Cognitive Behavioral Therapy and beyond (with David Burns)
Jan 10, 2024
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David Burns, an Adjunct Clinical Professor Emeritus at Stanford and a pioneer in Cognitive Behavioral Therapy, discusses the evolution and transformative power of CBT. He tackles the common misconceptions about therapy, addressing the dangers of overselling positivity and how negative emotions can illuminate personal strengths. Listeners will learn about innovative techniques like the TEA-M approach and the role of empathy in therapy. Burns also highlights revolutionary methods that require fewer sessions, emphasizing personalization in mental health treatment.
CBT focuses on identifying and changing distorted thoughts rather than promoting positive thinking.
Empathy and compassion are crucial in therapy to build trust and create an environment for change.
Positive reframing in team CBT helps patients find beauty and meaning in their negative emotions.
Therapists should combine empathetic skills with evidence-based techniques and continually measure progress.
Exposure therapy, when done properly, can lead to rapid recovery and long-lasting positive changes.
Deep dives
Cognitive Behavioral Therapy and the Origins of CBT
David Burns discusses the early days of cognitive behavioral therapy (CBT) and its evolution. He shares how he initially thought CBT was a flawed approach but changed his mind when he saw its effectiveness. Burns emphasizes the importance of thoughts in influencing emotions and introduces the concept of thinking errors or cognitive distortions. He shares an example of a patient who believed she was worthless but ultimately discovered her value through challenging her negative thoughts. Burns also addresses the misconception that CBT promotes positive thinking and explains that it focuses on identifying and changing distorted thoughts rather than simply positive affirmations.
The Compassionate Approach in Team CBT
Burns stresses the significance of empathy and compassion in therapy. He discusses the five secrets of effective communication and how therapists can use techniques like the disarming technique, thought and feeling empathy, and assertive, innocent respect to create a strong therapeutic relationship. By validating patients' experiences and responding with empathy, therapists can build trust and create an environment for change. Burns emphasizes the importance of humility and the willingness to fail in the process of training therapists to develop strong empathetic skills.
Positive Reframing and Embracing Negative Feelings
Burns introduces positive reframing as an innovative technique in team CBT. He explains how therapists help patients reframe their negative feelings as reflections of positive aspects of their core values. Rather than trying to make the negative feelings disappear, therapists guide patients to find beauty and meaning in their emotions. They work with patients to identify distorted thoughts and develop alternative, more balanced perspectives. Burns shares examples of patients discovering the positive qualities revealed by their negative feelings, leading to profound shifts in their emotional experiences.
Integration of Empathy and Evidence-Based Techniques
Burns emphasizes the importance of combining empathetic skills with evidence-based techniques in therapy. He highlights the need to continuously measure patient progress and therapist performance through scales and feedback. By setting measurable goals and addressing resistant thoughts and behaviors, therapists can create a structured and effective treatment plan. Burns encourages therapists to remain humble, embrace continuous learning, and cultivate skills that allow rapid and profound change in their patients' lives.
Importance of Confronting Fears
Confronting fears is key to overcoming anxiety and phobias. In a podcast episode, a therapist shares the story of a patient with contamination fears who was encouraged to touch germs and confront her fear head-on. Through this exposure therapy, the patient experienced rapid recovery and expressed relief from her lifelong struggles.
Psychologist's Response to Criticism
A psychologist shares his experience of receiving hostile criticism through an email. Instead of lashing out, he responded with empathy and curiosity, asking the critic to teach him and share important information. This approach led to a positive transformation in their interaction, highlighting the power of responding to criticism with kindness.
The Effectiveness of Exposure Therapy
Exposure therapy is discussed as a powerful technique for treating anxiety disorders. The therapist in the podcast explains its effectiveness in helping patients overcome their fears by gradually exposing them to triggering stimuli. Although some therapists hesitate to use exposure therapy due to misconceptions, it is emphasized that when done properly, exposure therapy can lead to rapid recovery and long-lasting positive changes for patients.
The Ineffectiveness of Physical Exercise on Mental Health
The podcast explores the speaker's perspective on the role of physical exercise in mental health. The speaker argues that physical exercise is not effective in improving mental health, but it can have a placebo effect. They cite research that debunks the notion of endorphins being responsible for mood improvement from exercise. The speaker shares a personal anecdote of trying to help a man feel better through exercise, but it did not alleviate his feelings of worthlessness. They emphasize the importance of targeting and addressing specific thoughts and problems in therapy, rather than relying solely on exercise.
The Dodo Bird Hypothesis and the Effectiveness of Different Therapeutic Techniques
The podcast discusses the Dodo Bird Hypothesis, which suggests that different therapeutic techniques perform similarly in terms of their outcomes. The speaker acknowledges the limited effectiveness of various forms of psychotherapy and argues that most therapies only provide a modest improvement beyond the placebo effect. They introduce their own therapy approach called team therapy, which aims to deliver more powerful and fast-acting treatments with significant effects. The speaker highlights the need for therapies to go beyond placebo effects and the importance of personalized, data-driven approaches to maximize results and reduce resistance in patients.
What was therapy like in the years leading up to the advent of CBT? Has CBT now been over-sold? How does CBT differ from "the power of positive thinking"? How can therapists who use CBT avoid invalidating clients' feelings? When, if ever, should people listen to their negative thoughts? To what extent can a person's good qualities contribute to their depression? Can empathy be learned? Is it possible to cure depression in a single psychotherapy session? What is TEAM-CBT? Is exposure therapy cruel? What are some strategies for silencing the voices in our heads that lead to depression, anxiety, and other negative mental states?
David Burns is Adjunct Clinical Professor Emeritus of Psychiatry and Behavioral Sciences at the Stanford University School of Medicine, where he is involved in research and teaching. He has previously served as Acting Chief of Psychiatry at the Presbyterian / University of Pennsylvania Medical Center (1988) and Visiting Scholar at the Harvard Medical School (1998), and is certified by the National Board of Psychiatry and Neurology. He has received numerous awards, including the A. E. Bennett Award for his research on brain chemistry, the Distinguished Contribution to Psychology through the Media Award, and the Outstanding Contributions Award from the National Association of Cognitive-Behavioral Therapists. He has been named Teacher of the Year three times from the class of graduating residents at Stanford University School of Medicine, and feels especially proud of this award. In addition to his academic research, Dr. Burns has written a number of popular books on mood and relationship problems. His best-selling book, Feeling Good: The New Mood Therapy, has sold over 4 million copies in the United States, and many more worldwide. When he is not crunching statistics for his research, he can be found teaching his famous Tuesday evening psychotherapy training group for Stanford students and community clinicians, or giving workshops for mental health professionals throughout the United States and Canada. Learn more about him at feelinggood.com.
