Navigating Therapeutic Goals and Patient-Focused Care

Waking Up Dreading the Day Mother-Daughter Problems Patients Who Are Afraid of Their Feelings Romantic Problems, and More

Questions for today:

1. Rose asks: I wake up dreading the day. What can I do?!
2. Maggie integrates TEAM-CBT with prayer and asks for help with mother / daughter issues.
3. Simon asks: “How can we deal with patients who are afrad of their feelings?”
4. Amanda asks: “Help! I have a romantic relationship conflict! What should I do?”
5. Aaron asks: Why are feelings of depression and anxiety correlated? In other words, why do they frequently go hand in hand?

The following questions and answers were written prior to the live podcast. Make sure you listen to the podcast to get the full answers, including role-play demonstrations, and so forth.

 

1. Rose asks: I wake up dreading the day. What can I do?!

Hi David,

I've been reading your book, "Feeling Good," for help with my anxiety ever since my 100-year-old mom moved in with me.  Your techniques are helping, but every morning I wake up anxious, dreading starting my day.  Is there a technique to help with this?

I really am working to change my thoughts from negative to more positive thanks to you.

I look forward to hearing from you.

Rose

David’s reply

In my book, Feeling Good, I urge people to write down your negative thoughts, and emphasize that it won’t work very well unless you do this. Many people refuse. How about you? What were the thoughts you wrote down when you woke up feeling upset and dreading your day.

Could use as an Ask David on a podcast if you like.

Best, david

Rose wrote: Thanks for your speedy reply.  I'm new at this and just started reading the book yesterday, but I will start writing down my thoughts.  Thanks for your help.

2. Maggie integrates TEAM-CBT with prayer and asks for help with mother / daughter issues.

Dear Dr. Burns,

I want to begin by expressing my deep gratitude for your work, which has had a profound impact on my life. Your book Feeling Good: The Workbook helped me overcome a very dark period of depression after being diagnosed with infertility. It truly transformed my mental health, and I continue to rely on your techniques—especially your list of cognitive distortions, which I use often to stay grounded.

Your podcast has also been a great resource for me, and I’ve noticed recent episodes touching on the self and spirituality, which caught my attention in a special way. I felt compelled to share something personal with you. While your methods gave me the tools to change my thinking, I also found solace and strength through my faith. Prayer was an essential part of my healing process, and for me, it provided something beyond my own power. In moments when I felt I couldn’t make it through on my own, the belief that there is a God I can turn to brought me peace and comfort.

Both your work and my faith were crucial in my journey. Your research and teachings helped me take control of my thoughts, but my relationship with God gave me hope when I needed it most. I believe that the combination of these two—your scientifically backed methods and the power of prayer—made a tremendous difference in my recovery.

I’m also excited about your app, but as someone living in Honduras, I was unable to download it. I would love to know if there are plans to make it available outside the U.S. in the near future, as it would be an incredible resource for me and others in similar situations.

Lastly, can I make a suggestion for a podcast subject?  Mother daughter issues. I really need help in this area of my life.

Thank you for your dedication to helping others. I hope that sharing my experience offers some insight into how both your studies and faith in something greater can bring peace and healing.

With gratitude,

Maggie

David’s reply

Thanks, and we’d love to read part of your beautiful note, with or without your correct first name, on a podcast.

If you can give me a more specific example of the mother daughter issue you want help with, it would make it much easier to respond in a sensible way!

Warmly, david

Maggie responded

Dear Dr. Burns,

Thank you so much for your thoughtful response and for asking me to clarify my suggestion regarding mother-daughter issues. I deeply love my mother, and I know she means well, but our relationship has become increasingly challenging as she gets older.

One of the major difficulties I face is her tendency to offer passive-aggressive criticism, which leaves me feeling undermined. I’ve always known her to be this way—she was never very affectionate, and I’ve gotten used to that. However, lately, it feels like it’s getting worse. She’s hard of hearing, even with a hearing aid, and often adopts a “my way or the highway” attitude, which makes conversations with her exhausting. Simple moments where I hope to share something exciting are often met with dismissive or critical remarks.

Here are three examples of the kind of interactions that affect me:

1. I recently purchased tickets for a trip to Australia with friends, and her response was to ridicule my choice, saying that Spain or Italy is a much more beautiful destination. I had just bought the tickets, and all I wanted was for her to share in my excitement.
2. I sent her a picture of a new piece of art I was excited about, and her immediate reaction was, “I liked the other one better. That one doesn’t match the color of the walls.”
3. As I was about to leave for a party with my husband, she commented, “Don’t you think you’re wearing too much makeup?”

These kinds of remarks constantly make me feel inadequate, and it’s emotionally draining. As a result, I’ve found myself avoiding calling or visiting her. However, this leads to feelings of guilt, especially because I love my father very much, I enjoy his peaceful company and wise conversation and advice, and not visiting them also affects my relationship with him.

What I struggle with most is that I know I might regret not spending enough time with her as she gets older, even though she isn’t sick or dying. I just don’t know how to manage the criticism without feeling constantly undermined, and I’d appreciate any advice you might offer on how to navigate this dynamic while preserving my sense of self-worth.

Thank you again for your time and for the incredible impact your work has had on my life.

With gratitude,

Maggie

David’s reply

I notice you’re pointing the finger of blame at her. If you want to shift things, it can be helpful to examine your role. I’m attaching a copy of the Relationship Journal. Please do three of these, one for each example below. You already have half of Step 1—what, exactly, did she say. To complete Step 1, circle all the feelings you think she may have been feeling.

Then complete Steps 2 and 3, which should be fairly easy.

Then I can take a look, and we’ll see what we can figure out, if you’d like. Also, this will not be therapy, but general teaching. LMK if that’s okay.

Best, david

Here are the three examples she provided, along with how she responded to her mom:

Three Maggie examples of interactions with her mother (Ask David podcast)

#1 Mom said: Dear, I would never have thought of Australia as a destination. I would much rather fly to Italy or Spain, filled with culture, art, and great food. Sydney would be the LAST place I’d want to visit!

I replied: Well, mom, we’ve already been to those places, and we love a great adventure, and we’re really excited by the outdoors.

#2 Just as we were about to leave, Mom said: “Don’t you think you’re wearing too much make up?”

I replied: I probably am, I didn’t notice (and rushed immediately to my room to remove it.)

#3 I share a piece of art I brought home, and Mom said: “I liked the one you had before. It matched the walls much better than this one. Why did you change it? Who is the artist?”

I replied: “Well, we have to like it because it’s the only wall in the house where it will fit, so we’re just going to have to live with it.”

3. Simon asks: “How can we deal with patients who are afraid of their feelings?”

Dear Dr. David Burns, Hi, my name is Simon and I'm a clinical psychologist from Chile, sorry if my English is kind of broken, it isn't my first language. First of all, I want to tell you how grateful I am for your great work and all the knowledge you give to the general public for free. Of course I also must praise the work of the entire team working at the podcast (which I am the biggest fan from my country). I hope one day I can be a certified team cbt therapist myself in the future, but that would be a different story. I think the world needs more people with such a love for mental health and I hope I can continue to listen to your content for more years to come.

Today I wanted to ask you guys some questions related to feelings. I have applied some techniques to myself and my patients and it's really mind blowing noticing how effective they are.

Nevertheless, I still have one patient who struggles with accepting or permitting himself to feel his feelings. He is grieving the loss of his father and he is very good convincing me that if he does feel his sadness or anxiety (as I suggested him), he may go crazy and commit suicide. He reports good empathy from me, but I'm afraid that he may be too nice to criticize me.

So, I ask for your opinion: How can we deal with patients who are afraid of their feelings? How can we build a solid relationship with our patients regarding this subject so they can finally vent these feelings?

Thank you all for all the hard work and have a great day!

With Love,

Simon

David’s answer

Hi Simone,

Thanks for your kind words, and may want to use your question on an Ask David. LMK if that’s okay.

Here’s the quick answer. It sounds like venting feelings is your agenda. Nearly all therapeutic failure comes from well-intentioned therapists who try to “help” or “rescue” the patient. I get the best results working on the things my patients want help with.

Rhonda has a free weekly group on Wednesdays at mid-morning, and I have a free weekly training group at Stanford on Tuesday evenings (5 to 7 PM California time.) You’d be welcome to join either.

Best, david

4. Amanda asks: “Help! I have a romantic relationship conflict! What should I do?”

Hi Dr Burns!

Firstly, I would like to thank you for your tremendous work and heart to help people who are suffering from depression & anxiety around the world. I found your book in 2021 through a YouTube video you did with Tom Bilyeu and the rest was history. I went down to our local bookstore to get Feeling Good and I was reading it everywhere I went. It saved my life and cured my anxiety! Every time I hit a roadblock, I will go back to the book and try the techniques. I also love the podcasts as they have been very helpful for me. Shoutout to Rhonda and Dr Matt May too!

I currently face an issue and would like to submit it as a question for Ask David series.

Please address me as Amanda.

I am in a stable and committed relationship (for 8 years) but am facing issues with my boyfriend which causes resentment between us. Meanwhile, a friend pursued me despite knowing that I am in a relationship. He told me during a meetup that he felt attracted to me and asked if I will choose him if I am single. I was attracted to this guy as he is confident, funny and carefree, which are qualities that I desire and find lacking in myself. I like him but I know that he is not a good match for me because of his actions and behaviour. The actions seemed manipulative and reflected some narcissistic tendencies.

At the start, he would text me frequently then the messages became short when I declined to meet up on a 1-1 basis with him as I want to protect my own relationship. He would drop me a short message every week, using intermittent reinforcement, to ask me how I am doing and then asked if we could meet up for a meal. Example 1: Guy-"Lunch?" Me-"Ok if it's with the group." Guy-"Ok." End of communication. Example 2: Guy-"How are you recently?" Me- "I am feeling better, thanks for checking in!" Guy- "Thumbs up emoji" End of conversation. If I initiate a meetup to run errands or for a meal, he would accept it readily. In a way, there is only communication and interaction when we meet up and I know this is not a healthy interaction or something that I want.

Fast forward, I ignored him and he is in a relationship now but our dynamics remain the same. If I reached out to him for a meal, he would respond and behave in a caring way when we met. He offered to buy food for me when I was sick and find ways to continue to meet up. I feel that this guy is just trying to get me as it gives him an ego boost (and thrill) that I care for him even though I am in a committed relationship. In our last meetup recently, I made sure to record how I felt and noticed that the satisfaction level has gone down to about 60% as compared to  previously when I was eager to meet him. I would like to reduce it to 10% or even 0%. I also recorded my satisfaction level when I did things alone or with my boyfriend. I realized that my satisfaction/pleasure level is higher and more consistent when I do things that I set out to do on my own and there are times it is enhanced/lowered when I spend time with my boyfriend.

Using the daily mood log, the upsetting event is: I will ignore this friend for a period of time then I will go back to the same communication and meetup with him. Then, I'm stuck in the same dynamic again. My negative thoughts are:

1. I will never be able to get out of this. I am doomed.
2. I have no power or control, he has all the power. People always take advantage of me because I'm weak. I am a loser because I keep going back.
3. I will never be happy again since I cannot overcome this. Things will be as such.
4. This chapter will leave a mark on my life and I will be miserable. I am a horrible person for allowing myself to fall for someone while being in a relationship.

I have been re-reading the chapter in Feeling Good on love addiction and spending more time with myself to build a relationship with myself so that I can be happy alone. I am also using the cost benefit analysis to melt my own resistance so that I do not go back but I do not seem to be able to totally defeat the negative thoughts above.

I hope to receive some guidance related to this on the podcast if possible. Thank you so much!

Love,

Amanda

David’s Reply

Hi Amanda,

Thanks so much. There are many paths forward, but one thing that might help would be to use the Decision Making Tool since you seem to be unclear on what you want to do. That might be a good first step, or next step. You can download it from the bottom of the home page of my website, feelinggood.com.

I can understand your negative feelings and confusion and self-doubt, anxiety, discouragement, frustration. I’m just speculating.

There are many ways to challenge your thoughts, but some good positive reframing might help before trying to  challenge them, so you could check out your goals for each negative emotion. Including a recent Daily Mood Log, in case you don’t have one.

All the best, david

PS What you are doing all makes good sense, developing a relationship with yourself, doing a cba, etc., Kudos!

In addition, the “25 things I’m looking for in an ideal mate” tool in Intimate Connections might also be helpful.

5. Aaron asks: Why are feelings of depression and anxiety correlated? In other words, why do they frequently go hand in hand?

Hi Dr. Burns,

I am rereading When Panic Attacks, this has lead to a question. In the book you mention that one theory about why people have both anxiety and depression is that they "can't distinguish different kinds of emotions." Can you expand on this to help me better understand what this means?

My interpretation now has me thinking that people are just saying they are depressed and anxious because they don't understand what each word for the emotions means.

Thank you for your help,

Aaron W. California---LMSW (Idaho)

 David’s reply

David D. Burns, MD

Sure, but that is not my thinking, just a common theory that of course deserves respectful consideration and testing.

To me, depression is the feeling that accompanies loss, and anxiety is the feeling that accompanies the perception of imminent threat or danger. Beck put it like this: Anxiety is like clinging by your fingertips at the edge of a cliff, fearing you will fall at any moment. Depression, in contrast, is more like thinking you have already fallen, and you are at the bottom of the cliff, broken and injured beyond repair.

Here are a couple other things that might interest you. When people are depressed, they will also report feelings of anxiety nearly 100% of the time. However, when they are anxious, they will only report feelings of depression about half the time. This is because you can have some type of anxiety, like a phobia such as the fear of heights, or elevators, or flying, but not feel depressed about it.

And here is one more tidbit. My research on the beta test data from our Feeling Great App indicates that all seven negative feelings we measure are strongly correlated and go up or down together, which was quite unexpected.

The statistical models that simulate the data provide strong evidence for an unknown “Common Cause” that activates all negative emotions simultaneously. We are trying to figure out what that Common Cause might be. It is a bit like “Dark Matter.” Scientists have proven it’s existence, but don’t yet know what it is. And this unknown Dark Matter represents 95% of the matter in the universe.

The statistical models also provide strong evidence that the Feeling Great App helps people because of its strong causal impact on this unknown “Common Cause.”

Would love to include this an Ask David in a podcast. Would it be okay?

Warmly, david

Aaron replies

Hi Dr. Burns,

I would be honored if you used my question in your podcast. Please let me know when that podcast is posted! I would love to watch it. In the email you sent, are you saying that one theory is that people just cannot accurately define what they are feeling?

David replies again

Yes, that is one theory, and I have seen that some people, including therapists, have trouble recognizing the names of feelings that their patients are having, based on what the patient says, and also they sometimes have trouble knowing how they are feeling, using “I Feel” Statements.

This is, I think, part of what has been called “Emotional Intelligence.” And, just like any skill or talent, there is a great deal of individual difference in “Emotional Intelligence,” and likely some cultural differences as well. I have heard that up until recently, the Chinese did have a word for “depression,” but when a person was appearing depressed, they were kept indoors out of a sense of shame.

Thanks!

david