Feeling good | David Burns | TEDxReno

Summary

In this powerful talk, Dr. David Burns discusses the impact of depression and anxiety, sharing his journey from a biological psychiatrist to adopting cognitive therapy. He explains the theory that negative thoughts create moods and how cognitive distortions contribute to mental health issues. Through his experiences and research, he demonstrates the effectiveness of cognitive therapy in treating depression, including his own personal application when facing his son's health crisis, ultimately emphasizing the potential for healing and happiness.

Takeaways

• 😔 Depression and anxiety are common and can be deeply distressing, with some individuals even praying for death as a preferable alternative to suicide.
• 🤔 The speaker initially pursued biological psychiatry, focusing on brain chemistry and the idea of chemical imbalances causing mental health issues, but found this approach insufficient.
• 💊 Antidepressants were prescribed extensively, but the speaker observed that they only helped a minority of patients, leading to a search for alternative treatments.
• 💡 The introduction of cognitive therapy by Aaron Beck offered a new perspective, suggesting that negative thoughts, not chemical imbalances, are the root of depression and anxiety.
• 🧠 Cognitive therapy is based on the idea that our thoughts create our moods, and by changing our thought patterns, we can change our emotional states.
• 🔍 The therapy identifies ten common distortions in thinking that contribute to negative emotions, such as all-or-nothing thinking and overgeneralization.
• 📚 The speaker's personal experience with cognitive therapy began skeptically but led to profound changes in his patients' lives, including those with long-term depression.
• 📈 Research has shown that cognitive therapy can be as effective, if not more so, than antidepressant medications for treating depression.
• 📖 The book 'Feeling Good' was written to provide tools and techniques from cognitive therapy to the general public, allowing self-help and acceleration of recovery.
• 🌟 The speaker's work and the development of cognitive therapy have led to significant advancements in the field of psychotherapy, making it the most researched form of therapy in history.
• 👨‍⚕️ The speaker's personal application of cognitive therapy techniques during a family crisis demonstrated their effectiveness and the importance of practicing what is preached.

Q & A

What is the main topic of the speaker's talk?

The speaker's talk is focused on depression and anxiety, exploring their causes and potential treatments.

Why did the speaker initially believe in the chemical imbalance theory of depression and anxiety?

The speaker initially believed in the chemical imbalance theory because he was a biological psychiatrist and was conducting research on brain chemistry at the time.

What were the two main problems the speaker faced with the chemical imbalance theory?

The two main problems were that the speaker's own research did not confirm the chemical imbalance theory as the cause of depression and anxiety, and the fact that antidepressants were not helping most of his patients.

What is 'cognitive therapy' as mentioned in the script?

Cognitive therapy is a form of psychotherapy developed by Aaron Beck, which posits that thoughts create all of our moods and that negative thoughts during depression and anxiety are distorted and not realistic.

What is the significance of the patient Martha's story in the script?

Martha's story is significant as it illustrates the effectiveness of cognitive therapy. By challenging her negative thoughts, she was able to recognize her accomplishments and change her mood from depression to a more positive state.

What was the speaker's reaction to the idea of cognitive therapy initially?

The speaker initially dismissed the idea of cognitive therapy as 'bullshit', doubting that it could help with serious cases of suicidal depression.

What did the speaker do after trying cognitive therapy with his first patient?

After trying cognitive therapy with his first patient, the speaker began to see positive changes in his patients and decided to commit his life to this form of therapy, even returning a government grant to focus on it.

What is the role of the book 'Feeling Good' in the script?

The book 'Feeling Good' is a manual written by the speaker for patients and the general public, providing tools and techniques of cognitive therapy to help people deal with depression and anxiety on their own.

What was the outcome of the research conducted at the University of Alabama regarding the book 'Feeling Good'?

The research found that 69% of the patients who read 'Feeling Good' while on a waiting list for therapy recovered and did not need additional treatment.

How did the speaker apply cognitive therapy to his own life when his son was born with breathing difficulties?

The speaker identified and challenged his own negative thoughts and distortions about his son's condition, which helped him to alleviate his anxiety and provide emotional support to his son.

What was the impact of the speaker's personal application of cognitive therapy on his son's condition?

After the speaker calmed his own anxiety and provided emotional support to his son, the baby calmed down, started breathing, and was discharged from the intensive care unit.

Outlines

00:00

🧠 The Search for Depression's Cause and Cognitive Therapy Introduction

The speaker, a psychiatrist, discusses the profound impact of depression and anxiety on individuals, highlighting the severity of these conditions through personal accounts of patients wishing for fatal illnesses over suicide. The speaker's journey begins at the University of Pennsylvania Medical School, where initial beliefs in biological causes of mental health issues, such as chemical imbalances in the brain, were challenged by research findings and the limited effectiveness of antidepressants. The introduction of cognitive therapy by Aaron Beck is presented as a paradigm shift, with the foundational idea that negative thoughts, not just chemical imbalances, are the root of depression and anxiety. Three core concepts of cognitive therapy are introduced: thoughts create moods, negative thoughts during depression are distorted and unrealistic, and changing thought patterns can alter feelings.

05:00

🤔 Skepticism and the Exploration of Cognitive Therapy

Initially skeptical of cognitive therapy's ability to combat severe depression, the speaker recounts a pivotal moment in their professional development. Attending Aaron Beck's seminar and applying cognitive therapy techniques to a patient who had attempted suicide, the speaker discovers the power of examining negative thoughts. Through the process of 'examining the evidence' and encouraging the patient to list her accomplishments, the speaker experiences a profound realization of the therapy's effectiveness. The patient's transformation upon recognizing her significant life achievements challenges the speaker's preconceptions and leads to a deeper exploration of cognitive therapy.

10:02

📈 The Impact and Research of Cognitive Therapy

The speaker shares their commitment to cognitive therapy, foregoing a government grant to focus on this therapeutic approach. They detail the burgeoning research supporting the efficacy of cognitive therapy, highlighting a pilot study at Penn and subsequent studies that position it as the most researched form of psychotherapy. The speaker's personal involvement in authoring a manual for the general public, 'Feeling Good,' is described, along with its significant impact on individuals' lives, as evidenced by emails and fan letters. The narrative includes a study from the University of Alabama, demonstrating the book's effectiveness as a standalone therapeutic tool, and the speaker's reflections on the distinction between being a technician and a healer.

15:04

👨‍⚕️ Personal Application and Healing Power of Cognitive Therapy

In a deeply personal account, the speaker recounts applying cognitive therapy to their own life during a family crisis when their son was born with breathing difficulties. By identifying and challenging negative thought patterns, the speaker experiences a profound reduction in anxiety. The narrative illustrates the power of cognitive therapy not only as a clinical tool but also as a means for personal healing and growth. The story concludes with the speaker's son, Erik, expressing gratitude for his father's work and the impact it has had on his life, emphasizing the message of hope and the potential for happiness despite adversity.

Keywords

💡Depression

Depression is a mental health disorder characterized by persistent feelings of sadness, hopelessness, and a lack of interest or pleasure in activities. In the video, it is a central theme, with the speaker discussing the profound impact of depression on individuals and their search for effective treatment methods. The script mentions patients praying to develop cancer as a preferable alternative to suicide, highlighting the severity of depression.

💡Anxiety

Anxiety refers to a sense of worry, nervousness, or unease, often about an imminent event or without a clear cause. The video addresses anxiety as a common struggle that can lead individuals to feel self-doubt and inferiority. The speaker's narrative includes the question of how to alleviate these negative emotions and the exploration of cognitive therapy as a potential solution.

💡Self-doubt

Self-doubt is the lack of confidence in one's own abilities, leading to negative self-assessment and a belief that one is not good enough. The script uses self-doubt as a gateway to discussing the broader issues of depression and anxiety, with the speaker asking the audience to raise their hands if they have ever experienced such feelings, thereby personalizing the issue.

💡Cognitive Therapy

Cognitive therapy, also known as cognitive-behavioral therapy, is a form of psychotherapy that focuses on identifying and changing distorted thought patterns that lead to emotional distress. The video emphasizes cognitive therapy as a breakthrough approach, with the speaker recounting their initial skepticism and subsequent realization of its effectiveness in treating depression and anxiety.

💡Chemical Imbalance

The term 'chemical imbalance' in the context of the video refers to the hypothesis that depression and anxiety are caused by an imbalance of chemicals in the brain. The speaker initially pursued this line of research and treatment with medications but found it wanting, as it did not align with their findings or patient outcomes.

💡Antidepressants

Antidepressants are a class of medications used to treat depression by altering brain chemistry. The script discusses the speaker's experience with prescribing antidepressants, noting that while some patients benefited, many did not see significant improvement, leading the speaker to seek alternative treatment approaches.

💡Mood

Mood, in the video, refers to the emotional state of an individual, which can be influenced by thoughts and external events. The speaker explores the idea that negative thoughts can create negative moods, such as depression and anxiety, and that changing these thoughts can improve one's mood.

💡Distortions

Distortions, as discussed in the video, are cognitive errors or irrational thought patterns that individuals who are depressed or anxious often exhibit. Examples given include all-or-nothing thinking and overgeneralization. The speaker explains that recognizing and challenging these distortions is key to cognitive therapy.

💡Epictetus

Epictetus was a Greek philosopher mentioned in the video who posited that people are disturbed not by events but by their views of those events. This philosophical notion is foundational to cognitive therapy and is used in the script to underscore the idea that our interpretations shape our emotions.

💡Suicide

Suicide is the act of intentionally causing one's own death and is depicted in the video as a tragic consequence of severe depression. The speaker recounts patients' desperate wishes for death and the importance of finding effective treatments to prevent such outcomes.

💡Empathy

Empathy is the ability to understand and share the feelings of others. In the video, the speaker demonstrates empathy by applying cognitive therapy techniques to his own feelings of anxiety when his son was born with breathing difficulties, illustrating the personal relevance and power of the therapy.

Highlights

Depression and anxiety are among the worst forms of human suffering, with some individuals praying for death as a more dignified alternative to suicide.

The speaker began as a biological psychiatrist, researching brain chemistry and chemical imbalances as potential causes of depression and anxiety.

Antidepressants and other medications were found to help only a few patients, leading to a search for better treatment methods.

Cognitive therapy, developed by Aaron Beck, was introduced as a new approach focusing on the role of thoughts in creating moods.

Three core ideas of cognitive therapy: thoughts create moods, negative thoughts in depression are distorted, and thinking patterns can be changed to improve mood.

The concept that thoughts influence emotions dates back to Greek philosopher Epictetus and Buddha, emphasizing the power of interpretation.

Depression and anxiety are linked to ten common thought distortions, such as all-or-nothing thinking and overgeneralization.

Cognitive therapy techniques, like 'examine the evidence,' help patients challenge and change their negative thought patterns.

A personal account of using cognitive therapy on a suicidal patient revealed the power of identifying and reframing negative thoughts.

The transformational impact of cognitive therapy is illustrated through the story of a patient who reevaluated her life's accomplishments, shifting from feelings of worthlessness to self-worth.

Research indicates cognitive therapy is as effective, if not more so, than antidepressant drugs for treating depression.

The book 'Feeling Good' was written to provide patients and the public with tools to apply cognitive therapy techniques in their own lives.

A study at the University of Alabama demonstrated that reading 'Feeling Good' led to significant mood improvements and recovery in patients with severe depression.

The speaker's personal application of cognitive therapy techniques during a family crisis highlights the practicality and effectiveness of the approach.

The story of the speaker's son's birth and the subsequent application of cognitive therapy principles to manage anxiety and despair.

The profound moment when the speaker's son, Erik, was introduced, expressing gratitude for the impact of cognitive therapy on his life.

The importance of self-belief and the power of cognitive therapy to change lives, as reflected in the speaker's and his son's experiences.

Transcripts

Translator: sevgi özgüngör Reviewer: Tanya Cushman

Well,

my talk is on depression and anxiety.

Sometimes,

some of us fall into black holes of self-doubt, anxiety, inferiority,

feeling like we're not good enough,

beating up on ourselves.

How many of you sometimes feel that way?

Put your hands up if you've ever struggled with depression or anxiety or self-doubt.

It's one of the worst forms of human suffering.

I've had patients who told me

that they pray to God at night that they could develop cancer

so they could die in dignity, without committing suicide.

How many of you have ever felt, maybe, that your life was not worth living

or have known a friend or a loved one or a colleague who made a suicide attempt?

Put your hands up if that's ever touched you.

It's one of the most horrible, horrible things.

I started out at University of Pennsylvania Medical School.

I finished my residency, and I did a research fellowship on depression,

and I was always curious:

What makes us depressed?

Why do we fall into these black holes?

What's the cause of it?

What can we do to turn these moods around?

And I started out like many young psychiatrists -

it's what you call a biological psychiatrist.

I was doing research on brain chemistry,

this idea that depression and anxiety

are due to some kind of chemical imbalance in the brain.

I was treating patients

with antidepressants and other medications,

but there were only two problems from my point of view.

The first is our own research we did;

it didn't seem to confirm that depression or anxiety

were actually due to a chemical imbalance in the brain.

In fact, our research indicated

that this probably is not the cause of depression and anxiety.

In addition,

I was giving out antidepressants by the bucketful to patients.

I had hundreds of patients,

and while a few of them were being helped,

most of them were not.

They were going on week after week, saying, "I want to die. I feel worthless."

And I said, "Gosh, there's got to be a better way."

If the pills had worked, I would have been perfectly happy.

And I thought, "Maybe there's some type of psychotherapy

I could combine with the medications,"

because I wanted people to be able to wake up

and say, "It's great to be alive."

and have joy and full of love: "I'm full of life,"

and I was rarely seeing that.

I tried different kinds of psychotherapy; they didn't seem to work.

And then a colleague said, "You know, there's something new

fellow here at Penn is developing - Aaron Beck -

and he calls it 'cognitive therapy,' and it's kind of simple in its theory,

and maybe you could try this out with some of your patients."

A cognition is a thought; it's just a fancy word for a thought,

and there's three basic ideas behind cognitive therapy.

The first is that our thoughts create all of our moods,

and that when you are depressed and anxious,

you're giving yourself negative messages,

you're blaming yourself,

you're telling yourself something terrible is going to happen.

Now, this idea is not new;

it goes back to the Greek philosopher Epictetus.

Nearly 2,000 years ago, he said, "People are disturbed not by things" -

in other words, not by the events of our life,

but by the views we take of them,

that we create all of our emotions, positive and negative,

at every moment of every day

through our interpretations of what's going on.

And it goes back even before Epictetus

to the Buddha, who was saying the same thing 2,500 years ago.

Well, the second idea is that when you're depressed and anxious,

those negative thoughts -

"I am no good," I'm a loser," "What's wrong with me?"

"I shouldn't have screwed up," "I should be better than I am" -

those thoughts are not realistic thoughts;

they're distorted,

that depression and anxiety are the world's oldest cons,

and that there's ten distortions that you always see

in the negative thoughts of individuals who are depressed and anxious.

Like all or nothing thinking:

"If I'm not a great success today, I'll be a total failure."

Shades of gray don't exist.

Or overgeneralization -

seeing a negative event as a never-ending pattern of defeat.

Or "should" statements or self-blame.

And the third idea

was that you could train people to change the way they think

and then suddenly change the way they feel.

Well, I heard that theory, and I said, "That sounds like so much bullshit."

(Laughter)

I know my patients have negative thoughts.

That's certainly the case.

But you can't help serious suicidal depression

with some kind of power of positive thinking.

And I told a colleague this.

He says, "Well, David, why don't you go to Beck's weekly seminar,

and as part of your research, try this with a few of your toughest patients,

and then you can prove to yourself that it doesn't work."

And I thought, "That's a great idea. I think I'll check it out."

Well, the first patient I tried it out on was a woman

referred from the intensive care unit of the university hospital.

She had made a nearly successful suicide attempt,

an elderly Latvian immigrant,

and they referred her to me for follow-up.

And I said, "Martha, there's this new form of therapy.

I'm doing some investigating.

Would it be okay if I present your case at this weekly seminar,

and then I can tell you what they say,

and maybe we can find some new techniques?"

She was fine with that; she gave me permission.

So I presented her case to Dr. Beck and said,

"How would you use this cognitive therapy with someone who's suicidal?"

And he said, "Well, our thoughts create all of our emotions,

so just ask her,

'What were you telling yourself the moment you tried to commit suicide?'"

So I went back to her, and she said, "What did you find out in the seminar?"

I said, "Well, I'm supposed to ask you

what you were telling yourself the moment you attempted suicide.

What were your negative thoughts?"

And she said, "Oh, I was telling myself that I'm a worthless human being

because I've never accomplished anything meaningful or significant in my life."

And she said,

"Now what am I supposed to do about that?"

And I said, "I'm not sure. You have to wait a week,"

(Laughter)

"[I'll] go back and ask at the seminar."

So I went back and said,

"Here's what I found out. What should I do?"

And Dr. Beck said, "Well, one technique we use is called 'examine the evidence.'

See if what you're telling yourself is true or not.

Ask her to make a list of several thing she has accomplished."

I thought, "That makes sense."

So I went back; she said, "What did you find out at the seminar?"

I said, "You're supposed to make a list of several things you have accomplished."

She said, "Well, that's just the problem. I can't think of anything."

And I don't know, maybe some of you folks felt that way some times

and look back on your life and say,

"What have I done that was really meaningful,

that was really significant?

What did my life really amount to?"

So I said, "Well, why don't you take it as a homework assignment?

Maybe you can think of something."

Well, the next week, I forgot I gave her the homework assignment;

I did my usual non-specific schmoozing and "How are you feeling?"

and "Do you need a refill on the antidepressant?"

and this type of thing,

and halfway through the session,

she said, "Well, aren't you going to ask me about my homework?"

I said, "Ah, I forgot. Did you come up with anything?"

And she handed me a list of about, oh, seven or eight things

that she had accomplished during her life,

and the first one, she said, "I overlooked the fact that -

I smuggled my children out of Nazi Germany.

My husband died in the concentration camps.

All of our relatives died in the concentration camps,

but I got the children out, and we made it to America.

And I've worked, scrubbing floors and cleaning people's houses,

to keep food on the table and to keep the roof over our head.

And this week,

my son just graduated first in his class from the Harvard Business School.

So I thought, 'Well, maybe that's an accomplishment.'"

(Laughter)

And then she said, "And I forgot that I speak five languages fluently,

and I'm a gourmet chef."

And she had all these amazing things.

And I said, "Martha, how do you reconcile this

with your claim that you're a worthless human being

who's never accomplished anything meaningful?"

And she said, "Dr. Burns, it doesn't compute.

It doesn't make any sense.

I don't know how I could have been thinking that."

And I said, "How are you feeling now?"

She said, "I'm feeling a lot better."

She said, "Do you have any more techniques?"

I said, "No, that's the only one I've learned so far.

You'll have to wait till next week. I'll learn another technique."

And so that's how it began to go,

and I began to see patient after patient that I'd been stuck with,

some patients who'd said they'd been depressed,

had failed therapy for more than 50 years,

some who said they've never had one moment of happiness in their entire life

suddenly experience joy and self-esteem.

And I said, "This is the thing I want to commit my life to."

I had just received a grant from the government - a five-year grant -

to develop a brain-chemistry research laboratory at the medical school.

And I sent the money back.

I said, "I don't want to spend my life

doing research on a theory that's not going bear fruit.

This is what I want to do."

And then the research began to come in.

First a pilot study at Penn that showed that this new form of therapy

was as effective, if not more effective, than the best antidepressant drugs.

And then study after study has come in,

and now it's become the most researched form of psychotherapy in history.

We all got excited, and Dr. Beck said,

"David, would you like to co-author the manual

that we're writing for therapists

so people can learn how to do this new form of therapy?"

And I said, "You know, you've got enough people -

Brian Shaw, Gary Emery and others -

who can co-author that book for you.

I think my calling is to write the manual for the patients and the general public

to show people, give them tools,

to begin to use these tools in their own lives,

and maybe patients could read the book between the sessions

to accelerate their recovery."

So then I wrote the book "Feeling Good."

Other research came along:

a fellow at University of Alabama began to do some research

on what is the fastest and most inexpensive way

to treat people with depression.

And he did some research I was unaware of.

He took people coming to the University of Alabama

asking for therapy for severe depression

and said, "You've got to be on a waiting list for four weeks

before you can see the psychiatrist,

but in the meanwhile, we want you to read this book, 'Feeling Good'."

And then he did research on them every week to see,

Would there be any change in mood?

And he reported that 69% of the patients

in four weeks were recovered and needed no additional therapy.

He's repeated - he's done at least eight outcomes studies

with older citizens and teenagers, people all ages in between

and has continued to come to the same conclusion.

And I kind of knew that was true

because I've gotten at least, probably 50,000 emails and fan letters from people

who said, "I read your book, and it changed my life."

Now, in my group at Stanford, my psychotherapy development group,

it's getting even better,

and we're developing even newer and more powerful techniques.

I think there's a difference between a technician and a healer,

and one of the differences is,

Can you use your tools in your own life?

Can you practice what you preach?

I kind of believe in the idea of "Physician, heal thyself."

And certainly I've known my own moments of anxiety,

like when I was invited to come to speak here,

and despair as well.

And I was put sorely to the test when our son was born.

I was there at his birth, and after he was born, the doctor said,

"You've got a wonderful, healthy son here,

but the only problem is he can't breathe."

And I looked at him, and he was bright blue.

His lips were blue and his fingernails were blue,

and he was struggling to get air.

And he said, "We're going to put him in the intensive care unit."

And I thought, "Oh my gosh. This is horrible."

He was born, I think, at around 10 at night,

and I went home, and I was feeling anxious and depressed and terrified.

And I told myself, "Well, remember it's not the events,

it's your thoughts that upset you."

And I said, "Oh no, that can't be true.

This is real."

I said, "That's what your patients say.

Why don't you write your thoughts down

and see if there's some distortions in them."

And so I thought, "Okay, I will."

And the first thought is,

"Well, my son needs oxygen for his brain, and he's going to have brain damage."

And then the second thought:

"We'll be bringing him to clinics for the rest of his life."

Then I did a little thing called the downward arrow:

If it were true, what would it mean to you?

And the third thought:

"Well, then people will look down on me because I have a mentally retarded son."

Then I said, "Are there any distortions here?"

I said, "Well, gosh, here's fortune-telling.

I don't know that he's going to have brain damage.

Doctor never said that, he just said, 'We'll put him the intensive care unit.'

And then,

are people going to look down on me because I have a son with brain damage?"

I said, "That's ridiculous.

People will feel about me depending on how I treat them.

And if I love them and treat people with care and compassion,

they will respond."

And suddenly all my anxiety disappeared.

And then I said, "You know, look at how self-centered you're being.

Your son needs you; he's suffering in the hospital,

And I said, "I'm going to go and see him."

I was on the faculty, so I said, "I can get into the intensive care unit."

I went in there about three in the morning,

and I said, "Can I see my son?"

They said, "Yes, certainly, Doctor."

And then he was in this incubator, and he was going [Raspy breathing],

and just his whole body was shaking to get a breath,

and he was still blue,

and it was so sad, and I said, "Can I touch him?"

They said, "You have to put this glove on

and put your hand through this hole in the incubator,

and so I put my hand in, and I put my hand on his forehead,

and I said, "Erik, I want you to know that we love you.

Your mommy and daddy love you,

and we're going to be with you every step of the way."

And I felt better, and I went home and felt at peace,

and the phone rang.

It was the intensive care unit nurse,

and she says, "You know, Dr. Burns, the oddest thing happened.

The moment you walked out of the intensive care unit,

Erik calmed down and started breathing, and the doctor discharged him.

He's cuddling with his mommy for the first time."

Well, that's about it.

Erik suggested I tell this story; I've never told it in public before.

I said, "I'll tell it if you'll come on up to Reno with me

so I can introduce you to the group."

(Applause)

(Erik) Wow. I think if I had dry eyes right now then I would not be your son.

I just wanted to - in case you didn't get the message -

I think it's that you don't have to be blue anymore.

All right? We can all be happy.

I just want to say to you, Dad, for inviting me up here -

it's such an honor.

I'm so proud of you. Wow, I'm so proud.

This speech is just phenomenal, and your life's work.

I just want to say I'm so thankful

that you had enough faith in yourself to have faith in me, to give me my life.

So thank you.

(Applause)