Air Date: 10/12/20

The Upgrade by Lifehacker

How to Handle Your Pandemic Anxiety, With Psychologists Dr. Elena
Welsh and Dr. David Burns
Alice ​Hello and welcome to The Upgrade, the podcast of the team of Lifehacker where we
help you improve your life one week at a time. I'm Alice Bradley, editor in chief of
Lifehacker.

Jordan ​And I'm Jordan Calhoun, Lifehacker's deputy editor.

Alice ​And today we are coming to grips with our pandemic anxiety.

Jordan ​And we're learning just how to handle that anxiety with some useful tools.

Alice ​Yes, and helping us do that today is psychologist Dr. Elena Welch.

Dr. Elena Welsh ​You know, this fight or flight response was developed to keep us safe in
real predatory situations and mammals don't worry in the way that we do. So what's
happening with all our stress-related diseases is I'm worried about losing my job, losing my
home, being homeless. My body thinks that's really happening. My body's like, "Oop.
We're in danger. Freak out." And that's where the stress hormones are released.

Alice ​Dr. Welsh is a clinical psychologist based in L.A. who specializes in a wide range of
anxiety, mood and depressive disorders. She's also the author of several books, including
Trauma Survivors' Strategy for Healing. Five Minutes Stress Relief and the Cognitive
Behavioral Therapy Workbook for Panic Attacks.

Jordan ​We'll also hear from CBT pioneer Dr. David Burns. David is currently an adjunct
clinical professor emeritus of psychiatry and behavioral sciences at the Stanford University
School of Medicine and has won numerous awards for his research in the field of
psychiatry and brain chemistry.

Dr. David Burns ​And what we've discovered is that people get stuck in depression and
also anxiety and relationship problems and habits and addictions for different reasons. But
people get stuck in depression and anxiety because your symptoms are actually the
expression of what's most beautiful and awesome about you.

Alice ​We interviewed Dr. Burns in 2018 about his first book, Feeling Good: The New Mood
Therapy. His latest book, which just came out, is called Feeling Great: The Revolutionary
New Treatment for Depression and Anxiety.

Jordan ​Alice, on a scale of one to 10, where's your pandemic anxiety at?

Alice ​Oh, my goodness. Well, it's not just pandemic anxiety anymore. It's a, it's a heady
mix of political anxiety, environmental anxiety, pandemic anxiety's in there, sure.

Jordan ​A nice cornucopia of anxiety.

Alice ​School starting anxiety. Winter is coming. I mean, how can you choose?

Jordan ​Why only have one type when you can have 17?

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Alice ​So true. How about you? How's your anxiety going? And what different, what
different sections of the pie are you enjoying these days?

Jordan ​Let's see. In my fruitcake of anxiety, I think I actually think I'm pretty okay right
now. I think this is the quiet before the winter storm. I think being socially distant and
relatively isolated with, you know, little contact with the outside world was not as bad in the
summer as it's going to be once we're heading into winter and the days are three hours
long and the sunsets at five o'clock. So I'm right now feeling relatively good in preparation
for how bad I might feel in about two or three more months.

Alice ​Well, I think the whole idea of the day being three hours long is what Dr. Burns
would call distorted thinking.

Jordan ​Yeah, I might be exaggerating slightly. The day is maybe four or five hours.

Alice ​I mean, three and a half.

Jordan ​Glass is a quarter-full.

Alice ​Yeah. Yeah. I think, you know, this is an amazing, amazing time to really explore
anxieties. Really, really feel, feel it as hard as we ever are going to.

Jordan ​Well, I think Dr. Welsh and Dr. Burns are hopefully going to be the ones to help us
with our array of anxiety. So how about it? Let's get into it.

Alice ​Let's do it.

Alice ​Dr. Welsh, thank you so much for joining us.

Dr. Elena Welsh ​Yes. Thanks again for having me.

Alice ​So for people who don't know, tell us what is CBT and how does it work?

Dr. Elena Welsh ​So CBT is a form of therapy. And we like to call it evidence-based just
because it's been around a while. So it has a good body of kind of scientific literature that
now supports its effectiveness. So the basic premise behind CBT is that your thoughts,
behaviors, your emotions are all interconnected. So if you're intervening, really, you can
intervene at any point. Then if you change your behavior, it's going to have subsequent
changes for your emotions and your thoughts. If you change your thoughts, you're going to
have changes in your behavior. And your emotions, so just that everything is
interconnected. So CBT in terms of, again, where we're trying to make changes. Usually it
starts with looking at the thoughts and behaviors. So particularly with disorders like
anxiety, a lot of times our thought patterns are what kind of kick-off this cascade of then
physical symptoms, because our body is prompted to think we're in danger. So if we can
even do a little bit of modifying of the thoughts that automatically come up in kind of worry
provoking or anxious situations. Then you're kind of again, shifting subsequently your
behavior and your emotions and your physiological reaction. So, of course, the body's in
there, too, even though it's not explicitly addressed in CBT.

Jordan ​Can you talk about some of the opportunities or limitations even of CBT? Are there
particular people for whom it is particularly effective with? Is there a certain time
commitment before you start seeing substantial results? Can you talk a little bit about that?

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Dr. Elena Welsh ​Sure. So I think some of the major criticisms for the research evidence is
that it's pretty kind of regimented. So anytime we show effectiveness through research,
usually, it's a very kind of controlled group. You can't also have substance use issues, you
know, so trying to keep it clean because it's so hard to figure out what's affecting what in
psychological research. So some of the critiques are, when you see it working so
effectively, that's for like your model patient. But really, most folks are a little bit messier,
so change is a little harder to kind of come by. The other critique and, you know, frankly,
reality, I think, is that CBT is very symptom management focused. So what it's great at is
giving you that initial relief in your symptoms. What takes a little more time? But I think that
can't be done with CBT as long as you're augmenting with other kind of psychotherapies.
But is maybe more the domain of a different orientation of psychotherapy, like a kind of
psychodynamic therapy that's looking more at where did this come from? Like what kind of
childhood stuff is this bringing up? How did you learn this? So kind of going back a little bit
more. For some of that may be deeply rooted pain that usually our thoughts are kind of
giving us hints as to what's deep down there. But that takes a little more work and isn't as
conducive to working with or kind of CBT can get a little regimented, which is honestly
what works, because you have to be really consistent in some of this stuff to see a
reduction in symptoms. That's I'd say, the balance that we're walking. And when it can be
helpful to bring in, you know, other forms of therapies or other approaches after you've had
that initial symptom control and maybe you're in a place where you're more stable to
explore some of the underlying beliefs or, you know, pain that you might have, you know,
from early experiences or traumatic experiences or that more complex stuff. But I think
CBT's excellent at just helping people get a core kind of toolbox of skills for how to
manage, you know, anxiety as it comes up, not let it totally take control of you. And then
there's other things that can kind of come in later once you're just not so hijacked by that
anxiety and really have the space to even look at other things that might be going on.

Alice ​And I think right now, so many of us are hijacked by anxiety. Right. Whether or not
that's because of deep-seated issues or just the reality we're living in, the world we're
currently in today. And also, we're kind of in this position where we're not very mobile. We
may not necessarily be able to get to a therapist or spend the time to really dig in deeper.
So for those people and really for all of us, are there techniques we can use on a daily
basis, on a weekly basis to kind of get started with CBT, maybe address some of that
pandemic anxiety, political anxiety, whatever, whatever it might be?

Dr. Elena Welsh ​What's really tricky for me, working with clients, with their pandemic
anxiety is a lot of the work around anxiety is figuring out what am I kind of exaggerating
versus what's a real threat. So when we're taking an example like social anxiety, usually
it's very easy for me to kind of point out this ballooned, you know, expectations of I'm going
to stutter. They're going to laugh at me. No one's going to talk to me again. I'm going to be
lonely. And it goes, like, so dramatically out that it's very easy to kind of pull it back and
say, yes, you might be embarrassed, but like, really, you know what? What's the worst
thing that can happen? With Covid it's really tricky for folks that already had some kind of
health anxiety stuff because we're just we just don't have have the data. There is a
genuine threat there to folks' health. So it's much trickier for me to just say, "that's your
anxiety, you know, talking." So that's a part of the struggle that we're working with, is there
is just so much going on and there is real pause, you know, real reason for concern
unfortunately, in many cases. So it's just not making it worse on ourselves. So it's kind of
being as balanced as possible again. So part of what I think can help for everybody is to
just understand what happens with the fight or flight response and what happens with our
worrying. So in that famous book, Zebra Don't—Zebra's, excuse me, Don't Get Ulcers by

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Robert Sapolsky. He really introduced to us the idea that, you know, ​[00:10:13]​this fight or
flight response was developed to keep us safe and real predatory situations and mammals
don't worry in the way that we do. So what's happening with all our stress-related diseases
is I'm worried about losing my job, losing my home, being homeless. My body thinks that's
really happening. My body's like, oh, we're in danger. Freak out. And that's where the
stress hormones are released. Your heart might start pounding. You feel that kind of
shortness of breath. So just understanding what's happening physiologically when you
worry, I think is a really helpful tool. So that if you start to kind of notice the worry,
thoughts. Some people notice their physiological symptoms first like their heart rate. Some
people notice their thoughts first. So whatever you notice first. But anytime you notice
yourself kind of getting activated in that way, just even remembering, "OK, my body thinks
I'm facing a real danger. Let me take a deep breath." That immediately brings on the part
of your brain, that slows down the fight or flight response and kind of starts to calm you
down. And even saying aloud or kind of thinking to yourself, "everything's OK right now.
I'm having a worry thought about a future event." So literally kind of narrating what's
happening for your brain then helps everybody kind of work together. And then you can
calm down a little bit. ​[76.4s] ​Even if you're still having the worry thoughts, you're not going
to have as much of the physiological symptoms, which again then leads to long term
stress diseases, immune-compromisation, which, of course, is also not great right now. So
that's a huge piece of it. The you know, the kind of political situation and the race-related
issues that we're facing right now. That's another just real activating situation. And again,
where there's genuine threat there for many people. So it's we can't just simply say, you
know, that's your anxiety talking. So, again, ​[00:12:06]​it's that balance of, OK, I'm noticing
I'm getting activated. I'm having a fear response. What is this based on? Where is this
coming from? ​[8.8s] ​If it is kind of a real threat situation, obviously managing it one way
versus, OK, this is bringing up this. And so, again, reminding yourself of kind of what's
happening internally. Always start with a deep breath or two or three to just that at least
comes your body down. And the more your body's spiraling, the more your brain is having
a harder time kind of bringing that logical side of the thinking on board. So that's again,
where we're just trying to be aware of all those pieces and putting them together. The last
piece I'll just talk about is that that behavior piece. So what happens with anxiety is we're
often what it prompts us to do is avoid. Right. So if I'm anxious of something, I'm gonna
avoid it. And so that's another piece that you want to be aware of, is what am I what could
I do that would kind of tell my body that everything's OK? And so some of that is, again, if
it's not a real threat situation, then kind of confronting that any of those social anxieties. A
lot of folks are struggling a lot with hard conversations around, you know, social distancing.
Will you come over for dinner? No, I'm not comfortable for that. So a lot of even with the
real stressors happening, often there's a social kind of connotation that adds to the stress
for folks. So kind of, again, teasing that apart and just taking a deep breath and doing what
you can.

Jordan ​You mentioned potentially using CBT in conjunction with other psychotherapies. Is
that common for people to do?

Dr. Elena Welsh ​You know, it's more and more people are kind of calling themselves
"integrated therapists." And so they'll pull from different orientations again, because CBT is
so kind of instructive and skills-based. It gives you a lot of tangible tools that you can use
with clients like we often trap those automatic thoughts that come up when you're anxious.
We have, you know, specific kind of labels for ways are thinking can get off. We have
ways to start challenging that or exploring that. So I think that can be helpful in a lot of
different modalities. There's some newer kind of, I guess, expansions of CBT that we call
"third-wave behavior therapies," and that's things like dialectical behavior therapy,

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acceptance and commitment therapy. And those are also showing really good evidence
base and are incorporating more of the kind of mindfulness piece to all of this, as well as
particularly with acceptance and commitment therapy, less kind of fighting against the
emotion which CBT does a little bit of. Because, again, you're so focused on kind of
controlling the symptoms, whereas acceptance and commitment therapy works a little
more around. What do you want in your life? And then how is anxiety holding you back
from that? And then really the goal is just to live the life and let anxiety kind of come along.
So a big piece of that therapy is just really making peace with your anxiety, not reacting to
your anxiety. So accepting literally that, you know, you may have a little anxiety along for
the ride, but trying to focus more on living a life that's in line with your values and making
sure the anxiety isn't shifting your life in a direction that you don't want it to go. So those, I
think, work really nicely together because they're kind of evolutions of CBT. So it's got
some of the same premises and kind of thinking, but it tackles it from a different angle,
especially, again, if someone is kind of stuck in they've they've maybe seen an initial
reduction in symptoms, but then have plateaued and, you know, kind of want to work, work
another angle to move forward.

Alice ​I think a lot of us are getting used to really not looking at our feelings, right? Just sort
of going through the motions to get through the day, trying to get through the pandemic,
trying to get through the election. And I wonder if you could speak to kind of the value, if
there is one, and I think there is, of checking in with ourselves every day to just sort of take
a look at where we are. And I think there's a kind of a numbness overtakes people. And I
wonder if you can talk to them.

Dr. Elena Welsh ​Yeah, I mean, I think that's, as you've alluded to, that's happening so
much right now because our, you know, our nervous system is just overloaded.
[00:16:22]​There's genuine crises happening all around us. And then folks are either kind of
on top of that, dealing with job loss and or having to just kind of continue on as if the world
were not falling apart kind of all around us. So that, I think, is a real characteristic that is
predominant in our society more than others, where there isn't a built-in pauses for us to
acknowledge everything that's happening and what kind of might be coming up with that.
So we really are encouraged to numb and to just kind of continue on. And so I think as a
culture, we've become pretty emotion phobic because we're focused on production and
bottom line and productivity. But what happens from a psychological standpoint is if you're
feeling sad, you know, for whatever it is, but you kind of shove it down because you don't
have time for it. That does not go away. It usually gets bigger. So what can happen is you
have an increase in avoidance behaviors which are which are things like, you know,
drinking more, scrolling more, just doing the things that typically are less healthy for us that
help us numb out ​[67.8s] ​more. So you might see that or you just see the sadness getting
bigger and bigger and bigger until you're at work and kind of burst into tears on a Zoom
call or whatever it might be. So as much as we can making that pause for ourselves. And
that's, I think, where a lot of the mindfulness piece comes in and has been shown to be so
effective is it's helping us build space. And it really doesn't have to be as long as we kind
of imagine if you even just pause for a moment, take that deep breath as always, and kind
of check in with your emotions, acknowledge that you're feeling sad, even just that
momentary kind of check in with yourself and just noticing it, naming it. ​[00:18:10]​The
other thing that's happening right now that's so confusing is often we're having a lot of
emotions at one time. So it's like messy. It's like I'm angry. I'm sad. I'm overwhelmed. I'm.
And so that's a piece of it is naming everything that's happening to you. ​[12.7s] ​Again,
some people like to write it down as a way to to really acknowledge it. Other people, if
they've been doing this for a while, ​[00:18:29]​just kind of saying it to yourself, thinking it to
yourself, thinking is there anything I could do nice for myself to kind of help with this,

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depending on what you're feeling in the same way that you'd kind of brainstorm that for a
friend who is feeling that same way. And usually then it's going to interfere with your life
more. So it's that same kind of an ounce of prevention is worth a pound of cure, you know,
concept where the more we can kind of tune in and attend to our emotions in the moment,
the less likely we're gonna have that buildup of stress or emotion that's then just going to
spill over in inopportune times. That does end up interfering more with our lives. ​[39.1s]

Jordan ​When you're having that build up and you feel that you're about to be at that point
where the cup runs over. Are there certain tricks or questions that we can ask ourselves to
maybe pull, you know, make the water recede a little bit and come back to a closer place
where we can handle that situation?

Dr. Elena Welsh ​Well, if you think about kind of soothing yourself, you want to think about
all the different senses that you have. Right. And kind of utilize everything. So first off,
depending where you are, if you can kind of remove yourself from a public situation that's
ideal to give yourself some space. And then you're thinking about, OK, thoughts, thought
wise, you know, saying some calming statements to myself physiologically, what can I do
to kind of bring myself back in the moment? So, again, always starting with a deep breath.
But then if you need more of a kind of shock for some people, like splashing cold water on
their face, drinking a glass of water. So it's kind of pulling you out of your thoughts or
whatever it is and into a more calm state, smelling something soothing, looking out the
window, saying a calming statement. So kind of trying to pull on every tool that you have to
calm yourself before you kind of proceed. So, again, it doesn't have to necessarily take
long. But the more that you can kind of tackle all those different senses, so calm a brain
down, call my body down on my thoughts down, you know, what can I do across the
board?

Alice ​I've been hearing lately about people that I know in my circle doing virtual group
therapy. And I've been thinking like, that's brilliant, right? Because you're sort of getting
beyond the isolation, but also taking care of yourself. I wonder if you have experience with
that or can speak to how people can find those kinds of groups.

Dr. Elena Welsh ​Yeah, I mean, I think what's cool that we're seeing in the mental health
field right now is we've had some resistance to tell a therapy, telemedicine, you know, in
part because there is such a magic that can come from two people being in the room and
kind of working through things. But what we've also always dealt with is a real difficulty
accessing mental health services, whether it's a resource issue or a time issue. So there
also are, I think, a lot of benefits that we're seeing in the ways we can utilize technology to
kind of connect. So absolutely, I think that's a great option right now because you're
getting both the therapy and, like you're saying, kind of a built in supportive community.
And right now, most folks are offering at least some electronic or telehealth versions of
their services. So you can pretty much right now search in the same way you always
would and assume that you're going to be able to find some virtual options. So Psychology
Today is always a great search engine to kind of start with. But also if there's a particular,
you know, area of concern, just even Googling support groups that aren't necessarily even
therapists affiliated can be similarly helpful.

Alice ​Great. Well, thank you so much Dr. Welsh, this has been so helpful.

Jordan ​Very, very useful. Thanks for talking with us.

Dr. Elena Welsh ​Thank you.

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Jordan ​And now for our interview with Dr. David Burns. Dr. Burns played a major role in
making cognitive behavioral therapy a more commonly used mental health approach. And
his latest book, Feeling Great, takes CBT a step further by addressing challenges and
motivations and depressed or anxious patients. Here he speaks with us about his new
approach. What it is and what makes it revolutionary.

Alice ​Dr. Burns, thank you so much for joining us.

Dr. David Burns ​Great to be on your program. This is my second time and the first time
was awesome, so I'm excited to be coming back.

Jordan ​Welcome back.

Alice ​Yeah. Good to have you back. The last time you were with us was 2018, when I
think we all felt like we're as anxious as we're ever going to get, right. Like we're at the
height of anxiety.

Dr. David Burns ​Yeah.

Jordan ​We were so naive.

Alice ​Right. Then 2020 came around and said, hold my beer.

Dr. David Burns ​Oh, yeah.

Alice ​Here we are, just thinking what could possibly get worse. And every week there's
something else. And you've come right in time with a new book. No longer content to feel
good. Now we're, we're feeling great. Can you tell us a little bit about the new book and
why? But, you know, we kind of know the answer, but tell us anyway.

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Dr. David Burns ​Well sure, Feeling Good came out in 1980 and represented the
technology of that era, which at the time was mind blowing and a huge breakthrough in
psychotherapy. But now it's 40 years later. I've had 40 years of research. I've had over
40,000 hours treating people with depression and anxiety. And there've been many new
techniques, many new developments. So it was a time to really write the first true sequel to
Feeling Good, Feeling Great. And it should be even more effective for readers than
Feeling Good because it has all of the great techniques and feeling good, but tremendous
new techniques I've developed in the last 10 years in my weekly training group at
Stanford.

Jordan ​For someone who would read the book 40 years ago. What's an example of one
of the big revolutions or one of the big changes that has come up from 40 years ago
today?

Dr. David Burns ​Well, the huge thing in Feeling Good was that your thoughts create all of
your moods in the here and now. And that when you're depressed and anxious, the
thoughts that are making you miserable are distorted with like all or nothing thinking and
self-blame and mind-reading and fortune-telling and should statements. And when you
change the way you think, you can change the way you feel. And that's going to happen
rapidly. And that's what the new book is all about. A new technology in addition to
cognitive therapy. So like cognitive therapy on steroids.

Jordan ​When someone's feeling depressed, they can often feel a lot of difficulty even
having the motivation to improve their situation or improve how they're feeling. Can you
describe—

Dr. David Burns ​Yeah.

Jordan ​What can maybe spark that motivation or get someone to do the work required to
potentially feel better afterwards?

Dr. David Burns ​Yeah, absolutely. That's what the whole focus of my research has been
on what sucks people into depression so they resist treatment. And in the old days. This is
what we've kind of maybe turned upside down. ​[00:27:15]​We—people used to think, "oh,
those people who are fighting treatment and they seem stuck in their depression. They
want to feel sorry for themselves or they have secondary gains. You know, they want to try
to get attention from people." And that's how therapists, since the time of Freud have been
thinking about resistance and why people get stuck in depression. But there's two
problems with those interpretations. First of all, they're really hurtful to people. They're
insulting. It's like a putdown to people. So they don't help anybody. And most of the time,
they're not even true. And what we've discovered is that people get stuck in depression
and also anxiety and relationship problems and habits and addictions for different reasons,
but people get stuck in depression and anxiety because your symptoms are actually the
expression of what's most beautiful and awesome about you. ​[48.1s] ​For example, one of
the women in Feeling Great was a woman I treated in front of a live audience in San
Francisco, and she'd been depressed for nine years since a traumatic event involving her
12-year-old daughter. Her 12-year-old daughter said, "Can I go out and play mommy after
dinner?" She said, "yeah, okay, no problem," because she'd gone off to play after dinner
every day for years. And then some neighborhood boys snuck up on her daughter and
shot her in the face with a high powered pellet rifle. And the bullet hit her tooth, which
exploded and kind of ripped through her mouth. And she ran inside screaming. Blood was

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gushing out of her mouth and required multiple surgeries on her daughter and nine years
of failed therapy for her daughter for post-traumatic stress disorder. And Karen was upset.
[00:28:57]​Now, the cognitive therapy idea is your daughter's trauma, horrible as it was,
isn't causing your depression and your guilt and shame and anxiety. It's your distorted
thoughts. And when you change the way you think, you can change the way you feel.
[12.9s] ​And her thoughts, sure enough, were very distorted. She was saying, "it's my fault
that she got shot. I never should have let her go out and play after dinner. I'm a failure as a
mother." And then she was feeling intense anxiety, telling herself, the people in the
audience who were watching this also think I'm a bad mother. And she believed those
thoughts. But before I can get her to challenge them, I've got to show her how beautiful
and awesome her negative thoughts and feelings are. And so we do something called
[00:29:42]​positive reframing. ​[0.6s] ​Before I show her how to crush those distorted
thoughts and what it is, is to ask her to make a list. Let's make a list together of what your
negative thoughts and feelings show about you that's positive and awesome. And just to
give you an example, I said to Karen, "here's her magic button. Let's imagine there's a
magic button that if you push it, all your negative thoughts and feelings will disappear
instantly and you'll go into a state of euphoria where you press it." She said, "Oh, in a
heartbeat, I'd press it." I say, "Okay well let's slow down a little bit here. I've got some
awesome techniques. Maybe we can make all your symptoms disappear by the end of the
session, but I don't know if it's such a good idea." And she said, "well, why? Well, why
not?" I said, "well, what does your sadness and depression show about you that's positive
and awesome? See, if you press that button, your depression puts you now rated 100 out
of 100, the worst depression possible will go to zero and you'll be euphoric. Are you sure
you want to be euphoric about the fact that your daughter is suffering horribly?" And she
said, "oh, no, you're right!" You see, so her—that's a simple, obvious one hurt her sadness
and depression, shows her love for her daughter. And then her guilt, what does that show?
She says "I'm a failure as a mother." What does that show about her that's positive and
awesome. Anything come to mind?

Jordan ​She has high standards for herself as a mother. She has empathy.

Dr. David Burns ​Oh, yeah, absolutely. High standards, I said, "do you have high
standards? Karen?" She said, "Oh, absolutely." I said, "add that to the list. Is that
important?" She says, "Oh yeah, I do everything I can for my daughter. I have high
standards in my career. I got a Ph.D. in clinical psychology." "So OK. Let's add all of that.
What else does your guilt show about you that's positive and awesome?" And she said,
"well, humility maybe." And I said, "awesome. Is that real?" She said, "yes." I said, "Is that
important?" She says, "yes. I'm a very religious person. I've been praying for nine years for
my depression to go away. It didn't work. But I'm a very religious person. And humility is
very important." Then I said, "well, how about you're telling yourself that those people in
the audience right now are judging you, looking down on you and thinking you're a failure
or some other. What is that thought show about you that's positive and awesome?" And
she couldn't come up with anything. I said, "well, what kind? What does that show, the kind
of relationship you want with the people in the audience?" She says, "oh, it shows that I
want a warm, open, loving relationship or I don't have to hide things and I can be close to
people." So I said, "is that a good thing? Your desire to be close to colleagues?" She says,
"Oh, absolutely." And so we came up with about 25 things just like these, totally awesome
things about her. So I said, "well, now, Carol, if you press the magic button, sure. All your
negative thoughts and feelings will instantly vanish. But all these beautiful things go down
the toilet along with your negative thoughts and feelings. Why in the world would you want
to do that?" And now I put her into a kind of a paradox in a way. On the one hand, she
wants to get better. On the other hand, she realizes, here's why I've been depressed for

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nine years. My depression is my love for my daughter, my anxiety as my mother bears

desire to protect her. My anger is justified. Those parents never should let their boys go
out and play with a loaded rifle and then say, "well, maybe instead of pressing that magic
button, let's imagine we have a magic dial and we could dial it, each of them down. Is
there some lower level of sadness and depression that you could feel better? We could
dial it down to some level where you still have all your love for your daughter, but you
wouldn't be 100 percent depressed and incapacitated. How much depression would you
want?" And she says, "oh, 10 percent is enough." I said, "Are you sure? Can I sell you on
20 percent?" And then she laughed, she said "Oh no 10 is plenty." And she decided the
level she wanted for shame and guilt and hopelessness and anger. You know, like five
percent of this and two percent of this and 10 percent of that. And now I'd like made a deal
with her subconscious resistance to where she can dial them down. She's in control and
she doesn't have to give up all these beautiful parts of herself. And once we did that, then
it was really easy for her to crush her negative thoughts. And so bringing out to people,
here's why you've been stuck in depression. It's such a shock to them.

Alice ​My mind is blown by this because I think about my own experience with therapy,
right. Where you do sort of go through your distorted thought patterns and discuss, you
know, why they're distorted and how you can correct them. And then you come back the
next week and you're back to the same stuff. Even if you're not and you're not fully aware
of it all the time, because there's all of his other subconscious stuff. Right, shuffling around
in your in your brain. So why is your technique...How is it such a game-changer? Why
would it work that quickly?

Dr. David Burns ​Well, because the resistance wasn't dealt with in the original cognitive
therapy. It was just, as you say, all about changing these distorted thoughts. And half the
time, it works great. And half the time it doesn't work so well. ​[00:35:00]​And so I did
research how does psychotherapy work? Even though I was in private practice, I've
always collected data on my patients to find out what's the difference between the patients
who get better and stay better and the ones who seem slow to recover or they don't
improve. And then I discovered it was all about motivation and resistance. That that was
the missing dimension. And that just transformed my thinking and my practice. ​[25.4s] ​And
then with my group at Stanford, I developed these new resistance busting techniques. And
it just has transformed everything. There was another thing, too, is that once someone
recovers, see, I don't know how much you improve in a session, but if you're measuring
out, I don't call recovery until you're in a euphoric state. And then I do relapse prevention
training. I tell them as well, you know, these are going to come back these negative
thoughts. Here's a technique that works for you. Let's practice now what you're gonna do
when they come back.

Jordan ​Can you share some of those relapse prevention techniques? You know, if
someone's beginning to have these negative thoughts that are familiar to what they've felt
before. What are some of the questions that they could ask themselves or the things that
they could do to slow that down? And also, you know, you know, since so many of us are
struggling with depression and anxiety right now, that means many of us know people who
are living with or people who are having those challenges. Are there certain do's and
don'ts or questions that a partner or friend can ask to help spur that person, you know,
without being a mental health professional?

Dr. David Burns ​Yeah. Well, that let's take the second question first, although they're both
amazing questions. But being elderly and half demented, I can remember the second one.
The first one is a long term memory recall. ​[00:36:43]​But most people don't know how to

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help a loved one. They try to cheer them up or tell them to correct their distorted thoughts.
And that is never going to be effective. And what you need to learn is compassionate
listening. ​[12.5s] ​And to give you an example. Well, when I'm working, you know, with a
loved one or a family member, I generally don't try to do therapy but to be like a
compassionate father or friend. After my daughter's baby was born, she never wanted to
get married or have a baby. She was dead set on it. And then all of a sudden something
changed and she got married and want to have a baby and had a baby. But then she
would say to me, she loves her little guy tremendously. But she would say to me things
like, "Oh, Dad, you know, I'm in prison now for 18 years and I want people to do my aikido
anymore. And I'm trapped." And. And I tried not to help her in any way, but just to buy into
what she's saying is in a loving way as a senior. You know, "you're right. You're right.
There's tremendous demands on you and on mothers. And it is kind of unfair, all the
pressures on mothers. And you have to give so much and you have to give up all kinds of
activities. And you're right. It's like you're in prison now. And he's lucky to have such a
beautiful, wonderful mother. But my heart goes out to you. I totally agree with you." Now,
notice, I'm not trying to help her. And then she would say, "but on the other hand, Dad, I
love my baby! And I'm as happy as can be!" ​[00:38:16]​You know, it's just listening and
providing support rather than trying to cheer someone up or throw help at them. ​[6.4s] ​And
that's an art form and you can learn how to do it. Now, what was your first question? That
was also a mindblower.

Jordan ​Yeah, the first question was about how to address it yourself. You know, you're
mentioning those relapse prevention techniques. What are some of those questions you
could ask yourself?

Dr. David Burns ​Yeah. Well, there's three things I tell people for relapse prevention, the
three parts to it. Number one, I say I want you to know that there's 100 percent guarantee
that you're going to relapse forever. And what a relapse is, is one minute or more of feeling
like crap. And that's OK. And it's OK to feel lousy for a minute, an hour or even a day,
because that's part of the human condition. You're only entitled to five happy days per
week and two miserable days. And if you don't have your five happy days, you need a
mental tune-up. If you don't have your two miserable days, you're getting too happy. So
we're gonna have to put you on lithium because no one is entitled to be that that happy.
So that's the first thing is set a proper expectation because we all get, I'll get upset. I'm one
of the happiest guys you'd ever meet. But I would say in an average day, I probably get
upset five times. You know, life has bumps in the road. You get ticked off at people. But
having the capacity to pop out of it and to know that you can do that. That's what's crucial.
Secondly, I tell the person the technique that you learn from me. That worked for you. See,
I've developed more than 100 techniques. But the patient will only need one. And we try to
find that one as quickly as possible. And because there is this idea of fractals, a fractal is a
pattern that repeats itself over and over again in nature. And that's what depression is. It's
just a few neural circuits that keep doing exactly the same thing to the patient. And there's
the same thing will provoke the depression and then they'll have exactly the same thinking
pattern. And so the technique that I work out with them, that technique will work for them
for the rest of their life, and they have to know that.

Alice ​So now these days, we're all filled with various types of anxiety.

Dr. David Burns ​Yeah.

Alice ​And I'm thinking about pandemic anxiety. And I'd imagine that in everybody, it takes
a different form. Some people are worried about their parents, about their children, some

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are worried about their jobs. And, of course, like there are valid reasons to be anxious. So
how do you tell what's sort of reasonable anxiety and what's distorted thinking? And, you
know, then how do you kind of get to the bottom of that and feel better?

Dr. David Burns ​It's the same thing when people are depressed or anxious. You're giving
yourself distorted messages. My research shows that in women since the pandemic,
depression has doubled, anxiety is doubled, anger's doubled and hopelessness has
doubled. In men, anger has doubled. So there is a big increase, but it's the same things.
It's your thoughts, not the Corona that's causing your upset. And when you're depressed
and anxious, the things you're telling yourself will not be true.

Alice ​Dr. Burns, thank you so much. This has really been great.

Jordan ​So much to think about here. Thanks for sharing it with us.

Dr. David Burns ​Yeah, I can, just can't thank you people enough from the bottom of my
heart. You're both awesome interviewers and awesome people. And this is such a joy for
me to hang out with you. Thanks.

Ad ​Hi, I'm Danielle Belton, editor in chief of The Root. And I'm Maiysha Kai, managing
editor of The Glow Up. And this September, we're excited to bring you The Root Presents:
It's Lit. It's Lit as a podcast where we talk about all things literature, literally. More
specifically Black literature. And we have some incredible guests lined up, including Nikole
Hannah-Jones. The last thing I want is us to produce anything like The Green Book.
Ijeoma Oluo. Why this book? Why are we, why aren't we are picking up the how to burn
down this system book? You know, like, why can't we do that right now?The venerable
Claudia Rankine. I can't really separate the subject out from the structure. And the two
things for me are actually what makes writing exciting. And so many more brilliant Black
authors, writers and thought leaders. We're speaking with some of the most distinguished
voices in Black literature about their work, the books that influence them, and a lot more.
So please join us every Friday for some thought-provoking conversations. You can find us
on Apple Podcasts, Stitcher, Spotify or wherever you get your podcasts. And keep it lit!
(Whoop whoop!)

Alice ​Now it's time for our upgrade of the week where we talk about one tiny thing that's
making a big difference in our lives. Jordan, what's your upgrade this week?

Jordan ​So you know that old saying, what is it? What gets measured, gets managed. Is
that it?

Alice ​That's it.

Jordan ​OK. So I wanted to manage my word count in a way that I normally do during
national novel writing month.

Alice ​I thought you meant your spoken word count.

Jordan ​Oh, yeah. Normally I speak about x thousands of words a day. No, normally I write
in November for NaNoWriMo. I will write, you know, the seventeen hundred words a day or
so. And whether I get above or below that, I would keep track of it. And now I want to be
able to do that outside of NaNoWriMo, and to be able to keep track of my words, just to
see how many I write. And I think it will help me with consistency when it comes to writing

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a certain amount each day. So I found this site and there's probably a million of them out
there. But a site that just lets you keep track of your word count throughout the day. This
one is Word Keeper Alpha dot com by just some software engineer who created it and put
it out there for free. And I can keep track of my word count every day and have a bar graph
to see what it looks like. And I'm guessing that that's gonna do a good job, hopefully at
least of being able to manage my behavior when it comes to writing on a consistent basis.

Alice ​Does it measure everything you're writing, like emails and...?

Jordan ​No, no, no. You can just plug in every day to say it's pretty simple. You plug in the
same way that you might on NaNoWriMo site. If you ever did NaNoWriMo before, you
would just plug in your number of how many words you wrote that day. So today I wrote
250, tomorrow I wrote a thousand. The next day I wrote none. And I'll just show you a bar
graph over time. So it's just a tracker, just the online tracker to keep track of how many
words you said that you write. You wrote that day or that week.

Alice ​So it's the honor system you're putting that you're putting the word count in.

Jordan ​Absolute honor system. Yeah. Absolute honor system. You just plug in how many
words and you could do this on your own. You don't really need a site to do it, but a site
just gives you some cool visuals and data. So you get to see what your writing looks like
during a different season or a different month or a different week.

Alice ​Yeah I like a bar graph.

Jordan ​Yeah. I dig it. Got some pie graphs in there. Got some line graphs. I like all this
visual stuff. This data. I'm just going to big data the shit out of my life. Alice, what's your
upbraid this week?

Alice ​I think it's the opposite of yours, which is that I have been spending most of my time
these days managing my anxiety by shopping online for real estate and not in a realistic
way. Just like looking at websites that list...

Jordan ​Doing some Zillow browsing?

Alice ​Totally. We are 100 percent in on Zillow browsing and just coming up with ideas that
are more and more unrealistic of what we can buy. And like this house has a chapel. For
some reason, I literally found a house with a chapel, you know, like the more and more
upstate you go, the crazier things you can find for less and less money. And I'm like, "I
could do a...I can do a three-hour commute."

Jordan ​I feel like that's the new window shopping. You know, like in the past it used to be
walking through, you know, expensive 5th Avenue stores and looking inside and seeing
things that you would never actually pay for. And now were scrolling through Zillow and
looking at houses and looking at things that we can not afford. But it's sort of fun to
imagine.

Alice ​I almost enjoy more the houses that are sort of realistic for us to afford because
they're so shitty that the fact that, you know, there's a history behind them, it's not a glossy,
beautiful house with a with a pool and a tennis court. No, no, no. It's like a weird cape with
blood-red carpeting for some reason. And there you have the rooms which are like there's
a ghost in that room for sure. Like there's just a lot of like...

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Jordan ​Sixty five percent chance it's haunted.

Alice ​Like which room did somebody definitely die in at one point? It's really fun. I've been
really enjoying it.

Alice ​And that's our show, the upgrade is produced by Micaela Heck a mixed by Brad
Fisher.

Jordan ​Please rate us on Apple Podcasts and leave us a review. Help us continue to help
you by sharing us with other people. You can also reach us by calling at three, four, seven,
six eight seven eight one zero nine and leaving us a voicemail. Or you can write to us at
upgrade at Lifehacker dot com.

Alice ​You can also find us on Twitter, at Lifehacker, on Instagram, at Lifehacker dot com.
All one word. And on Facebook, dot com slash Lifehacker. Sign up for Lifehacker's daily
newsletter full of tips and tricks and hacks at Lifehacker dot com slash newsletter. And you
can find show notes for this and every episode of the upgrade at Lifehacker dot com slash
the show.

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