“Depression is cured without drugs”

David D. Burns is Professor of Psychiatry at Stanford University. He has created a method that optimizes the results of each therapy session and that is being taught to thousands of psychologists around the world. It offers a high percentage of success and speed of healing, especially in disorders such as anxiety and depression.

Burns points out the importance of identifying the resistance that the patient may have to cure himself. He is convinced that many people hold a certain addiction to negative emotions and one of his favorite questions is: “If you had a magic button that, when pressed, would make your problem go away, would you press it?”

Burns’ method is collected in his book Feel good (Ed. Paidós), of which 4 and a half million copies have been sold in the world. Reading it is a therapy in itself. against depression. “When I wrote it, I wanted my patients to read it between sessions,” says David D. Burns, a man who breathes calm and who loves to cultivate a sense of humor.

Resistance to change is a problem to leave depression behind

–What would you say to someone who distrusts psychological therapy?
“Well, I agree with him. Many therapies that are being applied are ineffective and what they do more is put people behind closed doors over and over again. It is something very sad. I believe that the quality of psychological therapy both in the United States and in the rest of the world can be improved.

That’s why I try to develop methods that really work. But it is disheartening to see that the therapies and medications being recommended often do not achieve good results. I know that many medications used are not effective, especially antidepressants.

I teach techniques to professionals, but it is difficult to disseminate them because many therapists, although they are committed to their work, are not motivated to learn something new. There are hundreds of rival schools of psychotherapy. If the therapies obtain a very low success rate, then the patient becomes discouraged and this goes against everyone.

–In recent years, the consumption of anxiolytics and antidepressants has more than doubled. Is current psychiatry abusing medication?
–In my opinion the benefits of anxiolytics, antidepressants and other medications are being exaggerated by the laboratories themselves. Most patients can be treated without medication, especially in cases of anxiety and depression, pathologies in which sometimes prescribing medication responds more to economic interests than anything else. On the other hand, it is also true that sometimes medication can save a life. In general, it seems good to me to try to carry out the therapy without medication.

How would you summarize your contribution to cognitive behavioral psychology?
–Cognitive behavioral psychology is based on the idea and theory that negative thoughts generate negative emotions and that people have to change their beliefs and way of thinking to change the way they feel. The TEAM – acronyms for Test, Empathy, Goal Agenda and Method – takes into account, in addition to this, other aspects of human nature, such as the fact that often some people who suffer from an anxiety disorder or depression struggle with a part of themselves that they do not want to change.

For example, when a person is suffering because they have a marriage or love relationship that is not working, there is a part of them that wants to continue to stay close to their partner and another that rejects or criticizes them. When someone is addicted because they drink or eat too much, a part of them wants to change, but there is also another part of the person that likes to drink or eat uncontrollably.

With the TEAM we develop techniques to overcome the patient’s resistance, so that they are fully motivated to collaborate with the therapist. It is surprising to see how the techniques we apply after overcoming these resistances work much faster and more efficiently.

–Why, despite the suffering, the resistance to change on the part of the patient can be so great?
–Because your negative thoughts, each of your negative emotions and harmful habits also have certain advantages. Determining and becoming aware of what these advantages are is the first step to overcome resistance to change them, which will be essential to be able to move forward in the process and will create the motivation to move forward. Two out of three psychological patients show significant resistance to change.

–In which disorders is TEAM most effective?
–In anxiety disorders and their manifestations, such as panic attacks, eating disorders, obsessive-compulsive disorders, fear of public speaking… In all forms of depression and anxiety, patients recover completely in a few sessions of therapy. In relationship problems the patient may not want help and, in my experience, the time it takes for the problem to be resolved is usually longer. In fact, there are many people who want to stay close to another, even if they have a hard time doing so. Addictions are more difficult to treat because the person does not really want to give up the alcohol or substance to which they are addicted.

Two effective tools: empathy and communication

What role does empathy play in the therapeutic process?
-It is very curious because most psychologists believe they have the gift of empathy with their patients but when we test patients and therapists we observe that many professionals have a wrong idea of ​​what is being useful to their patients in all what happens in a session. If I have worried about empathy, it is because I myself felt that I did not have it and I have had to work hard to improve it. I was wondering why others were getting better results than me. If I created a system that allows empathy to develop, it was in fact to help myself.

Could you explain in broad strokes what this system consists of?
–It is a system that I have called ‘The five secrets of effective communication’. The first step to improve communication when there is a conflict is to use “the disarmament technique”. That is, finding something true in what the other person is saying, even when it may seem totally unreasonable or unfair to one.

Secondly, you have to put yourself in the shoes of the other, trying to perceive the world through their eyes, for example, paraphrasing their words or recognizing how they must be feeling based on what they say.

The third step is to ask gentle probing questions to find out a little more about what the other person is thinking or feeling.

Fourthly, it is useful to be assertive, with phrases such as “I feel…” that express our feelings in a direct way, instead of focusing on statements or judgments such as: “it is you who is wrong”, “you get me out of crazy”, etc.

Finally, even if you’re feeling angry, find something genuinely positive to say to the other. These guidelines can be useful to us in everyday life if we are willing to save a relationship, but they are also appropriate when a patient expresses his dissatisfaction with therapy.

The therapist’s ego

– Is it difficult to admit to the patient that what is being done is not working?
–It is about seeing it as an opportunity to improve. What helps is to see what I have done well and what I have done wrong, and understand what I can do to improve the results. Upon reaching this level, suffering disappears. We do not know which technique will be the most effective. A failure of the therapies is to stay with a single technique and apply it to all patients as a solution. I offer fifty different ones.

To err in this case is not a problem, but a stimulus that allows us to try a new technique and thus find the one that will work for that patient sooner. When we train our students we see that at first they all fail. In most cases, its score does not reach 20 in any patient. On the other hand, when they practice “The five secrets of effective communication” their score can rise to 80. Now, to apply these five secrets of communication it is essential to put pride aside, so humility and honesty are crucial , while the excess of ego is the biggest obstacle.

–Proposes passing a test to the patient to assess their state of mind before and after the session as well as during the session itself. Because?
–We are observing very spectacular changes when we apply these measurements because thanks to them we know when we are doing it right and we also immediately detect when we are failing. We propose to obtain this information through a test because patients usually have great difficulty in telling the psychologist about the problems of the therapy. If a patient refuses to fill out the test, I tell them that I want to improve her life, but I can’t do it without this information.

When we work with a patient we tend to make judgments about whether or not progress. For example, if we have a patient who is in danger of committing suicide and we want to hospitalize him immediately, how can we know without a test how depressed he is, from 0 to 100? The degree of success in the best of cases after all the studies we have done is 10%. What the patient feels and what the therapist feels about the patient often don’t have much to do with each other.

When evaluating a patient’s level of anger, the therapist’s percentage of success is very low. A patient may make jokes with you while feeling deep depression inside. Sometimes at the end of a consultation I have given the questionnaire and I have seen that the patient came out worse than how she had entered.

Maybe it’s because their feelings were hurt during the session, maybe the therapist tried techniques that didn’t work… Whatever it is, it’s important to detect it because this information can save lives, especially if we are working with depression and a patient with suicidal tendencies. In this way, the family can be notified and remedy before it is too late. I like to measure things because therapists often have very misconceptions about what is happening to the patient.

The therapist can offer warmth and hope

– You have suffered from anxiety problems. Do you tell your patients?
-Yeah. Sometimes when I work with patients who suffer from anxiety I tell them that I have suffered from that too. But I also tell them that I can change their life, which is what they want to hear. Therapy is not about crying with the patient and saying, “I’m a hopeless loser too.” It is about giving warmth and also hope.

–Your latest book deals with panic attacks, a disorder on the rise. How much can the treatment be shortened by applying your methods?
–Sometimes we can solve them in a single session. I treated a woman who had suffered from panic attacks for ten years and was convinced that she would die of a heart attack. She had about five panic attacks every week and she lived…