037: Ask David — "My negative thoughts aren't distorted!"

"My problems are real! The world really IS screwed up! And that's not a distortion. So what can I do about my severe depression and anxiety?"

David and Fabrice discuss two questions submitted by Feeling Good Podcast listeners.

#1. Shari writes:

"I read your book Feeling Good and now I am reading your book When Panic Attacks--thanks to April's podcast with you. I still struggle but recently our current political situation and environmental research about our negative impact on earth—has triggered severe anxiety and depression again. The problem is that I don't think my thoughts are distorted—it certainly seems logical to assume that life on earth is threatened. So I am not sure how to do this. How can I make progress with my mental and emotional health while being aware of situations around the world? Any advice or thoughts would be deeply appreciated."

This is a wonderful note, and I'm sure that huge numbers of people feel the same way, in varying degrees. So how can we attend to our own emotional well-being in the face of genuine adversity?

Dr. Burns discusses this from the perspective of Paradoxical Agenda Setting, which is the key component of TEAM-CBT, and emphasizes the most common therapeutic error of all—jumping in to try to help, without seeing all the really GOOD reasons for the patient NOT to change. From this perspective, Shari's question becomes the most important question in all of psychiatry and psychotherapy—how do we help patients who may not want to change?

#2. After listening to the A = Agenda Setting portion of the live therapy with Mark, Paul submitted this question:

"Hi David,

Thanks to you, Fabrice and Jill for this episode - as with the previous episodes with Mark, this has really helped in bringing the TEAM approach to life. As I have been using your books in the past few years to self-treat feelings of anxiety and depression, I was very keen to hear how the new agenda setting step works.

I am wondering what your thoughts are on how effectively the "A" step can be carried out by a patient on his/her own (i.e. without someone else verbalizing the reasons not to change / playing the part of the patient's sub-conscious)? Do you have any tips? I think I heard Mark say something to the effect that, on his own, he wouldn't have thought of all the positives that you came up with in the session.

Thanks again for sharing these great tools and techniques - looking forward to the "M" step soon.

Paul"

This was another terrific question on a topic of great importance. David explains that it is actually easier for patients to learn to use Positive Reframing and the other Paradoxical Agenda Setting techniques than for therapists to learn them. Because of his excitement over this prospect, David has just begun a new book which will show depressed and anxious individuals exactly how to do this on their own in a step-by-step manner. He is optimistic that the new TEAM-CBT techniques, in book form, may be even more helpful to patients than his first book, Feeling Good: The New Mood Therapy. Research studies indicate that 65% of patients with moderate to severe depression improve substantially within four weeks of receiving a copy of Feeling Good, even without any other treatment. Dr. Burns is hopeful that his new book will provide the answers for the 35% who were not helped by Feeling Good.

So the answer is yes, I think many individuals WILL be able to do the "A" step on their own, and I am hopeful the positive impact will be great!

If you would be interested in David's new book, please indicate this in the Survey attached to this podcast.

David and Fabrice have exciting plans for upcoming podcasts. They will be addressing these two questions in one or two podcasts:

1. Is it possible to measure our "worthwhileness" or "worthlessness" as human beings?
2. Do we even have a "self"?

These two questions have been discussed by experts for thousands of years, going all the way back to the Buddha, and most recently by the incredible Austrian philosopher, Ludwig Wittgenstein. And although the answers are tremendously simple, people can't seem to "get it." The issues are not simply philosophical, but eminently practical, since most depression and anxiety result from the perception that one is "worthless," or "inferior," or simply "not good enough."

In addition, David and Fabrice are hoping to create a second live therapy session broken into smaller podcast chunks, but featuring David and a totally awesome former student and now highly esteemed colleague, Matthew May, MD. For the past ten years, David has been telling workshop audiences that Matt is one of the finest therapists in the world. So this is an event you won't want to miss!

Click here to listen to Fabrice being interviewed on Dr. Carmen Roman's podcast.