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Well,

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my talk is on depression and anxiety.

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Sometimes,

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some of us fall into black holes
of self-doubt, anxiety, inferiority,

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feeling like we're not good enough,

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beating up on ourselves.

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How many of you sometimes feel that way?

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Put your hands up if you've ever struggled
with depression or anxiety or self-doubt.

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It's one of the worst forms
of human suffering.

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I've had patients who told me

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that they pray to God at night
that they could develop cancer

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so they could die in dignity,
without committing suicide.

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How many of you have ever felt, maybe,
that your life was not worth living

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or have known a friend or a loved one
or a colleague who made a suicide attempt?

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Put your hands up
if that's ever touched you.

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It's one of the most horrible,
horrible things.

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I started out at University
of Pennsylvania Medical School.

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I finished my residency, and I did
a research fellowship on depression,

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and I was always curious:

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What makes us depressed?

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Why do we fall into these black holes?

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What's the cause of it?

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What can we do to turn these moods around?

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And I started out
like many young psychiatrists -

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it's what you call
a biological psychiatrist.

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I was doing research on brain chemistry,

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this idea that depression and anxiety

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are due to some kind
of chemical imbalance in the brain.

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I was treating patients

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with antidepressants
and other medications,

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but there were only two problems
from my point of view.

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The first is our own research we did;

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it didn't seem to confirm
that depression or anxiety

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were actually due to a chemical
imbalance in the brain.

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In fact, our research indicated

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that this probably is not the cause
of depression and anxiety.

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In addition,

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I was giving out antidepressants
by the bucketful to patients.

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I had hundreds of patients,

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and while a few of them were being helped,

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most of them were not.

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They were going on week after week,
saying, "I want to die. I feel worthless."

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And I said, "Gosh,
there's got to be a better way."

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If the pills had worked,
I would have been perfectly happy.

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And I thought, "Maybe
there's some type of psychotherapy

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I could combine with the medications,"

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because I wanted people
to be able to wake up

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and say, "It's great to be alive."

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and have joy and full of love:
"I'm full of life,"

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and I was rarely seeing that.

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I tried different kinds of psychotherapy;
they didn't seem to work.

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And then a colleague said,
"You know, there's something new

53
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fellow here at Penn
is developing - Aaron Beck -

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and he calls it 'cognitive therapy,'
and it's kind of simple in its theory,

55
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and maybe you could try this out
with some of your patients."

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A cognition is a thought;
it's just a fancy word for a thought,

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and there's three basic ideas
behind cognitive therapy.

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The first is that our thoughts
create all of our moods,

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and that when you are
depressed and anxious,

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you're giving yourself negative messages,

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you're blaming yourself,

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you're telling yourself
something terrible is going to happen.

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Now, this idea is not new;

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it goes back to the Greek
philosopher Epictetus.

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Nearly 2,000 years ago, he said,
"People are disturbed not by things" -

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in other words,
not by the events of our life,

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but by the views we take of them,

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that we create all of our emotions,
positive and negative,

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at every moment of every day

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through our interpretations
of what's going on.

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And it goes back even before Epictetus

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to the Buddha, who was saying
the same thing 2,500 years ago.

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Well, the second idea
is that when you're depressed and anxious,

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those negative thoughts -

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"I am no good," I'm a loser,"
"What's wrong with me?"

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"I shouldn't have screwed up,"
"I should be better than I am" -

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those thoughts are not realistic thoughts;

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they're distorted,

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that depression and anxiety
are the world's oldest cons,

80
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and that there's ten distortions
that you always see

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in the negative thoughts of individuals
who are depressed and anxious.

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Like all or nothing thinking:

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"If I'm not a great success today,
I'll be a total failure."

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Shades of gray don't exist.

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Or overgeneralization -

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seeing a negative event
as a never-ending pattern of defeat.

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Or "should" statements or self-blame.

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And the third idea

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was that you could train people
to change the way they think

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and then suddenly
change the way they feel.

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Well, I heard that theory, and I said,
"That sounds like so much bullshit."

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(Laughter)

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I know my patients have negative thoughts.

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That's certainly the case.

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But you can't help
serious suicidal depression

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with some kind of power
of positive thinking.

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And I told a colleague this.

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He says, "Well, David, why don't you go
to Beck's weekly seminar,

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and as part of your research, try this
with a few of your toughest patients,

100
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and then you can prove to yourself
that it doesn't work."

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And I thought, "That's a great idea.
I think I'll check it out."

102
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Well, the first patient
I tried it out on was a woman

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referred from the intensive care unit
of the university hospital.

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She had made a nearly successful
suicide attempt,

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an elderly Latvian immigrant,

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and they referred her to me for follow-up.

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And I said, "Martha,
there's this new form of therapy.

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I'm doing some investigating.

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Would it be okay if I present your case
at this weekly seminar,

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and then I can tell you what they say,

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and maybe we can find
some new techniques?"

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She was fine with that;
she gave me permission.

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So I presented her case
to Dr. Beck and said,

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"How would you use this cognitive therapy
with someone who's suicidal?"

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And he said, "Well, our thoughts
create all of our emotions,

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so just ask her,

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'What were you telling yourself
the moment you tried to commit suicide?'"

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So I went back to her, and she said,
"What did you find out in the seminar?"

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I said, "Well, I'm supposed to ask you

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what you were telling yourself
the moment you attempted suicide.

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What were your negative thoughts?"

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And she said, "Oh, I was telling myself
that I'm a worthless human being

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because I've never accomplished anything
meaningful or significant in my life."

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And she said,

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"Now what am I supposed
to do about that?"

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And I said, "I'm not sure.
You have to wait a week,"

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(Laughter)

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"[I'll] go back and ask at the seminar."

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So I went back and said,

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"Here's what I found out.
What should I do?"

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And Dr. Beck said, "Well, one technique
we use is called 'examine the evidence.'

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See if what you're telling
yourself is true or not.

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Ask her to make a list
of several thing she has accomplished."

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I thought, "That makes sense."

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So I went back; she said,
"What did you find out at the seminar?"

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I said, "You're supposed to make a list
of several things you have accomplished."

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She said, "Well, that's just the problem.
I can't think of anything."

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And I don't know, maybe some of you folks
felt that way some times

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and look back on your life and say,

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"What have I done
that was really meaningful,

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that was really significant?

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What did my life really amount to?"

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So I said, "Well, why don't you take it
as a homework assignment?

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Maybe you can think of something."

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Well, the next week, I forgot
I gave her the homework assignment;

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I did my usual non-specific schmoozing
and "How are you feeling?"

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and "Do you need a refill
on the antidepressant?"

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and this type of thing,

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and halfway through the session,

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she said, "Well, aren't you going
to ask me about my homework?"

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I said, "Ah, I forgot.
Did you come up with anything?"

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And she handed me a list
of about, oh, seven or eight things

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that she had accomplished during her life,

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and the first one, she said,
"I overlooked the fact that -

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I smuggled my children
out of Nazi Germany.

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My husband died
in the concentration camps.

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All of our relatives
died in the concentration camps,

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but I got the children out,
and we made it to America.

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And I've worked, scrubbing floors
and cleaning people's houses,

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to keep food on the table
and to keep the roof over our head.

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And this week,

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my son just graduated first in his class
from the Harvard Business School.

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So I thought, 'Well,
maybe that's an accomplishment.'"

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(Laughter)

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And then she said, "And I forgot
that I speak five languages fluently,

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and I'm a gourmet chef."

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And she had all these amazing things.

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And I said, "Martha,
how do you reconcile this

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with your claim that
you're a worthless human being

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who's never accomplished
anything meaningful?"

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And she said, "Dr. Burns,
it doesn't compute.

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It doesn't make any sense.

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I don't know how 
I could have been thinking that."

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And I said, "How are you feeling now?"

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She said, "I'm feeling a lot better."

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She said, "Do you have
any more techniques?"

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I said, "No, that's the only one
I've learned so far.

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You'll have to wait till next week.
I'll learn another technique."

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And so that's how it began to go,

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and I began to see patient after patient
that I'd been stuck with,

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some patients who'd said
they'd been depressed,

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had failed therapy for more than 50 years,

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some who said they've never had one moment
of happiness in their entire life

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suddenly experience joy and self-esteem.

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And I said, "This is the thing
I want to commit my life to."

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I had just received a grant
from the government - a five-year grant -

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to develop a brain-chemistry
research laboratory at the medical school.

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And I sent the money back.

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I said, "I don't want to spend my life

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doing research on a theory
that's not going bear fruit.

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This is what I want to do."

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And then the research began to come in.

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First a pilot study at Penn that showed
that this new form of therapy

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was as effective, if not more effective,
than the best antidepressant drugs.

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And then study after study has come in,

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and now it's become the most researched
form of psychotherapy in history.

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We all got excited, and Dr. Beck said,

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"David, would you like
to co-author the manual

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00:11:06,427 --> 00:11:08,028
that we're writing for therapists

200
00:11:08,028 --> 00:11:11,242
so people can learn
how to do this new form of therapy?"

201
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And I said, "You know,
you've got enough people -

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Brian Shaw, Gary Emery and others -

203
00:11:17,330 --> 00:11:19,717
who can co-author that book for you.

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I think my calling is to write the manual
for the patients and the general public

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to show people, give them tools,

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00:11:27,913 --> 00:11:31,068
to begin to use these tools
in their own lives,

207
00:11:31,068 --> 00:11:34,384
and maybe patients could read the book
between the sessions

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to accelerate their recovery."

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00:11:43,858 --> 00:11:47,768
So then I wrote the book "Feeling Good."

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Other research came along:

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00:11:50,896 --> 00:11:56,818
a fellow at University of Alabama
began to do some research

212
00:11:56,818 --> 00:12:00,268
on what is the fastest
and most inexpensive way

213
00:12:00,268 --> 00:12:01,799
to treat people with depression.

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00:12:01,799 --> 00:12:04,350
And he did some research I was unaware of.

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00:12:04,350 --> 00:12:07,544
He took people coming
to the University of Alabama

216
00:12:07,934 --> 00:12:10,251
asking for therapy for severe depression

217
00:12:10,251 --> 00:12:13,674
and said, "You've got to be
on a waiting list for four weeks

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00:12:13,674 --> 00:12:15,869
before you can see the psychiatrist,

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00:12:15,869 --> 00:12:19,709
but in the meanwhile, we want you
to read this book, 'Feeling Good'."

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And then he did research
on them every week to see,

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Would there be any change in mood?

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00:12:24,585 --> 00:12:28,718
And he reported that 69% of the patients

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00:12:28,718 --> 00:12:33,518
in four weeks were recovered
and needed no additional therapy.

224
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He's repeated - he's done
at least eight outcomes studies

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00:12:36,587 --> 00:12:42,549
with older citizens and teenagers,
people all ages in between

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and has continued to come
to the same conclusion.

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And I kind of knew that was true

228
00:12:48,600 --> 00:12:53,612
because I've gotten at least, probably
50,000 emails and fan letters from people

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who said, "I read your book,
and it changed my life."

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Now, in my group at Stanford,
my psychotherapy development group,

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00:13:03,303 --> 00:13:04,844
it's getting even better,

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00:13:04,844 --> 00:13:09,430
and we're developing even newer
and more powerful techniques.

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00:13:09,870 --> 00:13:14,369
I think there's a difference
between a technician and a healer,

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00:13:14,709 --> 00:13:16,883
and one of the differences is,

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00:13:16,883 --> 00:13:20,348
Can you use your tools in your own life?

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00:13:20,348 --> 00:13:21,932
Can you practice what you preach?

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00:13:21,932 --> 00:13:24,753
I kind of believe in the idea
of "Physician, heal thyself."

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And certainly I've known
my own moments of anxiety,

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like when I was invited
to come to speak here,

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and despair as well.

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And I was put sorely to the test
when our son was born.

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I was there at his birth,
and after he was born, the doctor said,

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"You've got a wonderful, healthy son here,

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but the only problem is he can't breathe."

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And I looked at him,
and he was bright blue.

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His lips were blue
and his fingernails were blue,

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and he was struggling to get air.

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00:14:03,849 --> 00:14:07,889
And he said, "We're going to put him
in the intensive care unit."

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And I thought, "Oh my gosh.
This is horrible."

250
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He was born, I think,
at around 10 at night,

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and I went home, and I was feeling
anxious and depressed and terrified.

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00:14:21,025 --> 00:14:23,613
And I told myself, "Well,
remember it's not the events,

253
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it's your thoughts that upset you."

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00:14:25,982 --> 00:14:28,311
And I said, "Oh no, that can't be true.

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00:14:29,091 --> 00:14:30,470
This is real."

256
00:14:30,700 --> 00:14:32,570
I said, "That's what your patients say.

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Why don't you write your thoughts down

258
00:14:34,407 --> 00:14:37,213
and see if there's some
distortions in them."

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00:14:37,503 --> 00:14:39,080
And so I thought, "Okay, I will."

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00:14:39,080 --> 00:14:40,547
And the first thought is,

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00:14:40,547 --> 00:14:45,572
"Well, my son needs oxygen for his brain,
and he's going to have brain damage."

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And then the second thought:

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"We'll be bringing him to clinics
for the rest of his life."

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00:14:51,232 --> 00:14:53,689
Then I did a little thing
called the downward arrow:

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If it were true,
what would it mean to you?

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And the third thought:

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"Well, then people will look down on me
because I have a mentally retarded son."

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00:15:01,774 --> 00:15:04,027
Then I said, "Are there
any distortions here?"

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00:15:04,027 --> 00:15:06,154
I said, "Well, gosh,
here's fortune-telling.

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00:15:06,154 --> 00:15:08,939
I don't know that he's going
to have brain damage.

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00:15:09,609 --> 00:15:14,174
Doctor never said that, he just said,
'We'll put him the intensive care unit.'

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00:15:14,174 --> 00:15:15,197
And then,

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are people going to look down on me
because I have a son with brain damage?"

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00:15:20,725 --> 00:15:22,054
I said, "That's ridiculous.

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People will feel about me
depending on how I treat them.

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00:15:25,192 --> 00:15:28,892
And if I love them and treat people
with care and compassion,

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they will respond."

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00:15:30,529 --> 00:15:33,589
And suddenly all my anxiety disappeared.

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00:15:33,589 --> 00:15:38,228
And then I said, "You know,
look at how self-centered you're being.

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00:15:38,228 --> 00:15:42,583
Your son needs you;
he's suffering in the hospital,

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00:15:42,583 --> 00:15:44,597
And I said, "I'm going to go and see him."

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00:15:44,597 --> 00:15:48,251
I was on the faculty, so I said,
"I can get into the intensive care unit."

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00:15:48,251 --> 00:15:50,293
I went in there
about three in the morning,

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00:15:50,293 --> 00:15:52,410
and I said, "Can I see my son?"

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00:15:52,410 --> 00:15:54,953
They said, "Yes, certainly, Doctor."

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00:15:54,953 --> 00:16:00,372
And then he was in this incubator,
and he was going [Raspy breathing],

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00:16:00,372 --> 00:16:03,079
and just his whole body
was shaking to get a breath,

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00:16:03,079 --> 00:16:04,509
and he was still blue,

289
00:16:04,509 --> 00:16:07,306
and it was so sad, and I said,
"Can I touch him?"

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00:16:07,306 --> 00:16:09,298
They said, "You have to put this glove on

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00:16:09,298 --> 00:16:11,830
and put your hand
through this hole in the incubator,

292
00:16:11,830 --> 00:16:15,192
and so I put my hand in,
and I put my hand on his forehead,

293
00:16:15,192 --> 00:16:18,169
and I said, "Erik, I want
you to know that we love you.

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00:16:18,169 --> 00:16:19,758
Your mommy and daddy love you,

295
00:16:19,758 --> 00:16:23,058
and we're going to be with you
every step of the way."

296
00:16:23,968 --> 00:16:27,410
And I felt better, and I went home
and felt at peace,

297
00:16:27,410 --> 00:16:28,926
and the phone rang.

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00:16:29,226 --> 00:16:31,260
It was the intensive care unit nurse,

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00:16:31,260 --> 00:16:34,834
and she says, "You know, Dr. Burns,
the oddest thing happened.

300
00:16:34,834 --> 00:16:37,944
The moment you walked
out of the intensive care unit,

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00:16:37,944 --> 00:16:43,858
Erik calmed down and started breathing,
and the doctor discharged him.

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00:16:43,858 --> 00:16:47,869
He's cuddling with his mommy
for the first time."

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00:16:49,009 --> 00:16:53,444
Well, that's about it.

304
00:16:53,444 --> 00:16:57,592
Erik suggested I tell this story;
I've never told it in public before.

305
00:16:57,592 --> 00:17:01,323
I said, "I'll tell it if you'll come
on up to Reno with me

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00:17:01,323 --> 00:17:03,950
so I can introduce you to the group."

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00:17:04,800 --> 00:17:06,548
(Applause)

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00:17:13,901 --> 00:17:19,252
(Erik) Wow. I think if I had dry eyes
right now then I would not be your son.

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00:17:19,912 --> 00:17:22,538
I just wanted to - in case
you didn't get the message -

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00:17:22,538 --> 00:17:24,983
I think it's that you don't have
to be blue anymore.

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00:17:25,142 --> 00:17:27,644
All right? We can all be happy.

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00:17:27,994 --> 00:17:30,678
I just want to say to you, Dad,
for inviting me up here -

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00:17:30,678 --> 00:17:31,689
it's such an honor.

314
00:17:31,689 --> 00:17:33,734
I'm so proud of you. Wow, I'm so proud.

315
00:17:33,734 --> 00:17:37,405
This speech is just phenomenal,
and your life's work.

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00:17:37,405 --> 00:17:39,809
I just want to say I'm so thankful

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00:17:39,809 --> 00:17:44,242
that you had enough faith in yourself
to have faith in me, to give me my life.

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00:17:44,242 --> 00:17:45,871
So thank you.

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00:17:45,871 --> 00:17:47,868
(Applause)