accidentally hurt someone or upset someone in my life. And then I didn't realize it at the time, but then it kind of, it suddenly blew up where they suddenly got very angry at me. And I think on some level, I feel a little traumatized by some of those experiences, where I feel like, oh, maybe this person's going to abandon me or they're maybe they're going to be suddenly angry at me. And so I think I'm a little oversensitive to that. And I think the other piece for me there is that I really care about being ethical. And so it feels to me like harming someone is unethical and that like feels like it's cutting against one of my core values. Yeah. So that's beautiful actually. So if I hurt them, then they'll abandon me. And that would mean that I'm unethical. Is that right? Yeah. Yeah. I guess I would think it is two different pieces. One, they might abandon me and two, I might have done something unethical. Yeah. Both of those I think weigh on me. Yeah. Yeah. Well, there's a couple of ways we can go with this. Yeah. So I said something in a colleague who I really love and admire so much just got really pissed off and said, I'm really angry with you. And I was actually kind of a relief because he's often unassertive and was actually, I was actually good that he was saying he was angry with man. We had a meeting today with with several of us where we're kind of all upset and and talked it through and it turned out to be very productive. But I know how painful how painful those kinds of thoughts and feelings can be. Is this something that you that you that you want to help with? Yeah. Absolutely. Why? Because 95% of time it's just in my imagination. Sure. It's just, oh, they were busy or you know, it was not a big deal or you know, it's just that my brain I think is like ready for that small percentage of time where I actually really did upset someone. Sure. So if we had a magic button and you could press it and be cured of this, would you press the button? Well, you know, what you said earlier really resonates with me. I wouldn't play it down to zero because I don't think that's the right amount. Right. I think that one should be conscious of their effects and others and shouldn't strive to notice if they've upset someone. But I think I do it maybe 90% too much. Yeah. Push it down to 10% of what I'm doing it at. Sure. So what, let's just make a little quick list of positives and then we can do some little externalization of voices. I don't know if 11.E value or go anywhere, but it might be kind of fun. So, so, so that that's makes just a little list of positives. And then oh, by the way, what are your negative feelings when you're having these thoughts? You feel anxious? Yeah, I feel anxious. I kind of will replay the the thing in my mind and I think that kind of drives an anxiety loop where I'm feeling tense and my stomach might hurt. Oh, yeah. And how anxious and tense would you feel between zero and 100? Probably 50. 50? Okay. What else? I think that's the main thing. I'll replay the conversation sometimes like I'll replay the last conversation we had and kind of go through a bit by bit looking for a mistake I might have made. Yeah. Like, oh, wait, maybe I maybe it was that thing. Maybe they're not texting me back because of that thing I said, you know, and it's a it's an unpleasant kind of fixated state to be. Yeah. That's what that's what I mean by obsessing. Do you feel guilty or ashamed when you're thinking these things? I think I feel a little guilty. If I think if I okay, so sometimes I just feel like I can't figure it out and that like I can't find anything I did that I could, you know, cause their change of behavior. Sure. And then I'll feel more anxious, but if I think I hit on something I'm like, oh, maybe maybe that thing I said was insensitive or something like that, then I will start feeling bad. I'll feel guilty. How guilty? Between zero and 100? I think it depends on how much I feel like I might have hurt them, but maybe 30 or 40? Okay. I'll put 40, put up or level on that. Do you feel inadequate or inferior? I don't. I don't tend to I tend to have a lot of confidence, so I don't tend to feel those kinds of feelings. Do you feel sad or unhappy or down when you're thinking like this? I feel sad if I start thinking, well, maybe this relationship is damaged. Yeah, sure. Oh, this relationship might be damaged, right? Right. And then I'll feel sad. Like there's something that could have been lost. Yeah. And how sad? We can just serve in the hundred. Maybe 30? 30? Okay. Any other feelings frustrated, hopeless, alone, lonely, angry, upset, embarrassed? I don't think I really feel those, but I do feel saying that maybe I don't know if there's a word for it, but it's kind of the feeling like I should have done better. I should have known better. Yeah. I should have been able to take charge. If you will, I'm writing this down. I'd call that another negative thought. I should statement. I should have done done done better. So now what are these negative thoughts? What are and feeling show about you that it's positive and awesome and how are they helpful to you as well? What comes to mind? I think that they hopefully they show that I really care about not hurting people. That I care about acting ethically, that I care about these relationships being good and that I want to avoid any kind of ruptured relationship. Yeah. So I'm writing down three things. You could be writing them down to these thoughts and feelings show that I care, show that I'm ethical, and show that I want positive or loving relationships. Mm-hmm. Well, I think in terms of benefits, I think it, you know, sometimes it does lead to me realizing I did do something wrong and making amends, right? Or, or, or, you know, noticing, hey, you know what, I could have done that better and then I could, and then it helps me do better in the future. So I definitely don't think it's useless. I just think I just doing it too much, right? I'm overly sensitive. Exactly. A lot of times or problems are just too much of a good thing. Yeah, the, but that I can, can make amends and it kind of keeps me on my toes, keeps me from getting complacent. Yeah. And helps you be a better friend. Yeah. Help helps me be a better friend. So I've written down five, five positives. There's probably more, but this is kind of a quick version of things. It shows that I care. It shows that I'm ethical. It shows that I want loving, caring relationships. It gives me, sometimes gives me the chance to make amends when I have screwed up. And it, it helps me be a better friend. Does that seem accurate? Yeah, that seems accurate. And so, are these things important? Absolutely. Are they real? Yes, I think so. Of course, are they powerful? I would say so. Yeah. So good, good reason not to press that magic button. But if we could redo, if we could dial them down, how anxious would you want to feel that that was 50 percent? What, what would be a healthy amount? I think about 10 percent, seems reasonable. Is that, is that enough anxiety for you? I think so. Because I feel that I just want nothing's idea that I'm aware that's on my radar, right? It's not enough that it's pulling me in, sucking me into the, yeah. Great. That sounds like a good amount. How guilty do you want to feel? Maybe with guilt. I want to, that was 40. Yeah, I think I want to feel zero until I actually am confident I've done something wrong. Right? Like I don't want to preemptively feel guilt when in fact, most of the time, maybe I didn't do anything wrong. Right? Okay. So zero is on the, how sad do you want to feel? The sadness really shows your love for other people, right? Yeah. And I think, I think, it's sort of like with the guilt. Like if it turns out I did damage the relationship, then I do want to feel sad. And maybe 40 percent is reasonable. But if I, but I want to jump the gun, I don't want to pre feel sad when maybe I, you know, didn't actually damage the relationship, right? I'm just kind of ruminating about the possibility of having damaged it. Okay. So you'd, you'd want to bring the guilt and sadness from 40 down to zero and maybe keep the anxiety from 50 down to 10, something like that. That sounds reasonable. Yeah. Okay. Now, let that's, do you want to try really a strong technique? Let's do it. Okay. Now, in this, in this technique, we'll take turns. One will both be named Spencer. Okay. And one of us will be the negative Spencer and one will be the positive Spencer. And I'll be the, the, the negative Spencer. And I'll, I'm going to attack you with your negative thoughts. And I'll sound like another person, but I'm not. I'm just talking to you. And I want you to be the positive Spencer and see if you can defeat me. And, and there are several strategies you can use, you can use self-defense, you can use the self self-acceptance. And you can use also something called the, the, the counter attack. And that'll become obvious as, as, as we work together here, but, and, and, and if the idea is to, to, to see if we can blow these negative thoughts out of the water, there's five of them. And, and you tell me which one you want to start out on. I upset or hurt them. They'll abandon me. I'm an ethical. This relationship might be damaged. And, and I should have done better. You know, abandon me. Okay. Okay. Could I talk to you for a minute, Spencer? Sure. You know who I am. Yeah. You're negative me, I assume. Yeah, that's right. And I just wanted to remind you, in case you'd forgotten that, that, that, that, they'll, they're, they're probably going to abandon you, Spencer. Well, the vast majority of my friends have never abandoned me. Okay. Who won? I don't know. How do you think? Why not? I don't know, one. I, I guess I did. You won. Okay. Did you win bigger small? Small. Small. Let's, let, let, let, let's try a, a, a role reversal. Okay. But by the way, that, that, that show, what, what does that show that you won small? That I have room for improvement, I guess? Right. But how does that relate to this relapse thing that you're talking about? Well, I imagine that with bigger wins, it would be more persuasive to myself and probably more persistent. Yeah. Yeah. That might be that, that's kind of what we'd be hoping for. We don't know that for a fact. But that's, that's, that's the reason we're doing this. Of course, do, do a role reversal. Okay. So I'm negative Spencer. Well, you know, you're, your, the reason they didn't text you back is probably because they're not interested in hanging out with you anymore. Well, I have several things to, to mention to you for first, I get tired of your bullshit. And there's really no evidence for that. You know, I've haven't had friends that don't want to hang out with me. But certainly I've screwed up at times and we'll screw up in the future. And I won't always be saying the correct thing. And, and I think in a good relationship, there's room for, for screwing up and for, hurting each other's feelings. And sometimes talking those things over can make relationships closer and, and, and better. But, but there, there is, you know, one person who definitely has abandoned me. Who's that? That, that's your bullshit. You're always talking in my ear or trying to put me down. Cut it out. I'm tired of you. Nice. Okay. Who won? Well, definitely a posis dancer won that one. Uh-huh. Was that bigger, small, bigger, bigger, huge, uh, somewhere between big and huge, I'd say. Okay. Let's do a real reversal back and see if we can, um, keep pushing it up higher. One thing I noticed is that you kind of addressed it at multiple levels. And I think that's what I didn't do. I just addressed it like one narrow level. Yeah. Yeah. That's right. Uh-huh. Yeah. Yeah. Yeah. You can come at these things from a number of angles. But, um, the Spencer, you know, the, your, your, your friend hasn't called, called you back. And, uh, you, you may have hurt, hurt his, his feelings and, uh, uh, and he's probably gonna, gonna abandon you. Well, first of all, it's really common that people don't call back for a few days. It happens all the time. It doesn't really mean anything at all. Second of all, you have a strong relationship with this person, even if they were annoyed at you, it could be an opportunity to make a relationship even stronger by working through it with them. And it's very unlikely to end your relationship. And even if it did end your relationship, you have so many other people that care about you that you have strong relationships with that you'd be completely fine. Um, but the reality is that you spend so much time with worrying about this and it almost never is actually the case that anything's wrong. Okay. Who won? Positive Spencer. Bigger small. Say big. Bigger huge. Yeah. Big. Sure. That's right. Do do a role river. Well, now let me ask you a question here. Um, maybe you don't want to get to huge on this one. Hmm. Hmm. Yeah. Well, there's that, there's that, I, I want to have that opening that I do make mistakes that I will sometimes screw things up. I will sometimes have offended someone and I don't, I want to leave that open, right? Like, it won't fully close that possibility. Okay. Now, now what rating do you give yourself adding that piece in that's called the acceptance paradox? Well, it feels like that helps close the gap, right? Oh, yeah. Yeah. Yeah. Like, there's that you want to leave that opening, uh, or like, I want to leave the opening that I could be in the wrong. Yeah. And so I don't want to go to 100% and, you know, just blow the completely out of the water because everyone's so well, that nagging voice will be right. Yeah, I love that. That's, that's, that's, that's great. And, and you just say, and they'll always be screwing up in my life. And my screw ups is something that can be opportunities to, to grow and to get closer to people. Absolutely. My problem isn't my, my problem isn't my screw ups. My problem is listening to your bullshit. Okay. I'm, are you ready for another attack? I'm ready. Yeah. You know, you know, Spencer Burns is trying to get you into some kind of ridiculous bullshit. But the fact is, uh, don't listen to him because you might have hurt or, or upset your friend. First of all, I'm tired of your bullshit. You're telling me this way too often. Second of all, I'm really good at taking criticism and building relationships with friends where they can bring things up if they do feel hurt. And so if they actually are feeling bad about our interaction, very likely, I'll find out about it. Third, even if they were hurt and I didn't find out about it, there's very high likelihood that our relationship would still be great in the end. They'd get over it after a little while and we'd still be able to get along well together and they'd forgive me. And even in the worst case scenario where this person did abandon me, I would still have so many other wonderful people in my life that I'd be totally fine. But I will leave open the possibility of being wrong. I'll keep that 10% in mind. So you don't have to keep bugging me with it because I am already aware of it. Okay, who won? Uh, positive Spencer. Bigger small. Big, that's a big. Bigger huge. Uh, say between big and huge, I think that was stronger. Yeah, what did you do that made it stronger? I think it was just felt more confident. It felt more self-assured and assertive, I guess. Yeah, I thought of one dimension, I know if it'll help it, but try another, try another role reversal. All right, are you negative Spencer again? Or is positive? I'll be the positive again. Okay, great. I thought it was pretty darn close to huge, but there's one little gap that we might be able to fail at. So you know Spencer, your friends are eventually going to ultimately abandon you. And you know, if someone doesn't text you back for a few days, that's a sign that they might be about to never respond to you again. And you should spend all your time trying to figure out what went wrong, how you fucked up. Well, I'm fucking up right now by listening to you. Let's start out with that one. And in the second place, I'd like to say that that's very unlikely. I'm really great at taking criticism. And if I did say something that hurt, hurt someone's feelings, we, we'd undoubtedly talk about it. And, and, and, and loving each other more. That they, I don't need to be afraid of raw spots and relationships. That's a part of life. But you, you've often told me this ridiculous thing that, you know, someone's going to abandon me because I said something in the hurt their feelings. If, if that happened, that, that would be show that there was something very sensitive in that person that I was not aware of that would be very unusual for a friend to, to, to take that, that behavior. And so I might let the dust settle for, for a bit. And then get back to them and just say, I've been missing you. And clearly, I said something that, that hurt you a lot. I don't even, I'm doubly cursed because I don't even realize what I did that hurt you so much. But if you'd be open to it, I'd, I'd love to, to get together and talk to you and tell you how much I, I love you and care about you and find out what way I screwed up and, and, and, and see the truth in your, in, in, in your criticism. So would, would you be open to doing something like that? And that, that's the way I would, that's the way I would, would handle it. So, although that's unlikely to occur, that could conceivably occur. And it would just let me know that I had among my many, pretty robust friends, someone who's, who's awfully, awfully, maybe fragile and, and, and, and vulnerable. And I could still offer support to, to that person. Yeah, I think that's a really good element to bring in because there's, there's this issue of responsibility, right? That if someone's upset, it doesn't necessarily mean that I'm in the wrong. And I think my brain jumps to blaming myself for it. Sure. Sure. Let me show you another way. Say, say, if, if, if someone's upset, it shows you're in the wrong. Say that to me. If someone's upset, it means that you fucked up, and it's your fault. I think there's a lot of truth in that. You know, I may have done it, because I was mad at somebody and kind of lashed out at them, or I might have said something that inadvertently hurt their feelings. But I can, I can tell them that I want to hear what they have to say and learn from them and find out the, the, the way I screwed up. I'll be screwing up for the rest of my life. But, you know, I, I do have one big screw up though, that I'm going to try to get over today. Oh, yeah, what's that? Listening to your horseshit constantly chattering in my ear, get the fuck out of here. It's, it's so funny to me because it's so different than the like, I don't know if you're familiar with like, they do have like internal family systems where you treat every kind of voice in your head as with kindness and compassion and, you know, as though all the, the concerns are valid and, and your approach is so different from that, it makes me laugh. Yeah. Who won that one? How did that work for you? Uh, yeah, well, I, I liked that. I think, uh, certainly positive Spencer won that one. Yeah, bigger, small, big, bigger, huge. I'd say huge, yeah. Huge. How did I get to huge? Well, I feel like you accepted the, the, you know, droplet of truth and droplet of wisdom in that, but also dismissed the voice at the same time. Yeah, yeah. And that's the, and I think that's the difference with, with getting to huge, the acceptance paradox. Right. And then that might be the, the thing for you to, to, to work on in terms of getting to your next level of enlightenment because you said that earlier, and are recording too, a little bit that, uh, you know, if someone criticizes you, you, you know, you don't have to let that upset or maybe that's a reflection on them. And I go in the opposite direction, say that's always a reflection on me and to some degree, but without that, that issue of, of blame to, to, you know, use the disarming technique and see the truth in their criticism. And that will generally dissolve the, the, the conflict and it, and whether or not it does, it, it, it, it gives you a lot more power when you can incorporate the acceptance paradox into your response. But at any rate, I know it's getting late and, and I just want to tell you one more thing. Mm-hmm. You should have done better. Well, I think I, I think I do a really good job, uh, building friendships that are deep and lasting, the last majority of the time. Of course, I have big mistakes. Of course, I sometimes screw things up, uh, but I think I do a good job of learning from those mistakes from listening to the critiques that people have trying to get better from them. But most importantly, shut the hell up. Yeah, great. Who won? Uh, positive Spencer. And, and, and bigger small. Big. Bigger huge. I think pretty huge. Yeah, getting, getting closer. Well, that's, that's my assessment is, is that, uh, going a little further into, into acceptance. Uh, if we could, could, could, could bring you to the level of, of greater, uh, happiness, you'll always have times of slipping back. But if the, the, the greatest thing that holds people back is working too much on self-defense and not, not on, not on, on, on acceptance. Just, just, let's, let's do, just a little final exercise here. And then I know that I'll demonstrate some acceptance. Just start ripping into David. Just save anything you want. Just horrible. Things true, true or false. Just, you know, David, you're, you're overhyping your therapy. There's no way you can really cure people in two hours. You're self-deluded. Oh, just one one at a time. All right. Sorry. Okay. So, sorry. Well, first of all, I, I, let's take that I'm overhyping my, my therapy. Uh, that's, that's, that's absolutely true. And that irritates a lot of people too. It's that, I have a lot of flaws. That, that's, that's just one of many flaws. If you knew me better, you'd see I, I, I have a lot of, a lot of things. I screw up in all, all kinds of ways. So I have to plead guilty as, as accused. Do you, do you actually believe that? Do you feel that when you're saying that? Yeah, it's true. It, it's not, it's, it's, it's, it's, yet I, I, I do see almost everyone get a elimination of symptoms in a, in a two hour therapy session. But so that, that part isn't overly high, but I, I, I really promote my, my therapy and, and a lot of people like that and a lot of people hate that, but it's, it's generally better to be humble than to be overly hyping things. It's, it's, it's, I genuinely believe that that's an error that I made it all the time. I probably made it a lot on your show. Try again. You know, you accused the psychologist says being cult leaders, who's to say you're any different? Are you just pushing your own paradigm? So it's better than everyone else's? Isn't that what every say, you know, big psychologist has done? Yeah, absolutely. I plead guilty as, as accused there too. I, I, I'm trying to move the field to a science of psychotherapy, data driven, so measuring things at the start andegt of every session and, and, and, and, and getting ratings from patients on empathy and helpfulness. I think that'll, that'll make a lot of people honest. And I think that's an important contribution to the field. And I don't have much respect for people who, who don't use measurement and testing. But at the same time, I, I, I do have kind of a cult following that, that, that's for, for sure. And, and I tell myself, God, you're, you're no better than the, than the, than the rest. And I think that's, that, that's true. I'm very narcissistic and I have a big ego. It's actually helped me because I'm not that bright. So I've worked so hard because of my, of my narcissism. And I have made a lot of, a lot of discoveries. But yes, you know, I, I'm also kind of a kind of a cult leader. I, I, I do research. I spend 10, 15 hours a week doing analyzing data from our, from our app and seeing what's good about it. What's not, we're, where's, it's falling short. So I give myself a lot of credit for integrity too. But yet, but yes. And, and I kind of, I love being a cult leader. In fact, if we do another episode, I want to do it in video and so I can wear robes and sit with flowers around me. So how did I do? I think you did great. Well, you did a great job of, of accepting the criticism and not trying to deny it, right? And not trying to deny it. Yeah. Yeah. And why should we have to deny anything? You know what I mean? Give me a harsher one. Give me a harsh criticism. You're giving me, so easy, easy. Really? Oh, man. All right. Well, you know, throughout your career, you must have let down hundreds or even thousands of people who came to you, thinking you were their last hope. And, and yet, you know, you didn't help them. Yeah. Especially early in my career, there were a lot of people I helped and, and a lot of people who, you know, fired me. They, they were turned off by me. I was too enthusiastic. And even to, to this day, even, you know, recently, you know, a couple of colleagues got pissed off at me and then I was very upsetting. I did, I hardly slept last night to tell you the truth. And we had a great conference just before the call and kind of work, work things out, which was a great relief to me. But ever since I've been little, even my parents used to tell me, David, you're really hard to get along with. And they were right. And so I'm just grateful that there have been so many that I've been able to help. And, and I'm grateful that my skills have evolved and I've been able to develop levels of compassion that I never had when I was, when I was younger and coccier. But I, I feel all the time, not only, you know, the, the patients I work with, but, you know, the family that I love, my son, my daughter, my, my wife, you know, I, I love them a lot. But I've, I've failed all of them in many ways. And I'm just, you know, think it's kind of a miracle that so many people seem to still like me in spite of all of my failures. And it seems kind of like, like a, a miracle. I have so many people in the, in the Tuesday group. I, I think the fact that I, I treat everyone for free and I teach for free. I, I figure that gives me a little slack there. So they can't say, well, you're not worth the money type of thing. But, but, but yeah, I'm, I have, I'm a very, very flawed person on, on, on many, all kinds of levels. Well, David, I just wanted to thank you so much for coming out. This has been really amazing conversation. Thank you, thank you so much. Really appreciate it. Thanks so much, Spencer. You're, you're really awesome. And, and I had high expectations for being on your show. And it was, you're even better than that. So thank you so much. I really appreciate you. Thank you, David. Thanks again for listening. We always love to hear from our listeners. So if you have questions or comments for us, just send us an email at clearer thinking podcast at gmail.com. This episode was edited by Ryan Kessler and transcribed by We Amplify. Miles Kesstren handles marketing for the podcast. And Erie Bram is the podcast's fact totem. If you like our show, then we'd really appreciate it. If you could rate and review us wherever you get your podcasts and tell your friends about us on social media. We also hope you'll subscribe to our email newsletter called One Helpful Idea. Each week will send you one idea that we think is really valuable that you can read about in just 30 seconds, along with that week's new podcast episodes, an essay by Spencer, and announcements about upcoming events to sign up for that newsletter or to find show notes, transcripts, and more info about the show. Visit podcast.clearthinking.org. A listener asks, what is the meaning of life? For my point of view, life doesn't have an objective meaning. So there's not quote A meaning of life. Meaning is an emotion that human tab or an experience of human tab. We can have a sense of something being meaningful. And when you think of it that way as an experience to human tab, then lots of things can be meaningful and it's going to differ from people. But for many people, things that are meaningful, love and building relationships, having children is meaningful for a lot of people, having projects that have ends that they really care about or that push them to their limits or challenge them. Those are the things that people tend to find meaningful. And if you think that meaning is not objective property of things, but rather an experience, a human experience or experience of conscious beings, then I think there's lots of things that are meaningful.

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