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)
