David and Jill begin using M = Methods to challenge the Negative Thought Mark wants to work on first: “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” You may recall that Mark believed this thought 90%.

Do you know what the necessary and sufficient conditions are for feeling emotionally upset? The necessary condition is that you have a negative thought in your mind, such as “I’m a failure as a father,” or “There’s something defective in my brain,” but the mere presence of a negative thought will not generally trigger shame, depression, or anxiety. The sufficient condition for emotional upset is that you believe the negative thought. And if you review his Daily Mood Log from the last session, you’ll see that Mark does have a high degree of belief in all his negative thoughts. When you’re feeling depressed, anxious, inadequate, or hopeless, I suspect that your mind is also flooded with negative thoughts that seem entirely true to you.

Do you know the necessary and sufficient conditions for emotional change?

The necessary condition is that you can challenge the negative thought with a positive thought that is 100% true. Rationalizations and half-truths will never help anyone, at least not in my experience. But having a valid positive thought is not sufficient for emotional change. For example, Mark could tell himself that he’s a very high powered physician in a world-famous medical center, and that thought would be 100% true. But that thought won't help Mark because he’ll still believe there’s something defective in his brain that prevents him from having a loving relationship with his son.

The sufficient condition for emotional change is that you can generate a positive thought that is 100% true, and in addition it has to crush the negative thought. In other words, the very moment you stop believing the negative thought that triggers your angst, in that very instant you will experience emotional relief, and the change will usually be dramatic.

But how can we challenge Mark’s belief in the NT. Remember, he is incredibly intelligent, and he’s been hooked on this NT for decades. So we can’t just tell him to cheer up, or encourage him to think more positively, or reassure him that his brain is A-Okay. Not only will those simplistic approaches fail, they would likely annoy him because they sound patronizing and might convey the message that’s he’s an idiot for believing something so ridiculous.

Instead, as a TEAM-CBT therapist, I think of 15, 20 or even more powerful and innovative techniques that I can use to gently guide the patient to his or her own discovery that the negative thought is simply not true. That's what we do during the M = Methods portion of a TEAM-CBT session.

You will listen as David and Jill generate Next, Jill and David generate a Recovery Circle, selecting 16 techniques they could use to help Mark challenge the Negative Thought in the middle of the Recovery Circle. To see the Recovery Circle, CLICK HERE. David and Fabrice discuss the rationale for the Recovery Circle--you never know what technique is going to work, since people are quite different. One of the many unique and arguably powerful aspects of TEAM-CBT is the use of more than 75 techniques drawn from more than a dozen schools of therapy.

One of the first methods we use is so basic that it is programmed right into the Recovery Circle, and it’s called Identify the Distortions. Fairly early in today's recording, Jill and David will ask Mark to identify the distortions in his Negative Thought (NT), “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” At that point, Fabrice will ask you to pause the recording and see how many distortions you can identify in the thought. You can write them down on a piece of paper, or simply print the linked PDF and identify them with check marks on the list of 10 cognitive distortions from my book, Feeling Good: The New Mood Therapy. CLICK HERE FOR TEN COGNITIVE DISTORTIONS

After Mark identifies the distortions in his Negative Thought, Jill and David encourage him to challenge it, using a variety of techniques on the Recovery Circle, starting with the Paradoxical Double Standard Technique. This is a gentle technique that is often effective for people who are compassionate. Because this technique seems to be helping,  they ask Mark to record his positive thought in the Daily Mood Log, and to indicate how strongly he believes it. Then you will see that Mark's belief in the Negative Thought is reduced to zero if you CLICK HERE.

In the next podcast, David and Jill will continue with the Methods portion of the session using additional techniques on the Recovery Circle. This will be a unique opportunity to hear many of these techniques in real time with a real person, as opposed to simply reading about them in a book. So--stay tuned to our Feeling Good Podcasts--and thank you so much for your enthusiastic support!

How can you help a depressed friend or family member? You may be surprised to discover that the attempt to “help” is rarely effective, and may even make the problem worse. In contrast, the refusal to help is nearly always helpful. But to understand that paradox, you’ll have to give a listen to this fascinating edition of "Ask David!"

David and Fabrice also address a related problem nearly all of us confront from time to time: How do you deal with a friend who is a relentless whiner and complainer? When you try to help them or suggest a solution to the problem, they just say, “That won’t work” and keep complaining. You end up feeling frustrated and annoyed, because the other person just won’t listen! David and Fabrice illustrate a shockingly easy and incredibly effective solution to this problem.

Finally, David discusses some disturbing recent research indicating that the ability of therapists—as well as friends or family members—to know how suicidal someone is, is extremely poor. David and Fabrice explain how to assess how suicidal someone actually is, and what to do if you discover that he or she really is at risk of a suicide attempt.

Podcast 288: TEAM-CBT for Video Game Addiction, Featuring Adam Holman, LCSW

We are joined today by Adam Holman, who specializes in the treatment of teens and young adults with video game addictions. Adam was drawn to this field by his own 16 hour a day addiction to video games which caused him to fail his first two years of college. Following his recovery, he decided to become a therapist so he could specialize in the treatment of this problem, and the rest, as they say, is history.

He was drawn to TEAM-CBT because of the emphasis on measuring outcomes with every patient at every session, using my Brief Mood Survey and Evaluation of Therapy Session. Prior to that, he said he felt like an “imposter,” and had no evidence that he was actually helping his patients. He explained that his clinical supervisor wasn’t much help, and simply said, “Well, Adam, your clients are coming back, aren’t they?” implying that this meant they were improving and satisfied with the treatment.

Adam explains how he created his own measures first, and then found an online therapist group at Reddit, and heard about the Burns measures, which, he says, “were a gift to me and my clients.” By looking at his feedback, he learned he was “helping” too much and trying to solve problems prematurely, before really “listening” and empathizing with his patients.

He had some tips for the parents of kids with gaming habits. The first is for them to recognize that the addiction is not the problem, but rather the child’s solution to the problems in his or her life. In his own case, for example, he explained that he was struggling with enormous amounts of anxiety, but felt relief when playing video games. Nearly all the kids he’s treated are struggling with depression, anxiety, and relationship problems, and often feel considerably better just by having the chance to talk and have someone show an interest in them.

He said that most of his patients start out with a scowl, arms folded, defiant that someone is going to try to control them or tell them what to do, and they aren’t looking for “help” because, in most cases, their parents bring them to treatment. They are surprised when Adam empathizes and tries to understand their thoughts and feelings. He said most do have issues they want to work on, although it’s not usually their gaming habits. Initially, this can cause conflicts between Adam and the parents, because they think Adam is siding with their children instead of “fixing” them.

He said the paradoxical techniques in TEAM are especially helpful, helping them identify all the really GOOD reasons for their addictions using tools like the Triple Paradox, although this is enormously confusing to the kids at first. They have to list all the positive advantages and benefits of their addictions, plus all really sucky things about quitting, as well as what the addiction / habit shows about them and their core values that’s positive and awesome. They get excited and want to share their lists with their parents.

He completes the Triple Paradox with the Acid Test question: “Why in the world would you want to change, given all of the positives?”

So, Adam’s second tip for parents is to focus on your relationship with your child and not on his or her gaming addiction. Adam teaches parents the Five Secrets of Effective Communication, and they find that the problem usually disappears on its own. However, he agreed that learning to use the Five Secrets skillfully requires a lot of commitment and hard work from the parents.  Adam recommends reviewing podcast episodes 65-70 on The Five Secrets to learn more.

Rhonda mentioned that in many cases, the kids are struggling with social anxiety, and Adam mentioned that when they are playing video games with others online, they usually do not feel anxious because they don’t feel judged.  Once again, the games are a solution to a problem, fulfilling the need for socialization and connection.

Adam uses the concept of “Sitting with Open Hands” to find out what the kids want to work on, instead of imposing an agenda on them. He described one client who was socially anxious and thought people were “creeped out” by him. Adam asked if he wanted to get over that “right now” and persuaded the young man to go outside where there was a lot of foot traffic and start doing “Smile and hello” practice as well as “Self-Disclosure” to strangers. One of the first people he said this to said he was, in fact, shocked, but added, “You made my day!”

This was a huge relief. The young man began feeling less anxious in social situations. He developed an interest in tennis and felt more
comfortable playing with his peers, and his interest in computer games reduced significantly.

Adam uses the full spectrum of TEAM-CBT techniques in his treatment, including the Devil’s Advocate Technique, Stimulus Control, and more.

Here are some of the tempting thoughts a video gamer might have:

1. Common now, it’s okay, everyone plays!
2. It’s going to be really fun!
3. It’s way more fun than homework!
4. Homework is not that important anyway.
5. I can do the homework later.

Adam’s third tip is to avoid trying to convince your child to change or to provide solutions for them. He explains that this creates a dynamic where it’s the parents vs. the child and the video game; a battle where neither side wins and both sides end up angry. For more on this topic, Adam would recommend podcast episode 146: When Helping Doesn’t Help.
Related to this, he described a case of a boy with a 12-hour a day habit, and his grades were suffering. The parents had tried everything to try to fight and control his behavior, including hiding all his power cords. Feeling as though this was unfair, he stopped at a garage sale on the way home from school and bought a used Gameboy. Clearly, this type of strategy is not effective.

Then the parents got better at listening, with the help of Adam, and they found success. Instead of restricting access to the games, they worked with their son to strike a balance. Their son developed an interest in skiing and the focus on video games diminished.

Adam’s fourth tip for parents is to try to encourage balance and stand with your kids, working together as a team. For example, you can ask them, “We understand that you enjoy playing games because it’s fun and helps you to relax, and we want you to be able to have fun and relax! What do you think would be a healthy and appropriate use of video games?”

In Summary, here are Adam’s four tips for parents:

1. Recognize that the addiction to video games is not the problem, but rather the child’s solution to problems in their lives. There are many good reasons they have likely found to play games ranging from relieving anxiety, to social connection, to simply having fun instead of doing boring homework.
2. The best way to support your child is to focus on your relationship with them and not necessarily the video game addiction. The Five Secrets of Effective Communication are a great tool for this.
3. Avoid trying to convince your child to change and don’t try to provide solutions for them. While boundaries are important, this creates resistance and his often ineffective.
4. Stand alongside your child and work with them to encourage balanced use of video games. This may involve encouraging other hobbies or agreeing on a plan together with regards to how much video game use is healthy and appropriate.

If you would like to contact Adam, you can find his information at mainquestpsychotherapy.com.

Warmly, David & Rhonda

369 The Invisible Racism

We All Deny, Featuring Drs. Manuel Sierra and Matthew May

Today we’re joined by Drs. Manuel Sierra and Matthew May on the sensitive topic of racism.

Manuel Sierra MD is a child and adolescent psychiatrist practicing in Idaho, one of the places where he grew up (he also spent time in Oregon). He was a classmate of Matt May during his residency training days at Stanford, and they remain close friends today.

Rhonda begins today’s podcast with this mail we received from Guillermo, one of our favorite podcast fans:

Guillermo asks: How do you respond to family or friends who make racist comments?

Hello, Dr Burns

Not sure if you have addressed this in any of the podcasts (I don’t recall it being a topic) but:

I was recently in a group chat with some cousins, and I read some really disappointing racist comments about a particular group. Many people ignored it (as I did) and a couple AGREED with the comments.

How can we balance not judging not just any people but our longtime friends and family about overtly racist actions/comments and the thinking that it is not the event but our thoughts that create our emotions?

I don’t care about “judging them” (in the sense that I don’t think it is my place to “change” their views) but just hearing/reading comments like this bothers me when they come from people close to me.

When I see it on tv or the internet, I don’t get affected because I feel it is beyond my control.

I don’t believe they will change their views so do I just remove them from my life? I apologize, the topic is too wide, but I’ve been thinking about this.

Sincerely grateful for all you do,

Guillermo

Manuel kicked off our answer to Guillermo by saying that he has been personally familiar with racism within families and communities, and says that he and Matt have talked about this topic “a lot.” He explained that:

Although I am proud of my Mexican-American heritage, I was born and grew up in Oregon and Idaho, where I’m currently practicing. I encountered considerable racial bias when I was a kid, and later in life as well. I clearly cannot speak for all Mexican-American people, I can only speak for myself and what I’ve personally experienced, and I am extremely aware of how difficult the current times are.

My grandparents didn’t teach my mom Spanish. She was a single mom, and we lived in a small town in Idaho. I also have family through marriage who live on Native American lands.

In grade school I began hearing jokes about Mexican Americans, and this was very awkward, painful, for me. I also got ridiculed for not speaking Spanish.  Even my grandfather asked me, “why aren’t you speaking Spanish?” There were also gangs where the racial bias got worse and frequently turned violent.

After learning more about Manuel’s experiences, we modeled various ways of talking to a friend or family member who has made hurtful racist comments. Manuel cautioned that it might be best to do provide the feedback individually, and not in public, so as not to shame the person. In addition, this can reduce the chance for social posturing and responding in an adversarial way.

Matt agreed and emphasized the importance of combining your “I Feel” Statement with Stroking. For example, you might say something like this, assuming the racial slur comment came from a relative or person you like,

Jim, as you know, you’re one of my favorite people, but I want you to know that when you said X, Y and Z, it really upset me, because it sounded like a put down to people who are (Mexican, Jewish, Moslem, gay, or whatever).

I (David) like this approach because it sounds respectful and direct, but not judgmental or condemning. Rhonda modeled an excellent alternative response which included this type of add-on: “And I’m going to request that you not say that again in my presence. “

I (David) would prefer not to add the directive statement at the end, which could, in theory, rankle some individuals with coercion sensitivity, because it might sound scolding. However, that’s just my take on it, and it’s not some kind of gospel truth. If you want to push your assertiveness and stick up for yourself, it might be effective, and was effective recently for Rhonda because the relative she said this to stopped making similar racial comments in her presence.

I would suggest ending any kind of response to the person who made a racial slur with Inquiry, asking them about their racial feelings as well as the fact that you are criticizing them. Do they feel hurt, angry, anxious, or put down? You might also ask something along these lines--Have they always had negative feelings about this or that racial or religious group?

Manuel described an experience in medical school when an attending doctor was supervising a group of medical students in how to do a particular medical procedure quickly, and said this to him, “You can be like a Mexican jumping bean!”

Then Manuel asked himself, “Should I say something?” Which of course incurs the risk of retaliation from an authority figure in a position of power.

Manuel mentioned that just because you’re working in a prestigious medical setting, this does not protect you from racial slurs. He described hearing people comment on how he and several Mexican-American classmates probably got into medical school because of their ethnicity, implying they weren’t sufficiently intelligent or on par  with their classmates.

He also mentioned an incident during his internship when he checked in on a patient wearing his white lab coat with stethoscope around his neck, and the patient asked him if he was there to pick up the trash and could he please get the doctor.  Manuel humbly replied that he could pick up the trash, and he was the doctor.

I asked Manuel how he felt when hearing these types of belittling and patronizing racist comments. He said that he felt annoyed, embarrassed, angry, put down, anxious, and alone.

He described one of his best friends growing up who was white. However, this fellow grew up poor as well, so they easily formed bond because they’d had similar class-based experiences. His friend sometimes lived in all-black neighborhoods and had also felt out of place at times, not accepted, and targeted.

I asked Manuel how he felt describing these intensely personal experiences on the podcast today, knowing so many people would be listening. He said, “It’s anxiety-provoking. My mouth is dry, my heart is racing, and I’m afraid I’ll sound like an idiot!”

We discussed the differences between being unintentionally or intentionally offensive with racist comments, and also mentioned the related topic of bullying which, of course, is intentionally hurtful. Manuel said that an example might be calling me names or saying terrible things about my mother, or making threats to hurt your family, or your mom. Often the bully is trying to get you to fight, so you’d be beaten up. The bully’s goal is to humiliate you in front of others and make you feel bad about yourself.

Manuel introduced us to some of the approaches he uses when working with kids who are bullied. I’d like to hear more on this topic but we were running out of time. We could address bullying on a future podcast with the same crew, since Manuel and Matt both have a lot to offer on that sensitive and exceptionally challenging topic. Let us know if you’re interested in hearing more.

The response to bullying has to have two dimensions. First, your thoughts, and not the bully’s statements, create all of your moods. So, you can use the Daily Mood Log to record and modify your inner dialogue. The goal would be to support yourself and not buy into the notion that you are somehow “less than” or a loser or coward just because someone is trying to bully and exploit you in a sadistic fashion.

The cognitive work is based on the idea that ultimately, only you can bully yourself. The words of the bully cannot affect you unless you buy into them. But then it’s your own beliefs that are the source of your emotional misery.

Second, your verbal response to the bully can also be helpful to you, or it can serve to make the situation worse. But these techniques, based in part of the Five Secrets of Effective Communication, can be challenging to learn, especially during the heat of battle, so considerable practice is vitally important.

The goal of changing your thoughts as well as the way you respond is not to blame you for the problem, but to give you some reasonably effective coping skills, perhaps similar to the verbal karate I mentioned in my first book, Feeling Good.

At the end of the podcast, we did a survey among the four of us on whether meanness and aggression and exploitation is one of the inherent and genetically based drives in human nature, along with our more loving impulses and drives, or whether humans are basically good and all the hostility and killing is the result of adverse influences along the way. There was a sharp difference of opinion, and you can listen to the podcast to find out what everyone thought!

We were, of course, just speculating, as this question is partly scientific and partly philosophical.

I asked Manuel how he felt at the end of the podcast, and he said he was feeling a lot better. He was powerful and informative, and I was grateful he could appear with our team and teach us from the heart today! I hope you enjoyed today’s program as well.

Thanks for listening!

Manuel, Matt, Rhonda, and David

392 The Empty Nest Cure

Featuring Jill Levitt, PhD

Plus BIG NEWS!

The Magical Annual Intensive 

Returns this Summer 

at the South San Francisco Conference Center

August 9 -13, 2024

You can Review the Exciting Details Below

Or click this link!

Today we are proud to feature our beloved Dr. Jill Levitt. Jill is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California, and co-leader of my Tuesday evening psychotherapy training group at Stanford. She is a dear friend, and one of the world’s top psychotherapists and psychotherapy teachers.

Today, Jill joins us to discuss the so-called “Empty Nest” syndrome. According to Wikipedia, this is the “feeling of grief and loneliness parents may feel when their children move out of the family home, such as to live on their own or to pursue a higher education.“

Jill emailed Rhonda and me to explain why she thought a podcast on this topic might be of some value. She wrote,

Recently, I was working with two different women around the same age who were having similar feelings of guilt and shame about the choices they made around parenting versus working.

Jane is a 60 year old high level executive with two boys who was super successful and is now retired. She is telling herself, “

• I did not do enough for my boys.
• I should have worked less.
• I should have spent more time with them.
• I was selfish, and worked because I enjoyed it.
• I should have done more for them.
• I’m a terrible mother.

Stephanie, in contrast, is a 60 year old stay-at-home mom of four adult kids, and now that her last kid has left for college, she is telling herself:

• I should have had a career.
• I have done nothing with my life.
• I am a smart woman so I should have done more.
• I am inferior compared to other women who have contributed to society in some way.

Jane and Stephanie both struggled with feelings of guilt, shame, sadness and inferiority, and they were both telling themselves that they should have made different choices.

I’m sure your life is very different from their lives, but you may have also looked in to the past and beaten up on yourself for what you should or shouldn’t have done. Or, you may be beating up on yourself right now with shoulds, telling yourself that you should be better, or smarter or more successful or popular than you are.

In fact, according to the late Dr. Albert Ellis, these “Should Statements” are responsible for most of the suffering in the world, and there are several different types, including:

• Self-Directed Shoulds, like “I shouldn’t be so klutzy and shy in social situations. These self-directed shoulds trigger feelings of depression, anxiety, inadequacy, inferiority, guilt, shame and loneliness, to name just a few.
• Other-Directed Shoulds, like “So and so shouldn’t be such a jerk!” Or, “You have no right to feel the way you do!” These other-directed shoulds trigger feelings of anger, blame, resentment, irritation, and rage, and can easily escalate into violence, and even war.

I’m sure you can see that both women were struggling with Self-Directed Shoulds. What can you do about these shoulds and the unhappiness they trigger?

Jill explains how both women experienced rapid recovery when she used simple TEAM methods systematically, including empathy and Positive Reframing as well as other basic techniques like the Double Standard Technique and the Externalization of Voices, and more.

I, David, then described a woman he treated who fell into a depression when her two daughters went off to college. And she was perplexed, because she’d always had a super loving relationship with them, just as she’d had with her own mother when she was growing up.

When I explored this with her, a Hidden Emotion suddenly emerged, as you’ll hear on the podcast, and that also led to a complete recovery in just two sessions.

Then Jill had a sudden “eureka” moment and realized that the Hidden emotion phenomenon was also central to the anxiety that one of her two patients was experiencing.

One of the neat things I (David) really like about TEAM is that we don’t treat people with formulas for “disorders” or “syndromes.” These three woman all had the same “Empty Nest Syndrome,” but the causes and the cures for all of them were unique, as you’ll understand when you listen to this podcast.

Our 400th podcast is coming up soon, and we want to thank all of you in advance for your support and encouragement over the past several years, which we all DEEPLY appreciate! We’ll be joined by a number of our podcast stars from the past 100 shows, as well as our beloved founder, Dr. Fabrice Nye!

And we have one VERY special event coming up this summer that might interest you if you’re a shrink. I (David) have done very few workshops over the past five years because of the pandemic as well as the intensive demands of developing our Feeling Great App which will be available soon.

The most fantastic work of the year was always the summer intensive at the South San Francisco Conference Center. Well, guess what! We’re bringing it back this year. The dates will be August DATES, and it will have the same magic it has always had, but with some cool innovations.

1. It will be Thursday to Sunday noon, 3 ½ days instead of four, but it will include two fantastic evening sessions, so you will get a MASSIVE amount of teaching.
2. It will be sponsored by the Feeling Good Institute in Mountain View for the first time, Jill and I will teach together, just as we do in the Tuesday group.
3. Of course, Rhonda will be hosting the event as well!
4. There will be many expert helpers from the FGI to assist you in the small group exercises throughout, so you will LEARN from actual practice with immediate expert mentoring and feedback.
5. There will be a live demonstration with an audience volunteer, as in earlier years, plus your chance to do live work in small groups on the evening of the third day. This is always the top rated event during the intensive.
6. You can attend in person if you move fast (seating will be limited to around 100 or so) or online (for half price or so.) That will give people from around the world the chance to attend without the extra cost and time to come in person. The online people will have leaders guiding you in the same exercises we will do with the in-person group.
7. You’ll get intensive TEAM training in the high-speed treatment of depression and anxiety, so you can really “get it” all at once and see how all the pieces of this amazing approach fit together.
8. You’ll also have the chance to do your own personal work and healing, which is arguably the most important dimension of professional training.
9. There’s a whole lot more but I’m running out of steam.

For more information, click this link!

Here are the details:

High-Speed CBT for Depression and Anxiety—

An Intensive Workshop for Therapists

with Dr. David Burns and Dr. Jill Levitt

Join in person or online!

Dates (3 ½ days)

Thursday, August 8: 8:30am-8:30pm

Friday August 9: 8:30am-4:30pm

Saturday August 10: 8:30am-9:00pm

Sunday, August 11 8:30am-12:00pm PT

Location

South San Francisco Conference Center
(10 minutes from SF Airport)

Cost

In Person $895* Early Bird Price (only 100 seats)

Online $495* Early Bird Price

To receive the online price, you must enter
the discount code: OnlineOnly when purchasing

The $100 price increase for live and online starts on 6/3/24

 Rhonda, Jill, and I hope to see you there!

And thanks for listening today!

In today’s podcast, we focus on a request by Tommy, a podcast fan who asked for a podcast on how TEAM evolved from traditional CBT. So here it is!

Hi Dr. Burns,

I hope you're doing well! I just recently completed Feeling Great and found it incredibly helpful. I found the technique chart that offered specific techniques for each distortion to be incredibly valuable and I've incorporated it into all my Daily Mood Logs. I've also listened to every podcast and have been already exposed to nearly all of the content within the book, but the book did such an elegant job of simplifying everything and putting it into context. I've already gifted it to several family members and am eagerly awaiting the audio version so I can gift it to my grandfather, a psychodynamic therapist of 30 some odd years who's vision impaired. I think he'll really get a lot out of it!

Beyond the well-deserved praise, I'm emailing because I just listened to your post recent podcast episode (222) with Dr. Barovsky and you asked for any suggestions the audience might have concerning future episodes.

There were two things that you mentioned that made me think an episode on the evolution of TEAM might be really cool and insightful. You mentioned that TEAM was specifically developed to deal with borderline personality patients that you saw at PENN and you also described an interaction with a stranger in California who approached you that inspired the concept of fractal therapy (at least that's how I understood that interaction). I think it would be incredibly interesting if you gave a sort of chronology of TEAM and what problems some of the core components were intended to solve.

Obviously, I wouldn't expect you to go through every technique. But some insight into how you came up with positive reframing, the magic dial, perhaps uncovering techniques, and whatever else you'd be willing to share. Besides being interesting, I think it would be valuable because it would provide greater insight into the TEAM processes through demonstrating how it's overcome some of the obstacles that traditional CBT was unable to overcome.

Dr. Mark Noble's chapter in Feeling Great led me to think quite a bit about this, particularly where he described how TEAM is really the ideal therapeutic structure from a neurological standpoint. Certainly you didn't just stumble into TEAM and I for one would find anything you'd be willing to discuss on this topic really interesting!

Thank you again for everything you do.

Best,

Tommy

Hi Tommy

Here are some historical highlights in my thinking. In the podcast I will describe them and dialogue with Rhonda, but in no particular order. Thanks for the great suggestion, and hope you enjoy the podcast.

Rhonda also mentioned how the empathy piece evolved, and we discussed that!

1. Psychotherapy homework: Early research and clinical observations on psychotherapy homework and recovery from depression; how I published research on this topic and decided to make patients accountable.
2. Helping: The man who I called at home twice every time he called me with some emergency one weekend, and my conversation with Dr. Wendy Dryden from England.
3. The beauty of depression: The businessman who thought he was responsible for the death of his stepson.
4. The universal importance of Positive Reframing: The time jill said she wished we’d done positive reframing during her session.
5. Fears of therapists that keep them stuck: My observation through supervising psychology and psychiatry graduate students, as well as teaching workshops, how really hard it is for the vast majority of therapists to give up because of their addiction to helping and their intense fears of making patients accountable.
6. Suddenly understanding “resistance.” The meeting of the Stanford voluntary faculty on teaching, and I mentioned making the concept of “resistance” more understandable for the psychiatric residents. They didn’t seem interested, and then I found the answer in a dream.
7. Creating techniques with more “oomph:” The first method I created, Externalization of Voices, how this was inspired by my experiences in psychodrama marathons when I was a medical student.
8. Giving up on “non-specific” techniques: The elderly depressed man who ran up to 12 miles a day.
9. Therapeutic Empathy: What I learned from Stirling Moorey, and how I set up an empathy training program along with a scale to assess empathy after every therapy session.

Rhonda and David

Ask David: Featuring Matt May, MD

What causes anxiety?

Is recovery permanent?

What if the cognitive distortions aren't helpful?

Do hormones cause anxiety and depression?

What's the role of vitamins and nutrition?

How do Exposure and Response Prevention work?

And many more answers to your questions!

In today’s podcast, three shrinks discuss many intriguing questions about anxiety from individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Several of the questions were answered on the podcast, and a great many more are answered in the show notes below.

But first, Rhonda opened the podcast by reading an endorsement from a listener named Rob, with a link. Here it is!

Hi Dr. Burns:

I'm a long-time listener/reader, first-time caller. I stumbled upon this endorsement for Feeling Good today, and I thought it was worth sharing with you. I can't think of a better endorsement for a book. I hope you enjoy it!

"I’ve replaced my copy close to ten times, as I keep lending it to friends who never give it back."

https://girlboss.com/blogs/read/feeling-good-david-burns-review

Have a great day!

Rob

Thanks, Rob! And now, for the many excellent questions submitted by listeners like you! Many were answered in depth on the podcast, but you'll see that all questions have written answers as well.

When you talk about someone recovering, is that free of panic attacks and anxiety forever, or a great decrease in symptoms but you will always be an anxious person to a certain extent? Especially for someone who has fundamentally been anxious since they were young so not episodic but continuous.

David's Answer. Some people are anxiety-prone, and that is likely due to a genetic cause. I am like that, for example. Once you are 100% free of any form of anxiety, like my public speaking anxiety, you need to continue with exposure, or the old anxiety will try to come creeping back in. So, I do public speaking all the time!

What if your client/patient understands the Cognitive Distortions but doesn’t believe them to be true?

David's Answer. It is hard for me to comprehend what you mean. But I will say this. Anxiety and depression and other negative feelings result 100% from distorted negative thoughts. And the exact moment when you stop believing the thought that’s triggering your anxiety or depression, you will almost instantly feel relief.

And here’s the precise answer to your question. When someone says, “I understand the distortions but it doesn’t help,” they still believe their negative thoughts.

Resistance, too, is an issue. Nearly 100% of therapeutic failure results from jumping in and trying to help the patient without first comprehending the many reasons why the patient will fight against the therapist’s efforts to “help.”

Has research been done on the possible relationship in hormone levels in women and anxiety or depression? Especially during pregnancy, post pregnancy, and those going through menopause? Also, can negative thoughts also depend on the person’s nutrition? Could it be that vitamins that are lacking?

David's Answer.  First, I am not aware of any convincing evidence linking hormone levels with depression, anxiety, irritability, or any other negative feelings. However, we can say with certainty that whatever the cause, which is unknown, distorted thoughts will always be present and will be the trigger for the negative feelings.

In or near the first chapter of my most recent book, Feeling Great, I describe case of post pregnancy depression, and you can take a look and see the mother’s negative thoughts clearly. And you will also see that the moment she crushed those thoughts, her depression disappeared!

People want to “biologize” emotional problems, and I started out as a “biological psychiatrist” and researcher, but found the biological explanations to be erroneous and unhelpful.

Could you please give a brief overview about Exposure with Response Prevention for OCD treatment.  Thank you!

David's Answer. Sure, these are tools that can be helpful, along with many other kinds of tools, in the treatment of anxiety, including OCD. They are not, for the most part, treatments. I use four models in the treatment of every anxious patient: the Motivational, Cognitive, Exposure, and Hidden Emotion Models.

Exposure is facing your fears and enduring the anxiety until the anxiety subsides and disappears. Response Prevention is refusing to give in to the superstitious rituals OCD users when anxious, like counting, arranging things in a certain way, and so forth.

END OF QUESTIONS DISCUSSED LIVE ON THE PODCAST

The answers to the questions below were written by Dr. Burns but not discussed on the Podcast.

Questions can I ask to overcome the Cognitive Distortion “jumping to conclusions”? That is the toughest for me.

David’s Answer. I would need a specific example. Jumping to Conclusions includes a vast array of topics and negative thoughts. Fortune Telling and Mind Reading are the most common forms of Jumping to Conclusions. Feelings of hopelessness always result from Fortune Telling. All forms of anxiety always result from Fortune Telling as well. Social Anxiety typically includes Mind-Reading, and Mind-Reading is almost universal in relationship conflicts.

In addition, I never treat a distortion, an emotion, a diagnosis, or a problem. I treat human beings systematically, using the T E A M algorithm.

Matt’s Answer. There are many methods in TEAM that can be applied in the form of a question. These methods and how they are carried out, depends on the circumstances and the specific thoughts a person is having. Below are some examples of negative thoughts (NT’s) and the types of questions that might help overcome them.

(NT): ‘Something really bad is going to happen’

 (Be Specific Technique): ‘Like what? What’s going to happen?’

 NT: ‘I’ll fail my biology test’

 What-If Technique: ‘What if I failed my biology test, why would I be worried about that? (write down any new thoughts) What if those things happened, too, what then? (write down any new thoughts) What’s the absolute worst thing that could happen? (write this down).

 Measurement: How certain am I, that these things will happen? On a scale from 0 – 100%, how likely are each of these predictions, in the form of negative thoughts, to occur?

 Socratic Outcome Resistance: What do each of these negative thoughts say about my values that I can feel proud of? (write these down) What is appropriate about how I’m feeling and thinking? (write these down) What are the advantages of having these thoughts? (write these down). What would I be afraid of, if I didn’t have this thought? (write these down)

 Pivot Question: Given the many positive values related to worrying, the advantages of doing so, the disadvantages of a carefree existence and the many reasons why my worry is appropriate, why would I change this?

 Forgetful Clone (Double-Standard Amnestic Technique for Outcome Resistance): What would you say, to a dear friend, in an identical situation, when they asked these questions: ‘I’m really worried about failing my biology test, would you be willing to help me? (if ‘yes’, then continue) … Don’t I need to keep worrying? Won’t that protect me from failing? Don’t I need to worry, so that I’m highly motivated to succeed? Don’t I need to worry, so I avoid making mistakes? Don’t I need to worry, to maximize my rate of learning new material? Won’t I get lured into a false sense of security, if I stop worrying? Won’t I jinx it, if I get too confident? What would you recommend to me? How much do you think I should worry? I am prepared to do so … would it be helpful for me to go into a sustained panic, at this time?’

 Cost-Benefit Analysis: Is worrying about failure worth the price? How would you weigh the advantages of worrying about failure against the disadvantages? What are the pro’s and con’s? How would you divide 100 points, to reflect the power of these two arguments?

 Examine the Evidence, Motivational: What evidence is there that worrying improves academic performance, concentration and learning? What evidence is there that worrying worsens academic performance, concentration and learning?

Magic Dial Question: ‘‘Should I remain maximally worried, at all times, forever? (If not, keep going) ’What amount of worry is best, for me, in this moment?’, ‘How about future moments? How frequently do I need to worry and for how long?’

 Process Resistance for Activity Scheduling, Worry Breaks/Cognitive Flooding, Self-Monitoring/Response Prevention: ‘Would it be alright to ignore my worry most of the time and only focus on it during scheduled times? Let’s say I could learn how to be extremely calm and focused most of the day, without worry … would I be willing to worry as intensely as possible, for ten minutes, three times per day, to achieve this? When my worry comes up at other times, would I be willing to observe and record that event, then return to the task on my schedule?

 Socratic Questioning: Am I absolutely certain that this thought is true, that I will fail? How do I know that I will fail? What specific questions will be on the Biology test that I will get wrong? What number grade will I get? A 60? 58? 39?’, ‘Would I bet money on my getting precisely that grade? Why not?’.

 Examine the Evidence (cognitive): ‘What evidence is there that I will fail? What evidence is there that I will pass?

 Reattribution: Let’s say that I fail. Would that be entirely my fault? Are there any other factors, outside my control, that might have contributed to this outcome? My genetics, for example? Or the nature of the world, into which I was born? Did I choose my genetics? Did I choose the world into which I was born, when I was born, my parents, teachers, etc.? Could any of these factors have played any role in the outcomes in my life?

 Other examples of Inquiry-based methods, using different NT’s:

 Negative Thought: ‘People will be angry and judge me, if I fail’

 Interpersonal Downward Arrow: ‘What kind of people are they, if they judge me and look down on me, when I fail? How would I feel towards those types of people? Is it possible I feel angry? How do I express that feeling? What ‘rule’ am I following, in my relationships?’

 Outcome Resistance: What’s good about me, for feeling anxious, rather than angry? What are the advantages of keeping my feelings inside? What would I be afraid of, if I expressed my feelings?

 Process Resistance, 5-Secrets: Would I be willing to spend the time to learn the skills required to express my feelings, including anger, to people, in a way that made them feel good?

 Negative Thought: ‘I’ll get sick and die’

 Be Specific: ‘When? What time of day will that occur? What illness is going to kill me?’

 Negative Thought: ‘I’ll lose my mind, crack up and go crazy’

 Examine the Evidence: Has that ever happened to me? When was the last time?

When you are working with clients, how do you handle it when they can challenge their thoughts very convincingly using a variety of techniques, state that they can see the logic in their restructured thought BUT they are still experiencing heightened anxiety and state that this hasn’t helped them?

David’s Answer. They still have a strong belief in their negative thoughts. It is 100% untrue that they have “challenged them very convincingly.”

Here’s an example. Let’s say you have an intense fear of glass elevators. You will say, “I can see that they are unsafe, but I am still terrified of going in one.”

The moment you get on the elevator your belief that you are in danger will suddenly skyrocket to 100%. In other words, you still believe your negative thoughts.

Of course, it is nearly always easy to overcome phobias, including an elevator phobia. As stated above, I use four models in treating every anxious patient. Simplistic formulas are just that—Simplistic! Treating humans is not like changing the oil in your car!

Matt’s Answer: I am hard pressed to add anything of value to David’s awesome response, above. I might just reiterate that the Cognitive model, challenging the logic behind negative, anxiety-producing thoughts, is the least powerful of the approaches we have to anxiety. It is necessary, but almost always insufficient. Exposure, motivational methods and Hidden emotion are the real heavy-hitters. Until trying these, it is likely that the negative thoughts can be disproven ‘intellectually’ but not at the emotional level.

How do you work with clients who state they are anxious all the time, experience strong somatic symptoms (body sensations) and cannot identify specific thoughts. They don’t catastrophize these somatic symptoms but really, really dislike them and want them gone!

David’s Answer. I just ask them to make up some negative thoughts. That works well. For example, they may have the belief that the anxiety must be avoided because it may never disappear, or may believe that they are on the verge of going crazy, and so forth.

Matt’s Answer, Anxiety can cause people’s brains to shut down, experiencing the ‘deer in the headlights’ phenomenon. Try to identify just one upsetting thought, then use the ‘what-if’ technique to expand on that. You’ll be off and running!

How do you do techniques with a person who has active suicidal thoughts?

David’s Answer. I don’t “do techniques.” I find out if they’re actively suicidal and in danger. If I know for certain that the person is safe, I treat them like human beings, with T E A M. I’m not a formula person. Each person will be different, and will respond to different methods. My books and podcasts are chock full of examples of actively suicidal people who responded.

Matt’s Answer. I let them know that I don’t have the skill to help them unless I know they’re safe. If I’m worried for their safety, I’ll be afraid to use aggressive methods that may be required for them to recover. I’d need them to convince me of their safety before agreeing to work with them. If they can do so, I offer TEAM. If not, I ask if they’re willing to escalate the level of their care, e.g. to meet with me while hospitalized in a safe setting. I don’t work with patients who are at risk of harming themselves because I don’t believe in my ability to be helpful to them.

Is it really okay to keep continuing the experimental technique when the patient does not want to continue? And, what if the therapist is not confident and something goes wrong in this situation?

David’s Answer. I would need a specific example, but you are right that 75% or so of therapists are afraid of exposure and will not use it, fearing that something will “go wrong!”

Matt’s Answer. It’s important to identify the resistance before initiating the method of exposure and to talk it through. Why would they not want to continue? What are they afraid of, if they get really anxious, during exposure? Write this down.

Then, surrender, acknowledging that these are some excellent reasons to avoid exposure, in which case we can’t help them with their anxiety. Perhaps there’s something else they want help with? If they can convince you, and themselves, that exposure is precisely what they want to do, and they’re willing to keep doing it, even if it makes them very anxious, it’s appropriate to push a bit, in the moment of their doing exposure, to bolster them and help them through the rough patch. That said, I always give my patients a way out, if they don’t want to continue. That’s their choice, I just want them to be aware of the consequences, including a worsening of their anxiety.

When doing experimental method, or the exposure method for example with who has sweating issue, how do you handle the hyper-vigilance he would have with people around, especially if someone actually laughed at him?

David’s Answer. I would use the Feared Fantasy Technique, and Self-Disclosure. I would likely go with the patient into the real world to do these things, and have done so on hundreds of occasions.

How would you work with someone who suffers from  Selective/Situational Mutism?

David’s Answer. I have not run into that in my clinical practice. But 100% of the time, I would want to know what the patient’s agenda is. I would also want to know if there are powerful motivational factors that need to be addressed, looking at the whole person rather than the symptom.

How different are Team CBT treatments for teens as compared to adults?

David’s Answer. My experience is limited, but I would say no difference, really. I have loved working with teens, even though my main focus was on adults.

When working with little kids, I think you need to incorporate play and games, although the basic concepts are the same. For example, you can do Externalization of Voices with puppets, the “Bad, Mean Self” and the “Positive, Loving Self,” or some such.

We have featured shrinks who work with kids on many times on our podcasts.

Thanks for joining us today!

Matt, Rhonda, and David

David and Fabrice begin by reading several incredibly touching reader comments on the live therapy with Marilyn. Marilyn experienced a severe depression relapse eight weeks after her initial session with Matt and David, because of a painful metastasis to her rib cage which frightened and demoralized her. She graciously agreed to come in for a tune-up with David and Matt which will be published as a special podcast within the next week or so. You will not want to miss this session!

David addresses two questions posed by listeners. The first question has to do with so-called “third wave” CBT as well as Mindfulness-Based CBT and other innovations in CBT. David stresses the difference between specific and non-specific therapeutic techniques. He also discusses the distressing but exciting fact that few or no therapies have proven to be much more effective than placebos in the treatment of depression, and why this is the case.

Another listener asked why David did not use Exposure initially in his treatment of the woman who was afraid that her baby would be switched at the hospital, and that she’d end up with the wrong baby. David concedes that if he’d thought of using Cognitive Flooding initially, it likely would have been effective. He also argues that Exposure and Response Prevention are not treatments for OCD, or for any anxiety disorder, but are simply tools one can use in treatment. David argues that for an optimal outcome, he combines four treatment models with every anxious patient: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. These models are discussed in detail on previous podcasts.

Hi everyone!

This special podcast features one of our favorite people, Professor Mark Noble from the University of Rochester in New York. Professor Noble is a world-renowned neuroscientist and cancer researcher, one of the pioneers in stem cell research, and all-around good guy. He contributed a brilliant chapter on how TEAM-CBT interacts with the brain for my book, Feeling Great. For the past two years he has been a very beloved member of the Wednesday TEAM-CBT Training group, adding his wisdom and clarity to the teachings.  Rhonda and my co-teachers, Leigh Harrington and Richard Lam, and all of our students feel very honored to have him in our midst.

This is our third podcast with Dr. Noble, and the first podcast to usher in the new year. We’re excited to speak with him again today. He will update us on his latest thinking on how the molecular biology of stress and learning are totally consistent with the rapid mood changes we see in TEAM-CBT. He also describes his latest writing project, tentatively entitled, The Brain User’s Guide to TEAM-CBT, and you can download it for FREE if you click here! (LINK)

In this booklet Professor Noble presents the “brainological perspective” on TEAM-CBT. He emphasizes that this booklet is written at the 9^th grade level so as not to intimidate anyone. If you’re curious, take a look, and feel free to share it with others who might be interested.

Professor Noble explains that his new booklet was inspired by patients who ask how TEAM differs from traditional (aka “normal”) talk therapy. Of course, the differences are many and profound, but one of the questions new patients and therapists ask is whether the rapid recoveries we observe during TEAM-CBT treatment are just superficial and temporary, or even fake.

Mark asserts that nothing could be further from the truth, and that the thing that makes TEAM-CBT so special is how closely it is aligned with how the human brain actually works. He explains that there are ten essential steps in TEAM, starting with Empathy. He defines Empathy as “being in a safe place, where you can share feelings without being judged.”

Empathy allows the patient to access the networks in the brain where the patient’s pain may be stored as memories. The spoken and written language exercises used in TEAM actively and rapidly modify the networks that generate the feelings of depression, anxiety, shame, inadequacy and hopelessness. Dr. Noble places a great importance on the written Daily Mood Log, which he describes as arguably the “greatest development in the history of psychology.”

He says that when you describe the horrible and traumatic things that happened to you, and you record your Negative Thoughts on paper in a systematic, step-by-step way, you can look at your thoughts, feelings, and painful memories as separate from your “self” and gain some distance from them. Then, when you pinpoint the many cognitive distortions in your negative thoughts, and substitute more realistic interpretations, you gain freedom and relief because you are actually re-wiring your brain.

He said that most of our human thinking is called Fast Thinking. This is the automatic thinking that we do 98% of the time as we go through our daily lives.

Fast thinking is great, but growth, learning and change can only result from Slow Thinking, where we reflect and analyze things. Slow thinking takes concentration and effort because you are changing actual networks in your brain when you challenge and crush your negative thoughts with powerful techniques like the Externalization of Voices.

He says that we are not just telling people to “Stop it!” or “Get over it!” Quite to the contrary, we are teaching specific, powerful techniques that give you the chance to pinpoint and modify the exact brain networks that cause your negative feelings. He explains that “language is a powerful tool for figuring out exactly how we see the world when we’re feeling down, and TEAM gives us many tools in TEAM to modify the errors in our perceptions that cause so much suffering.

Mark laments on the excessive misuse of medications for individuals, including children, who are struggling with behavioral and emotional problems. He wishes more people would simply sit down with the person who is upset and ask, “What’s going on? How are you feeling? What are you thinking and telling yourself?”

I have had the same thought when thinking about how therapists not familiar with TEAM or Cognitive Therapy use and promote dozens of presumably therapeutic approaches without simply asking patients, “What thoughts go through your mind when you are feeling depressed, anxious, ashamed, inadequate, or hopeless?” The answers to this question provide direct and immediate access to the brain networks that need re-wiring!

Mark concludes today’s podcast by saying,

“I went into medical research on cancer and other serious problems because I wanted to help people who are suffering. I’m convinced that TEAM-CBT, and the powerful Daily Mood Log that David has developed, have the potential to help millions of people around the world!”

Rhonda and I are grateful for Mark’s ongoing friendship and brilliance and want to wish all of you a happy and healthy 2022!

We are both very grateful for your support during the past year and hope you will continue to mention our podcast to friends or colleagues who might be interested in learning about TEAM-CBT.

We look forward to celebrating the five millionth download of the Feeling Good Podcast around July! Thank you!

Rhonda and David

Ask David featuring four terrific Should questions, and more questions about “asinine, stupid, narcissistic, self-serving humans! “

1. Oliver asks: Can a thought be thought as moral or immoral?
2. Vincent asks: I have suffered from depression for about 3 years and say to myself, "I should have gotten better sooner." Isn't this "should" appropriate?
3. Charles says: Your concept of “no self” shot my anxiety way up and made me feel hopeless. . . . It makes me feel worse than before!
4. Michelle asks: How is your requirement that new patients must agree to not make any suicide attempts for the rest of their lives any different to a “suicide contract” which you mention are not effective?
5. Brian asks: I’ve done a few things that made me feel intensely guilty. . . . The knowledge that I didn’t do what I should have done led to a lot of guilt and shame, and eventually depression. Just wondering your thoughts on this
6. Carrel asks: I'm a Democrat in Texas. How can we use disarming to heal the political rifts in our country?
7. Natasha asks: How do I stop the dark thoughts of wishing harm to come to stupid humans who do asinine, narcissistic, self serving, irresponsible things—like driving massive, loud pickup trucks around the neighborhood, honking incessantly as they wave their 20 ft political flags; or bringing the family for a paddle boat ride in the local pond, taking delight in teaching their human offspring to paddle the boat as quickly as they can to chase after the beautiful, innocent geese and ducks trying earnestly and fearfully to swim to safety. and more.

Dear Dr. Burns,

Can a thought be thought as moral or immoral?

In many podcasts and articles, you use "Thou Shalt Not Kill" to demonstrate morally should statement, which is one of the 3 valid should statements in English. I'm still somewhat confused about this concept. To tell you where I get stuck, I come up with three thought experiments.

Imagine the following situations in which a should statement may come to mind:

Situation 1

Lisa stole some money from a grocery store. When arrested by police, Lisa said with tears, "I shouldn't have stolen money. I feel ashamed for what I have done."

In this case, it is obvious that "I shouldn't have stolen money" is a morally should statement, and also a legally should statement, because Lisa did something that violates the law and her moral principle.

DAVID’S COMMENT: YES, YOU ARE CORRECT. LISA’S STATEMENT CAN BE CLASSIFIED AS A LEGAL SHOULD AND A MORAL SHOULD.

Situation 2

One day, Bob went to Walmart to buy a suit. When he was passing by a shelf, a thought appeared in her mind. "What would happen if I steal this suit? I really want it, but I have very little money." When he came back home, he talked to himself," I shouldn't have felt the urges to steal things. And I shouldn’t have thought about stealing the suit."

DAVID’S COMMENT: THESE WOULD NOT BE CONSIDERED VALID SHOULD STATEMENTS BY MOST PEOPLE, SINCE WE HAVE FREEDOM OF THOUGHT. HUMAN BEINGS HAVE ALL KINDS OF FANTASIES AND URGES ALL THE TIME—AT LEAST I KNOW THAT I DO! AN URGE ONLY BECOMES IMMORAL OR ILLEGAL WHEN YOU ACT ON IT.

HOWEVER, ALTHOUGH I DO NOT THINK THESE ARE VALID SHOULDS, BUT I TRY NOT TO IMPOSE MY VALUES ON OTHERS FOR THE MOST PART. I AM A SHRINK, SO I WORK WITH PEOPLE WHO ARE ASKING FOR HELP.

FOR EXAMPLE, PEOPLE WITH OCD OFTEN PUNISH THEMSELVES JUST FOR HAVING “FORBIDDEN” THOUGHTS, FEELINGS, OR URGES. THE FIGHT TO CONTROL THEM IS THE ACTUAL CAUSE OF THE OCD. THE SHOULDS TYPICALLY MAKE THE PROBLEM WORSE, NOT BETTER. SELF-ACCEPTANCE CAN BE ONE OF MANY HELPFUL TREATMENT STRATEGIES.

RELIGION CAN SOMETIMES BE A SOURCE OF OPPRESSIVE SHOULDS, ESPECIALLLY THE MORE FUNDAMENTALIST TYPES OF RELIGION. RIGIDITY MAY BE A PARTIALLY INHERITED TRAIT. FOR EXAMPLE, MANY RELIGIONS AROUND THE WORLD PROMOTE THE IDEA THAT HOMOSEXUALITY IS “WRONG” AND THAT PEOPLE “SHOULDN’T” HAVE URGES AND ATTRACTIONS TOWARD PEOPLE OF THE SAME GENDER. THIS IS AN AREA WHERE “SHOULD STATEMENTS” BECOME HIGHLY CONTROVERSIAL, AND ARE OFTEN A SOURCE OF HORRIFIC HATRED AND VIOLENCE, SOMETIMES IN THE NAME OF SOME “HIGHER POWER.”

Situation 3

Lucy was buying fruits in a grocery store when she found that a man was taking an apple off the shelf and hiding it in his clothe! Obviously, the man was stealing an apple. Lucy was very angry and said, "the man shouldn't steal things from the store. It's not right!"

In this case, Lucy didn't steal apples, the man did. But Lucy made a moral judgement about the man's behavior, not Lucy's behavior. Then is this should statement valid for Lucy?

DAVID’S THINKING. TO MY WAY OF THINKING, YES THESE ARE VALID LEGAL SHOULDS AND MORAL SHOULDS, SINCE OUR CIVILIZATION (AND ALL CIVILIZATIONS) HAVE DECIDED THAT STEALING IS ILLEGAL, AND IS ALSO CONSIDERED MORALLY WRONG IN MOST RELIGIONS: “THOU SHALT NOT STEAL” IS, I THINK, ONE OF THE TEN COMMANDMENTS.

THE GOAL IS NOT TO CLEAN UP YOUR SPEECH SO THAT YOU NEVER USE SHOULD STATEMENTS THAT DO NOT FIT INTO ONE OF THE THREE VALID CATEGORIES OF LEGAL SHOULDS, MORAL SHOULD, AND LAWS OF THE UNIVERSE SHOULDS. AT LEAST I HAVE NO INTEREST IN THAT. MY GOAL IS TO HELP PEOPLE WHO ARE SUFFERING BECAUSE OF SHOULD STATEMENTS.

sincerely

Oliver

Hi David,

What is it with "shoulds" related to recovery from depression? I suffer from depression for about 3 years and say to myself "I should have gotten better sooner." Isn't this "should" appropriate? Because who really wants to suffer through this agony?

Greetings from Geneva.

Vincent

Hi Vincent,

"I wish I had gotten better sooner." This is a correct statement without the "should." This simple shift in language is called the Semantic Technique, and it was developed by Dr. Albert Ellis who kind of gave birth to cognitive therapy in the 1950s, along with Dr. Karen Horney about the same time. Instead of using a should, you use “it would be preferable if” or “I wish X was true.”

In addition, it isn't actually true that you "should" have gotten better sooner! The universe does not always conform to our expectations. Just because we want something, it doesn't follow that it "should" happen. I'd love to have a new Tesla sports car, at least in fantasy, but it isn't true that I "should" have one. It would be “great” if you had gotten better sooner, that’s absolutely true.

“I should have gotten better sooner.” That’s totally false.

In addition, although one might think that no one would "want" depression, my research and new clinical work indicate that resistance is nearly always the key to recovery. In other words, people do cling to depression, anxiety, troubled relationships, and habits and addictions, but don’t realize why they are resisting change. Once you suddenly see why you are resisting, your resistance paradoxically disappears, and recovery is then just a stone’s throw away.

You can learn more about this in my new book, Feeling Great, available now on Amazon. Thanks! PS let me know if you like the new book, and if you find it helpful!

All the best,

David

A new comment on the post "108: Do You Have a "Self?"" is waiting for your approval

Author: Charles

Dr. Burns,

First off I want to say thank you. Your work has been helping me through my anxiety. However, I really struggled with this podcast. The concept of no self shot my anxiety way up and made me feel hopeless. It made me feel almost as if I was not real or that there is nothing worth striving for. I love helping people. But I feel like I don’t have a purpose if I don’t have a self. It makes me feel worse than before.

David’s answer.

Hi Charles,

The “great death” of the self is a challenging concept, and while it is incredibly liberating, lots of people—most, in fact—don’t “get it.” Some get angry. Some struggle with trying to understand what this could possibly mean. And some find the concept very threatening. That’s why I deleted the chapter from my book. In fact, a couple extremely brilliant and interested colleagues totally couldn’t grasp it, and felt frustrated by my writing on the concept.

sometimes, ideas are so simple and basic that people cannot grasp them. The Buddha ran into this problem 2500 years ago. People thought he was fantastic, but almost none of his followers experienced the enlightenment he was so excited to teach them.

The 20^th century philosopher, Ludwig Wittgenstein, ran into the same problem. He solve all the problems of philosophy, but when he was alive, it was rumored that only seven people in the world, including one of his favorite students, Norman Malcolm, could grasp what he was saying. He went in and out of intense depression and loneliness during his life, in part because of his frustration with trying to teach the obvious.

In my book, Feeling Great, I teach that there are actually four “Great Deaths” for the patient, corresponding to recovery from depression, anxiety disorders, relationship conflicts, and habits and addictions. There are also four “Great Deaths” for TEAM therapists. Those sections might be helpful for you!

In addition, I focus on the fact that people can never judge your “self,” only something specific that you think or do. Depression cannot exist on the specific level, only up in the clouds of abstraction. For example, Overgeneralization is one of the ten cognitive distortions I described in my first book, Feeling Good. When you Overgeneralize, you see a negative event as a never-ending pattern of defeat, and you might also Overgeneralize from some specific flaw or defect to your “self.”

You will read about an attractive and vivacious young professional woman who had the thought, “I’m unloveable,” when her boyfriend of two years broke up with her. This is classic depression thinking, and “self” thinking. She thinks she has a “self” that can be loveable or unloveable. But this is simply not true, and it’s not productive, because she’ll spend all her time ruminating and feeling worthless.

An alternative is to focus on why the (overall excellent) relationship didn’t work out, and what she can do to change and learn and grow, so as to make the next relationship even better. You can pick up on the details in the chapter on Overgeneralization if you’re interested!

As I point out in Feeling Great, the “death of the self” is not like a funeral, it’ like an incredible celebration of life. Death of your old concept of what you are is liberating, and leads to instant rebirth.

My teachings cannot make you happy or unhappy. Your thoughts about what I’m saying create all of your feelings, positive or negative.

At any rate, thank you for a most important question that most of my audience will definitely related to.

As an aside, I lost my “self” years ago, and what a relief that was. Sadly, it comes back to life from time to time, and then I struggle again, until I realize what’s happening.

One day, what I’m saying may make sense! In the meantime, please accept my apologies concerning the “self!”

If it gives you comfort to believe you have a “self,” no problem. But the “self” is just a concept, and not a “thing” that could exist or not exist. When you lose your precious and protected “self,” you lose nothing, because there was never anything there in the first place! But while you lose nothing, you do inherit the earth, as nearly all great religious leaders—Buddha, Jesus, and others—have taught us.

David

Hi Dr. Burns,

I’ve just listened to your podcast episode on suicide and found it really interesting and useful but I have a few questions.

Firstly, how is your requirement that the patient agree to not make any suicide attempts for the rest of their life any different to a ‘suicide contract’ which you mention are not effective?

Also, you talk about doing this assessment at the intake and making non-attempts a condition of therapy. If the patient/client agrees to this, why then do you continue to monitor suicidal thoughts in each session in the BMS? Presumably because the agreement is no guarantee of cessation of thoughts. Surely if you’ve told them it’s a condition of therapy with you to not make any attempts then they’d be likely to not tell you about them even if they occurred, and don’t see how setting the initial ground rule resolves the problem.

And lastly, when suicidal thoughts, urges, or fantasies do come again in the BMS how do you handle it then? Do you tell them you’ll end therapy, say “but you promised”?

Looking forward to your reply.

Thanks, Michelle.

Hi Michelle,

I have scheduled your email for an upcoming ask david episode, and will use your first name unless you prefer that i use some other name. Here is a brief reply. Most patients with borderline personality disorder will become enraged by the gentle ultimatum at the initial evaluation, and if they decide this is not the type of therapy they want, so be it. The techniques I use will not be effective with patients who continue to threaten suicide. TEAM therapy requires TEAM work.

Most, nearly all, patients will "get it" and will decide to continue with the therapy. They can have suicidal thoughts and urges, and we can work on them together in therapy. However, to my way of thinking, it is important that they therapist and patient be protected, in a safe environment.

If the patient starts threatening to make a suicide attempt, then they will need another form of more intensive treatment like hospitalization, day care, or intensive outpatient treatment. These are options I cannot personally provide for them.

I monitor suicidal urges before and after each session with every patient with no exceptions to protect the patient and to protect myself as well. Thanks!

PS the suicide contract is an agreement not to attempt suicide "while we are working together." This is very weak, as the patient can suddenly decide he or she is dropping out of therapy and making a suicide attempt. And this often happens.

My contract is more demanding, and intentionally so. Patients must also agree to do psychotherapy homework, too. Some patients want to make the therapist a hostage with suicide threats, which can and so work as a form of manipulation and hostility. Then the therapist is in an almost constant state of agitation, anxiety, and frustration. If I allow a patient to make my life miserable, how can I teach that patient how to be happy? We are all ONE—we go up and down together. If I allow you to make my life miserable, then I am allowing you to make your own life miserable, too.

David

Hello David,

Thank you so much for everything you do. I’ve listened to all of your podcasts, and read most of your books, and am very grateful for the changes you, Rhonda, Fabrice and the rest of the team have made to my life.

I’ve just listened to this episode, and there’s one thing I’m struggling with, which is the concept of the moral should.

I’ve done a few things that made me intensely guilty – one in particular was not standing by and supporting a friend who needed people when he was going through a particularly hard time. He was angry and disappointed with me, and, in hindsight, rightly so. He has since forgiven me but I still struggle with it.

I feel that supporting him was a moral should. The knowledge that I didn’t do what I should have done led to a lot of guilt and shame, and eventually depression. You say that a moral should is valid; so therefore, I feel that my negative thoughts on this are not misguided but valid – I did something morally wrong and deserved to feel bad for it.

Just wondering your thoughts on this.

Thanks again, and keep up the good work!

Hi Brian, thanks!

Would love to include this on an Ask David, using just your first name, or even a fake name if you prefer. A quick response might be to ask how many minutes per day would you like to dedicate to feeling guilty? And for how many days, months, or years?

In your spiritual or religious beliefs, is a person supposed to feel intensely guilty forever? Most of us have done things we are ashamed of, or feel guilty about. How much guilt and shame would you recommend for me, for example? And what is the goal of the guilt and shame? And how guilty would you recommend I feel, between 0% and 100%?

That's one approach. Another approach would be A = Assessment of Resistance, listing what the guilt shows about you that's positive and awesome, and then asking yourself why in the world you'd want to let go of the guilt, given all the many real positives.

Then you might validly decide to “dial it down” to some more acceptable level. For example, if you now feel 90% guilty, perhaps 15% or 20% would be enough. In addition, you could also decide how many minutes of guilt you would recommend. If you now feel guilty about eight hours a day, would 10 minutes be enough? If so, you could schedule your “guilt periods” ahead of time, and then really work hard at feeling guilty during those ten minutes.

Then, when you’re done with your “guilt work,” you can return to joyous and loving living!

Also, instead of one ten minute daily guilt binge, you could schedule, for example, three guilt binges, each three minutes long, in the morning, at lunch time, and in the evening, like three pills the doctor prescribed!

David

In reply to Dr. Burns.

Hi Dr Burns,

Thanks so much for your quick response! I really appreciate your advice; I will dedicate a bit of time today to approaching it the way you say.

And also, I’d be delighted if you included it on a podcast! You can use my first name by all means.

Thanks again!

Brian

Comment from Carrel

I'm a Democrat in Texas. How can we use disarming to heal the political rifts in our country? How does one find agreement across that ever-widening divide?

Carrel

David’s reply

Hi Carrel, It’s really tough, for sure! Have you listened to my podcast on this topic? There is a search function on my website. If you type in “political divide,” this podcast will pop right up: “127: How Can We Communicate with Loved Ones on the Opposite Side of the Political Divide?”

Let me know what you think! David

David emphasizes the value of the search function. Often you can find your questions have already been addressed.

In addition, the many podcasts on the Five Secrets of Effective Communication could be invaluable (links), and the emphasis would be on using the Disarming Technique to find some truth in what the other person is proclaiming and arguing for.

But first, you have a decision to make, and this is always based on ONE person you may want to interact with. First, ask yourself if you do actually want a better relationship with person X, Y, or Z. There is no rule that says we have to get along better with everyone.

I think that Joe Biden is doing a pretty good job of promoting unity, and not diverseness in our country. Hopefully, the forces of love and unity will win out over the forces of hatred and war, but it’s not at all clear what direction our country is heading for. And we’re seeing now that at times the tensions are become so intense, and the hatred so strong, that violence is once again on the increase.

In the next Ask David we'll have a really cool session devoted to the intense anger that many of us feel when confronted by human behavior that strikes us as narcissistic, vicious, self-serving, and aggressive. This topic should appeal to lots of people! And we have a wonderful question from a woman who's feeling pretty darn enraged!

David and Rhonda

Lisa Nicole Bell is the host of the highly regarded podcast, Behind the Brilliance. In this lively interview, Nicole and David talk about

• David’s path into the mental health field
• the difficulties and rejections David faced getting his first book, Feeling Good, published
• David’s advice to listeners interested in therapy
• how he approaches perfectionism, depression, and anxiety with patients
• the joys of a life free from the need to be special—
• and much more!

Lisa's show delivers a smart and funny take on pursuing ambitions, designing a life, and living joyfully. Lisa’s most recent media work includes producing an Australian documentary on identity and gender politics within sports and a digital docu-series produced by Academy Award-winning actress Viola Davis.

David and Jill do A = (Paradoxical) Agenda Setting with Lee, starting with the Invitation: Jill asks Lee if he wants help with the relationship conflict, and if this would be a good time to roll up our sleeves and get to work. Lee indicates that he does want help.

They review the first two steps of his Relationship Journal, where Lee had recorded one specific thing his wife said to him, and exactly what he said next. Here’s what he wrote down:

Step 1 – She said: Write down exactly what the other person said. Be brief:

I was trying to convince my 18-month-old daughter to put her pajamas on. I was calm. Eventually, I raised my voice an octave or two and in a stern voice I told my daughter to put her pajamas on.

Afterwards, Liza said, “I don’t think you need to use that tone with a small child.”

Step 2 – I said: Write down exactly what you said next. Be brief:

I said, “I don’t think there was anything wrong with what I did. You can be stern without losing your shit*. There are times when she needs to know I am serious and not messing about anymore.”

It then devolved into a debate over a clash of values on how to raise our daughter.

* Transcribed as-is from Lee’s Relationship Journal.

Lee also circled all the emotions he thought she was having, along with all of the emotions he was having. He thought she was feeling:

• Sad and unhappy
• Anxious and worried
• Rejected and alone
• Discouraged, pessimistic, and despairing
• Frustrated and stuck
• Angry, annoyed, irritated and upset
• Other feelings: troubled, defensive, dismayed, downhearted, and disconnected

Here’s how he was feeling:

• Unhappy
• Anxious and worried
• Guilty, remorseful, bad and ashamed
• Inferior, inadequate, defective and incompetent
• Embarrassed, foolish and self-conscious
• Hopeless, discouraged and despairing
• Frustrated
• Angry, mad, resentful, annoyed, irritated, upset and furious
• Other feelings: hostile, loud, critical, agitated, defensive, stubborn, exasperated, sarcastic, powerless, diminished, low, resistant, confused, judgmental, vulnerable, inept

Step 3. Good vs. Bad Communication. When David and Jill ask Lee to examine his response to his wife, he had to admit that his response in Step 2 had all the characteristics of bad communication—he did not acknowledge any of her feelings, he did not share his own, and he did not convey love and respect. This was disturbing and surprising to Lee.

Step 4. Consequences. When David and Jill asked Lee to examine the impact of what he said to his wife, they suddenly ran into a wall of resistance, which is almost universal in relationship work. The Relationship Journal is an incredibly powerful tool, and it can be extremely painful because you have to stop blaming the other person and examine your own role in the relationship.

Lee suddenly and painfully discovered the answer to his question of why his wife was so controlling and critical of him—it was NOT because of the influence of her mother, but rather because he was forcing her to treat him like that almost every time he interacted with her.

This insight cannot be denied when you do the Relationship Journal, and it’s potentially incredibly empowering, but it can be incredibly painful at the same time.

You will also hear a masterful and paradoxical response by Dr. Levitt when Lee resists—and as a result, his resistance suddenly disappears, and he jumps on board!

A Second Visit to David and Jill's

Tuesday TEAM Training Group at Stanford

Last week, you “sat in” on our Tuesday training group at Stanford and learned about two of the four most important techniques in the treatment of perfectionism, or any other Self-Defeating Belief. (For a list of 23 common Self-Defeating Beliefs, click here.)

• The Cost-Benefit Analysis (CBA): You weight the advantages against the disadvantages of trying to be perfect.

• The Semantic Technique, to find out how to word your new belief if you decide that your perfectionism belief isn’t working for you

The purpose of those two techniques is to provide intellectual change. Tonight, you will join us again as we aim for emotional change at the gut level.

This will be our agenda for the students in the class you will observe:

1. Please describe an example of a specific time when you felt upset due to perfectionism. What were your negative thoughts? How were you feeling? What was happening?

2. Downward Arrow Technique: Suppose you weren’t perfect, or you failed or screwed up in some way. Why would that be upsetting to you? What would that mean to you.

3. Externalization of Voices (Optional: possibly we will do this, maybe just mention it, depending on time.)

4. Experimental Technique / Examine the Evidence

5. Feared Fantasy

6. Wrap-up and Teaching Points

As you can see, some exercises will be performed in the large group, with everyone present and contributing, and some exercises will be in the small, breakout groups. The small groups provide more time for participants to practice. We plan on recording both of the small groups so you can observe the training techniques we use for mental health professionals.

Last week our focus was motivational, so we asked: is to your advantage to aim for perfection? How will this mind set help you and how will it hurt you?

Tonight, one of the key techniques will focus on TRUTH: is it TRUE that you need to aim for perfection? We will be using the Experimental Technique and / or Examine the Evidence to see if we can answer this question.

In addition, we will go into an Alice-in-Wonderland Nightmare World and meet an imaginary monster who claims superiority because she or he really is perfect and really has achieved incredibly more than anyone. This can sometimes help us answer two questions: Is it possible to be or become a “more worthwhile” or “superior” human being? Would it be desirable if you could?

I hope you enjoyed this new format of “dropping in” on my Tuesday training group at Stanford. Let Rhonda and me know what you think. It was just an experiment, and we want to know what you might have liked or disliked about it. Thanks!

Our free weekly Tuesday and Wednesday training groups are open to therapists of all persuasions from all around the world. For information including the requirements, you can contact:

• Tuesday night training group with David and Jill, Contact Ed Walton: EdWalton100@gmail.com

• Wednesday mid-day group with Dr. Rhonda Barovsky and Richard Lam, Contact Ana Teresa Silva:  ateresasilva6@gmail.com

This is the second of three interviews with Stephanie James on her superb radio show and podcast, The Spark. Stephanie is an experienced therapist and dynamic radio personality from Colorado. She is co-authoring a book on how to live a “spark-filled life.”

This interview with Stephanie focused, in part, on the evolution of the new TEAM-CBT from traditional Cognitive Behavioral Therapy (CBT). Stephanie asks Dr. Burns questions on a wide range of topics, including:

• How would you treat a case of social anxiety?
• What is “therapeutic whitewashing” and how can therapists get over it? What should therapists do instead?
• How would you work with violent incarcerated teenagers, such as gang members?
• Why is it so important for therapists who are learning TEAM-CBT to check their egos at the door?
• After you published your first book, Feeling Good, and the first research study on CBT was published, cognitive therapy swept the world. After your initial euphoria, your enthusiasm dimmed somewhat. Why? And what new direction did your research lead?
• What are the most common errors that therapists make in thinking about the causes of therapeutic resistance?
• How can you overcome a patient’s resistance to change?
• Can TEAM-CBT work rapidly for someone with horrific abuse and decades of failed therapy?
• How can you prevent relapses following the patient’s initial recovery?

Dr. Burns' third interview with Stephanie will be on the interpersonal TEAM model—how to convert conflicted relationships into loving, rewarding ones.

Ask David, Rhonda and Matt

More on Insomnia; Porn Addiction Guilt; Rage

Questions for today

1. James asks for help with insomnia.

2. Arjun Asks: How can I stop blaming myself for my porn addiction as a teen?

3. Stephan asks: How do you treat feelings of rage? And what if you are simply very angry, but you don’t have any thoughts?

1. James asks for help with insomnia,

Hi Dr. Burns,

I enjoy your newsletter and have experienced moments of clarity with your book. However, my current struggle is that I have developed terrible sleep anxiety. I feel nervous tension in my stomach and trembling limbs as nighttime approaches. Some nights I can put these feelings aside and dose off and others I just cannot stop dwelling on the negative body sensations and it does not allow me to sleep. I wonder if you can offer some advice on how to get over this fear and accompanying sensations.

Best,

James

David’s reply

Thanks, James. Sorry you’re struggling with trouble sleeping.

Yes, a Daily Mood Log can help, to find out what you are telling yourself that makes you so anxious about not sleeping.

Also, the Hidden Emotion Technique may be important to find out if there’s a problem in your life that’s bugging you.

There are also the typical sleep hygiene tips that can be useful for some folks, too! You can find these with an internet search.

Can I use this as an Ask David question for a podcast, with your first name or a fake name?

Best, david

2. Arjun Asks: How can I stop blaming myself for my porn addiction as a teen?

Hi Rhonda,

I Really appreciate the work that you guys do and I listen to most of the feeling good podcasts. I'm 27 and have struggled with depression and anxiety since my teens. I'm currently in therapy with a TEAM certified professional from India, but I'm still grappling with feelings of being stuck in my past.

During my pre-teen years, I battled a porn addiction for about a year, which has left me with ongoing feelings of anxiety, guilt, and depression. Despite trying various therapies, I haven't found relief.

I keep fixating on the thought: "I shouldn't have indulged in porn addiction in the past. It's led me to develop anxiety and depression."

How do I debunk this thought, reduce its hold on me, and cope with the regret it brings? It feels like I'm trapped in my past. and constantly blaming myself for that one mistake. because that indulgence in porn really did change my life. I wasn't the same as before. and never could go back to being who I was.

How do I put the lie to this thought? Any methods you'd recommend putting in the recovery circle?

Your insights would be invaluable in helping me move forward.

Thank you,

Arjun

David’s reply: The key concept is that the problem is perfectionism, plus the beating up on yourself in the here and now, and not the behavior or misbehavior in your past. In the live podcast, we can discuss the importance of T = Testing (with DML), E = Empathy and A = Assessment of Resistance, and M = Methods, like explain the distortions, Perfectionism / Self-Blame CBA, D. Standard, EOR, EOV, etc. etc.

The issue, as I see it, is that you are looking for a technique to help you accept yourself, but in reality, it is a decision for you to make. The choice is to accept yourself with compassion or continue to beat up on yourself.

There are many really GOOD reasons to beat up on yourself, and we can perhaps outline some on the podcast. You would then have to explain why you’d really want to accept yourself, given all the good reasons to keep beating up on yourself, and given all the positive things your self-criticisms show about you.

Also, I will try to remember to tell one of my favorite Buddhist stories that relates to this problem.

3. Stephan asks: How do treat feelings of rage? And what if you are simply very angry, but you don’t have any thoughts?

Hello Mr. Burns, I hope this email finds you in good spirits.

I’ve just begun your book “Feeling Good” and I have just reached the point where you begin to speak about cognitive distortions and how to get over your thinking. I’ve been doing your exercise on the days that my thoughts are heavily saturated in my mind and I’ve realized something within doing this exercise.

A lot of my thoughts do focus on the cognitive distortions that you’ve outlined in your book, but the other 75% of my thoughts focus on pure trauma of past situations and experiences that channels pure hate, anger and rage that pours out of my thoughts about the past situations. For example, one situation was someone purely scamming and taking advantage of me for years. And while doing your exercise, my hate and rage for that situation really comes out to where I wrote down “F*** that stupid a** b***** I hope she continues through her life being scammed as the fraud she is”.

A lot of my thoughts surround things like this with situation that I’ve been in. Or another example “This stupid a** girl gonna be married and divorced five times before I get married once And I went the wrong path. Ha.” Most of my thoughts are like this surrounded past relationships, friendships, and coworkers. And honestly, I don’t think it has anything to do with the list of cognitive distortions that you’ve provided. Not saying that I don’t have those thoughts, but the majority of my thoughts surround different topics.

I would love your input in your thoughts on what is going on in my head, and possibly even the name to the type of cognitive distortion, that these thoughts could fall under, if any. In the meantime, I will continue reading your book. Hopefully the answer is in there, but if not, I graciously await your response and I also thank you for your time.

Best regards, Stephan

David’s reply

Hi Stephan,

Anger always results from thoughts, and those thoughts are often extremely distorted. This thought, for example, contains Labeling, and many other distortions: “F*** that stupid a** b*****

Sorry you’ve been taken advantage of by someone acting fraudulently and scamming you, as I understand from your note. Anger is totally understandable. The first treatment tool would be a paradoxical Cost-Benefit Analysis, which we could illustrate on a podcast, if you are interested. Your questions touch on many important topics!

Best, david

Matt’s Reply

Thanks for the question, Stephan, like David is saying, getting out of rage and into peace and harmony, which is part of ‘enlightenment’, requires identifying the motivational elements that are pushing you away from, as well as pulling you into, that emotion.

For example, David has identified, over 30 Good Reasons to Blame Others and has a handout on this.

Here's an example of a reason to keep rage: You’ll be protected, from being taken advantage of, again, if that person is labeled as ‘bad’. This keeps them, and others like them, at a distance.

Another motivator for rage is that revenge fantasies can be pleasant, feel powerful, just, and gives us a sense of moral superiority.

Also, sometimes we’re not quite ready to just ‘let go’ and ‘move on.’ There might be things we really liked about the relationship that we don’t want to lose and we might not want to grieve the loss of that person, or the loss of our own time. We want our time back and for them to change!

Lots of other good reasons, again there’s a list of 30 Good Reasons to Blame, created by David.

Please bear in mind that rage can get you into lots of trouble, so if you’re at risk of acting out your anger, it’s a good idea to get professional help, not something we can provide, here.

Thanks for listening today!

Rhonda, Matt, and David

Feeling Down?

Try the Feeling Great App for Free!

The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it  out at FeelingGreat.com!

What's a Give-Get Imbalance?

What's the Best Treatment for Anxiety and Dysthymia?

Can you do Externalization of Voices on Your Own?

The show notes for today’s podcast were largely written prior to the show. Tune in to the podcast to hear the discussion of these questions by Rhonda, Matt, and David.

And keep the questions coming. We enjoy the exchange of ideas with all of you. Thanks!

1. Suzanna asks: What’s a “Give-Get” imbalance? And how can you get over it?
2. Martin asks: What’s the best treatment for anxiety and dysthymia?
3. Eoghan (pronounced Owen) asks: Can you do Externalization of Voices on your own?

 1. Suzanna asks: What’s a “Give-Get” imbalance? And how can you get over it?

Description of Suzanna’s problem.

Suzanna is a woman with a grown daughter with severe brain damage due to a severe brain infection (viral encephalitis) when she was an infant. Suzanna was constantly giving of herself and catering to her daughter. She explains that her daughter can be very demanding and throws tantrums to get her way, and kind of controls the entire home in this way.

She can only talk a little and has the vocabulary of about a two-and-a-half-year-old. She can mostly express the things she wants or doesn`t want on a very basic level. She mostly understands what I want from her, but mostly does not want to do what I ask her to do. She can be very stubborn. And I cannot reason with her because she has her own logic and, in her eyes, only her logic is valid. Maybe all a little bit like a two-and-a-half-year-old.

Suzanna struggles with negative feelings including guilt, anxiety and depression, because she is constantly giving, giving, giving and feeling exhausted and resentful. And she tells herself, “I should be a better mum.” Can you spot any distortions in this thought?

Put your ideas in the text box, or jot them down on a piece of paper, and then I’ll share my thinking with you!

There are many distortions in this thought, including All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Magnification and Minimization, Emotional Reasoning, Self-Directed Should Statements, and Self-Blame. There may be one or two more, too!

The first step in change nearly always includes dealing with motivation and resistance. Suzanna decided to do a Cost-Benefit Analysis, as you can see below, and a revision of her Self-Defeating Belief, as you can see below.

Another helpful step might include “No Practice,” which simply means saying “no” so you don’t constantly get trapped by “giving,” as well as “giving in.”

A third critically important strategy involves the mom and dad making the decision to work together as a loving team in the management of a troubled child, rather than fighting and arguing with each other, as we've discussed on previous podcasts. However, in many, or possibly most cases, the parents are not willing to do this. They are more concerned about being "right" and so they continue to do battle with each other, as well as the child who needs a more loving structure.

David

 Semantic Method: Re write your personal value

I want to be a mum to My daughter and help her along and invest myself into her. But I also want to treat myself the way I treat her. She has a “right” to live a happy and fulfilling life, but so do I. Our needs and desires are equally important and deserve the same attention and care. I can only continue to look after My daughter well if I look after myself too and take myself and my needs and desires as seriously as I do hers. There needs to be a give-get balance so that both of us can be healthy and happy and stay healthy and happy. I want to help her to slowly take new steps into independence and support her lovingly along the way.

2. What’s the best treatment for anxiety and dysthymia?

Hello Dr. Burns,

What method of treatment would you suggest for GAD and dysthymia? 3rd wave CBT, ACT? What is best based on science?

Can you recommend some books please?

thank you

Martin

David’s Reply

My books are listed on my website, FeelingGood.com. They all describe my approach, which is a bit like CBT on steroids. But every patient is treated individually and uniquely, following a structured and systematic approach that facilitates rapid and dramatic change.

I don’t recommend “methods of treatment” or “schools of therapy” based on so-called “diagnoses,” but treat the individual with TEAM. Every session with every patient is an experiment, with precise measures at the start and end of every session.

The new Feeling Great App, now available, gets a mean of 50% or more reductions in seven negative feelings, such as depression, anxiety, and more, in 72 minutes of starting to use the bot. You can check it out for free! Anxiety and depression often co-exist, and the app targets both.

My book, When Panic Attacks, describes my approach to anxiety, based on four models of treatment: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. If you use the search function, you can find podcasts describing those models. Also, there's a free anxiety class on this website.

Thanks, Martín, for your excellent question!

Best, david

3. Can you do Externalization of Voices on your own?

Hi David,

Long time listener of your great podcast and huge fan of your book Feeling Great.

I’ve often heard you mention that “externalization of voices” is one of, if not the most powerful CBT techniques. I am just wondering if it is still almost as effective when done solo without a therapist i.e. the person takes on both the roles of positive and negative by recording themselves talking or similar?

Also, have you any data comparing the efficacy of TEAM CBT work carried out solo using Feeling Great/your podcast as a guide vs. TEAM CBT performed with a trained TEAM therapist?

I am very much looking forward to the Feeling Great app launch in the UK as hopefully that will be a much more effective way to do personal work without a therapist.

Many thanks,

Eoghan (pronounced Owen)

David’s reply

Thank you, Eoghan! Appreciate your support and thoughtful question.

I don’t have any data on the use of EOV on your own. One could use a recording device, like your cell phone, and record  your negative thoughts in second person, “you,” and try to defeat them when you play them back, one at a time.

But in my experience, people nearly always need an experienced role player to do role reversals to show them how to get to a “huge” win. People almost never get a huge win when doing it for the first time, because the therapist (in the role of positive self) can model unfamiliar strategies for the patient.

Generally, a hugely successful response involves a combination of self-defense, self-acceptance, and the CAT, or counter-attack technique. And sometimes other methods as well, like Be Specific, for example

Radical new learning is definitely the key to success with EOV.

Now, thanks to the app, everyone can practice, since we’ve trained our Obie Bot to role-play with users, do role reversals, give feedback, and so forth.

Great question that I will include in the next Ask David if that’s okay!

We are also exploring the combination of the Feeling Great App plus a trained TEAM therapist from the Feeling Good Institute in Mountain View, California.

We are hoping that 1  + 1 may equal 3. Wouldn’t that be awesome?

What I’ve found when doing research is that the results are virtually always wildly unexpected! Somethings come out great, and some things come out dismally. I always tell myself that “the Lord giveth, and the Lord taketh away!”

Seems to be the rule in research! Especially when you’re wanting to be guided by the truth, and not so much by your hopes and expectations.

Best, David

David and Fabrice are joined by Lisa Kelley, a certified TEAM-CBT therapist and former journalist from Littleton, Colorado. Lisa interviews David about an interview / blog David has just published on this website.

Lisa begins by asking how people responded to a survey on David’s website asking this controversial question: “Do you believe that a depressed individual could experience a complete elimination of symptoms in a single, two-hour therapy session?” More than 5,000 individuals completed the survey and most were extremely skeptical.

David states that ten years ago, he would have felt exactly the same way, and would have dismissed anyone making such a claim as a con artist. However, he has now changed his mind and believes that sometimes it is possible.

David explains that he has done more than 50 live demonstrations in workshops and other teaching settings with individuals who are struggling with severe feelings of depression, anxiety, shame and anger. Many of these individuals who volunteer to be the patient have experienced horrific personal traumas. This gives David the opportunity to demonstrate how TEAM-CBT works with someone who is really suffering, and not just a role-playing demonstration. Usually, these live demonstrations are the highlight of a workshop because they are intensely emotional and real. Surprisingly, in the vast majority of these sessions, the individuals who were in the patient role experienced a complete, or near-complete, elimination of symptoms in roughly two hours.

David emphasizes that while we would not expect this to generalize to a clinical practice situation, it does seem to suggest significant improvements, or even breakthroughs, in psychotherapy. Many of the new developments have to do with helping patients overcome their resistance to change. Although David makes these techniques look easy, they are challenging to learn, and require a radically new and different way of thinking about why patients sometimes resist change and fight the therapist.

Lisa, Fabrice, and David explain exactly how the new techniques work, using as an example an Asian-American woman who had experienced decades of domestic violence and rape.

Dr. Burns suddenly abandons the role of healer and instead assumes the role of the patient’s angry, paranoid and defiant resistance.

Ask David

What do you do when someone won’t stop asking questions?

Hello David,

It’s been a while since I’ve emailed you, but that’s because I’ve been doing really well thanks to you! I started a new job 3-1/2 months ago, & this woman seemed to take to me right from the start. It was nice at first having someone to talk to etc, but it has quickly turned bad. She sits in the cubicle right next to me. All day long she talks to me asking me questions. What did I do after work? Who was I with? How long was I gone? What did my husband do? And on & on. It feels like she’s interrogating me because the questions never stop. I’m trying to get more vague with my answers hoping if will deter the conversation, but no luck. It really becomes distracting at times & then other times it just feels like she’s being nosy & freaks me out. I just want her to leave me alone! I think this would be a good opportunity to use the 5 secrets of effective communication, but I’m struggling. Could you help?

Thank you,

Brittany

Hi Brittany,

Will send to Rhonda for an Ask David. But a simple approach would be to tell her that you admire her and appreciate her interest, but that you sometimes find the questions distracting from doing your work. Perhaps you could sit down with her for lunch or something, and then use your five secrets skills.

Using the relationship journal, you could write down one thing she said to you, and exactly what you said next. Then we can see exactly what you are doing that is fueling the problem! I've attached one, and you could send it to us after you have completed Steps 1 and 2.

David

Thank you for the reply! It really made my day. I attached the relationship journal. It was actually more helpful than I thought it would be for this situation. Once I was able to think of a good example, I realized that maybe my lack of inquiry or showing interest in her is causing her to ask me all these questions. Although if I ask her more about herself, I don't know if it would result in her talking even more? Hard to say.

Thanks for your help, and I appreciate your thoughts on my relationship journal.

-Brittany

Hello,

Wanted to give you an update on how it went using the five secrets. First thing Monday morning my coworker started right up with the questions. I used the five secrets & said something similar to what I wrote to you. She apologized for bothering me, & things have been great all week! She actually brought in headphones & has been listening to music now. And there’s no tension or animosity between us which was my fear initially. We still chat here & there & are friendly. Thanks again!

-Brittany

How can a pastoral counselor get training in TEAM-CBT?

Dear Doctor David,

I am a pastor from South Africa, married to an Australian, living in Dubai :)

I was struggling with mild depression & came across your book "feeling good" and read it & applied all your techniques & it has been life-changing - THANK YOU!

What surprised me most was the simplicity and effectiveness of the exercises. I believe that much of what you teach is life skills everyone should have! I wish I was taught these things when I was younger!

Over the years I have helped people, from all walks of life - inmates, students, business people, etc., but primarily from a spiritual perspective. I believe I can be more effective and help so many more out there if I learn how to apply your exercises to others.

I would love to train in TEAM and learn how to apply these techniques with the people I minister to, but I am not a psychologist or certified as per your requirements.

I realize practice and critical feedback is paramount in order to get really good in TEAM.

Please advise me on an alternative route.

Any help with this regard would be highly appreciated!

Thanking you in advance.

Yours sincerely,

Gareth Noble

Hi Pastor Noble,

Sure there is a certification program at the Feeling Good Institute. I believe pastoral counselors would be very welcome. They offer many online introductory classes in TEAM-CBT. Check our my free weekly Feeling Good Podcasts, too. I will include your question, with your permission, on an Ask David Podcast. I also offer a free depression class on my website, and about to post an anxiety class too, also free. There are tons of resources, almost all free, on my website, www.feelinggood.com. You can check out my website page from time to time for online workshops.

Dr. Angela Krumm angela@feelinggoodinstitute.com is head of the certification program at FGI, which is www.feelinggoodinstitute.com.

Angela and I are both PKs (Pastor’s kids)!

All the best,

David

Is love an adult human need?

Rhonda said that people in the TEAM certification listserve thought they heard David say that love is not an adult human need. Is this true?

David comments on hearing Dr. Beck say that decades ago, in one of Dr. Beck’s weekly training groups at U. Penn, and what he (David) discovered.

What’s the best training program to learn TEAM-CBT?

David and Rhonda,

I hope this note finds you well. I'm writing for a few reasons. The first is to thank you for your podcast and related resources. I found your podcast and started listening at the beginning of COVID-19 (mid-March) because I was feeling acute anxiety. The T.E.A.M. approach and your teaching are such an amazing gifts. The positive reframing in particular is truly life changing and revolutionary for me. Considering what my negative thoughts show about me that's positive and awesome and then finding the cognitive distortions has provided me such relief.

I have been so excited about T.E.A.M. therapy that I often discuss it with my husband, friends, and family. I really loved David's comment in the most recent podcast that good therapy isn't evangelizing; rather it's letting the patient define problems and goals within his/her own values. I also liked your comment that doing therapy well is like an artform or a dance- that's such a beautiful sentiment, and I've been able to see the conversational "dances" you perform in the amazing, transformative, empathic live therapy sessions with Michael, Rhonda, Sarah, and others. These sessions have often brought tears to my eyes.

This brings me to my second reason for writing. Listening to the podcast has been transformative for me in another way- it's made me seriously consider becoming a therapist myself. I have considered this possibility over the years, but now that I'm familiar with the T.E.A.M therapy approach and can see how helpful it is, I'm excited to explore this path more. I have a B.A. in psychology so I would need additional education- do you have suggestions for masters programs that you think would provide good alignment with the T.E.A.M. approach? I live in Charlottesville, Virginia and have two young children, so a local or online program may be the best bet for me. Thanks in advance for any ideas you may have.

All the best to you,

Molly Hurt

Thanks, Molly.

We can read your wonderful email on an Ask David if that is okay with you, but here is the quick answer. In graduate school, you don’t typically learn much that is useful. It is more getting a license to practice, then you learn from mentors, workshops, etc. The FeelingGoodInstitute.com has training and certification programs, including 12 week beginner classes in TEAM that are excellent. The whole area of coaching is emerging now too, and the certification is rather informal. If you get a degree like a masters degree in social work online, and then get licensed to do therapy, that is one approach, but there are many ways to get certified—counselor, psy d degree, marriage and family therapy, and so forth.

So in short, I would, personally, find some way—the easiest way—to get certified so you can legally do therapy. But concentrate on learning TEAM as the tool to use.

In California, as an aside, anyone can call themselves a “psychotherapist,” but you need the degree and license to call yourself a “psychologist.”

Good luck, and thanks again! david

Why are should statements considered distortions?

Thanks for your quick and helpful reply. It's useful to have a better sense for how to prioritize my time and training. I'm excited to continue to explore T.E.A.M. therapy! And you are welcome to read my email on the podcast, thanks for asking.

If I may, one other question for you: how do you recommend someone defeat "should" statements when his/her behaviors aren't healthy or beneficial? For example, "I should not overeat when anxious" or "I should not procrastinate" or "I should not be impatient with my daughter." I understand that saying "should" in these cases adds pressure and can lead to shame, but I don't see the distortion in these statements. In other words, these statements may not be helpful to a patient, but how are they not 100% true? I would appreciate any additional guidance you can offer on what I find to be the most difficult cognitive distortion!

Thanks again to both of you for generously sharing your loving and kind approach to helping people deal with their problems and feel better. The impact you're having is profound. I love listening to you empathize with patients- it makes me strive for building an even more loving connection with my husband and daughters, as well as others in my life.

Best,

Molly

Hi Molly,

You may want to listen to podcast #205 pm Should Statements. You can also find a lot in my books, like Feeling Good, which you may have already read. There is also a chapter on how to crush should statements in my new book, Feeling Great, which will be released on September 15, 2020.

Shoulds are distortions because they are not valid. It is not true that you “should not overeat when anxious.” You SHOULD overeat when anxious because it is very appealing, tasty, and makes you feel better.

A correct statement would be, “It would be preferable if I did not overeat when anxious.” This statement removes the shame and pressure, while honoring your goal. There are three correct uses of should: the moral should (thou shalt not kill), the legal should (you should not drive 90 miles an hour because you’ll get a ticket) and the laws of the universe should: this pen should fall to the floor if I drop it because of the force of gravity.

But overeating when anxious is not immoral or illegal, and it does not violate the laws of the universe. So it is not a valid use of the word. There is a podcast on this, I think, and you can search for it on my website use the search function.

Rhonda and David

230. Ask David: Questions on self-esteem, recovery from PTSD, dating people with Borderline Personality Disorder, recovery on your own, and more!

Jay asks:

1. Is psychotherapy homework still required if you’ve recovered completely from depression in a single, extended therapy session?
2. Is Ten Days to Self-Esteem better than the single chapter on this topic in Feeling Good?
3. Are people who were abused emotionally when growing up more likely to get involved with narcissistic or borderline individuals later in life because the relationship is “familiar?”
4. Many patients can read your books and do the exercises and recover on their own. Is a teacher or coach sometimes needed to speed things up?
5. Is it possible for a person to become happy WITHOUT needing anyone else if they have had depression in past and/or PTSD?
6. Also, how would Team-CBT address treating PTSD? PTSD can involve a person having multiple traumas.

* * *

1. Is psychotherapy homework still required if you’ve recovered completely from depression in a single, extended therapy session?

Thanks, Jay, I will make this an Ask david, if that is okay, but here is my quick response.

Although many folks now show dramatic changes in a single, two-hour therapy session, they will still have to do homework to cement those gains, including:

1. Listening to or watching the recording of the session
2. Finish on paper any Daily Mood Log that was done primarily in role-playing during the session. In other words, write the Positive thoughts, rate the belief, and re-rate the belief in the corresponding negative thought.
3. Use the Daily Mood Log in the future whenever you get upset and start to have negative thoughts again.
4. I also do Relapse Prevention Training following the initial dramatic recovery, and this takes about 30 minutes. I advise the patient that relapse, which I define as one minute or more of feeling crappy, is 100% certain, and that no human being can be happy all the time. We all hit bumps in the road from time to time.

When they do relapse, their original negative thoughts will return, and they will need to use the same technique again that worked for them the first time they recovered. In addition, they will have certain predictable thoughts when they relapse, like “this proves that the therapy didn’t rally work,” or “this shows that I really am a hopeless case,” or worthless, etc.

I have them record a role-play challenging these thoughts with the Externalization of Voices, and do not discharge them until they can knock all these thoughts out of the park. I tell them to save the recording, and play it if they need it when they relapse.

I also tell them that if they can’t handle the relapse, I’ll be glad to give them a tune up any time they need it. I rarely hear from them again, which is sad, actually, since I have developed a fondness for nearly all the patients I’ve ever treated.

But I’d rather lose them quickly to recovery, than work with them endlessly because they’re not making progress!

People with Relationship Problems recover more slowly than individuals with depression or anxiety for at least three reasons, and can rarely or never be treated effectively in a single two-hour session:

1. The outcome and process resistance to change in people with troubled relationships is typically way more intense.
2. It takes tremendous commitment and practice to get good at the five secrets of effective communication, in the same way that learning to play piano beautifully takes much commitment and practice.
3. Resolving relationship conflicts usually requires the death of the “self” or “ego,” and that can be painful. That’s why the Disarming Technique can be so hard for most people to learn, and many don’t even want to learn it, thinking that self-defense and arguing and fighting back is the best road to travel!

* * *

2. Is Ten Days to Self-Esteem better than the single chapter on this topic in Feeling Good?

Yes, Ten Days to Self-Esteem would likely be a deeper dive into the topic of Self-Esteem. It is a ten-step program that can be used in groups or individually in therapy, or as a self-help tool. There is a Leader’s Manual, too, for those who want to develop groups based on it.

* * *

3. Are people who were abused emotionally when growing up more likely to get involved with narcissistic or borderline individuals later in life because the relationship is “familiar?” I was involved with a woman with Borderline Personality Disorder, and it was exhausting! Why was I attracted to her?

Thank you for the question, Jay.

Most claims about parents and childhood experiences, in my opinion, are just something somebody claimed and highly unlikely to be true if one had a really great data base to test the theory. We don’t really know why people are attracted to each other. Many men do seem attracted to women with Borderline Personality Disorder. Perhaps it’s exciting and dramatic dynamic that they’re attracted to, and perhaps it’s appealing to try to “help” someone who seems wounded.

Good research on topics like this would be enormously challenging, and people would just ignore the results if not in line with their own thinking. Our field is not yet very scientific, but is dominated by “cults” and people who believe, and who desperately want to believe, things that are highly unlikely, in my opinion, to be true.

I do quite a lot of data analysis using a sophisticated statistical modeling program called AMOS (the Analysis of Moment Structures) created by Dr. James Arbuckle from Temple University in Philadelphia, someone I admire tremendously. This program does something called structural equation modeling. In the typical analysis, the program tells you that your theory cannot possibly be true, based on your data. If you are brave, this can lead to radical changes in how you think and see things, especially if you are not “stuck” in your favored theories. But this type of analysis is not for the faint of heart.

All the best,

David

Here is Jay’s follow-up email:

HI Dr. Burns,

As you know A LOT of people attribute their present problems (depression / anxiety / relationship conflicts / addictions) to their "abusive" or "toxic" relationship with their parents. It is interesting that it seems some people internalize negative beliefs about themselves based on what their parents said to them on a consistent basis.

But it seems you are saying the data does not support that theory.

Jay

Thanks, Jay, I’m glad you responded again. There may be some truth to those kinds of theories. We know, for example, that abused or feral cats often have trouble with trust. So, we don’t want to trivialize the pain and the horrors that many humans and animals alike endure.

At the same time, people are eager to jump onto theories that “sound right” to them and serve their purposes, and most of these theories are not based on sound research. Here are two examples from my own research.

I tested, in part, the theory that depression comes from bad relationships, and also that addictions result from emotional problems.

I examined the causal relationships between depression on the one hand and troubled vs happy relationships with loved ones on the other hand in several hundred patients during the first 12 weeks of treatment at my clinical in Philadelphia, and published it in top psychology journal for clinical research. (will include link) That was because there were at the time two warring camps—those who said that a lack of loving and satisfying relationships causes depression, and those who said it was the other way around, that depression leads to troubled relationships. And the third group said it worked both ways. My study indicated that although troubled relationships were correlated with depression, there were NO causal links in either direction. Instead, the statistical models strongly hinted that an unobserved, third variable had causal effects on both simultaneously.

This is the only paper in the world literature that I am aware of that has tested the causal links between intimacy and depression, but because the results did not satisfy anyone, the paper is rarely or never quoted, and did not seem to influence those who were advocates of one or the other theories. As they say, wrong theories die hard.

Here’s the reference:

Burns, D. D., Sayers, S. S., & Moras, K. (1994). Intimate Relationships and Depression: Is There a Causal Connection? Journal of Consulting and Clinical Psychology, 62(5): 1033 - 1042.

I also looked at the causal links between all kinds of emotional problems and all kinds of addictions in 178 or so patients admitted to the psychiatric inpatient unit of the Stanford Hospital. I was unable to confirm any significant causal links between depression, anxiety, loneliness, anger, and so forth and any kind of addiction (overeating, drugs, alcohol, etc.) The only possible causal link I could find was a small causal link of depression on reducing the tendency to binge or overeat. This was a secondary and unpublished analysis of data I collected in validating my EASY diagnostic system.

I don’t mean to encourage insensitivity to suffering or and I don’t want to stop or stifle creative thinking about the causes of depression and anxiety and addictions. I simply want to emphasize that the causes of depression, and most other emotional problems, are still totally unknown. That is a very simple statement, but it seems to me that most folks don’t “get it,” or don’t want to hear it.

Maybe we all want to explain things, or blame others, or think of ourselves as “experts,” or perhaps we feel uneasy with thinking that we don’t yet know the causes of most psychiatric problems, like depression and anxiety or troubled relationships. It may be comforting to think we do know the causes of negative feelings or human conflict.

This is my thinking only, and I’m often off base!

Tell me what you think.

David

This is the first in a series of podcasts by David and Rhonda focusing on the best techniques to crush each of the ten cognitive distortions in David’s book, Feeling Good: The New Mood Therapy.

David and Rhonda discuss the amazing positive feedback that Rhonda received following her two recent podcasts doing live personal work. David emphasizes that being open and genuine about your own flaws and insecurities can often lead to far more meaningful relationships with others. This is a paradox, since we often hide our shortcomings, fearing others will judge and reject us if they see how we really feel, and how flawed we are.

David and Rhonda begin the discussion of the Cognitive Distortion Starter Kit with a review the three principles of cognitive therapy:

1. Our positive and negative feelings do NOT result from what happens in our lives, but rather from our thoughts about what’s happening or what happened.
2. Depression and anxiety result from distorted, illogical, misleading thoughts. What you’re telling yourself is simply not true. Depression and anxiety are the world’s oldest cons.
3. When you change the way you THINK, you can change the way you FEEL. This can usually happen rapidly and without drugs.

The first idea goes back at least 2,000 years to the teachings of the Greek Stoic philosophers. Although the idea that our thoughts create all of our feelings is very basic, and enlightening, many people still don’t get it! This even includes lots of therapists who wrongly believe that our feelings result from what’s happening to us!

David describes an innovative "Pepper Shaker" game devised by George Collette, one of his colleagues in Philadelphia to make the hospitalized psychiatric patients aware, through personal experience, that their feelings really do result from their thoughts. The game can be done in a group setting, and is entertaining. Rhonda suggested that the therapists who attend David's Tuesday training group at Stanford might enjoy this game as well!

There are key differences between healthy and unhealthy negative emotions. Healthy negative feelings, like sadness, remorse, or fear, also result from our thoughts, and not from what is happening to us. However, the negative thoughts that trigger healthy feelings are valid and don’t need to be treated or changed. In contrast, unhealthy negative feelings, like depression, neurotic guilt, or anxiety, always result from distorted negative thoughts.

David and Rhonda briefly describe each of the ten cognitive distortions, with examples. They warn listeners that the goal of these podcasts will be to learn how to change your own distorted thoughts, and not someone else’s. Pointing out the distortions in someone else’s thoughts or statements is obnoxious and will nearly always lead to conflict. David and Rhonda do a humorous role-play to illustrate just how incredibly annoying it is when you try to correct someone else’s distortions, or when someone tries to correct your own distorted thoughts!

David and Rhonda remind listeners to focus on one negative thought from a Daily Mood Log, like “I’m defective” or “my case is hopeless,” and to remember that the thought will typically contain many distortions, and possibly all ten. This means that there will be lots of techniques—often 20 or more—to help you crush the thought.

They also discuss the new idea that you can do Positive Reframing with cognitive distortions as well as negative thoughts and feelings.

In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the first distortion, All-or-Nothing Thinking.

David D. Burns, MD / Rhonda Barovsky, PsyD

#250: How to Tell Someone, “You Suck!”

Featuring special guests, Dr. Matthew May and the always exciting but pedantic Dr. Rutherford Knows, plus our podcast regulars, Rhonda and David

Rhonda begins the podcast with a wonderful email from a woman who asked how you might use the Five Secrets of Effective Communication when you have to deliver give negative feedback to someone.

Hi David and Rhonda,

I’m an avid listener of the podcast and reader of Dr. Burns’ material. I’ve been working my way backwards listening to all the podcasts, and I now own all of Dr. Burns’ books and am working my way through those, too!

I’ve especially found the live therapy on the podcast and role-play using the Five Secrets incredibly useful.

The Five Secrets of Effective Communication are like a cheat code for life. As I’ve been applying it in my own life, every conflict has had a phenomenal outcome and I end up closer with the other person. It’s incredible.

You’ve given many useful examples of using the Five Secrets on the podcast to respond to someone, for example, who is attacking you and you use the disarming technique and inquiry to hear more about how it’s been for them.

My question is, how would you use the Five Secrets to initiate a conversation where you have to be the one to bring up something that the other person doesn’t want to hear, or that it may be painful for them to hear?

I started to think about this when consulting for a CEO who needed to fire someone, but needed to keep the relationship amicable, as well as consulting with another business owner whose employee had been deceitful and she needed to have a "come-to-Jesus" talk with him.

Similarly, I’ve always struggled to bring up something that's bothering me to a spouse or loved one, because I didn't know how to initiate the conversation, and keep it from devolving into an argument (my greatest fear!).

Could you perhaps do a role play on the podcast to demonstrate using the Five Secrets of Effective Communication to initiate a difficult conversation, such as:

• • Firing or correcting an employee?
  • Telling a spouse (or loved one) when you’ve felt hurt or angry because of something they did?

Obviously you would still use all the same techniques (Stroking, I Feel statements, Inquiry, etc.), but I would love to hear an example. I find the role plays especially useful and would love to hear your expert wording for how you would approach this.

Thank you to both of you for all your tremendous work!

Rosemary

We loved this request, and model how to deliver the bad news to someone using the Five Secrets.

David mentioned that when he was in clinical practice, several women he treated were reluctant to give clear negative signals to men who were chasing them, for fear of hurting their feelings. So, out of excessive “niceness,” they ended up leading the man on, sometimes for months, and hurting him even more. It is probably far more merciful and caring to be honest with someone in a kindly way, so he or she can let go and move forward with his or her life.

Rhonda, Matt, and David illustrate David’s “Intimacy Drill.” In this exercise, the person delivering the bad news is Person A, and the person receiving the bad news is Person B. The drill involves four steps.

1. First, Person A delivers the bad news to Person B, trying to use the Five Secrets of Effective Communication (link). The bad news might be telling Person B that she or he has been fired, or that you’re angry with Person B, for example.
2. Then Person A gives himself or herself a letter grade on how well she or he did. Was it an A,  B,  C,  D, or an F? Then Person B and the observers give a letter grades to Person A as well..
3. Next, everyone points out what Person A did that was effective, and what was ineffective, using Five Secrets terms. For example, you might say that the Feeling Empathy and Stroking were great, but there was no “I Feel” Statement or Inquiry at the end.
4. Then you can do a role-reversal, and try to model an improved response.

This is, by far, the best way to learn the Five Secrets of Effective Communication. However, it requires non-defensiveness on the part of all who participate, and the philosophy of “joyous failure.” This means that you view your errors as opportunities for learning and growth instead of shame and defensiveness!

If you want to master the Five Secrets for use in ANY situation, the “Intimacy Exercise” is a fantastic way to practice. However, remember to check your ego at the door, because you’ll probably gets some low grades and make plenty of errors, especially if you’re a beginner. But if you work at it, and keep practicing—which very few people do—you can develop some fantastic communication skills that can help you in personal and professional relationships.

Today, we also introduced, in a small way, the very shy and erudite, and somewhat pompous, Dr. Rutherford Knows, who makes an occasional comment. He may agree to participate in future podcasts as well.

Dr. Knows could be a really great podcast enhancement, since he (hopefully) makes the rest of us look really good! Let us know what you think!

Rhonda and I are really pleased to work with Dr. May again. He is a dear friend and colleague, and, according to David and Rhonda, Matt is one of the finest therapists and teachers on planet earth!

I strongly agree with this assessment of Dr. May. If you wish to contact him, you can reach him at: www.MatthewMayMD.com. Matt added that people interested in treatment can schedule a free 15-minute phone call there, my schedule permitting.

Thanks!

Rhonda and David

Rhonda, Matt, and David (with Dr. Rutherford Knows)

There are 4 powerful treatment models for anxiety, including

• The Cognitive Model
• The Exposure Model
• The Motivational Model
• The Hidden Emotion Model

Each approach has a completely different theory about the causes of anxiety and utilizes completely different treatment techniques. For example, cognitive therapists believe that distorted thoughts trigger all anxiety, and that the most effective treatment involves challenging these distortions. In contrast, exposure therapists argue that avoidance is the cause of all anxiety, and that exposure is the only effective treatment. Those who adhere to the Motivational Model emphasize the role of resistance. In other words, anxious individuals are reluctant to let go of the anxiety because they secretly believe that the anxiety will protect them from danger.  And those who adhere to the Hidden Emotion Model claim that “niceness” is the true cause of all anxiety in the United States at this time, and that hidden problems and feelings may need to be brought to conscious awareness before the patient can recover.

Dr. Burns argues that, in fact, all four theories are correct, and that if you skillfully integrate all four approaches, you will often see a rapid and total elimination of anxiety in the great majority of your patients.

Dr. Burns describes how he created the Hidden Emotion Model when he was treating a woman with mysterious and intractable case of Panic Disorder. Every time her boss walked past her desk, she became nauseous and panicky, and had the overwhelming urge to vomit on him. Then she would have to rush to the ladies’ room to rest until the nausea and panic diminished, and she sometimes had to go home because the symptoms were so severe. This was all the more puzzling because she insisted she had the best boss in the world and that there were no problems at work. She explained that her boss constantly praised her and gave her promotions and generous raises, and that she had no complaints whatsoever.

Cognitive and exposure techniques were only partially effective, until an unexpected discovery suddenly emerged during a therapy session that led to a surprising outcome. What do you think the hidden emotion was? Tune in and you’ll find out!

In the next several podcasts, Drs. Burns and Nye will bring these four models to life, using real life examples, including some of Drs. Burns’ personal struggles with anxiety early in his career.

163: Ask David: Anxiety, Dreams, Cyclical Negative Thoughts, Secrets of Selling, Exposure, and more

"I don't matter!"

Did you ever feel like you aren’t important? Did you ever feel like you don’t matter? These thoughts are extremely common and can be extremely painful. I know from my clinical experience over the years, with more than 40,000 hours of therapy with people struggling with mild to extreme depression and anxiety. I know from personal experience as well, because I’ve been there personally at times! And one of the reasons I love doing therapy is because of the joy of helping someone transform these feelings of inadequacy and tears into feelings of joy and exuberance, and even laughter.

Today, my highly esteemed colleague, Matthew May MD, and I, work with our highly esteemed and beloved colleague and podcast host, Rhonda Barovsky, on concerns that emerged when a scheduling difficulty made it difficult for Rhonda to join a podcast recording on “The Phobia Cure” which was going to feature Matt May MD doing live exposure with a colleague named Danielle who has an intense fear of leeches. I suggested that Matt, Danielle and I could do the podcast without Rhonda, to save her from having to commute from her office in Walnut Creek, California to the “Murietta studios” twice in one week. (It’s a 90-minute commute in both directions, and sometimes traffic makes it even worse.)

When Rhonda read this email, she was flooded with negative emotions, which you can see on pages 1 and 2 of her Daily Mood Log at the start of her session. As you can see she felt down, anxious, ashamed, inadequate, rejected, self-conscious, angry, jealous, and more, and these feeling were intense.

Have you ever been suddenly and unexpectedly triggered like that?

What triggered Rhonda’s feelings?

According to the TEAM-CBT treatment model, our negative feelings are not the result of what happens, but how we think about it.

So, what were the thoughts that triggered Rhonda’s angst?

Take a look at the negative thoughts on her Daily Mood Log. As you can see, she was telling herself that

• She didn’t matter and wasn’t important.
• David didn’t value her.
• She shouldn’t have such strong negative feelings, like jealousy.
• The people listening to the podcast (like you, for example) will think she looks like an idiot and will judge her.
• She shouldn’t be taking up time and space on the podcast in the “patient” role again.

One of the things I like about the TEAM model is that it gives us a clear blueprint about how to proceed. One of the things I love about Rhonda is her openness, vulnerability, courage, and intense desire to teach and reach out to others, like yourself. And one of the things I admire so intensely about Matt is his tremendous kindness and compassion which are coupled with extraordinary technical skills. I feel very blessed to have Matt and Rhonda as colleagues and friends!

In the podcast, we go through the TEAM model, step by step, starting with T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods. We encountered some tears, some memories of childhood and tons of laughter as well.

During the Assessment of Resistance, we used the Straightforward Invitation, Miracle Cure Question, Positive Reframing, and Magic Dial. To me it is always surprising to see how many positives are embedded in our so-called “negative” feelings and “negative thoughts.” Positive Reframing nearly always eliminates resistance and opens the door to rapid change. You can look at Rhonda's Positive Reframing list on page 5 of the attachment. You can also take a look at her Emotion's table when she filled in the Goal column on page 3 of the attachment.

The first thought Rhonda wanted to challenge was “I don’t matter,” and we started with the Downward Arrow Technique to identify the Self-Defeating Beliefs that gave rise to this thought, as you can see on page 4 of the attachment. Rhonda also told a moving story about her father, and how her belief that she was not important may have gotten started. She also told a beautiful story about reconciling with her father eight years before he died.

We used several methods to challenge and crush the thought, "I don't matter," including Identify the Distortions, the Double Standard Technique, the Externalization of Voices, the Feared Fantasy, the Acceptance Paradox, and Examine the Evidence to crush this thought. Several role reversals were necessary before Rhonda knocked the ball out of the park.

The first negative thought is generally the most difficult to crush. Once Rhonda no longer believed this thought, she could easily challenge and defeat the rest of her negative thoughts as well, resulting in a dramatic transformation in how she was feeling, as you can see on page 3 of the attachment. It seems like when you crush one negative thought, there is a sudden change in the brain, as if the negative circuits get turned off and the positive circuits get turned on. You will have the chance to hear this first hand when you listen to the live session.

If you'd like to take a peak at Rhonda's final Daily Mood Log, you'll see how she challenged all the rest of her Negative Thoughts. (David, link to final DML when you get the final version from Rhonda.)

To review Rhonda's Evaluation of Therapy Session, click here. 

Although this podcast was long (roughly two hours), it seemed like very little time had passed because the experience was incredibly engaging and rewarding. Rhonda, Matt and I hope you enjoyed it as well, and hope it gave you some help as well, if you—like the rest of us—have ever struggled with the fear that maybe you don’t matter, or aren’t important, either.

Let us know what you think, and thanks for listening today!

Rhonda, Matt, and David

PS Following the podcast, Matt and I received this beautiful email from Rhonda:

Dear David and Matt:

My thanks to you both for an incredibly powerful experience.  I am not enough of a poet to describe my experience and gratitude to you both.  But you helped me tackle something that has been painful for me for such a long time!

I am grateful and humbled by your brilliance and your commitment to me

Rhonda

#254, Ask Matt, Rhonda, and David
(with the famed Dr. Rutherford Knows)

Today we are again joined by the fantastic Dr. Matthew May for an Ask David. Rhonda and I are thrilled that Matt will be joining us every month. His input will give you a broader range of insights and answers to your many excellent questions!

Here are the questions we will address on today’s podcast.

Karine asks: How can I help my daughter with anorexia?

Shirley asks: How can you deal with people who are emotionally abusive, using the Five Secrets of Effective Communication?

Guy asks: Are there any Five Secrets practice groups I could join?

* * *

Karine asks: How do I help my daughter with anorexia?

Hello Dr. Burns,

I am trying to help my daughter who is starting to have anorexia with your book as the consultations are not working and we are waiting on a list for a specialist which can take months or even year here in Quebec.

I have read both of your last books and i am getting good to use it for social anxiety. However. i can’t see exactly how to apply it for eating disorder.

I asked her to list the benefits she gained from not eating and i am trying to help her see the cognitive disorder in it but it is much harder (ex: i loose weight quickly...which will do ... ) i may help her see the cognitive disorder in the « which will do ... » but not in the « i will lose weight » statement ).

Could you help me see the pattern i should follow please as i really think your technique can help her faster and better than the traditional psychologist conversation.

Regards

Karine

* * *

Shirley asks: How can you deal with people who are emotionally abusive, using the Five Secrets of Effective Communication.

Hello David and others,

I have been convinced how important using the Five Secrets of Effective Communication are. I do have a question about living with a person who is emotionally abusive. He uses his criticisms of others to manipulate and control them. How do you accept the criticism of such a person who is taking advantage of you accepting the criticism. My soul wants to rebel against these criticisms and against the person who is trying to manipulate me.

How do you navigate such a relationship when the abuser will never acknowledge that they are abusing others. He lives in a fantasy world of excuse making and blaming others. Also, how do I acknowledge my weakness and allow the “death” of my ego to happen?

Thanks for your consideration and help.

Shirley

We reviewed this problem and describe how we treat relationship conflicts using TEAM-CBT. This involves giving up blame and examining your own role in the problem. You will discover--and this might be disturbing, or enlightening, or both--that you are contributing in a BIG way to the very problem you're complaining about.

You can review Shirley’s partially completed Relationship Journal if you link here.

* * *

Guy asks: Are there any Five Secrets practice groups I could join?

David,

Please consider asking one of your skilled therapists to create a Five Secrets of Effective Communication "Practice Group." Possibly the group could be run weekly (virtually) and it would be an opportunity to repeatedly practice each of the secrets.

I practice on my own, but I know that learning is often strongest when working with others.

Guy Marshall

David’s Response

Hi Guy,

Ana Teresa Silva has a five secrets zoom practice group. Check with her! They are just getting started.

ateresasilva6@gmail.com

We have an exciting podcast scheduled the next time Matt visits. We will address the many controversies around exposure therapy, and will be joined by a patient Matt recently treated with the fear of leaches! We will also address some of the hundreds of questions submitted by the more than 6,000 fans who registered for my free 90-minute presentation on rapid Recovery from Anxiety which was sponsored by PESI.

All the best,

Rhonda, Matt, and David (plus Rutherford)

If you would like to contact Dr. May, you can reach him at: www.MatthewMayMD.com. Matt added that people interested in treatment can schedule a free 15-minute phone call there, my schedule permitting.

Dr. Rhonda Barovsky practices in Walnut Creek, California, but due to Covid-19 restrictions is working mostly via Zoom, and can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com.

“My problems are real! The world really IS screwed up! And that’s not a distortion. So what can I do about my severe depression and anxiety?”

David and Fabrice discuss two questions submitted by Feeling Good Podcast listeners.

#1. Shari writes:

“I read your book Feeling Good and now I am reading your book When Panic Attacks--thanks to April's podcast with you. I still struggle but recently our current political situation and environmental research about our negative impact on earth—has triggered severe anxiety and depression again. The problem is that I don't think my thoughts are distorted—it certainly seems logical to assume that life on earth is threatened. So I am not sure how to do this. How can I make progress with my mental and emotional health while being aware of situations around the world? Any advice or thoughts would be deeply appreciated.”

This is a wonderful note, and I’m sure that huge numbers of people feel the same way, in varying degrees. So how can we attend to our own emotional well-being in the face of genuine adversity?

Dr. Burns discusses this from the perspective of Paradoxical Agenda Setting, which is the key component of TEAM-CBT, and emphasizes the most common therapeutic error of all—jumping in to try to help, without seeing all the really GOOD reasons for the patient NOT to change. From this perspective, Shari’s question becomes the most important question in all of psychiatry and psychotherapy—how do we help patients who may not want to change?

#2. After listening to the A = Agenda Setting portion of the live therapy with Mark, Paul submitted this question:

“Hi David,

Thanks to you, Fabrice and Jill for this episode - as with the previous episodes with Mark, this has really helped in bringing the TEAM approach to life. As I have been using your books in the past few years to self-treat feelings of anxiety and depression, I was very keen to hear how the new agenda setting step works.

I am wondering what your thoughts are on how effectively the "A" step can be carried out by a patient on his/her own (i.e. without someone else verbalizing the reasons not to change / playing the part of the patient's sub-conscious)? Do you have any tips? I think I heard Mark say something to the effect that, on his own, he wouldn't have thought of all the positives that you came up with in the session.

Thanks again for sharing these great tools and techniques - looking forward to the "M" step soon.

Paul”

This was another terrific question on a topic of great importance. David explains that it is actually easier for patients to learn to use Positive Reframing and the other Paradoxical Agenda Setting techniques than for therapists to learn them. Because of his excitement over this prospect, David has just begun a new book which will show depressed and anxious individuals exactly how to do this on their own in a step-by-step manner. He is optimistic that the new TEAM-CBT techniques, in book form, may be even more helpful to patients than his first book, Feeling Good: The New Mood Therapy. Research studies indicate that 65% of patients with moderate to severe depression improve substantially within four weeks of receiving a copy of Feeling Good, even without any other treatment. Dr. Burns is hopeful that his new book will provide the answers for the 35% who were not helped by Feeling Good.

So the answer is yes, I think many individuals WILL be able to do the “A” step on their own, and I am hopeful the positive impact will be great!

If you would be interested in David's new book, please indicate this in the Survey attached to this podcast.

David and Fabrice have exciting plans for upcoming podcasts. They will be addressing these two questions in one or two podcasts:

1. Is it possible to measure our “worthwhileness” or “worthlessness” as human beings?
2. Do we even have a “self”?

These two questions have been discussed by experts for thousands of years, going all the way back to the Buddha, and most recently by the incredible Austrian philosopher, Ludwig Wittgenstein. And although the answers are tremendously simple, people can’t seem to “get it.” The issues are not simply philosophical, but eminently practical, since most depression and anxiety result from the perception that one is “worthless,” or “inferior,” or simply “not good enough.”

In addition, David and Fabrice are hoping to create a second live therapy session broken into smaller podcast chunks, but featuring David and a totally awesome former student and now highly esteemed colleague, Matthew May, MD. For the past ten years, David has been telling workshop audiences that Matt is one of the finest therapists in the world. So this is an event you won’t want to miss!

Click here to listen to Fabrice being interviewed on Dr. Carmen Roman's podcast.

A Riveting Story of Raw Emotion. . .

“Dad, I let you down!"

Part 2 of 2

Special Announcement 

The long awaited Feeling Great App

is now available in app stores.

IOS and android!

Check it out. Take a free ride!

And now, on with the exciting conclusion of the personal work Dr. Jill Levitt and I did with Chris, along with a fabulous followup interview you will hear at the end of the session.

I hope you enjoyed the session with Chis, and hope you found it inspiring. His message of hope and joy could be helpful and inspiring to any of you who may be struggling, and feeling, as he was, that you're just "not good enough." His work is, of course, important from a psychological perspective, because it illustrates the powerful steps of TEAM in a sequence that brought Chris from the depths of despair to the peaks of enlightenment. However, as you will hear in the postscript dialogue, the work for sure takes on a spiritual and mystical quality for sure!

When you hear Chris live during the follow-up interview at the end of Part 2 of this two-part podcast, you will not be disappointed!

Postscript

As I mentioned earlier, I was overjoyed when I learned that Chris had unexpectedly changed his mind and offered us the chance to publish his personal work and provide a follow-up recording of how he’s doing now.

Here’s my email to him just prior to the follow-up recording.

Hi Chris,

I’m assuming that Rhonda will coordinate this and she has us scheduled for this Friday, I believe. When it is 4 PM in your time zone, what time is it in our time zone? Are you two hours later?

I just reviewed my chart notes from a year or so ago, and it will be terrific to reconnect with you. I deeply appreciate the chance to share your session with our many listeners, as it is full of raw emotion and is riveting. You are making a super strong statement to the world, to my way of thinking, and it takes incredible courage to say, “This is me! I am very real, and sometimes very raw!”

I think many people suffer due to thinking that everyone else is somehow “better” than they are, and that they are somehow “not good enough.” That is perhaps the main theme I hear when doing clinical work, and that includes my work with mental health professionals who are equally vulnerable to this kind of thinking.

What triggered your decision to go public, so to speak. And how might this impact your students, and their parents, and so forth?

Hopefully, we can chat this Friday about those and any other questions or topics that touch or interest you. It will be great to get caught up on your past year!

If Jill or Rhonda want to add your thoughts, please do! To me, this is a very significant occasion to have the chance to connect with you, Chris, again! The work you did is among the most powerful and impactful ever in my memory, although every time we do live work it is pretty incredible to my way of thinking, especially when people become “real,” whatever that means!

Humans have a dark side, to be sure to my way of thinking, but something incredibly beautiful and amazing can emerge.

I am babbling so will stop. But I am so excited to talk to you again, Chris!

Warmly, david

Thank you for listening, and please let us know what you think.

if you are a therapist, and want to learn how to do this, consider attending the summer intensive from August 8 to 11, on line, or in person at the South San Francisco Conference Center (ten minutes from the SF airport.) See the details and a link below, or go to www.cbtintensive.com.

Chris, Rhonda, Jill, and David

Click for registration / more information!

Are there some special techniques therapists need
to use when working with LGBTQ patients?

Does the therapeutic approach have to be different?

In today’s podcast, Rhonda and David interview Kyle Jones, a brilliant 5^th year PhD student at Palo Alto University. Kyle has been a member of David’s training group at Stanford for the past four years, and now sees patients at the Feeling Good Institute in Mt. View, California. Today’s program is based on Kyle’s doctoral research on the treatment of LGBTQ patients.

To get the interview started, Kyle defines LGBTQ:

L = lesbian

G = gay

B = bisexual

T = transsexual

Q = questioning, or queer.

Then Rhonda asks the obvious question: How does the treatment of LGBTQ individuals differ from the treatment of individuals who are heterosexual? What are the key differences? What special techniques or procedures should therapists use? And what does Kyle’s research reveal about the important factors in the treatment of gay individuals?

Kyle emphasizes that most important factor is the therapist’s attitude toward the patient, as opposed to any special techniques or procedures that are unique to the treatment of the gay population. Sensitivity to and awareness of the unique challenges this population faces in terms of hatred and prejudice are tremendously important. Kyle points out that some therapists place an excessive focus on the patient’s gayness, while some tend to sweep this “uncomfortable” issue under the rug.

Kyle emphasizes that the therapeutic approach is largely the same for gay and straight patients. In TEAM, we first provide strong empathy, so the patient feels understood and accepted. This, of course, is crucial for all patients. Then we set the agenda, asking the patient if she or he wants help, and if so, what is the problem that he or she wants help with?

In other words, there is no special “agenda” that the therapist should impose on the treatment simply because the patient is gay. Kyle mentions that this is not a trivial point, because many therapists will try to set the agenda for the patient, thinking there is some “correct” way one should treat gay people, or some “correct” set of issues that must be addressed. David points out that thinking there is a special approach to gay patients could actually be viewed as a type of bias, thinking that the treatment of members of the LGBTQ community must be somehow “different” or special.

In TEAM, we do NOT treat disorders, diagnoses, or “types” of patients. We treat humans in a highly individualize way, using the fractal approach described in a previous podcast. In other words, we ask the client to describe one specific moment when he or she was upset and wants help. Then the treatment flows from the exploration of that specific moment, because all the patient’s problems will be encapsulated in how she or he was thinking, feeling, and behaving at that moment. The treatment might then focus on depression, anxiety, a relationship problem, or a habit or addiction.

Rhonda, Kyle and David discuss the problem of therapists who have a strong anti-gay bias. David talks about his father's work, trying to convert gay students at the University of Arizona after he retired from his work as a Lutheran Minister in Phoenix, and how much shame and anger David felt about this. David described his positive bias toward LGBTQ individuals, because of the suffering most have had to endure due to hatred and prejudice.

David asks whether gays therapists are obligated to announce their sexual orientation to their patients, and Rhonda and Kyle come up with some pretty cool answers! Rhonda points out that when and how to do self-disclosure is a question all therapists face, and that the goal of self-disclosure in therapy should be on how best to help the patient, not the therapist. Again, this question of the hows, whens and ifs of self-disclosure is a general therapy issue, and not something specific to gay therapists.

Kyle and David reflect on some of the personal work Kyle did during his training program, and how important that work has been to Kyle as he has evolved into a dynamic, compassionate therapist and teacher. They reminisce about the first personal work Kyle did with David on one of the Sunday hikes. Kyle was feeling depressed because he’d just been rejected, unexpectedly, by his boyfriend, and was able to turn the situation around dramatically and quickly using TEAM-CBT. Kyle also describes his own discovery during college that he was gay, and what happened when he shared his sexual orientation with his parents and brother.

The message of this podcast turned out to be pretty simple and basic. The key to the effective treatment of all of our patients is acceptance. The therapist needs to accept the patient, and the patient needs to learn to accept himself or herself. In fact, acceptance seems to be the path to recovery and enlightenment for all of us, whether gay or straight!

David D. Burns, MD, Rhonda Barovsky, PsyD and Kyle Jones (PhD candidate)

Podcast 290: A Case of Social Anxiety: Featuring David with Dr. Stirling Moorey (Part 2 of 2)

Last week, you heard the first part of this live therapy session with Anita, a woman struggling with severe social anxiety. David and Dr. Stirling Moorey, from London, are co-therapists. Last week included the T = Testing and E = Empathy portions of the session. Today you will hear the A = Assessment of Resistance, M = Methods, along with end of session Testing and follow-up.

A = Assessment of Resistance

David asked Anita if she was ready to roll up her sleeves and get to work, or if she needed more time to talk and be listened to and supported.

Because she was eager to get to work, David asked the “Miracle Cure Question:” He said, “What would happen in today’s session if it went really great and knocked your socks off?

She said that her negative feelings and self-critical thoughts would be greatly diminished.

David asked the Magic Button Question, and she said she’d press it for sure!

David said he had no Magic Button, but did have some powerful techniques that could be super helpful, but was reluctant to use them. Anita was puzzled, and this led to Positive Reframing. He encouraged Anita to ask the three questions about each Negative Thought and feeling on her Daily Mood Logs:

1. Why might this thought or feeling be perfectly appropriate, given your circumstances?
2. What are some advantages, or benefits, of this negative thought or feeling?
3. What does this negative thought or feeling show about your core values that’s positive, beautiful, or even awesome?

Although puzzling at first, Anita soon got into the swing of it and came up with the following list of Positives.

1. If I tell myself “I have nothing to say” in a group, I’ll listen more and learn more.
2. I won’t risk speaking and making a fool of myself. So my social anxiety is really a source of self-protection, or even a form of self-love.
3. My self-criticisms show I have high standards.
4. My high standards motivate me to work hard and do my best.
5. My self-doubt shows that I’m humble.
6. My concerns about being judged show that I care for the people in the group and want to have positive relationships with them.
7. Shows I’m not pushy, dominating, or arrogant.
8. When I tell myself that “They are all better than me,” it shows that I have room to learn from all the people who are ahead of me.
9. This shows I want to grow and do better.
10. This shows I’m honest and realistic about my limits and flaws.
11. This shows I’m accountable.
12. This gives me “vicarious joy” in the accomplishments of others, a Buddhist concept.
13. This thought shows that I can appreciate the gifts of others, which is a gift to them.
14. When I tell myself, “I wasted a year,” it shows that I value hard work, learning, and dong a good job.
15. It shows that I value what other people think, and take their criticisms seriously.
16. It shows that I want to be seen for who I am!

David pointed out that there were many positives on the list, and if we had time many more could be added, but asked Anita if the positives were:

• Real?
• Important?
• Powerful?

She gave enthusiastic “yes” answers to all three questions, and then david asked the Pivot Question: Why in the world would you want to press that Magic button, because if you do all these positives will go down the drain, right along with you negative thoughts and feelings

Anita suddenly didn’t want to press the Magic Button, but agree to use the Magic Dial and lower her goals for each negative feeling, which you can see if you click here.

This concluded this part of the session, which brought us to the M of TEAM.

M = Methods

During the Methods portion of the session, David and Stirling used a number of techniques, including:

• Identify the Distortions
• Explain the Distortions
• Straightforward Technique
• Externalization of Voices with Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique)

And more, using frequent role reversal until she got to “huge” wins, which didn’t take long. Stirling also asked gave Anita how she might test if her fears about the way others saw her were accurate, and they devised some homework to do in the Wednesday training group to find out if other group members had experienced similar doubts about their abilities as therapists. This would involve using:

• Self-Disclosure -
• Survey Technique
• “I stubbornly refused” Technique

You can see her final Daily Mood Log if you click here (LINK).

We also jumped in and tried to work with Anita’s conflict with her supervisor, but ran out of time and might pick up that thread again in a future session if she is interested.

I might add that both David and Stirling also used Self-Disclosure and Story-Telling during the session, as well as some spontaneous humor, which can also be viewed as a valuable treatment method, but one that is hard to explain or teach.

You can see Anita's final Daily Mood Log with the outcomes of all of her negative feelings. As you can see, she exceeded her goals in every category, which is not unusual, and was feeling pretty terrific!

She had the homework assignment to listen to the recording of the session and complete her DML, so you will only see a couple of the Positive Thoughts listed.

Final T = Testing

You can see Anita's final BMS here, and her  Evaluation of therapy Session here  As you can see, there were dramatic reductions in depression and anxiety, but only a modest boost in happiness. It would be interesting to see if the happiness goes up further after her "behavioral experiment" at Wednesday's tuesday group. Her scores on the Empathy and Helpfulness scales were perfect.

Follow-up

This is the email we received from Anita three days later, right after her "behavioral experiment" in Rhonda's Wednesday TEAM-CBT training group::

Hi Stirling, Rhonda, and David,

I did the survey question in Rhonda’s Wednesday training group. Here’s what I said:

“I am so nervous right now. I sometimes feel like I do not have much to say and so I stay silent in the group. I get anxious and think you all are so far ahead of me in your skills, so I miss out on sharing. I was wondering if any of you sometimes feel the same way?”

So many hands shot, so many affirmed my question and thanked me for asking because they get anxious too. I was a little overwhelmed. Loved the experience!

Rhonda I hope I did not take too much time.

 Anita

Rhonda, Stirling, Anita, and David

360: The Story of Indrani

“Why can’t I get close to my
daughter who I love so much?”

Today, we present Part 2 of the awe-inspiring work that David and Jill did with Indrani in the Tuesday group at Stanford. Indrani was a mother with a heart-breaking but all-too-common story of a conflict with her daughter. Sometimes, we love someone tremendously, but every time we try to get close, they seem to push us away. The story should ring true and be helpful to so many people, as nearly everyone runs into conflicts at times with our family members, including our parents, siblings and children.

And, as usual, the solution often involves attending to your “inner” dialogue, which is the conversation you’re having with yourself about the conflict, and the “outer” dialogue, which is what happens when you try to get close to the person you love.

And today’s session illustrates not one, but two forms of enlightenment. The changes in the inner dialogue involves challenging and crushing the negative messages you’ve been giving yourself about h problem with the person you love so much. You can see Indrani’s Daily Mood Log if you click HERE. As you can see, she’s been telling herself that her daughter has shut her out of her life, and that she’ll die alone/ That’s incredibly sad! And she’s also telling herself that all of her friends have wonderful relationships with their daughters “and I don’t” and she’s blaming herself for the problem: “I deserve this treatment,” and “nothing I do pleases her.”

You can also see the intensity of Indrani’s negative feelings, including sadness, anxiety, inadequacy, loneliness, embarrassment, discouragement, irritation, and more.

You can also see a typical exchange with her daughter if you look at her Relationship Journal (RJ). As you may know, the whole theme of my interpersonal model in TEAM-CBT is that we create our own interpersonal reality at every moment of every day. In other words, we unknowingly create and cause the exact relationship problems that we complain about, but just don’t realize this, so we think there’s something wrong with the other person.

But how can this be? If you look at Step 2 of Indrani’s RJ, her response to her daughter seems innocent enough! But stayed tuned, because Indrani makes a shocking and mind-blowing discovery during the session, and that discovery requires the exceedingly painful “death” of the “self.” But this “Great Death” is instantly followed by a “Great Rebirth.!”

At the end of the session, a Tuesday group members named Keren, said this to Indrani: “You wowed me!” One of the men, Ed, could barely speak because he was sobbing. You may also be sobbing for joy when you listen to this heart-warming story.

In part 1, today’s podcast, you’ll hear the initial T = Testing and E = Empathy. In part 2, in next week’s podcast, you’ll hear the M = Methods, including Jill and David’s incredible work with Indrani on her R and her rather sudden discovery, in Step 4, of exactly how and why she’d been driving her daughter away—and how to stop doing that and begin to communicate in a way with a far greater chance of enhancing closeness and love.

The Jill and David turn to Imani’s Daily Mood Log so she can smash her distorted negative thoughts with the Externalization of Voices, and several role reversals illustrating the integration of Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique.)

You can see Imani’s initial and final Brief Mood Surveys plus her Evaluation of Therapy Session,

We are extremely grateful to Indrani for giving us this very intimate glimpse into her inner life in a way that will illuminate and inspire every person with the good fortune to listen to Indrani’s amazing Journey this evening!

PS I emailed Indrani this morning to see how she's doing, and recevied this wonderful reply:

I’m still feeling great…very light and hopeful. I’ve listened to the audio. I sound goofy at times but loved re-living the moment when the truth dawned on me and how I felt immediately afterwards. My daughter Soni ( like the Japanese electronic company :) is coming on Thursday. I would’ve been filled with intense anticipatory anxiety but now I can’t wait to give her a big hug and use what I’ve learnt to connect with her.

I’m looking forward to watching the video with Soni.

Thank you so much Dr. Burns and Jill!

Thanks for listening!

Rhonda, Jill, and David

Podcast 257: What's an Intensive?

Today’s podcast features Dr. Lorraine Wong and Richard Lam who describe the intensive TEAM-CBT treatment program at the Feeling Good Institute in Mountain View, California. Dr. Wong is a board certified clinical psychologist and the Clinical Director of The Feeling Good Institute in Mountain View.

Richard Lam is TEAM Certified Therapist, Trainer and Certification Program Manager at the Feeling Good Institute.

An intensive is a departure from the conventional weekly 50-minute session and compresses an entire course of therapy into a brief period of time. David describes how he created this treatment approach accidentally at his hospital in Philadelphia when one of the world’s most famous and beloved actors, a man who was a great fan of Dr. Burns first book, Feeling Good: The New Mood Therapy, contacted him and asked for treatment.

However, there was a catch. He only had two days available, and asked if he could fly from Hollywood to Philadelphia and book all of my sessions for two days. I was delighted to do that, and scheduled 17 back-to-back 45-minute sessions on a Thursday and Friday.

He came in a disguise, and explained that fans and the paparazzi were constantly hounding him, and that he felt like a hunted animal. I asked if the disguise was effective, and he said it wasn’t working at all. People still hounded him and asked why he was wearing the disguise and asked for autographs.

Because he was a powerful actor, the roleplaying techniques I have developed, like Externalization of Voices, were tremendously effective, and he actually made a complete recovery within a couple hours.

Later on, I developed an intensive program for the patients in our inner-city neighborhood, with the help of the president of our hospital, and it was also incredibly effective for our patients who had few resources. However, they loved cognitive therapy!

Richard and Lorraine explain how they are implementing the intensive concept at the FGI, working with people from around the United States and the world who come to Mountain View for several days for the treatment. They describe their work with a severely and chronically depressed man who came from Europe who seemed incredibly challenging at first. He was super skeptical and said that that he’d had tons of failed therapy but nothing and no one had ever helped him.

He was telling himself things like this:

• Life isn’t worth living.
• I’m a special case and no one will be able to help me.
• Life shouldn’t be so hard.
• I should be able to enjoy life more.

However, once they blew away his resistance using Paradoxical Agenda Setting, Richard explains that “it was a breeze to blow all of his negative thoughts out of the water.”

The treatment is costly in the short-term, but can be extremely cost-effective in reality because recovery often happens rapidly. It is my impression, too, that in the hands of a skillful therapist, extended sessions and intensive treatment with TEAM-CBT can often be amazingly effective.

If you would like to contact them, you can go to the FGI website (www.feelinggoodinstitute.com) or email them: Richard@feelinggoodinstitute.com or Lorraine@feelinggoodinstitute.com.

Thanks for listening, and thanks to Richard and Lorraine for being especially fun and gracious guests on today’s podcast!

Rhonda and David

Dr. Rhonda Barovsky practices in Walnut Creek, California. She sees clients via Zoom, and in her office.  She can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com.

You can reach Dr. Burns at david@feelinggood.com.

Feeling Down?

Try the Feeling Great App for Free!

The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it  out at FeelingGreat.com!

What's the Meaning of Life?

Before we start today, I have a special shoutout to Max Kosma, our new colleague, friend and brilliant technical guru who helped make our new video studio possible! Next week, we’ll see if we can pipe him in to say hello to all of you. His spirit is joyous, infectious, incredibly generous and supportive.

Thanks, Max!

Rhonda opened today’s podcast with a vibrant and inspiring endorsement from Jeff, a podcast fan who was raving about the Feeling Great App. Thank you Jeff, and please check out our new app at FeelingGreat.com.

Important Announcement

Rhonda, along with a group of dedicated TEAM Therapists, including Amy Berner, Brandon Vance, Leigh Harrington, Mariusz Wirga, and Mark Noble, has just created a new non-profit organization called TEAMCBT International (TCI). TCI will provide seed money in the form of no-or-low-interest loans for groups around the world who want to offer TEAM-CBT intensives for therapists in your country. Rhonda has been instrumental in the organization of successful intensive workshops in India, Poland, Mexico, England and Ireland. They have been well received, but can be somewhat costly to produce, so Rhonda’s new group is ready to provide a helping hand.

I’ve had the honor of presenting keynote addresses, live therapy demos, and Q and A sessions in many of those programs, and have totally enjoyed them. A big hug and THANKS to Rhonda once again! To learn more, just go to TEAMCBT.International.

Today, Matt joins us for a discussion of the meaning of life, something young people often worry about, but people of any age can be concerned. So, today, you may finally find the answer to that lofty question!

But first, I (David) mentioned a little about one of last week’s questions, “Is the universe real?” I provided the type of answer the famed philosopher, Ludwig Wittgenstein, might have provided. Namely, that the question is nonsensical, it is language “out of gear.” So, we can dismiss the question, as opposed to trying to answer it.

HOWEVER, the question DOES make a ton of sense when we ask if human beings are “real.” And I am not referring to some metaphysical nonsense, but rather the tendency of many people to present a happy or confident false front, all the while feeling empty, lonely, anxious and ashamed inside.

Two of the now more-than-140 TEAM techniques include Self-Disclosure and the Survey Technique, where you take the chance of opening up about some of the secrets you’ve been hiding, and ask others what they think about you. Although this takes tremendous courage, it often results in tremendous warmth and connection to others.

I provide a description of a young man who disclosed a tremendous amount he’d been hiding in our recent Tuesday group at Stanford, and he was convinced the group would judge him and look down on him. But just the opposite happened. He encountered a flood of warmth, admiration, and respect from the people in our group.

A small miracle, perhaps, but a real and meaningful miracle at the moment when his universe suddenly became “real” and radically different from the dangerous and critical world he’d feared and imagined.

Then we tackled today’s philosophical question: “What’s the Meaning of Life?” As usual, our brilliant and beloved Matt May began with a description of an extraordinarily depressed patient he once treated who’d been hospitalized for 180 days with no improvement, including a very dangerous suicide attempt.

Matt was worried for the patient’s safety, so told the referring doctor that he’d been willing to talk with the patient while the patient was still in the safe environment of the hospital. The patient called Matt and, after some listening and empathy Matt said he would like to help and that there would be committed to helping the man and thought he could help him make a complete recovery, work with this man, and thought there was an excellent chance for significant progress, perhaps even complete recovery, but the patient probably wouldn’t want to work with him.as long as he’d be willing to give Matt what he needed in order to work together effectively. Matt suggested the patient give him a call.

On the call, Matt told him he might not be able to afford treatment, since part of the “cost” of therapy was that the patient had to make a commitment to life, and that he must agree never to attempt suicide no matter what, for the rest of his life.

After a couple days of reflection, the man convinced Matt that he WOULD make that commitment.

Then Matt described the man’s problem. Both of his parents were world famous, successful scientists, and during his upbringing, his parents emphasized how fantastic and rewarding a career as a scientist could be, and he was convinced that his parents expected him to follow in their footsteps. He had "learned that doing science was the "meaning of life" and would inevitably result in his feeling satisfied, joyful and proud.

So. sure enough, this young man, who was extremely bright, pursued a scientific career, and eventually one of his papers was accepted for publication in one the world’s most prestigious research journals.

There was a big party at his laboratory, and everyone congratulated him and sang his praises.

But there was one big problem. He felt nothing!

Of course, he smiled and didn’t let on that he felt nothing. He tried to act happy, but simply WASN’T. He said, “I faked it.”

He concluded that he must be defective, since he’d done what he was supposed to do, in order to feel joyful and happy, but he felt nothing, even though he had fulfilled his parents dreams and expectations for him. This plunged him into his severe depression, with the familiar theme of “I’m not good enough. In fact, I am deeply flawed and defective, incapable of feeling joy or happiness. There must be something terribly wrong with me!”

Sound familiar? Did you ever feel like YOU weren’t good enough?

During an early session, Matt asked his patient what he really enjoyed, what he’d really LIKE to do with his life.

The patient confessed, after much resistance, that he felt that his fantasies were totally ridiculous, but what he really loved were trains, photography, and painting. He said his dream job would be to be a conductor or engineer on a train where he could take pictures of the scenery and especially, the people on the train.

BUT, he said, that would be meaningless, since he wouldn’t be contributing to science and would be letting everyone down., etc. etc. etc.

I bet you can guess what followed! If you were his shrink, what would you say or do?

Put your ideas here, into the text box, and then I’ll tell you!

If you took a guess, thanks! If you didn’t, no problem.

Matt suggested he do those very things—take a train somewhere, start snapping photos, and do some painting. Predict how satisfying each thing will be (0 to 100) BEFORE you do it.

Then do it, and record how satisfying each activity actually was on the same scale of 0 to 100.

He exclaimed, “I’d LOVE to do that,” and started crying. His depression score immediately fell to zero.

The next week he brought a large cardboard box to his session. It was filled with books on ancient philosophy and how to find the “meaning of life.” He said, “I don’t need these anymore, so they’re a gift to you!”

Matt said, “I don’t need them either!”

Now you know about the “meaning of life.”

We discussed some of the many meanings in this story, including:

1. Rhonda pointed out what Kurt Vonnegut said on the meaning of life. He said, “We’re all here to fart around!”
2. David discussed the basic idea that it’s not what we’re doing, but our thoughts, that trigger ALL of our feelings. And at the moment you learn to turn off that critical voice in your brain, you will experience your own “enlightenment.
3. David has also said, over and over, that when you discover that you no longer need to be “special,” you can experience the “Great Death” of the “self,” but it’s not like a funeral. It’s more like a celebration, because when you lose your “self,” and discover you didn’t “need” the things you wrongly thought you needed (like love, achievement, perfection, etc.), at that moment you’ll experience enlightenment and you’ll inherit the world, and life, and deeper connections with the people you love.
4. There’s not one “meaning” to life. There are many meanings every day. And today, for Matt, Rhonda and David, it is VERY meaningful and joyful just to hang out with each other, and with you, so we can shoot the breeze together! Or, as Kurt Vonnegut said, so we can "fart around" together.

Please keep your wonderful questions and comments flowing, and be sure to catch us in our new video version on my feeling good YouTube channel.

Warmly,

Rhonda, Matt, and David

Podcast 285: TEAM-CBT for Chronic Pain. Featuring Derek Reilly--

with the Exciting Findings from a New British Outcome Study

Rhonda begins the podcast with two inspiring emails about our recent podcast on “The Unexpected Results of the Latest Beta Test id the Feeling Good App, Part 1 of 2, published on2-28-2022. One is from Vivek Kishore, who used to come to all of my Sunday hikes prior to the pandemic, and Rizwan Syed, from Pakistan, who is an enthusiastic member of my Tuesday training group at Stanford as well as Rhonda’s Wednesday training group.

Here’s what Vivek wrote

Dear David and Jeremy, This is so amazing and has the potential to change the world. I am sure millions across the globe will benefit from this app. Can't wait for its launch. Thank you!

Vivek

Here’s what Rizwan wrote:

Dear David:

Reading your books changed my life completely. I am so much happy and optimistic about life compared to highly critical of myself and others and had been so much bitter.

I am sure your team therapy app would be as mind boggling and revolutionary as had been your bibliotherapy.

I am no God. Had I been one, I definitely would have chosen you as my prophet to spread my message.

Rizwan

Today, we interview Derek Reilly, a Cognitive Behavioral Psychotherapist, and Registered Mental Health Nurse with 20 years of clinical practice  specializing in the treatment in chronic pain. He is an Accredited CBT therapist with the British Association for Behavioral and Cognitive Psychotherapies in the United Kingdom, and a TEAM certified Level 3 TEAM-CBT therapist.

Derek is also a founding member of the new TEAM-CBT UK group. He has published papers on panic, OCD, and pain. He lives in Darfield, a small village in South Yorkshire, which is a mining area in England.

Derek, like a previous guest, Dr. Peter Spurrier, attended a two-day workshop I conducted on TEAM-CBT in the treatment of anxiety disorders in London in 2015. Although I felt quite discouraged during and after the workshop, thinking I’d done a poor job, and since the crowd size was modest at best, a number of those who attended apparently got the message and became excited about TEAM.

Derek said that the emphasis on T = Testing and on A = Assessment of Resistance made the biggest impact on him. He explained it like this:

David described the four forms of Outcome Resistance and the four forms of Process Resistance. I suddenly realized that resistance was huge in the population I was treating, and that my biggest error had been trying to “help,” which usually just triggered more resistance and yes-butting by my patients, who would complain that no one was helping them with their pain. Dropout rates were high, and I also felt frustrated with the lack of progress I was seeing in my patients.

Both Derek and Peter then attended my four-day intensive at the South SF Conference Center in 2017 and got hooked. Derek said:

I thought about testing, and where it could be improved, and developed my own Pain Problem Survey (PPS) of the most common kinds of negative thoughts I was seeing in my patients, as well as the negative feelings these thoughts were triggering, like frustration, anger, anxiety, and more.

I asked them to rate three emotions on a scale of 0 to 10, as well as their cognitions and behaviors, and tried to figure out what the resistance was all about. I also discovered that the simple step of T = Testing helped greatly with the E = Empathy, because my patients began to feel understood. This was different from the way I’d been trained which was to push this or that technique to “help” with their pain.

He said that the concept of “acceptance” is a popular and common buzzword these days among mental health professionals, but there’s a huge difference between intellectual “acceptance” and acceptance at the gut level. He liked the fact that TEAM offered specific tools to bring resistance to conscious awareness and to quickly reduce the resistance as well, as the paradoxical techniques that David has developed.

Some of the common Negative Thoughts he heard from his patients included:

1. I should bed doing things quicker.
2. I should be responding faster.
3. The doctor should fix me.
4. Why is this happening to me? This is unfair!

Many had been feeling demoralized that there was no medical solution, and ashamed of the fact that the could no longer work and do things that had once been automatic, like housework, or picking up and hugging the grandchildren, or going to work and earning money. Their disabilities seem to contradict their personal values, and they felt like they were letting people down.

He said:

Many of my patients had 10 or even 20 years of suffering and failed treatments, including multiple surgeries in some cases for back pain, for example, and often complained that nobody had been listening to them. That’s why the E of TEAM was so important, and I practiced using the Five Secrets of Effective Communication to respond to their complaints. I worked especially hard on Feeling Empathy. Previously, I’d been way to quick to try to “help,” that just turned my patients off.

I was helped by the empathy technique David developed called “What’s my grade?” I ask my patients, “would you give me an A, a B, or a C or lower so far?” This was crucial.

Then, when I went on to the A = Assessment of Resistance, we began to uncover, or discover, what their negative thoughts and feelings showed about them that was positive and awesome. Because I was practicing in an economically deprived area, I, and many of my colleagues, thought this would be a waste of time, and that my patients might not “get it” because it would seem too brainy or intellectual.

But it was the opposite, and by the third session, many were already beginning to see things through an entirely different set of eyes. For example, they could see the many positive in their feelings of shame, inadequacy, anxiety, hopelessness, and even anger. So they began to feel proud of their negative thoughts and feelings.

It was also helpful to take the “shoulds” out of their negative thoughts and feelings using methods like the Semantic Method and the Double Standard Technique. These approaches proved much more effective in helping people come to terms with loss/change.

Derek described his work with a man who’d been struggling with chronic back pain and depression and daily alcohol abuse, who’d had a suicide attempt and felt useless. Derek said:

He was open to examining his own role in his problems, and agreed to cut down on his alcohol intake. He found the Positive Reframing to be helpful, and saw that his negative thoughts and feelings were actually an expression of his high standards, and that his frustration was the expression of his determination not to give up.

His guilt and shame showed that he had a conscience, and a moral compass, and that he was honest with himself, and that his frustration and depression about being unable to work showed his core values.

Then we did the Magic Dial to see how much he wanted to dial down each negative feeling, like guilt, and used a variety of M = Methods to challenge and crush his negative thoughts. Once he pinpointed and challenged his Hidden Should Statements, his feelings of self-acceptance increased dramatically. Then we ended up using the Externalization of Voices to wipe out his negative thoughts.

Derek and I discussed the role of negative emotions in patients with chronic pain and other “medical” symptoms, like dizziness, and chronic fatigue. I summarized my experience as a medical student working in Stanford’s outpatient medical clinic with Dr. Allen Barbour, and how that approach was similar to the approach that Derek was taking.

I summarized my statistical modeling of three data bases that all showed identical results that the correlation between physical pain and emotional distress is not because physical pain causes emotional distress, but because emotional distress causes an amplification in the experience of pain. This is true of physical pain with a clear medical cause, such as arthritis, as well as so-called “psychogenic pain” where no physical cause can be detected.

Derek summarized his recent study of 60 chronic pain patients he treated with TEAM, which was a retrospective “clinical audit,” or chart review study. The study indicated a 57% reduction in scores on the PHQ-9 & GAD7 (commonly used depression and anxiety tests). These reductions were significant at the p < .0001 level. The changes  in the scores on the PPS were also significant.

This is the first piece of preliminary evidence in the UK to show effective TEAM-CBT can be in the treatment of chronic pain. He is writing up these finds with a colleague, Anne Garland, a Consultant Nurse Psychotherapist, and hopes to publish them soon. He also found that other negative feelings were also comparably reduced, including the “big three:” frustration, guilt, and anxiety.

Derek and his colleagues have their own Tuesday training group in England, and I will soon be joining them with Rhonda for a 90 minute Q and A session. If you’d like to learn more about Derek’s work, or if you’re interested in training, you can contact him at dwr1971@yahoo.co.uk or www.feelinggood.uk.com.

Rhonda and I greatly enjoyed the recording and share great enthusiasm for Derek’s work spreading the word about TEAM-CBT in England. We hope you enjoyed the podcast as well, and thank you for your support of our efforts!

Rhonda, Derek, and David

The Feeling Good App: Part 2 of 2--

The Surprising Basic Science Findings--

How Does Psychotherapy REALLY Work?

And Why Did Everything Change So Fast?

Feeling Good Podcast Special Edition #2: March 07, 2022

Today’s special podcast features the second part of the recording with David and Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the basic science findings most recent beta test, which included 140 participants. David uses an advanced form of statistics, called Structural Equation Modeling (SEM) to identify causal effects and to learn more about how the app actually works. This information has immense practical and theoretical implications.

Here's a portion of what we’ve discovered so far.

1. All seven negative feelings are high correlated because they all share an unknown Common Cause (CC) predicted by David in one of the top psychology research journals in the late 1990’s. Here’s the reference2

Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473.

2. The CC accounts for most of the variance in all seven negative feelings, with R-square values ranging from 66% for anger, and 98% for Anxiety. Since there has to be some error variance in the estimates of the negative feelings, there is practically no room left for any significant additional causes.

If you would like to see the standardized output of the SEM model, click here.

3. The CC also has causal effects on Happiness, but these effects are much smaller, with an R-square of only 30%. This proves that Happiness has its own causes that are completely different from the factors that trigger depression. Happiness, in other words, is NOT just the absence of depression.
4. The radical reductions in all seven negative feelings were mediated by the reduction in the user’s belief in their negative thoughts, as predicted by cognitive therapists, like Albert Ellis and Aaron Beck, as well as the Greek Stoic philosopher, Epictetus, nearly 2,000 years ago. This is the first proof of that theory!
5. At least three components of the app have been isolated which appear to have substantial causal effects in the Common Cause, which in turn triggers simultaneous changes all negative feelings as well as happiness. Those three components include:
   1. A cognitive variable: the user’s belief in his or her negative thoughts.
   2. A motivational variable: measured with extremely precise and sensitive instruments.
   3. the user’s liking of the app.

The magnitude of all three causal effects was large. However, the motivational variables and user’s liking did not have direct effects on changes in depression and other negative feelings. The changes were ALL mediated via reductions in the user’s belief in his or her negative thoughts. This finding is consistent with the hypothesis that it is impossible to reduce negative feelings without change the belief in the negative thoughts that trigger those feelings.

6. The SEM models were replicated in two independent groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The fit of the model was outstanding in both groups, and there were few or no significant differences in the parameter estimates. This indicates that the findings are valid and do not represent capitalization on chance.
7. David has reported extremely rapid changes in all negative feelings in his single-session treatment of individuals using TEAM-CBT. Some people have suggested that this is because he often treats mental health professionals as well as individuals who are very acquainted with his work.

CLICK HERE FOR THE FULLL REPORT

However, data from the beta test indicates this is not likely to be true. Mental health professionals did not respond any differently from non-professionals. In addition, the Familiarity with David or with TEAM variables did have modest effects on the degree of liking of the app, but no direct causal effects on changes in depression or the Common Cause.

The basic research is just beginning and ongoing. David believes that the research potential of the Feeling Good App may be as significant as the healing effects documented in the outcome findings with the app in the previous podcast.

If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training module, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques for the first time to find out if the improvements last.

Research on more than 10,000 sessions by human therapists using TEAM indicates that a portion of the gains patients make during individual sessions dissipates between sessions, but the “staying power” of the gains is facilitated by the patient’s homework between sessions. As a result, patient gains tend to reach a steady state after four or five sessions.

We anticipate that something similar may be documented in longitudinal studies with the app, and are eager to see what we can learn in the next study which will extend beyond one day.

So, hopefully, the new study will be pretty cool, too! And who knows what we’ll discover, with your help! Make sure you sign up if you’re interested in being one of our beta testers!

David and Jeremy

Rhonda, Jeremy, and David

I was concerned that our recent “Ten Most Common Therapist Errors” show might antagonize people, but we got quite a lot of positive and encouraging feedback from listeners, which was surprising to me. As a result, Fabrice and I decided to take a chance and publish two more shows on common therapist errors this week and next week. We hope you like these shows!

Make sure you let us know what you think, and let me apologize in advance if I come across as annoying or overly cynical. All of the errors I describe are correctable; the goal is to improve the treatment of individuals struggling with depression, anxiety, troubled relationships, or habits and addictions. Thanks!

Here are the five errors discussed in today's show.

1. Failure to hold patients accountable. Example, the therapist may let the depressed patient slip by without doing psychotherapy homework, since the patient insists he or she doesn’t have enough time or motivation to do the homework; or the therapist may agree to treatment an anxious patient without using exposure, since the patient may resist exposure; or a patient may treat someone with a relationship conflict without exploring the patient’s role in the problem, and so forth.

David argues that this rarely or never leads to significant change, much less recovery. However, many therapists, and perhaps most, get seduced into this error for a variety of reasons.

2, The “corrective emotional experience.” This is the belief that the patient’s long-term relationship with the therapist will be sufficient for growth and recovery, without having to do any psychotherapy homework or be accountable. Therapist may imagine himself or herself as the loving and nurturing parent the patient never had.

David argues that this caters to the therapist’s ego and feeds into what the patient wants as well—a long-term relationship built on schmoozing.

But does it lead to recovery?

Here’s David’s short answer: Nope! Warmth, empathy, and trust are necessary ingredients for good therapy, but they are simply not sufficient. Your patient may think you’re the most wonderful and supportive listener in the world, but that will rarely or never lead to recovery from depression, an anxiety disorder, or an addiction, and it will not lead to the skills to heal troubled relationships, either.

3. Responding defensively to patient criticisms. David argues that therapists almost always react defensively to criticisms by patients, such “you don’t’ get me,” or “you aren’t helping,” or “you don’t really care about me.” He describes an interesting five-year study of psychoanalysts in Atlanta, Georgia, sponsored by the National Institute of Mental Health (NIMH), to find out how the analysts responded to patient criticisms. You may find the results surprising!

He gives an example of defensive responding during a workshop he conducted at a hospital in Pennsylvania. Therapists can learn to correct this error with lots of practice with the Five Secrets of Effective Communication, but this requires several things:

• Using the Patient’s Evaluation of Therapy Session after each session so can quickly pinpoint empathy / relationship failures.
• Lots of practice with the Five Secrets.
• Humility, and the willingness to see the world through the eyes of the patient. This requires the “Great Death” of the therapist’s ego!

4. Joining a school of therapy and treating everything with the same method or approach. Can you imagine what it would be like if medicine was organized like this, with “schools of therapy,” like the “penicillin school”? David apologetically argues that the abolition of all schools of therapy would be a good thing. Fabrice disagrees, and argues that the treatment of psychological problems is inherently different from the treatment of medical disorders.

Let us know what YOU think!

5. Confirmation paradox. I (David) majored in the philosophy of science in college, and this was one of the first topics, and it definitely applies to our thinking about the causes of emotional problems. I’ll try to make it really simple and understandable.

Here’s the essence of this error. If I have a theory that predicts the patient’s behavior you may conclude that your theory is correct. But this logic can be very misleading. Here’s a general science example

• Your theory: the sun circles around the earth.
• Your prediction: if my theory is true, the sun will come up in the east each morning and set in the west each evening.
• Your observation: the sun DOES come up in the east and set in the west, exactly as predicted.
• Your erroneous conclusion: the sun circles around the earth.

Now let’s consider a psychotherapy example. Many therapists believe that perfectionism and insecurity result from growing up with parents who emphasized hard work and high standards as a precondition for being loved. Now let’s assume that you have a perfectionistic and insecure patient who remembers feeling like s/he wasn’t good enough when growing up. So, you conclude that the patient’s interaction with demanding parents caused the perfectionism and insecurity.

But the perfectionism and insecurity may not have resulted from any childhood experiences or interactions with parents. It may have been strongly influenced by genetic factors, or social / environmental pressures.

We can put this in the same framework as the example about the sun:

• Your theory: Perfectionism and insecurity result from growing up in unloving families that emphasized high standards and achievement rather than unconditional love and nurture.
• Your prediction: Insecure, perfectionistic patients will report childhood experiences with unloving parents who pushed them to work harder, etc.
• Your observation: Your insecure, perfectionistic patients DO describe their parents as demanding and lacking in love and support.
• Your erroneous conclusions: The patient’s childhood experiences caused the perfectionism. 2. The patient will have to “work through” these childhood experiences if s/he wants to overcome the feelings of perfectionism and insecurity.

Secrets of Superb Interviewing--

How to Be Everyone's Number 1 Choice!

Today we feature our beloved Kyle Jones, Ph.D, a clinical psychologist who suggested we might do a really cool podcast on the interviewing skills featured in Chapter 16 of my Feeling Good Handbook. Rhonda and I are absolutely delighted to welcome Kyle for his third appearance on to the Feeling Good Podcast. (Rhonda had to excuse herself after introducing this episode because she was not feeling well)

In that chapter on interviewing skills, I listed the five basic principles of successfully interviewing for a job, for admissions to a school, or really almost any type of interview at all. I have to warn you that these ideas may be unfamiliar, and will definitely be quite different from what you've been taught about winning interviews.

#1: Be personable and friendly. Don't try to impress the person who's interviewing you!

#2 Make them sell themselves to you.

#3 Be honest, but present yourself in a positive light.

#4 Don't get defensive.

#5 Punt when you don't know the answer to the question.

To illustrate the first idea, I told a story from Dale Carnegie's book on How to Win Friends and Influence People, in which he describes his interview with a wealth and powerful man in the hopes of soliciting a donation  for the Boy Scouts of America. This was back in the era many years ago when the Scouts were still very popular. The receptionist who made the appointment warned Dale Carnegie that he would have only 15 minutes, and emphasized that her boss was 100% meticulous about time. He started exactly on time, and ended exactly on time, whether or not you were done, so he better talk fast once the interview started.

When the time came, and Dale Carnegie entered the office, the receptionist again reminded him that he'd be kicked out after 15 minutes no matter what! As he walked in, Dale Carnegie spotted a trophy fish proudly displayed on the wall above the rich man's desk, and asked, if the wealthy man he'd caught it. himself, The rich man said he had caught it in lake so and so. Dale Carnegie got excited and said, "I fish there too. Where, exactly, were you fishing on the lake when you caught this fish?" The man told him where his favorite fishing hole was, and they become engrossed in a vibrant conversation about the joys of fishing.

Suddenly, the office door opened, and the receptionist appeared and said the time was up. On the way out, the wealthy man said, "Oh, I forgot to ask you what the purpose of the interview was."

Dale Carnegie said, "Oh, I'm sorry, I forgot to mention that I am trying to raise money to support the Boy Scouts of America." The man replied, "You'll receive a check in the mail tomorrow for a million dollars." And those were the days when that was an enormous amount of money.

What's the moral of the story? Relate to the person who's interviewing you as a person, and show an interest in them, instead of pitching your talking points and trying to impress them. People usually make decisions influenced greatly by how much they like the person they are talking to. Don't try to be impressive. Aim for friendly, real and human.

How do you do this? Well, let's say that you have an interview with a law firm, hoping to get hired, and you're just out of law school. I used to be the shrink for the University of Pennsylvania Law School, and at the time there were too many law school  graduates looking for too few job openings, and almost no one was hiring. They referred despondent and panicky students to me who'd had a string of rejections. At the time, the top firms had at least 50 to 100 top notch candidates for every position. Was there any hope of starting their careers?

I told them to do some research on the person who was going to interview them, or on their firm. Find something interesting about them. Then, at the start of the interview you can say something like this: "I'm so excited to meet you because I've been following your work for some time. I was amazed and blown away by your strategy in the X, Y, and Z case, and I was wondering if you're still using that approach in litigation and how it's been working out? I'd love to hear more about your work, and how you came up with the approach you're using, and what you like the best about this firm."

This will get them to talking about themselves. DON'T try to impress them with how great you are . That will just bore them, or turn them off, and it will certainly put you under pressure to perform. This pressure will probably make you anxious, and your  anxiety and insecurity will show. Instead, impress them with how great THEY are. They'll love you!

I trained the students in this doing role-playing of imaginary job interviews. Every student I trained in this approach became the #1 choice at every firm they interviewed at!

This approach is not just for law students, it's for every type of job, as well as interviews for college, graduate school, and more. Here's the underlying idea. People don't really care much about you. They care about themselves. This is true of all of us. So, use this to your advantage, and you'll suddenly be super happy and glad you were OTHER centered and not SELF centered!

Does this mean you should hide your own skills and accomplishments? Of course now. You can answer questions about what you offer with humility and integrity. But that alone will rarely be enough.

#2 Make them sell themselves to you.

Let's say you're applying for graduate school, and it's very competitive. Again, they have 100 brilliant candidates for every position. Suppose the interview says something challenging, like "As you know, all the top candidates in the Unites States apply to us here at Harvard. Most of them were #1 in the their college classes and several have already been nominated for Nobel Prizes. Why should we be interested in you?" This, of course, is absurd, but I'm taking the worst imaginable question in an interview.

Yikes! This sounds impossible, right? How in the world could you respond?

Actually, it's easy. You can just say, "Gosh, I don't know if I'd be a good fit here. That's what I'm hoping to learn today. Maybe you can tell me what you're looking for in a top notch candidate. What kinds of candidates have gone on to be stars, and what types have been disappointments? Then I can give you a better answer on whether or not I might be a good fit. Although I love your company, and I'm so impressed with your own career, I wouldn't want to accept a job unless I was convinced I could really contribute to your firm."

Is this realistic, or just some David fantasy?

During my senior year in college, I was planning to go to graduate school in clinical psychology, since I'd majored in philosophy and psychology seemed like a way more practical career.  However, my college adviser said that medical school would be a far better choice because medications were becoming more and more important in treating mental illnesses, and only psychiatrists could prescribe drugs.

I told him that I'd never had any interest in being a medical doctor, and wasn't even a premed student, so there was no way I could get into medical school. I hadn't even had a single biology class in college.

He said "That won't be a problem I don't think. You've got the gift of gab, and they probably won't even notice."

So, I applied to a number of medical schools and landed an interview at Stanford, and several others. My interview was with someone in the Anatomy Department which was located in the basement of the museum on campus.

I went down the stairs and into a room where I met the man who was interviewing me. I said, "It's a bit dark down here. Is this where the medical students dissect their cadavers?" He said, "Absolutely. But it's actually pretty awesome down here. In fact, my laboratory his just down the hall.

I said, "Oh, could I see your laboratory? I'd love to take a look and find out what kind of research you do."

He seemed excited and as we walked into his lab I noticed all kinds of fancy equipment and read the name on one of them, so kind of photometer or something. I had no idea what it was, but said, "Oh, I see you have an X, Y Z photometer. (or whatever it was). Do you use this in your research?"

He said, "Oh, absolutely, it's extremely important in my research."

I asked him about the research he did. He excitedly started explaining it, and for the most part I had no idea what he was talking about, but kept expressing interest and asking him for more and more information. I was terrified that he'd ask me questions about my undergraduate work and my research, which of course did not exist. I'd never done any research! Just philosophy classes and such.

Well, we had quite the conversation, but after a while he suddenly looked at his watch and said, "Oh, my goodness. We were only supposed to talk for 15 minutes, and we've been talking for nearly two hours. I have to rush over to the medical school quad for an important meeting I'm almost late for. Why don't we walk over in that direction together?"

As we were walking out of the basement, he said, "Oh, my goodness, I forgot to ask you who you are and where you're from."

I said, "Oh, I'm David Burns from Amherst College."

He said, "Well, David Burns, I want you to know that you're the kind of young man we need at the Stanford Medical School.!"

I said, "It's really kind of you to say that, but I'm afraid I won't be able to come to the Stanford for medical school."

He said, "That's nonsense? Of course you can come! Do you think Harvard is going to make you a better offer? We'll top anything they offer."

I said, "Oh no, sir, that's not it. You see, my father is a minister, and we don't have much money, and I've heard that attending medical school would cost more than one hundred thousand dollars. And he believes that borrowing money is a sin."

He said, "David Burns, I'm the head of the admissions committee, and that's where I'm headed right now. And I'm going to tell them that you're the #1 choice for admission this year. And you won't have to pay a thing. We'll pay for tuition, room, board, books, expenses, everything. It won't cost you one cent to go to Sanford medical school."

I said, "Oh, thank you so much! That's an offer I can't refuse!" I got my acceptance letter two days later and the rest, as they say, is history.

But to spell it out. Why was I accepted to a top-flight, highly competitive program when I had absolutely NO credentials? Because I expressed an interest in him, and I was friendly, and I believe that meant a great deal to him. And I'll always be grateful for his help.

My wife and I returned to Stanford almost 30 years ago, where I've served on the voluntary (unpaid) faculty at the medical school, teaching  and doing research and continuing to develop TEAM CBT. I turned out to be a terrible medical student, and dropped out for a full year on two different times because I just wasn't the "medical" type. I had very little aptitude or interest in medicine.

But I did end up as a psychiatrist, and came to love medicine and healing people who were suffering, and doing research. And my voluntary work is my way of trying to repay my tremendous debt to Stanford! And I'll never forget the kind gentleman who interviewed me.

Kyle and I jammed on all five examples, including many additional stories to bring these ideas to life. Kyle used this strategy when interview for his internship in psychology, and it worked like a charm. I would say that I've taught many people how to use these ideas, including family members, students, and colleagues. The impact has been nothing short of incredible.

That probably sounds over the top, and I "get it." But the stories are true, and the ideas can change your life. Remember what the Buddha said, 2500 years ago: "Selling yourself sucks! So, Stop it, and do what works!"

Warmly, Rhonda, Kyle, and David

Contact information

Kyle is a superb TEAM CBT therapist who practices virtually throughout California. Here's his contact information:  Dr. Kyle Jones

New Ask David Questions

1. Kelly asks: Would love to hear a podcast about to use or not to use touch in therapy. I personally feel touch is extremely helpful (what is more natural than to hug or put a hand on someone hurting), however I believe our profession has become so “professionalized” that is leaves out such a power act of healing. Did you ever use touch when you were practicing, and do you feel it is appropriate?
2. Against Machines Taking Over asks: You say that depression always results from distorted thoughts. But the sadness that results from a failure, rejection, or disappointment is not distorted. Can you explain a bit more about this?
3. Against Machines Taking Over also asks: Is there something you used to advocate for before but then you changed your mind?
4. Eduardo asks: How do you treat hypochondriasis. Almost all articles and advices I've read for hypochondriasis try to cover the writer's back by first and foremost telling you that you should get yourself checked for real causes for your concern.
5. Eduardo also asks: I've been struggling with anxiety, and after reading When Panic Attacks, I got very interested in giving The Hidden Emotion model a try, but it seems to be structure-less. It seems to require a lot of detective work with no clear sheet or procedure. It's just Detective Work, and then do something about it. Is there some newer technique to dig into what's eating you?

David and Fabrice answer five intriguing questions submitted by listeners:

1. Joshua: How can I cope with panic attacks during job interviews?
2. Dan: I feel traumatized by criticisms from my boss at work. what can I do?
3. Susan: How fast can you taper off of anti-anxiety drugs and antidepressants?
4. Ross: What if a patient who's been the victim of trauma or abuse asks for a male therapist? Isn't this a form of avoidance? Should patients be matched to therapists based on gender? Isn't it best to avoid the situations that trigger you?
5. Sumit: I think I have "endogenous depression." Can TEAM-CBT help me? Or will I have to rely on medications? What is endogenous depression?

If you have a question, make sure you email david and we will try to answer your question on an upcoming Ask David Podcast!

On April 9, 2020, David and Rhonda did a live TEAM-CBT session with Dr. Taylor Chesney, a former student of David’s who is now the head of the Feeling Good Institute of New York City. Her husband, Gregg, is an ER / ICU (Emergency Room / Intensive Care) doctor in New York, and she was terrified he might contract the corona virus and die. Gregg was also terrified, as he had to intubate two of his colleagues who are struggling in the ICU, and recently had trouble breathing. He is working long hours and lives in a separate apartment to protect Taylor and their three young children.

The response to that podcast was extremely positive. Here's an email from a therapist in India, Nivedita Singh:

Dear Dr Burns, Rhonda and Taylor,

Just finished listening to your 4th podcast of the Corona series. What an emotional roller coaster learning and healing journey it's been. Can never ever thank you enough. Living far away in India and watching the Corona story unfold on the international news channels has been overwhelmingly scary for most of us, especially those who have our kids attending different schools in the United States. They share their fears and anxieties or protect us (their parents) by withholding it ... both of which makes us feel helpless and fills us with dread.

The podcast today built some amazing perspective. Taylor is a Braveheart to Gregg being a Superhero. The podcast was so pure, had such integrity and absolute raw honesty! It required great courage from Taylor to allow her vulnerability to surface and an equal amount of brilliant skills set by both the therapists to communicate empathy that soothed the right spot not just for Taylor but for everyone of us across the globe who are dealing with the pandemic. When you addressed the distortions you were addressing all of us and our anxieties.The role play method had us confronting our own demons! Yes! All of us on this planet who have families stranded somewhere ...  who are battling the virus ...  or fighting in the front-lines, felt therapeutically addressed.

I personally found myself choking when Taylor did, relaxing when she relaxed and found myself to be gripped by fear when she became vulnerable again. I was on the rollercoaster with her. By the time the podcast drew to an end I could sense my shoulders relaxing ... my breathing getting even and my fists unclenching. Something in the head or somewhere inside of me felt right. I insisted my family and friends listen to the podcast ... and the unanimous feedback was that plenty of pennies dropped for all of us at different times in the podcast. You, Dr Burns and Rhonda made all of us feel less anxious, less fearful and more in control of our emotions; and also compassionate and super, super proud of the Greggs and Taylors of the world.

I am extremely grateful to Taylor (who I have met as a beautiful and driven young professional; and I got to see the devoted mum and wife in her) for letting us in to be a part of her journey. Wish her and her family lovely times ahead.This too shall pass ...

Stay safe. Take care.

Warmly and even more awestruck (by you Dr Burns). Thank you again for giving us TEAM.

Nivedita Singh

(Your biggest fan this side of the Pacific).

One week after the recording of that podcast, Taylor learned that Gregg, has, in fact, been struck by the Covid-19 virus, so her worst fear has become a reality. What do you think happened? Did the monster have no teeth, as David sometimes argues?

Listen to this powerful podcast and you will find out!

David describes several patients he treated who had intense fears of going bankrupt, who did, in fact, go bankrupt while in treatment. What happened when their worse fears were realized--and why?

The cognitive model states that only our thoughts can upset us, and that the thoughts that upset us will be distorted. Depression and anxiety, David argues, are the world's oldest cons. Could the cognitive model be correct in this era where we are fighting something that IS real and IS dangerous?

During today's podcast, Rhonda asks Taylor about her romance with Gregg, how they met, what happened on their first date playing frisbee in Central Park, and how their relationship evolved. Taylor recalls the psychodynamic training she received during her graduate work in clinical psychology, which was all about listening without teaching patients to use specific tools to change. Taylor's teachers explained that there was no point in trying to change until you discovered the cause of your problems.

Gregg did not agree and urged Taylor to think more about helping her patients change their lives, using specific tools. After all, a medical doctor doesn't just help patients understand why they have pneumonia--the goal is rapid cure whenever possible--understanding the causes doesn't necessarily help or lead to change. In addition, the causes of all psychiatric problems are currently unknown, so the focus on endless talk to understand the causes of depression, anxiety, relationship problems or habits and addictions could even be seen as nonsensical.

Taylor had a chance to check this out when she and Gregg moved to California shortly after they were married in 2012. Gregg had a two-year Critical Care fellowship at Stanford, and Taylor joined Dr. Burns TEAM-CBT weekly training group at Stanford to prove that the rapid-change techniques wouldn't work. But they did work. She concluded that TEAM-CBT really IS all it's cracked up to be and fell in love with TEAM. The rest his history. When Taylor and Gregg returned home to New York two years later, she founded the highly acclaimed New York Feeling Good Institute. 

During today's interview, Taylor is caring for her three beautiful and charming children, but they all want mommy's attention. It's obviously an overwhelming job, on top of her clinical work with patients, and most moms face similar challenges. Taylor provided several tips for moms who may be listening to the show from home during these days of "Shelter in Place" orders, restricting people all around the world to their homes.

1. Emotional Intelligence Training. I try to check in with each child every day to get an emotional read on how they're doing. This varies for each child based on their age. For my 6 year old, we use the Yale Mood Meter since that's what he uses in school. For my 4 year old, I name a few emotions such as happy, angry, sad, and ask her what's a time today she felt any of those. For my 2 year old, I try to find a time where he's thrown a toy or pushed a sibling and mention an emotion he might be feeling such as happy, sad, or angry, and act it out. He often just laughs but it starts to help him develop his emotional intelligence.

2. Scheduling. Every evening I write out our daily schedule for the following day. This helps to keep me organized, but also helps my children know what to expect each day and gives us a flexible guide for the day. This includes things such as meals, brushing teeth, nap time, screen time, social time, exercise, and academics.

Certain activities are required, while others are more flexible. Since my kids are just 2, 4, and 6 years old, there are fewer "requirements" but over time I plan to try to push them a little more to stick to the schedule. Since social distancing and being home is something we have not had any practice with, I want to ease into our new schedule.

3. Independent play. I schedule some time for independent play each day. This is a skill I've really been focusing on with each child, and find that it's important for them to learn to play by themselves. Social playing is great, but learning to be alone is important as well!

For my 6 year old the goal is 20 mins, for my 2 year old it's 10 mins with minimal help from mommy. We make it a fun game, and they get a  small reward if they are able to reach their goal. The rewards could include a hug, high-five, praise, stickers or even a new action figure. I try to switch the types of rewards to keep it fun and interesting, and also so they're not just doing it so that they get X privilege or Y toy.

4. Little Steps for Big Feets. I try to set small, manageable goals each day for each child as well as myself. Sometimes it's something I impose on the kids such as "today each of you will help me with one chore, such as taking the garbage out, cleaning up your toys, washing the table, etc."

At other times it's something they want to learn. For example my daughter wants to learn to write her name so for several days her goal was to practice writing her name four times. For me it's usually a small manageable goal related to work or house-cleaning. This is similar to David's principle of "little steps for big feets!" For example, instead of saying I'll clean my entire apartment today, I focus on one small goal that I can attain.

Taylor gives an awesome example of how to use the Five Secrets of Effective Communication with small children, especially when they are angry or upset. This is an example every parent might want to emulate! And it's the first example I've heard of how to do this!

Thanks for tuning in, and please let us know what you thought about today’s program!

Rhonda, Taylor, and David

On February 24, 2020 we published Podcast 181, "Live Therapy with Sarah: Shrinks are Human, Too!" This was a live session with Sarah, a certified TEAM-CBT therapist, conducted at my Tuesday psychotherapy training group, because Sarah was struggling with intense anxiety, bordering on panic, during  therapy sessions with her patients. It was a phenomenal session with outstanding results. The Hidden Emotion technique was the main focus of that session, bringing to conscious awareness some feelings of anger and resentment that she'd been sweeping under the rug. This is a common cause of anxiety.

But a month or so after that session, Sarah relapsed in a big way, so I agreed to treat her again during the psychotherapy training group at Stanford, and Dr. Alex Clarke was my co-therapist. This time, we used very different treatment techniques.

Once you've recovered, the likelihood of relapse is 100%--that's because no one can be happy all the time. We all hit bumps in the road from time to time, and when you do, your "fractal" will come into prominence again. This means that the same kinds of negative thoughts and feelings will return in an almost identical form. This can give you the chance to defeat them again and strengthen the positive circuits in your brain.

That's exactly what happened to Sarah. Approximately one month after the first treatment session, she had a viral infection, and began taking large amounts of Advil to combat the symptoms. This led to severe feelings of nausea, followed by panic. Multiple trips to the doctor failed to reveal any diagnosable cause for her somatic symptoms, aside from the possibility of Advil side effects. However, the discomfort was so severe that she panicked, fearing that she had a more severe medical problem that the doctor had overlooked. She lost 13 pounds over the next two months, and requested an emergency TEAM-CBT session, which Dr. Clarke and I were very happy to provide, since live work almost always make for superb teaching.

If you take a look at Sarah's Daily Mood Log, you'll see that the upsetting event was waking up Sunday morning still sick and anxious for the 100th day in a row. She circled nine different categories of negative emotions, and all were intense, with several in the range of 80 to 100. and she had many negative thoughts, including these. Please note that she strongly believe all of these thoughts:

After empathizing, I asked Sarah about her goals for the session. She said she wanted greater self-confidence and less anxiety, and said her husband had theorized that if the anxiety disappeared, her somatic symptoms would also go away. But when we did Positive Reframing, Sarah was able to pinpoint more than 20 overwhelming benefits of her intense negative feelings, including many awesome and positive qualities and core values that her negative thoughts and feelings revealed about her. This always seems to be a shocking and pleasant discovery for the patient!

At this point, we used the Magic Dial to see what Sarah wanted to dial her negative feelings down to, as you can see here. Then we went on to the Methods portion of the session, using techniques like Identify the Distortions, Externalization of Voices, Acceptance Paradox, and more. We also had to revert back to the Assessment of Resistance once again when Sarah began to fight strenuously against giving up her self-critical internal voice. We did a Cost-Benefit Analysis on the advantages and disadvantages of being self-critical and not accepting her fragileness, weaknesses, and flaws.  Once we "sat with open hands" and listed all the reasons for her to continue criticizing herself, she suddenly had a change of heart and really poured herself into crushing her negative thoughts. It was interesting that as she began to blow her negative thoughts away, she suddenly got hungry for the first time in months!  If you click here, you can see how she felt at the end of the session.

It was a mind-blowing session, with much potential for learning. Rhonda, Dr. Clarke and I hope you enjoy it!

Here were some "teaching points I sent to the tuesday group members after the session.

1. This could not have been done in a single session. At least in my hands, a two hour session is massively more cost-effective than a bunch of single sessions. But even then, you have to have a plan and move quickly.
2. Although you all said wonderfully admiring things to our “patient” during the E = Empathy phase of the session, few or none of you used Thought Empathy or Feeling Empathy, which is vitally important. I thought that Fabrizio did a magnificent job with “I Feel” Statements, expressing genuine warmth and compassion.
3. As usual, resistance was the key, and could not have been overcome with efforts to “help” or attempts to use more M = Methods. Learning the dance of reverting instantly to A = Assessment of Resistance is key (revisiting this when the patient resists during M = Methods. But this requires “sensing” that the patient is resisting during Externalization of Voices, for example. You have to kind of “smell” what is happening, and then suddenly change direction. You also have to be able to “see” that the patient is absolutely committed to some underlying schema or belief, like “I should always be strong and vivacious,” etc. The Assessment of Resistance cannot just be an intellectual exercise, as it might then revert to “cheer-leading.”
4. Emotion and tears are crucial, and amazing work was done by Sarah, our “patient,” during the tears. She gave herself compassion at that moment. But tears alone without the structure would not have had nearly the impact. Skillful therapy integrates multiple dimensions at the same time. It cannot be formulaic. It's an art form, based on science, and it is data-driven, based on the patient's ratings at the start and end of the session.
5. During the Externalization of Voices, I would recommend that you NEVER settle for a “big” win. Shoot for huge, and stick with the same thought for as many sessions as necessary to get to “huge.”
6. During the role playing I switched back and forth from Ext of Voices to Paradoxical Double Standard and then back frequently, as they both draw on different sources of pretty incredible healing power.
7. As a therapist, I never give in to a patient’s feelings of hopelessness, because rapid and dramatic recovery is usually possible.
8. Relapse Prevention Training (RPT) will now be necessary, since NTs always return. RPT only takes about 30 minutes.
9. I apologize for taking over last night, but felt my strongest commitment is to provide relief for the person in the “patient” role.
10. Sometimes what you think of as your worst “flaw” (eg being suddenly weak and fragile and fearful) can be your greatest asset in disguise, once you accept your flaw(s). But we fight against acceptance, thinking that if we beat up on ourselves enough, something wonderful will happen. And, of course, the self-criticism can sometimes reap big dividends. At the same time, I try to remind myself that self-acceptance is the greatest change a human being can make.
11. The goal of therapy is not just feeling somewhat better, but getting to enlightenment and joy. That's what happened tonight!

After the session, I received this awesome email from Sarah:

Thank you from the bottom of my heart, David, Alex, and all members of our training group who were present tonight.

Such beautiful contributions from all, and I appreciate so deeply this 2nd opportunity to do personal work, especially given that we are ALL going through difficulties during this Covid-19 crisis (or in general).

I feel so much lighter, even enlightened, ate some pot roast for dinner (What??? I haven't had an appetite for something like that in a LONG time... and find myself looking forward to my sessions with my patients tomorrow). And I also know I'll have moments of relapse, but I really felt like I finally defeated those thoughts and especially the core belief.

Stay healthy and safe everyone, I look forward to opportunities in the future when we reunite, to be in support of YOU.

Best,

Sarah

Rhonda, Alex and I want to thank you, Sarah, once again, for your tremendous courage and generosity!

David and Rhonda

In today’s podcast, we discuss a few of the many differences between Feeling Good, my first book, and my new book, Feeling Great, which was just released. We also discuss some of the differences between the cognitive therapy that I launched in Feeling Good, and the powerful new TEAM therapy that I feature in Feeling Great.

I wrote Feeling Great because there’s been a radical and enormous evolution of the treatment methods and theories in the 40 years that have elapsed since I first published Feeling Good in 1980. I now have many more techniques than I had then, and there’s been with a radical development in my understanding of the causes of depression. I also have new ideas about the most effective treatment techniques, based on my clinical experience since I wrote Feeling Good (more than 40,000 hours treating individuals with severe depression and anxiety), as well as fresh insights about what's important, and what's not, based on four decades of my research on how psychotherapy really works.

Rhonda asks many questions about the unique features of TEAM including the new T = Testing techniques, the new E = Empathy techniques, the A = Assessment of Resistance techniques, as well as the M = Methods.

Rhonda is particularly curious about the four “Great Deaths” of the therapist’s ego in TEAM therapy, which correspond to the four TEAM components of TEAM, as well as the four “Great Deaths” of the patient’s ego, which correspond to recovery from depression, anxiety, relationship problems, and habits and addictions. One of the goals of TEAM is not simply the complete and rapid elimination of the symptoms of depression and anxiety, but the development of personal enlightenment and the experience of great joy and a deeper appreciation of life.

Toward the end of the podcast, David tearfully talks about the life of his hero, Ludwig Wittgenstein, who is viewed by many as the greatest philosopher of all time, and David, a philosophy major when he was a student at Amherst College, would definitely agree with this assessment. But Wittgenstein was very lonely, and prone to depression, because very few people understood his ground-breaking contributions when he was still alive. In fact, it was thought that only five or six people in the world “got it.” Part of the problem is that what he was saying was so basic and obvious that most people just could grasp it, or the extraordinarily profound implications of his work.

His depression and loneliness, sadly, perhaps also resulted from the fact that he was gay, and living at a time when this was far less acceptable than it is today.

He never published anything when he was alive, because when he was depressed, he thought he'd made no meaningful or enduring contributions. However, his remarkable book, Philosophical Investigations was published in 1950, following his death, and was soon regarded as the greatest book in the history of philosophy. Because of that book, David gave up his goal of a career in philosophy, since Wittgenstein wanted all of his students to give up philosophy and do something practical instead.

So that’s what I did! My only regret is never having the chance to meet Wittgenstein and tell him, “I got it!” and thank him for his incredible contributions. If you want to learn more, check out the short read by his favorite student, Norman Malcolm, who wrote “Ludwig Wittgenstein: A Memoir.” I cry like a baby every time I read the book, and tears come to my eyes when I even look at the book, which is proudly displayed in my office. If you ever visit me at home, make sure you check out the  book.

I feel so fortunate to be able to work with Rhonda and bring my message to so many of you every week. Thank you for your support!  [Note from Rhonda:  I feel extremely honored to work with David and be a part of bringing David's message, and the TEAM therapy model to our listeners!]

David and Rhonda

The Mindfulness Mystery Tour!

And Two Mind-Boggling Discoveries about Meditation!

Featuring Jason Meno

Today, Jason Meno, our beloved AI guy on the Feeling Great App team, shares some incredible and innovative research he recently did on the effect of meditation on how we think and feel. As you know, basic research is a high priority of our app team, and our major focus is to make basic discoveries in how people change, and especially on what triggers rapid and dramatic change. We use that information to develop and refine the app on an ongoing basis, and also to contribute to basic science.

Jason recently created a “New Cool Tools Club” which has 160 members who Jason can notify whenever he has a cool new app tool that he wants to test. If you are interested in joining, you can find his contact information at the end of the show notes. There is no charge if you’d like to join this group!

Jason had a strong background in Buddhism and has been working with our company for several years, focusing in the last year on the AI chat bot portion of the Feeling Great App. He has meditated for many years, and uses TEAM-CBT as well to deal with his personal moments of stress and unhappiness, something that most if not all of us experience at times!

Introduction

Jason was interested in evaluating the short-term impact of meditating, and did a literature review but found that most or all of the published studies had a focus on the effects of daily meditation over longer periods of time, like two months for example.

He was also interested in how long and how often people should meditate, and what types of meditations, if any, were the most effective.

So, he decided to test a one-hour meditation experience consisting of five ten-minute recorded meditations, including

1. A body scan meditation, systematically relaxing various parts of your body, beginning with your feet and toes.
2. A breathing and counting meditation, where you focus on your breathing and count the breaths going in and out.
3. A loving kindness meditation, starting with sending feelings of love, happiness, and health first to someone you love, then to yourself, then to someone you aren’t especially close to, or don’t particularly like, and on and on until you are projecting love and kindness to the entire universe.
4. A mindfulness exercise where you notice if you are thinking, hearing, watching, remembering, and so forth as various thoughts pass through your mind.
5. A “Do Nothing” meditation where you are instructed to simply “do nothing” for ten minutes.

Because previous research on meditation did not use scales that assessed specific kinds of negative feelings in the here-and-now, he decided to use the highly accurate 7-item negative feelings sliders as well as the 7-item positive feelings sliders prior to the start of the medicine, after each meditation, and at the end of the app.

He also asked many questions about motivation and expectations prior to the start of the meditation experiences, all answered from 0 (not at all) to 100 (completely), including

1. How familiar are you with David’s work?
2. How familiar are you with meditation?
3. How strongly do you believe that meditation will make you feel better?
4. How strongly do you believe that meditation will be rewarding?
5. How strongly do you believe that meditation will only have a small effect?
6. How strongly do you believe that meditation will be a waste of time?
7. How strongly do you believe that meditation will make you feel worse?
8. How strongly do you believe that it will be painful or difficult?

You can find these data at this link.

He also asked every participant to generate an upsetting negative thought, like “I’m a loser,” and use 0 to 1000 sliders to indicate how strongly they believed that thought, and how upsetting it was.

60 individuals started the experiment, and 35 completed it, with 25 dropping out prematurely before they completed some of the meditations.

He presented the data as a two-group analysis, those who completed and those who failed to complete the hour of meditation. Here, are just a few of the preliminary findings, and more refined analyses are planned so we can look at causal effects.

1. Both groups were moderately to very familiar with David’s work and with meditation.
2. The completers had higher scores on the questions about positive expectations than the dropouts, although the differences were not great.
3. The dropouts had substantially higher scores on four questions about negative expectations for the experience, like “it will be a waste of time” or “it will be painful or difficult.”
4. The initial scores on the belief in the negative thought were similar in the two groups (76% and 74%, respectively), but the Upsettingness of the thought was a bit higher in the completers (83% and 79%.
5. The mean of the initial scores on the 7 negative feelings sliders was significantly higher in the dropouts (37% and 46%, respectively), while the initial scores on the 7 positive feelings sliders was somewhat lower in the dropouts (49% and 45%, respectively).
6. Both groups expected a modest reduction in negative feelings and a modest boost in positive feelings during the hour of meditation.

Results on the 35 completers

1. After the first ten-minute meditation, there were significant reductions in the negative feeling sliders (from 37% before to 25% after) and increases in the positive feeling sliders (from 45% before to 55% after).
2. There did not appear to be any additional improvements in negative or positive feelings in the subsequent four meditations.
3. There was a significant reduction in the belief in the negative thought after the first meditation, and the reduction continued throughout the next four meditations. (76% to 54%), for a reduction of 29%.
4. There was a significant reduction in the upsetness caused by the negative thought after the first meditation, and the reduction continued throughout the next four meditations (79% to 47%) for a reduction of 40.5%.

You can find the remarkable results if you click here!

There are many fascinating results, but one of the most amazing--which we've replicated almost exactly in independent beta tests--is the remarkable similarity between the changes in negative and positive feelings the participants predicted, and the actual results. They are so close it looks like somebody faked the data, but that's not the case at all.

We will have to do more analyses to figure out what this means, but in simple terms, this seems to be iron clad proof that our expectations of the mood changing results of any intervention can be tremendously powerful. In fact, you could argue--and it would need further statistical analyses to test--that the causal impact of the expectations eclipsed the causal impact of the actual intervention, which in this case was meditation.

One of the cool things about quantitative research is that it nearly always shoots down our favorite hypotheses, and also gives us new and totally unexpected gifts to stimulate our thinking! In this instance, there were at least two mind-boggling and toally unexpected results:

1. When people mediate, the improvement in negative feelings is accompanied by parallel reductions in participants belief in their negative thoughts.
2. Participants predictions of the changes in seven negative and seven positive feelings by the end of the hour of meditation were spot on, and seemed almost impossibly accurate!

Discussion

The findings are exciting and specific, and suggest that the reduction in negative feelings during meditation may be, and is, mediated by the reduction in the users’ belief in their negative thoughts. We will attempt to look into this more deeply using non-recursive analytic methods with SEM (structural equation modeling).

All samples are biased, and it can sometimes be extremely helpful to understand the bias in your sample when interpreting the results. The sample in this case included users favorably disposed to meditation, and responding to an email inviting them to participate in a meditation experiment. Only those who persisted the full hour were analyzed in the final outcome data, which could be another source of bias in the data. How much improvement would we have documented if we were analyzing completers (45) AND dropouts (35)?

Actually, this type of analysis is possible using Direct FIML (Full-Information Maximum Likelihood) with SEM techniques. I will, in fact, do these analyses as soon as I get the data set from Jason. This will allow me to estimate the scores at the end for all participants, including those who dropped out. It seems mathematically impossible, but it actually can be done.

If those who dropped out are systematically different from those who continued, it will “know” and correct for this. For example, if those who dropped out were, on average, doing more poorly, then the estimates based on those who persisted will be biased, and the degree of bias could potentially be infinite. The SEM analyses will also tell us if there are no significant differences in those who  persisted and those who dropped out.

Finally, the data LOOKS like the meditation “caused” some fairly significant improvements, although the results were in some ways puzzling. Using SEM, I should be able to determine whether, and to what degree, the improvement was simply a “placebo” effect resulting from the participants expectations of improvement, as opposed to an actual result of the meditation.

So, stay tuned for updates on this amazing and deeply appreciated research initiative by our beloved Jason Meno!

Thanks for listening today.

Rhonda, Jason, and David

#252: Sadness as Celebration, Part 1

In today’s podcast, Rhonda and David present Part 1 of their work with a young woman named Rose. Rose is a 38-year-old mother of two boys aged 2 and 5. She works as a Therapist at an outpatient clinic, the East Bay Center for Anxiety Relief, and is a member of our Tuesday training group at Stanford.

Rose sought help because of her profound grief after talking to her mother about her father’s recent visit to his oncologist. Her father has had many severe health problems in the past several years. He’s been a survivor, but suddenly the outlook seems bleak, and Rose feels tremendous sadness and fear, because of her deep love for her father.

In most cases, grief does not need treatment. Clearly, grieving is healthy and even necessary when you lose someone you love. However, it can be helpful to distinguish healthy from unhealthy grief.

From a cognitive therapy perspective, all feelings, including grief over the loss or impending loss of someone you love, result from your thoughts. Healthy grief results from negative thoughts that are not distorted. For example, if a loved one dies, you may think of all the things you loved about that person and the experiences you will no longer be able to share. Your sadness is actually an expression of your love.

Healthy grief, in contrast, results from distorted thoughts. For example, in my book, Feeling Good, I described a young physician who became suicidal when her brother committed suicide because she told herself; “I should have known he was suicidal that day. His death was my fault, and so I, too, deserve to die.”

This thought triggered intense guilt, and it contains many of the familiar cognitive distortions, including Self-Blame, Emotional Reasoning, Should Statements, and Discounting the Positive, and Fortune-Telling, to name just a few. With my help, she was able to challenge and crush her distorted thoughts, and her depression disappeared.

Then she was then able to grieve his tragic death. Paradoxically, the distorted thoughts that triggered the unhealthy grief had actually prevented her from grieving in a healthy way. Today’s podcast is illuminating because Rose is experiencing a combination of healthy and unhealthy grief resulting from a mix of undistorted and distorted thoughts.

The work that Rose did is incredibly inspiring, and sad. Today we will publish the first half of the session, including T = Testing and E = Empathy.

Next week, we will publish the second half of the session, starting with the question, “What do we have to offer our patients once we’ve empathized?” Then you will hear the A = Assessment of Resistance and M = Methods portion of our work with Rose.

T = Testing

Take a look at the Daily Mood Log (LINK) that Rose shared with us at the start of her session. You will see that she had very elevated scores in 8 different categories of negative feelings, suggesting she was in pretty intense distress. We will ask her to rate these feelings again at the end of the session so we can see if she experienced any changes during the session.

I’m a firm believer that all therapists should use testing at every session, and many are now doing this, but lots of therapists still refuse for a variety of reasons. I was going to say “bogus reasons,” but didn’t want to sound harsh or dogmatic!

To me, the refusal of psychotherapists or psychiatrists to measure symptoms at every session is the “unforgiveable sin!” I don’t believe it is possible to do good therapy, much less world class therapy, without Testing, for a wide variety of reasons:

1. Therapists perceptions of how patients feel, and patients feel about them, are not accurate.
2. Measuring suicidal urges at the start and end of every session can save lives.
3. Seeing how effective. or ineffective, you were at every session allows you to fine tune the therapy and abandon strategies and methods that aren’t working in favor of better techniques. This turns your patients into the greatest teachers you’ve ever had—IF you can take the heat!
4. You will see, for the first time, how your patients rate your Empathy and Helpfulness at every session. At first, this information can be incredibly shocking, but if you process it with your patient at the next session in the spirit of humility, warmth, and curiosity, the experience can be transformative.

E = Empathy

Rose explained that she was feeling acute grief because of her father’s health problems. He had extensive surgery to remove a cancerous kidney in 2014, but the surgeons found additional unusual growths around his spleen.

Her dad has also had open heart surgery, surgery to remove a bone tumor, and many other serious medical problems. She said, “he’s like a cat with nine lives, but we’re concerned that now he’s near the end.”

He experienced GI distress and vomiting in September of 2020, and was hospitalized again in February of 2021, but they found nothing. In March, he was again hospitalized, and the doctor found an aggressive cancerous liposarcoma in his abdomen.

Then they found more tumors in his back, and determined that it was Stage 3. The usual treatment would include radiation and more surgery, but he simply cannot stand any more surgeries, so we began to lose hope.

Rhonda commented that he’s suffered greatly, and the family has suffered as well, since 2014.

Rose and her family finally got to visit him in San Diego on Memorial Day, and this was helpful. She said he’s still really active with the activities he loves, including golf and gardening, and treasures every moment, and loves spending time with his two grandsons.

Rose painfully described the impact of the pandemic, which meant they were only able to visit him twice in the past year. That made it especially nice to connect and see his grandsons during their Memorial Day visit. She said he was especially “present” and cherished those moments.

She said:

He was doing pretty well, and was telling his friends that he’s happy with what he’s accomplished in his life. He grew up in Bosnia, and was poor, with many challenges, so family is really important to him. Catholicism was the center of his culture. The whole family feels more connected now. The grief has brought us closer together.

He’s started chemotherapy, but I’m pessimistic. The doctor said it was only 20% effective, and it’s expensive: $3,000 a month. I do not really know what the timeline is, but it was helpful to visit in person and to see that he can feel joy.

My negative feelings typically run in the range of 50 to 60, but they can be suddenly triggered and spike much higher; for example, when I tell myself that he won’t get to see his grandchildren and share so many important moments with them when they’re growing up.

He tries to comfort us when we ask how he’s doing, and he says, “I’m okay; I’m just a little tired.”

My anxiety fluctuates because so much is not known. I’m not sure how this will affect him. What will the impact be? I’m afraid he’ll get depressed because he may not be able to do the activities he loves, like golf.

I also struggle with feelings of guilt. Should we have visited more? Should we move from the Bay Area to San Diego?

We’ve been having some zoom calls, but they’re hard. The boys compete for his attention on the calls.

Rhonda asked: “You seem to have so much love for him. What has it been like to have him for a dad?”

Rose answered:

I have two brothers, and I’m the only daughter, so there’s always been a special connection between my dad and me, and his values of hard work and family. Soccer has been really important, and he was so proud when Croatia won the world cup.

Connection has always been so important. I wanted to go to South America when I was in my 20’s, because I wanted to learn more Spanish and seek adventure. Everyone said it could be dangerous, so don’t go alone. So my dad went with me, and we had our own wonderful adventures. When I think about that, it makes the feelings of loss all the more painful, because we’re losing that connection.

Rhonda and I asked for a grade on empathy. She said: “The session feels warm and I feel connected with both of you. A+”

End of Part 1

Next week, you can hear the inspiring and moving conclusion of today's session.

Getting to Know David

David Answers Personal Questions!

We all know David Burns as the creator of TEAM-CBT, but not many people get to know David, the person. It is fun to know David the person, because he is just like all of us. He is a real person (not a robot), full of life and love.

I want everyone in our audience to be able to relate to David on a deeper level, to feel a sense of connection with him, and hopefully for all of us to build our sense of community with each other. Thanks so much to Stan Dickens, TEAM UK, for submitting these questions and sparking this discussion. The complete list of questions was much longer, but I (Rhonda) have selected the ones listed below.

I hope you like listening to this podcast, Rhonda

The questions are not necessarily in the order listed below, but all are answered on this podcast. David’s answers are all 100% spontaneous, and you will hear them on the podcast!

Music & Entertainment

1.  Which band do you like most, the Beatles or the Rolling Stones? (David, please say The Beatles!)

2.  Following on from that, what kind of music do you listen to? Can you tell us about some of your favorite musicians, bands, or composers?

Here are some links to just a few of a great many favorite songs of mine. David

• Tom Waits Never Let Go (of your hand)

  https://www.youtube.com/watch?v=pROjyuj2P8k&list=RDpROjyuj2P8k&start_radio=1&rv=fGe2igm7Ieo

• Rickey Nelson It’s Up to You

  https://www.youtube.com/watch?v=vsBP5P0Xe2c&list=RDvsBP5P0Xe2c&start_radio=1

• James Brown Please Please Please

  https://www.youtube.com/watch?v=vruy2GRUsV8

• Mick Jagger and Muddy Waters Please Don’t Go!

  https://www.youtube.com/watch?v=Mbao_laqF8E

• Jim Croce I’ll have to say I love you in a song

  https://www.youtube.com/watch?v=WB6FQBp-YwU

• Last Train Home Pat Metheny

  https://www.youtube.com/watch?v=goXJTv_U-PM

• Lucy Thomas “Hallelujah”

  https://www.youtube.com/watch?v=dLk9pzmaFHY

3.  If your life were turned into a film, who would play you?

4.  Can you speak with an English accent? Would you be brave enough to give it a try right now?

Career & Professional Reflections

5.  If you hadn’t dedicated your life to cognitive behavioral therapy and mental health or authored Feeling Good, what might you have done instead?

6. Is there a common misconception about you or your work that you’d like to clear up?

Personal Insights & Philosophy

7.  If you could have dinner with three historical or modern figures, dead or alive, who would it be and why?

8.  If you could give your younger self just one piece of advice, what would it be?

9.  How did you meet Melanie, and what do you love most about her?

David Meets the British TEAM Group, Part 2:

Burns vs. Van de Kolk, Treating somatic symptoms, chronic doubters, GAD, and more!

Last week, David answered four questions posed by the British TEAM-CBT group. Today, he answers five more questions, including one on controversies in the treatment of PTSD.

5. Peter – Positive Reframing in TEAM—How much is “enough?”

When you do Positive Reframing to reduce Outcome Resistance, how extensively do you have to do it? Do you have to include every emotion the patient has listed on their Dailly Mood Log? Do you also have to focus on most or all of their Negative Thoughts? What’s the best approach?

6. Tom – Burns vs. Van De Kolk

After reading The Body Keeps the Score, by trauma specialist and psychiatrist, Dr Bessel Van De Kolk, it would appear that people with complex trauma require a high degree of stabilizing work, like deep-breathing, meditation, or yoga, before they can engage with effective therapy. Otherwise, they might not have the words to describe their emotions, or might have repressed memories. In addition, they might not engage or might become destabilized and highly emotional or destructive towards themselves and other people.

I wonder if that’s your experience with patients you have seen with severe complex trauma in your career? Do you think the TEAM-CBT model has limitations in this area and would you refer to a trauma specialist before embarking on TEAM therapy with such a patient?

7. Sean – Treating Somatic Symptoms with TEAM

I’m curious about dealing with the somatic experiences of patients struggling with anxiety, depression, insomnia, trauma, etc. Clients can often challenge their distorted Negative Thoughts but still struggle with the somatic symptoms.

I’m curious to know David's thoughts.

8. Hassam – Treating Chronic Doubters with TEAM

I’m wondering if David has had experiences with chronic doubters - obsessive doubt in which a patient might say:

"Yeah, all these cognitive techniques seem good and all, but what if really I am useless and worthless, and all of this has just been a gimmick? What if it is all a lie? What if we have missed something which really would show how worthless I am ?"

Basically, this is closely related to the Pure O version of OCD. OCD is known as the doubting disease, and I really want to hear David's thoughts on how he operates with extremely sticky doubting thoughts.

9. Jacky – Treating Generalized Anxiety Disorder (GAD) with TEAM

I have a question about clients with Generalized Anxiety Disorder. When they present with multiple worries, do we need to cognitively restructure every worry? Clients with GAD often have multiple worries so we could be there for quite a while if we have to work on every single worry!

End of the Part 1 Questions. David will return to the British group for Part 2 in the future, since they had many additional questions.

Here is a note from Dr. Peter Spurrier to all who want more information about the UK TEAM-CBT training group:

If you are interested in learning more about our group, or want to contact members, please visit us at: https://feelinggood.uk.com/

You will find contact details for many of us on the "Our TEAM CBT Practitioners" page. If you are interested in joining our TEAM-CBT training group, or want more information, you can email me (Dr. Peter Spurrier) at Docspurr@gmail.com.

Ask David

The fear of ghosts;

the truth about nutritional supplements;

the fear of fear;

how does anxiety treatment work? And more. 

Today, David and Rhonda answer six cool questions submitted by podcast listeners like you!

1. Joseph asks: How would you use exposure to confront your fear of ghosts?
2. Salim asks: What herbs and supplements will help me become more zen and relaxed?
3. Peter asks: How do you stop fearing the fear and discomfort of anxiety?
4. Jillian asks: How does cognitive therapy work to help reduce anxiety?
5. Sanjay asks: How do you give up wants, needs, and desires?
6. Dana asks for help with the Disarming Technique.

In the following, David’s reply was David’s email response to the person prior to the podcast, just suggesting some directions we might take on the podcast.

The Rhonda comments were based on notes she took during the live podcast.

For the full answers, make sure you listen to the podcast!

Joseph asks: How would you use exposure to confront your fear of ghosts?

Hi David and Rhonda,

Thank you again for your wonderful replies and the amazing podcast.

If you would humor me, I have another question -- I know David talked about exposure therapy in overcoming fears, but I wonder how this could apply to some fears like the fear of ghosts where it is caused by an over-active imagination (in which case, what should one be exposed to?)

Regards

Joseph

 David’s reply

Cognitive flooding would be one approach.

Will give details on podcast. Thanks!

David

 Rhonda’s notes

Find out what is happening in the person’s life, and treat that specific problem.

Maybe someone developed a fear of ghosts after the death of a loved one, so the idea of being around death or dead things may also cause intense anxiety. Going to a cemetery may be part of their exposure.

Other examples of exposure for overcoming the fear of ghosts could be:

• Approaching a scary, abandoned house
• Watching a scary movie about ghosts

Fear of darkness may accompany fear of ghosts so staying in the dark may be part of your exposure.

Fear of sleeping alone may also accompany fear of ghosts so sleeping alone in your home may be part of your exposure.

Salim asks: What herbs and supplements will help me become more zen and relaxed?

Hello Mr. David D Burns,

I want to tell you that i loved "Feeling Good", your book helped me a lot in improving my life, I have a question, can you recommend herbs or supplements that help me be more Zen and more relaxed? I would be eternally grateful. 🙏.

Thank you so much.

Salim

David’s reply.

Hi Salim, I don’t believe in the efficacy of herbs etc. except for their placebo effect. However, the written exercises in the book, like writing down your negative thoughts, can help a lot. You’ll find lots of free resources on my website.

At the same time, the use of herbs and supplements is kind of a “cult” thing, and as you know, cult followers don’t like to have their views challenged!

And our field of mental health is, to my way of thinking, a mine field of cults!

Thanks!

David Burns, MD

Peter asks: How do you stop fearing the fear and discomfort of anxiety?

David’s Reply

Exposure!

However, I don’t “throw” methods at symptoms, but rather work systematically with the TEAM approach, and always incorporate four models in my work with every anxious patient: The cognitive, motivational, exposure, and hidden emotion models.

You can learn more about this in the free anxiety class on my website! You’ll find it right on the homepage for www.feelinggood.com.

Thanks, David

Rhonda added

You don’t stop fearing the fear and discomfort of anxiety before doing an exposure. You do all of the work necessary using the three other models of treating anxiety (see the anxiety question directly below this one) and then you dive into the exposure, embracing the discomfort until it’s reduced or gone.

Jillian asks: How does cognitive therapy work to help reduce anxiety?

Hi David,

I have questions about how using your methods helps people. I’m someone that uses an acceptance method for my anxiety with success and throughout this journey I’ve really been able to catch my mind trying to focus on the negative and trying to spiral into ruminating.

With negative thoughts, how do your methods actually help, does it start to change the way you think or make you automatically think in more of a positive way (eventually without having to “challenge” each thought?) Do you have to believe the challenges to your negative thoughts in order for it to work? What if you believe the original negative thoughts more? Do you actually start viewing things in a more positive light?

Kinds regards,

Jillian

David’s Reply

Hi Jillian,

I can make this an Ask David question for my weekly podcast if you like. You can find the answers, too, in the free anxiety class on my website and in my book, When Panic Attacks. Thanks1

Essentially, and I’ve covered this in detail in a podcast, cognitive techniques can be very helpful in reducing anxiety, but they are only one strategy among many. I actually use four models in treating anxiety: the Motivational Model, the Cognitive Model, the Behavioral (Exposure) Model, and the Hidden Emotion Model. You can learn more about them in Podcasts #22-28. You can find links here: https://feelinggood.com/list-of-feeling-good-podcasts/

I use all four models with every anxious individual I treat.

The Acceptance Paradox is a small but important part of the Cognitive Model.

Positive Thoughts have to be 100% true to be effective, but that does not mean they will be effective. They also have to radically reduce your belief in the negative thoughts triggering your anxiety.

If you still believe your negative thoughts, you need to try a different method to challenge them. I have developed 125 or more methods for challenging negative thoughts, since each person is a bit different!

Thanks!

D

Rhonda’s comments

We do not treat a diagnosis with a formulaic process. We treat a human being, one specific event at a time. Empathy is absolutely necessary for the treatment.

Here are David’s Four Models for treating anxiety:

1. Motivational Model. You need to address the Outcome & Process Resistance with every anxious patient before trying any other methods.

• Outcome Resistance. Reasons clients may not want the change/outcome they are asking for. Or to put this in simple words, anxious patients may not want to let go of their anxiety, fearing something bad will happen. You can use the WHAT IF technique to get to their outcome resistance. What are they the most afraid of? What’s the worst that might happen?
• Process Resistance. What will I have to do that I don’t want to do?

Exposure. No one wants to do exposure. You may also have to feel feelings that you do not want to feel. Feel intense emotions instead of binging, for example.

2. Cognitive Model. Pick a specific moment you were anxious about a thought. Go through the DML, what is going on with your patient? The positive thought needs to be 100% true, and it must drastically lower the belief in the NT to be effective.
3. Exposure and Response Prevention Model. Exposure is necessary and often helpful, both gradual exposure and flooding.
4. Hidden Emotion Model. Nearly all anxious patients tend to be exceptionally nice people because people who are prone to anxiety tend to avoid conflicts and negative feelings. (Wanting something you are not supposed to want, or feeling anger). These feelings are swept under the rug, and they come out indirectly, as some type of anxiety.

Sanjay asks: How do you give up wants, needs, and desires?

Hello David, Rhonda, and Fabrice,

It was really nice to meet Fabrice after a long gap. The topic Fabrice has started is very special of Should , Want and Need. I have heard about this topic in bits and pieces by you in many podcasts and also in your set of 4 podcast of self-deaths.

I kept thinking a lot about this beautiful concept of Want versus Need. And if we are able to learn technique to balance between Want & Need ,our lives will become happier and more stress-free.

Buddhist teachings say that Desire is the cause of suffering, so they want us to achieve a state with zero desires, which is Nirvana.

Also, the Holy book of Hinduism Geeta says further that if the purpose of our desires are to fulfill a duty or to help someone, only in these two cases will desires be good and bring happiness to the person. So, desire to eat a Mango will not fall in any of the two😄

But the penultimate question is that if we don’t have desires, life will be very dull and boring. As you had mentioned in podcast number 348 with Dr. Tom Gedman that unless one is in a very very positive state (which is rare like Buddha himself was) then only you can remain in a state of zero feeling otherwise you are bound to fall down and will lead to a very fast relapse .
I also agree that zero feelings or Zero desires state will ultimately lead people into depression therefore I feel the best way is to do positive-reframing of Need and dial it down to Want. So that we get the advantages of desires and leave the disadvantages of it .

As you have mentioned a number of times that FEELING GOOD APP is a very high priority for you but you try to keep it as your “want” and try not to enter this desire in the NEED zone.

Balancing desires on the border between Need and Want is quite challenging I request that please do a podcast for discussing as how to keep desires in check till want and if possible please develop a self-assessment questionnaire in a podcast with Matt May and Rhonda ,sounds i feel this is a valuable topic for exploration. It can provide listeners with tools and insights to strike a balance between fulfilling their desires for happiness and well-being without becoming enslaved by them.

I hope my message is clear and I am eagerly looking forward to the discussions amongst yourself.

Warm regards, Sanjay

New Delhi , India

David’s Reply. We can discuss this on a podcast, and I can tell you the story of a woman who attended a workshop I gave in San Antonio. She was raised as a Buddhist, but her family gave up Buddhism because her mother felt she’d “failed” at giving up wants and needs and desires.

Rhonda added these definitions:

1. Wants are personal preferences for things or experiences.
2. Needs are essential requirements for survival and well-being.
3. Desires are strong longings or aspirations that go beyond basic needs and contribute to a person's happiness and fulfillment.
4. Shoulds are when we scold ourselves because we did or did not do something.

Dana asks for help with the Disarming Technique.

Dear David,

I would like to request that you, Rhonda, and Matt show your listeners how disarming practice would sound with the following statements.

• Are you going to start that again? Or don’t start that again!
• Why are you back peddling again?
• You just want to rest on your laurels.
• Why are you doing this to me again?
• You’re going back on your word.

I feel like when my flight response is in mode I cannot think of how to respond to targeted questions especially. I feel so inferior. Please think of any others you can and add to these to help.

Thank you so much!!!!

Dana

 David’s reply.

Thanks, Dana, We might include these on an Ask David.

It might help, too, if you could provide a brief context for these statements, and what, exactly, you typically say next.

That way, we might be able to point out your errors as well, if you are interested in learning how you might trigger these statements.

Of course, most folks don't want that, preferring to blame. But it can be empowering, at least for the brave!

David

Rhonda described one of the responses we modeled on the podcast.

• Are you going to start that again? Or don’t start that again!

David’s A+++ reply (according to Rhonda)

Ouch, I’m feeling zapped right now, and you’re right. I am starting up on something that’s been very annoying to you. I think it was aggressive on my part. I have to plead guilty as accused.

I love you to death. When we go round and round it is painful for me, too. Clearly, I am to blame for that right now. I am ready to listen.

Maybe you can tell me what it is like for you when I start preaching again and we go round and round. It is clearly disrespectful.

I want to listen. You may be angry, frustrated, and pissed off. Can you tell me what this has been like for you and how you’re feeling right now?

At the end of our answer on the podcast, David added:

Dana, will you please take one of the examples you sent us, give us a context or a few details, and we will illustrate better disarming responses on a future podcast.

Will you also please use the Relationship Journal, and make your own attempt at a 5-Secrets response that we could evaluate and make suggestions on a future podcast?

Thanks for listening!

Rhonda, and David

Ask David: Featuring Matt May, MD

How can I help my son?

Is rapid recovery just "First Aid?"

Do early "attachment wounds" cause anxiety?

What's the Hidden Emotion Model?

Are anxious people overly "nice?"

And more!

In today’s podcast, three shrinks discuss many intriguing questions about anxiety from listeners like you, and begin with a question from a man who is worried about his relationship with his 11 year old son, who is just starting to get cranky and a bit rebellious. Then we field questions posed by thousands of individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago.

Most of the answers included in the show notes below were written prior to the podcast, so the live podcast will contain more information than the answers presented below.

Guillermo asks: How can I get close to my 11 year old son?

Hi, Dr Burns

Thank you for all the knowledge you share through your books and your podcasts. “the way you think creates the way you feel” has changed the way i view life.

I wanted to share an exchange I had with my 11 yo son 2 days ago. I was asking him to move some stuff around to clean his room and he was not loving it so his attitude reflected that, then i asked him about a particular lovely drawing of his that i found (from kindergarten) and he was dismissive and said “just throw it away” and i raised my voice and said “I CAN ALSO HAVE A BAD ATTITUDE, WOULD YOU LIKE FOR ME TO TALK TO YOU LIKE THIS?” (I was rude and loud)

To which, he got startled and teary eyed and said “no”. And i immediately felt bad, noting that i pushed him away when i wanted to get closer to him.

I later came to his room and apologized for my behavior and gave him a hug. I said “im sorry i raised my voice, im sure that hurt you and that hurts me bc you're the most important person in the world to me” and i gave him a hug.

That same night I heard podcast 278 or 279 and you said “the road to enlightenment is a lonely one, my friend” when responding to someone asking about the other person in a relationship. I thought, damn that’s true hahaha. I was going to say sorry but was thinking about what happened, this just reinforced it so much! After this I went over to his room to apologize.

I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this?

Thank you again for all you do,

Guillermo

David’s answer:

I can't tell you what to do, but I loved your last sentence, " I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this?"

In my book, Feeling Great, my dear colleague, Dr. Jill Levitt did this exact thing with her son with fantastic results. Said almost that exact thing!

Warmly, david

ANSWERS TO DAVID'S PESI ANXIETY LECTURE QUESTIONS

Is this rapid response merely first-aid. Am I right in assuming the sustained work (psychodynamic, therapy, body work etc.) is still required?

David's answer. Nope! But of course, all humans are unique, and some will require a longer course of treatment than others, but this is not due to any “first aid” problem!

Matt’s Answer: I agree with a lot of this.  While we are frequently seeing rapid and complete elimination of negative feelings, like depression and anxiety, while using the TEAM model, we expect 100% of people to ‘relapse’, at some point in the future.  Educating people about this is important and part of ‘Relapse Prevention’.  Part of Relapse Prevention involves accepting the impermanence of things, including our euphoric, enlightened experiences.  As the Buddhists say, ‘we all drift in and out of enlightenment’.

 Relapses, the ‘drifting in-and-out’ is a sign of a healthy brain.  Recovery is a bit like learning a new language, including how to talk-back to your negative thoughts.  While you can learn a new language, your healthy brain will not permanently forget your native tongue, so you’ll occasionally go back to old habits in thinking.

 So, achieving optimal mental health requires an ongoing practice with the methodology.  Rather than some new methodology, however, the one that is effective will be the one that helped you recover, in the first place.  If it was Exposure, you’ll have to keep on doing that.  If it was talking back to your negative thoughts, then you’ll have to do that, occasionally, etc.

 This can be a bit disappointing or disheartening to hear, if you were expecting permanence or perfection.  Paradoxically, accepting the imperfect and impermanent nature of our reality is what leads to relief and recovery.  That is to say, ‘Enlightenment’ is not a ‘perfect’ mental state but an acceptance of an imperfect one.  If this seems distasteful, Enlightenment may not be what you’re after!

 For those of you willing to embrace and appreciate your average, imperfect and impermanent experiences in life, you are very likely to recovery.  You’ll still need Relapse Prevention, including a commitment to continue to practice on an ongoing basis.  This leads to a higher level of recovery, in which you become your own ‘best therapist’.

 Another place where I agree with you is that one might achieve (imperfect) recovery from anxiety and depression, and even take on the responsibility of maintaining these results, and yet still not be satisfied with some other aspects of life.  It’s possible (in fact likely) for any given person to suffer, not only from mood problems, like anxiety and depression, but from other types of problems, like unwanted habits or addictions, or relationship problems.  TEAM contains methodologies that address these concerns as well.  ‘Recovery’ from these conditions is the same as for mood problems, in that recovery will be imperfect and impermanent and require practice to sustain.

 What type of practice that might be depends on the individual and we can’t predict, in advance, what types of exercises will be effective, for a particular person.  In fact, there’s a danger in assuming we know what will be effective and closing our minds to alternative approaches.  It’s a common error, for therapists, to pick up one tool and use that, regardless of results, rather than trying new approaches.  This is kind of like having a hammer in your hand, and seeing all your patients as nails!  I like how David says it: ‘Treat people, not conditions’.

 So, I think I agree with what you’re saying, in that it requires trial-and-error with multiple methodologies to achieve initial recoveries, as well as ongoing practice to achieve optimal results.

 I also feel compelled to observe the tendency for certain dangerous and wrong ideas to persist in our culture, kind of like ‘Urban Legends’ or ‘Mythology’.  One example is the revolution that occurred in medicine when people realized that pathogens, like viruses and bacteria, cause disease.  It had previously been thought that disease states were caused by an imbalance of the ‘Four Humours’, blood, bile, phelgm and calor (heat).  The treatment, for pretty much anything that ailed you, back then, was leeches and blood-letting, in hopes of restoring the balance of these ‘humours’.  A revolution in our understanding of disease occurred with the invention of the microscope.  It was now possible to visualize microscopic organisms, like bacteria, that we now know, after many experiments, are responsible for disease states. This allowed us to develop medications, like Penicillin, that kill bacteria and lead to rapid recoveries from infections, like pneumonia and immunizations that prevent infection.

 Despite undeniable scientific evidence, people are prone to believing the old mythology, keeping the wrong and outdated model alive.  For example, many people are afraid, on a cold day, because they think that exposure to cold temperatures will lead to having a disease, which is even called a ‘cold’.  Meanwhile, we know, scientifically, that it’s not cold temperatures or an imbalance of any ‘humour’, that is causing colds, flus, and pneumonia.  It is microorganisms, like viruses and bacteria.  If you don’t want to get a cold, it’s better to sanitize your hands and wear a mask, than to bundle up on a cold day.  Instead of bloodletting and leeches, try vaccines and antibiotics.  Of course, people also make up new mythologies, around these, much to their detriment and at great cost to society.  My advice would be to listen to develop a skeptical mind and read the scientific literature.  Or, try to understand Neil DeGrasse Tyson, when he says, ‘Science is True, whether you believe it, or not’.

 A similar revolution in our understanding has occurred in the field of Mental Health.  Like seeing bacteria, for the first time, after the invention of the microscope, we are returning to the understanding (which ancient Greek and Buddhist philosophers noted, as well) that it is our negative thinking that causes our suffering, more than our circumstances.  We know, now, that psychoanalysis is not required, to optimize mental health, any more than bloodletting or leeches is required to treat Pneumonia.  Thanks to Dr. David Burns, there is now a rapid, highly effective and medication-free treatment for depression and anxiety, called TEAM.

Is the Hidden Emotion Model suitable for anxiety caused by early attachment wounds?

David's answer. These big words are out of my pay scale, although they certainly sound erudite! In fact, the cause of anxiety is totally unknown, so when you say “caused by” we are in different universes! But the simple answer is yes, in 75% of cases, anxiety is helped greatly by the Hidden Emotion Model. Thanks!

Matt’s Answer:  The Hidden Emotion model would always be on my list of methods to try, for an individual who wanted help reducing their anxiety.  That said, it’s better to select methods based on an individual’s specific negative thoughts rather than the presence or absence of trauma in childhood.  In fact, the assumption that we know the cause of anxiety is problematic because it may lead to a kind of therapeutic ‘tunnel-vision’ and delayed recovery, as time is wasted, trying the same approach, repeatedly, expecting different results.

For example, assuming that ‘early attachment wounds’ are the ‘cause’ of anxiety may trigger the false belief that the most effective treatment would be many years, even decades, of Psychoanalysis.  This has been disproven, scientifically, yet it lingers in our minds, as a kind of mythology, passed down from our past.  Rather than subjecting our patients to decades on the couch, talking about their childhoods, it’s far more effective to ‘fail our way to success’, using multiple methods and measuring outcomes after each one, to discover what is actually effective for them.  Once you find the method(s) that are helpful, these will continue to be helpful, for that individual, throughout their lifespan, and it’s just a matter of practice.

Another question about the Hidden Emotion model: when do you consider it “niceness” in anxious people and when is it the fear/anxiety to upset others due to the anxiety?

David's answer. That can happen, but not usually in my experience. The “niceness” typically results from automatic suppression of uncomfortable feelings and problems. When they hidden problem or feeling is brought to conscious awareness, in most cases the anxious individual deals with it or expresses the feelings, and that’s when the anxiety typically disappears completely.

As a part of my anxiety disorder, at times, I feel flat, emotionless and disconnected from everything around me. How do you treat that?

David's answer. I use T E A M, not formulas! I do not treat symptoms, I teat humans.

Matt’s Answer:  You could start with a Daily Mood Log, writing down the details of what was happening, in one specific moment in time, when you felt this way.  Include what you were thinking and feeling, including ‘flat’, ‘emotionless’ and ‘disconnected’.  For example, let’s imagine you had thoughts like, ‘nothing will ever change’, ‘this is pointless’, ‘I’ll never feel better’ and/or, ‘I shouldn’t be feeling so disconnected and flat’ or ‘I should be more in-touch with my emotions’ and/or ‘I need to be more up-beat’ or ‘people will reject me if I’m not more enthusiastic’.  You’d have to identify your particular thoughts, these are just guesses.

After this, you could decide what, if anything you wanted to change.  If some change is desired, you might imagine a ‘magic button’ that would achieve that change, without any effort on your part.  For example, the button might eliminate all the upsetting feelings on your Daily Mood Log.  However, everything else in your life would remain the same.  Can you identify any reasons NOT to press that button?  Are there any positive values you have, related to these thoughts?  Would there be any down-side to pressing that button?  This represents your ‘Outcome Resistance’.  Typically, there will be many pieces of resistance that would need to be acknowledged or addressed before methods will be effective in helping you.  You can read in one of David’s many excellent books, like ‘Feeling Great’ and ‘When Panic Attacks’ how to make the most of this approach and what the next steps are.

Thanks for listening today. MANY more cool questions on the best treatment techniques for anxiety next week.

Matt, Rhonda, and David

1. Sanjay asks: How can we convert our “needs” into “wants?”
2. Vanessa asks: How can we think upon the threat of a nuclear war, or the thought of America becoming a totalitarian state, or the loss of voting rights, without becoming anxious or depressed?
3. Cliff asks: I have pure obsessive OCD and get stuck on intrusive thoughts. What should I do?

Upcoming Questions in Ask David podcasts

4. William asks: How would the T.E.A.M. model look with addiction and procrastination?
5. Caroline asks: I’ve done Cost Benefit Analyses (CBAs) for many of my SDBs (Self-Defeating Beliefs), and the disadvantages greatly outweigh the advantages? What’s the next step?
6. Al asks: Can you help me with fear?
7. Khoi asks: How do you deal with colleagues who gossip about your boss?
8. Matt asks: How do we help patients who don’t “get” the Acceptance Paradox?
9. Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness!
10. Al asks: Can you help me with worrying and fear of symptoms?
11. Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives?  I’m in that boat

1.  Sanjay asks: How can we convert our “needs” into “wants?”

Dear Dr. Burns

I thank you for pointing out “dramatic shift” in the foot notes and it has given me immense satisfaction .

So my learning from this is that ‘Low Level Solution’ remains just a “first aid” only because it is still in the category of “NEED” has not yet moved into the category of “WANT”.

A further question comes to mind So what is the process / formula to keep the deepest desires of ours from not entering into NEEDs and remain in the WANT zone. and yet we can work with highest passion and love to achieve them . OR in other words , how do you keep your biggest desire of your APP in the WANT zone and still maintains the highest level passion to achieve it . what is he process to reach that stage?

You have already given us the answer to this and shown us the way towards Enlightenment via FOUR GREAT DEATHS of the “self.” Still if you would like to say something more that will help us to grasp the process of keeping the desires in WANT only.

warm regards

Sanjay

David’s reply

In reply to Sanjay Gulati.

You can also do two Cost-Benefit Analyses CBA. For example, the first might be a CBA on the Adv and Disadv of Needing love, achievement, or approval, for example, and the second would be a CBA on the Adv and Dis of Wanting the same.

You could also use the semantic Technique. What could you tell yourself instead of “I NEED great achievement (or love or approval or whatever) to feel happy and fulfilled.”

A third could be to do an experiment and see if it is really true that happiness always or only comes from achievement, love, approval, etc.

A fourth strategy would be to do a Feared Fantasy and have a conversation, in imagination or in role play with a therapist, with someone who has achieved tremendously. That person would have to explain that she or he looks down on most other people because they haven’t achieved as much, so s/he feels they are less worthwhile.

You might suddenly discover that such a person doesn’t actually seem especially “worthwhile,” but more of an egotistical type.

With regard to the app, I’m just having fun with it, and making all kinds of amazing discoveries. Parts of it are really effective. Other parts are ineffective and need to be changed. But it is all an adventure.

I can’t control the outcome—will it be popular? Will we develop a business model that allows us to pay our bills? Maybe yes, maybe no, maybe partially. But to be honest, I don’t really care!

And not “caring” or “needing” frees me up to care way more effectively, and more creatively, and more lovingly. And with inner peace along the way.

Here is something else. You begin to realize that there is no such thing as “failure,” only information. For example, if people don’t like some lesson, or some word I have used, I just change it and make it better. Most of the negative and positive feedback is totally unexpected and surprising, which is really fun!

I feel privileged, not pressured. These feelings are quite rewarding and addictive.

I realize, too, that most people don’t really care how “successful” I am, including you. Most people do appreciate it when I treat them well, however.

Same with our cat that we adopted at the local humane society after her owner died.

Might make this an Ask David if it is okay!

Thanks, david

By the way, you subsequently emailed me and asked me to comment on “intense wants” vs. “needs,” so here’s a little more.

When I was a young man, I used to collect antique paper money from around the world as a hobby. I can vividly recall seeing a rare uncut sheet of banknotes at a trade show that I feel in love with instantly.

It was from the US Virgin Islands from the 1850s, if I recall correctly, and it consisted of a one thousand dollar bill and three five hundred dollar bills. It was gorgeous and I was instantly hypnotized, thinking it was one of the rarest and most desirable things in the world!

But sadly, I was a poor graduate student and could not afford it, and I’m not sure the dealer, a really nice guy from New Mexico named Larry Parker, was willing to sell it. Finally, I gave up on it and stopped thinking about it.

Years later, that exact same item came up in an auction in Los Angeles, and I was starting my clinical practice in Philadelphia. So I called the auctioneer, who I knew, just an hour or so before the end of the auction, and asked how much I should bid in order to be sure that I would win that intensely coveted item. At the time, the bidding was around $2,000, and I thought I could likely get a loan from the bank to buy it.

The auctioneer told me that no matter how much I bid, there was no chance I could win it.

I asked why. He said the wealthiest man in Caribbean was bidding on it and would pay any amount of money to get it, no matter what.

I was devastated and felt my chance for true happiness and worthwhileness had just evaporated! My “intense want” was not fulfilled!

Years later, similar notes started appearing in auctions, and I was able to figure out they were all reprints, including that original uncut sheet. Although they had some modest value, they were easy to obtain, and . . . suddenly I had no desire at all to own them!

And it also dawned on me that all those years when I couldn’t have that “fabulous” (or so I thought) uncut sheet, I’d been absolutely happy.

So much for our so-called “needs!”

2. Vanessa asks: How can we think upon the threat of a nuclear war, or the thought of America becoming a totalitarian state, or the loss of voting rights, without becoming anxious or depressed?

Hi Dr. Burns,

First off thank you so much for your podcast and books. They've helped me immensely grow and I am forever appreciative!

Recently, I've been hearing statements like "American democracy may not be around in 10-15 years", "America is becoming a totalitarian state'', and "We're heading to nuclear war" from both sides of the political spectrum. All of these statements make me very anxious to hear.

I know that thoughts create feelings, so even if something is true (like the threat of nuclear war, or that voting rights are being infringed upon, etc.), is there a way we can think upon these issues without becoming anxious or depressed over them?

Thank you so much,

Vanessa B.

David’s reply

Hi Vanessa, Thanks. I’m sure many people have similar concerns. However, this is a very general question, and you have not given me any specific examples of your own negative thoughts.

So, I can only give you an equally vague and general response, which is guaranteed not to be helpful. That’s because general questions and answers tend to be little more than babbling.

All that being said, I will say that there is a healthy and an unhealthy version of every negative feeling. So, some alarm and concern is probably totally appropriate and healthy, but getting crippled with excessive anxiety and depression is perhaps not useful.

Healthy negative feelings result from valid negative thoughts; unhealthy negative feelings always result from distorted negative thoughts.

But, as I pointed out, without a single example of your negative thoughts, all of the “good stuff” will remain unseen!

Thanks.

david

PS I will make this an Ask David for an upcoming podcast.

3. I have pure obsessive OCD and get stuck on intrusive thoughts. What should I do?

Hey Doc!

Very glad I ran into your work. Started with a video and have been reading and listening to your stuff for a couple days now.

I’ve been diagnosed with OCD (PURE O). I struggle with intrusive thoughts. I have had a lot of trouble exposing myself to the thoughts in order to face them. I’ve tried a writing a narrative of my fears etc…. I just can’t seem to get the right exposure.

A couple examples: I get stuck on… I don’t believe in God, or don’t believe enough or that maybe there isn’t a God?

I get stuck on… what if I go crazy?

I wish there was a dirty sink I could go touch or something tangible I could face.

Any suggestions?

Cliff (name disguised)

David’s reply

Hi Cliff,

Sure, and sorry you've been struggling, and fortunately, the prognosis is very positive.

But I have a few questions so I’ll know what you’ve done already. First, which of my books have you read, and did you do the written exercises while reading? For example, When Panic Attacks is all about techniques for anxiety.

Second, have you done a search for OCD as well as anxiety on my website? You will find many resources.

Third, have you completed the free anxiety test and class on my website?

Fourth, sometimes a therapist with expertise in exposure can help with exposure, although that is one of a great many powerful techniques for treating anxiety. Trying to treat OCD or any form of anxiety with exposure alone is a huge mistake.

Fifth, have you used the Hidden Emotion Technique?

Let me know, and thanks.

david

Rhonda, Matt, and David

David and Fabrice discuss Inquiry, the third of the Five Secrets of Effective Communication. Inquiry means asking gentle, probing questions to learn more about what the other person is thinking and feeling.

David encourages listeners (that includes you!) to try using Inquiry five times each day, even in superficial interactions with people in any setting, such as the grocery store, and gives examples of how to do this. Although this will not be the deepest application of Inquiry, the practice will give you a clear understanding of how this technique works.

Rhonda and David address a question from Karolina, a therapist in Poland who was failing with a depressed patient who felt totally convinced he was a “useless” human being. I think you will find their discussion of this case fascinating, as it deals with the cause of practically ALL therapeutic failure, and illustrates the solution al well, using TEAM-CBT methods and concepts.

Today’s podcast is intended for therapists and patients alike!

For the show notes, we are including the email David received from Karolina, as well as his initial response.

Dear Dr. Burns,

I've been listening to your podcast for 6 months now and it's been so helpful with my work as a therapist as well as in my personal life. I'm starting to develop a habit of considering every unwanted state with a "what does it say that's awesome about me?" and I'm much happier now :).

I'm wondering if you'd consider helping me some more. I have a client who's been struggling with depression for many years. At the moment he's doing ok and his mood is up. Lately the topic of his uselessness came up again and he's willing to work on that. He said he'll consider the possibility that he's not a useless human being and asked me to not to dismiss the possibility that he is - that's how he'll know that I'm not just trying to cheer him up.

It's been bugging me ever since. Although I've agreed, I really can't find in me any part that is ready to think that. I strongly believe he's not a useless person. I can't imagine labeling anyone in that way and in his case it feels so personal as I like him very much and I care about him.

I'm starting to have dreams about our next session when I fail him by trying to convince him to think as I do. How can I be open about our conclusion when my mind is already fixed? Any thoughts on this would be deeply appreciated.

Best wishes from Poland

Karolina

Hi Karolina,

Thanks! The term has no meaning. It is just a vague put down, like what a bully might say.

I might ask him what time of day he was feeling useless, and then have him fill out a Daily Mood Log for that moment, step by step. We can only help him at one specific moment.

You can use a large number of techniques but must first get an A on Empathy, and then do effective paradoxical agenda setting, starting with the Paradoxical Invitation Step and then asking “what type of help would you be looking for?” then you can do the Magic Button and Positive Reframing.

All of the negative thoughts and feelings on the Daily Mood Log will be advantageous and will show something about him that is awesome and positive. You should be able to generate a list of at least 25 overwhelming positives. Then you can use the Magic Dial.

When you get to M = Methods, you can put the thought, “I am a useless human being” in the middle of a recovery circle, and then select a minimum of 16 methods to challenge it.

You can start with Identify the Distortions. There are likely at least 9 distortions in the thought, including AON, OG, MF, DP, MAG / MIN; ER; LAB; SH; SB.

You can try, “let’s define terms,” and ask what’s the definition of a “useless human being”? You’ll find that no matter how you try to define it,

1. 1. The definition will apply to all human beings.
   2. The definition will apply to no human beings.
   3. The definition does not apply to him.
   4. The definition does not make sense.
   5. The definition is based on some kind of arbitrary cut-off points.

You can do this as a role-play, being a close friend trying to find out if you’re useless, and asking him for guidance on how to find out.

You can do the Paradoxical Double Standard Techniques, Downward Arrow, Hidden Emotion, Externalization of Voices, Acceptance Paradox / Self-Defense Paradigm, Examine the Evidence, Semantic Method, and on and on.

The problem is NOT that he’s a “useless human being” but rather that he’s obsessing and wasting time on a meaningless construct, and beating up on himself.

The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge, since it may be working for him, and also reflects all those 25 wonderful things about him.

The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge, since it may be working for him, and also reflects all those 25 wonderful things about him. Remember that just about 99.9% of therapeutic failure results from Agenda Setting errors. Is this something you want to help him with, or something he is desperately asking you for help with? I am almost 100% positive that this is your agenda, not his. In fact, your need to “help” him with this may actually keep him stuck.

In fact, here is the proof. You write: “I'm starting to have dreams about our next session when I fail him by trying to convince him to think as I do. How can I be open about our conclusion when my mind is already fixed?”

If you don’t understand this, I recommend some supervision from a TEAM therapists or join one of the online classes, or attend my workshop on resistance, coming up in a month or so, check out my website workshop page for details. You can join online.

David D. Burns, M.D.

Hi Dr. Burns,

Thank you so much for your quick and thorough response!

I kinda felt that my "helping" is the issue here as I've felt my own frustration rising...

Thanks for reminding me that uselessness is just a meaningless concept, I needed that. And I love the idea of role-playing as a friend asking for help with defining his uselessness. I'll pace myself, though, and give us time to walk through all the steps, especially Empathy and Agenda Setting and check how it goes and what my clients wants, not I.

I appreciate information on the resources and supervision I can access online, so good to know there are options!

You can use my real name, can't wait to hear the podcast :).

Karolina

Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast.

See below for details and links!

David

The featured photo shows Dr. Carly Zankman
at the Big Sur with her 8 month old nephew, Micah

Podcast #268 : An Ectopic Pregnancy (Part 1 of 2)

October was Pregnancy & Infant Loss Awareness Month. We are dedicating this and next week's podcast to all the mothers and fathers who have lost infants or struggled with pregnancy complications and tragedies.

This will be the first of two podcasts featuring a live therapy session with Dr. Carly Zankman. Dr. Zankman, a 27 year-old clinical psychologist in our Tuesday training group at Stanford, is facing a serious crisis involving motherhood. She is struggling with the aftermath of a traumatic ectopic pregnancy and some intense fears that she may never get the chance to be a mother. In addition, she is 100% convinced that she can never feel happy or fulfilled in life unless she becomes a mother.

The featured photo for this podcast is Dr. Zankman at the Big Sur with her 8 month old nephew, Micah. You can see the love and joy in her face, and her intense desire to become a mother herself.

The session took place at my Tuesday training group at Stanford, and my co-therapist was Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, California.

You can see Carly’s Daily Mood Log (DML) and Brief Mood Survey (BMS) at the start of the session  The DML reflected her feelings several weeks before, when she felt that her chances for pregnancy were greatly diminished, and the BMS reflects how she was feeling at the beginning of our session. As you can see, she was still moderately depressed and anxious, and her happiness and marital satisfaction scores were quite low, indicating that she was unhappy and somewhat dissatisfied with her relationship with her husband.

Carly was also anxious about being on the podcast, due to these additional negative thoughts:

1. I’m not going to be able to describe what I’ve been through. She believed this 70%.
2. There’s a potential to be judged by people. She believed this 100%.

In today’s podcast, you will hear the T = Testing and E = Empathy portions of the session, and in next week’s podcast you will hear the A = Assessment of Resistance and M = Methods portion of the session, and hopefully Carly will be able to join us for a follow-up to see how she’s been doing since the session.

The show notes for next week's podcast will include eight teaching points.

Rhonda Jill and I are all extremely grateful to Carly for her courage in sharing this intensely personal part of her life with us. She received, as you might imagine, incredibly support from all the members of the training group during and after her session, as others had struggled with similar fears as well.

Thank you for listening, David, Rhonda, Jill & Carly

The responses to the Marilyn session were extremely positive. At the start of the podcast, Fabrice reads a response from a listener who was moved and inspired by the work Marilyn did.

David and Fabrice discuss two questions commonly raised by people who have seen David's live demonstrations with individuals experiencing severe depression and anxiety. Since the change in Marilyn’s scores were so fantastic, some skeptical listeners have asked, “Was this real, or was it staged?” Others have asked if patients are simply giving favorable answers on the Brief Mood Survey and Evaluation of Therapy Session forms as a way of being “nice” to the therapist.

David points out that the opposite is true. If patients are in treatment voluntarily, without some kind of hidden agenda such as applying for disability, they tend to be exceptionally honest in the way they fill out the forms. In fact, most therapists find that they get failing grades from nearly every patient on every scale at every session at first. This can be very upsetting, especially to therapists who are narcissistic and defensive about criticism. But if the therapist is humble and open to the feedback, the patient’s feedback on the Brief Mood Survey as well as the Evaluation of Therapy Session forms can provide a fabulous opportunity for growth and learning.

So in short, it is not true that patients fill out the forms just to be “nice” and to please the therapists. The scores are brutally real! If you are a therapist and a doubters, you can give the assessment instruments a try, and I think you’ll be surprised, and perhaps even shocked when you review the data!

Still, David acknowledges that the rapid and phenomenal changes he now sees most of the time when using TEAM-CBT are hard to believe, especially when you've been trained to think that recovery is a long, slow process. David discusses a model of brain function proposed by a molecular biologist / geneticist, Dr. Mark Noble, that allows for extremely rapid change.

David and Fabrice also address the question—can these kinds of miraculous results last, or are they only a flash in the pan? David emphasizes the importance of ongoing practice whenever the negative thoughts return. The “one and done” philosophy is not realistic. Part of being human is getting upset during moments of vulnerability, and that’s when you have to pick up the tools and use them again!

David describes experiencing three hours of panic just a few days ago, and Fabrice asks what techniques he used to deal with his own negative feelings, including Identify the Distortions, Examine the Evidence, Reattribution, and the Acceptance Paradox.

David agrees with the Dalai Lama that happiness is one of the goals of life, but emphasizes that it is not realistic to think one can be happy all the time. Fortunately, you can be happy most of the time--but you have to be willing to pick up the tools and use them from time to time when you fall into a black hole!

Rajesh asked:

• Is it possible to change an SDB?
• Does the mere knowledge of an SDB change it?
• How long does it take to change an SDB?
• How do you change SDBs?

Nikola asked:

• Aaron Beck said the SDBs never really go away. They just get activated and deactivated and activated again. Does this mean that depression is an incurable disease that will keep coming back over and over again?
• What’s the point in battling against a core belief if it cannot be changed?

Fabrice and I appreciate your questions--they often give us ideas for shows! In today’s Podcast you'll learn the answers to several questions about Self-Defeating Beliefs.

What’s the difference between Self-Defeating Beliefs (SDBs) vs. Cognitive Distortions?

The thoughts that contain cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, Discounting the Positive, and Self-Blame are distortions of reality, they are the cons that trigger depression and anxiety. When you're upset, these thoughts will flood your mind. These thoughts can be show to be false, and when you crush a distorted negative thought, you'll immediately feel better.

Self-Defeating Beliefs are stipulations, values that you've set up for your self. For example, you may base your self-esteem on your accomplishments due to your belief that people who accomplish more are more worthwhile as human beings. SDBs like this cannot actually be shown to be false--they are simply your personal, subjective values, and they are thought to be with you all the time, and not just when you're depressed, anxious, or angry.

The question with an SDB is this: What are the advantages and disadvantages of having this value system? How will it help me--what are the benefits--and how might it hurt me? What's the downside?

Why are Self-Defeating Beliefs thought to be important?

When you challenge and defeat a distorted thought, you feel better in the here-and-now. When you challenge and change an SDB, you change your value system at a deep level. This is thought to make you less vulnerable to painful mood swings and relationship conflicts in the future.

What are the different kinds of SDBs?

• David’s list of 23 Common SDBs is attached. This list is not comprehensive, as there are many more, but the ones on the list are very common. There are several categories of SDBs.
• Individual SDBs are often “Self-Esteem Equations”
  • Perfectionism
  • Perceived Perfectionism
  • Achievement Addiction
  • Approval Addiction
  • Love Addiction
• Interpersonal SDBs are expectations of what will happen in certain kinds of relationships, or relationships in general
  • What’s your understanding of the other person’s role in your relationship? What adjectives describe him or her?
  • What’s your understanding of your person’s role in the relationship? What adjectives describe you?
  • How would that kind of relationship feel?
  • What rules connect the two roles?
• Other kinds of SDBs
  • Anger / conflict cluster
    • Entitlement
    • Truth
    • Blame
  • Anxiety cluster
    • Niceness
    • Conflict Phobia
    • Anger Phobia
    • Emotophobia
    • Submissiveness
    • Spotlight Fallacy
    • Brushfire Fallacy

How can you identify your own, or a patient’s, Self-Defeating Beliefs?

• Look at the list of 23 individual SDBs (easiest). You might want to do that right now. Review the list, and you'll probably find many of your own beliefs!
• Individual Downward Arrow
• Interpersonal Downward Arrow

Today, Rhonda and David answer several challenging questions submitted by listeners like you.

1. What schools of therapy are embedded in TEAM?
2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither?
3. “Can TEAM-CBT help bipolar patients during the depressed phase?”
4. How do you make Externalization of Voices work? I get stuck! For example, my patient said, "It's unfair that I cannot get a job!"
5. Is there a cure for OCD?

1. What schools of therapy are embedded in TEAM?

Dear Dr. Burns,

I have some questions specifically about T.E.A.M. therapy. You mention in a blog post that T.E.A.M. therapy "integrates features and techniques from more than a dozen schools of therapy." I'm aware of many of the CBT techniques you use, but I don't think I've read yet of any technique belonging to any other schools of therapy. Would you be so kind as to mention such techniques?

Madelen

Hi Madelen,

This is important because I believe we need to get away from competing schools of therapy and need to create a new, data-driven structure for therapy based on research on how therapy works, which is what TEAM is. At the M = Methods part of the session, you can include methods from any school of therapy.

Here are some of the schools of therapy that I draw upon TEAM-CBT.

1. 1. 1. Individual / Interpersonal downward arrow: same (psychoanalytic / psychodynamic)
      2. Flooding / Experimental technique: behavior therapy (exposure)
      3. Externalization of Voices: Gestalt / Psychodrama / Buddhism
      4. Acceptance Paradox: Buddhism
      5. Self-Defense Paradigm: REBT
      6. CBA / Paradoxical CBA / Devil’s Advocate: Motivational techniques
      7. Identify the distortions / examine the evidence: cognitive therapy
      8. Empathy: Rogerian (humanistic) therapy
      9. Five Secrets / Forced Empathy: Interpersonal therapy
      10. Shame-Attacking Exercises: Humor-based therapy / Buddhism
      11. Be Specific / Let’s Define Terms: Semantic
      12. Feared Fantasy: Role-Playing / Psychodrama / Exposure
      13. One-Minute Drill / Relationship Probe: Couple’s Therapy
      14. Time Projection / Memory Rescripting: Hypnotherapy
      15. Anti-Procrastination Sheet: Behavioral activation therapy (Lewinsohn-type therapy)
      16. Brief Mood Survey / Evaluation of Therapy Session: data-driven therapy
      17. Talk Show Host / Smile and Hello Practice / Flirting Training: Modeling / teaching effective social behavior
      18. Storytelling: indirect hypnosis.
      19. Positive Reframing: Paradoxical psychotherapy.
      20. Hidden emotion technique: psychoanalytic / psychodynamic
2. Do you need more? Can provide if you want. Let me know why you have this particular interest!At any rate, I really enjoyed and appreciate your thoughtful questions, thanks!David

2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither?

Hello Dr Burns,

I would like to thank you for your podcasts. I greatly enjoy listening to them and find them very much helpful both in my personal life and my work as a psychologist.

I do have a question: you talk about how cognitive distortions cause anxiety and depression. Are cognitive distortions also a result of depression and anxiety? For instance, if a person was to become depressed after experiencing loss, would they then discount the positive in their lives to a larger extent, for example?

Thank you very much!

Audrey

Hi Audrey,

Yes, depression creates a negative bias in perceptions, so you pick out information and details that support your distorted thoughts, like "I'm a loser" or "my case is hopeless." My research, which I'll report in my new book, Feeling Great (sept 2020) indicates that negative thoughts trigger feelings of depression and anxiety, which, in turn trigger more negative thoughts. This is a negative vicious cycle. There is also a positive cycle, in that positive thoughts that you believe to be true trigger positive feelings, which, in turn trigger more positive thoughts! Thanks for the question, Audrey.

david 

3. “Can TEAM-CBT help bipolar patients during the depressed phase?”

Name: Sarah

Comment: Hi, Dr. Burns.

I am a big fan of your work and very much enjoy reading your blogs and listening to you and Fabrice on you weekly podcasts.

I am writing with a question that has to do with the depression side of bipolar disorder and the potential usefulness of CBT. I have not heard you speak about this topic before.

My sister in law lives in Switzerland and has been diagnosed with a fairly severe case of bipolar disorder. She does not cycle rapidly, but her manic and depressive states are quite severe. In fact, she has been hospitalized several times during her manic episodes.

For the first time in her life, I believe my sister in law has finally accepted the fact that she is bipolar, and she is actively pursuing treatment and trying to get better. After hearing me talk about all the great information I have learned from you, my husband has hunted down several CBT practitioners in Switzerland, in the hopes that changing my sister in law’s thoughts will help her navigate the overwhelming depression she is currently experiencing. Unfortunately, most of the practitioners she has contacted have said that they cannot help her, because she has bipolar disorder. Of course, this is only adding to her sense of hopelessness.

In your opinion, could CBT and challenging negative thought distortions be helpful to someone who is bipolar and currently experiencing the depressive side of the disease?

In my mind (a layperson who has used CBT to help with panic disorder) it seems so obvious that it could help, but several Swiss psychotherapists seem to disagree with me! Are these therapists afraid to take on a complicated case or is there really nothing they can do?

I would love to hear your take on it. Thank you so much for your endless work helping people to feel good!

Sarah

David will describe his experience running the lithium clinic in Philadelphia at the VA hospital, and will discuss the very important role of good psychotherapy for bipolar patients, although medications will also play an important role in the treatment.

4. Externalization of Voices: How do you make it work? I get stuck! "It's unfair that I cannot get a job!"

Dear Dr Burns and Rhonda,

I've just finished listening to all of the Feeling Good Podcasts. What a gift! My immense gratitude to you and Fabrice for the time and effort that has gone into these podcasts, as well as the wonderful show-notes.

I am a family physician and I work with impoverished patients, many of them refugees. Depression and anxiety are common. We can't find CBT therapists for our patients within their means, so I end up trying to provide some counselling despite not having much background or training (a dangerous proposition, I know, but we have little choice.) Medications tend not to be too helpful, as David points out. I am starting to try to integrate TEAM concepts.

I have a question about Externalization of Voices. In all of the examples you've shared in the podcast, whenever David does a role reversal and models the positive voice, he always seems to "win huge". I'm less experienced and find I'm not batting 1000. What do you do when neither you nor the patient have been able to win huge?

Many thanks again for all you do,

Calvin

PS The episode on How to Help and How Not to Help was one of the best yet!

Hi Calvin,

Thanks for the kind comments! Can you tell me what the thought is that you’ve failed with?

All the best,

David D. Burns, M.D.

Hi David,

There have been a couple of examples where we could only get a small win.

With the first patient, the thought he was tackling was: "It's not fair that I've worked so hard in life, but I can't get a job."

I tried modelling self-defense, along the lines of "I've accomplished a lot given how many challenges I've faced." I also tried suggesting the Acceptance Paradox with something like: "It's true that life's not fair. Who said it should be fair?" This was only a 'small win.' I felt stuck.

Another patient felt her chronic insomnia was driven by anxiety. She feared she would never sleep well again. The though was "I'm going to be chronically tired and no longer able to enjoy life the way I used to." We tried: "Sure, I may be more tired than I used to be, but I'll still be able to enjoy life to some extent." Again, this was a small win, not enough to crush it.

Thanks again for your willingness to help!

Calvin

David’s response

Hi Calvin,

All therapeutic failure, pretty much, results from a failure of agenda setting. I’m not sure you’ve been trained in A = Paradoxical Agenda Setting. The A of TEAM is now also called Assessment of Resistance. When people can’t easily crush a Negative Thought, it is nearly always because they are holding on to it. This is called “resistance.”

Let’s focus on the first thought, "It's not fair that I've worked so hard in life, but I can't get a job."

This thought triggers anger, and anger is the hardest emotion to change because it makes us feel morally superior and often protects us from feelings of inadequacy, failure, or inferiority. If you do not deal with the underlying resistance to change, the patient will defeat your efforts.

When you do Positive Reframing, you start with a Daily Mood Log with one specific moment when the patient was upset and wants help. The anger will be only one of a large number of negative emotions the patient circles and rates, and there will always be numerous negative thoughts as well.

The negative feelings might also include sad and down, anxious, ashamed, inadequate, abandoned, embarrassed, discouraged / hopeless, frustrated, and a number of anger words like annoyed, resentful, mad, and so forth.

This is super abbreviated, but you would then do A = Paradoxical Agenda Setting (also now called Assessment of Resistance.)

You would start with a Straightforward or (better in this case) Paradoxical Invitation—does the patient want help with how he’s feeling? You might tell him he has every right to feel angry and upset and might not want help with his negative feelings as long as he has no job.

If he insists he DOES want help, you can ask the Miracle Cure Question, and steer him toward saying he’d like all of his negative thoughts and feelings to disappear, so he’d feel happy.

Then you can ask the Magic Button question. If like most patients, he says he WOULD push the button, you can tell him there is no Magic Button, but you DO have lots of powerful techniques that could be tremendously helpful. But you’re not sure it would be a good idea to use these techniques.

When he asks why not, you could say it would be important to look at the positive aspects of his negative thoughts and feelings first. Then you do Positive Reframing, and together you can list up to 20 or more positives that are based on each negative emotion and each negative feeling. To generate the list of positives, you can ask: 1. What are some benefits, or advantages, of this negative thought or feeling? 2. What does this negative thought or feeling show about me, and my core values, that’s positive and awesome?

For example,

1. 1. 1. My sadness is appropriate, given that I don’t have a job. If I was feeling happy about this, it wouldn’t make sense.
      2. The sadness shows my passion for life, for work, and for being productive.
      3. My anger shows that I have a moral compass and value fairness.
      4. My anxiety motivates me to be vigilant and to look for a job, so I don’t get complacent and starve.
      5. My anxiety, in other words, is a form of self-love.
      6. My anger shows self-respect, since I have a lot to offer and contribute.
      7. My hopelessness or discouragement shows that I’m honest and realistic, since I have tried so often and failed.

This is just an example, and with a real patient, it can be very powerful as I have the facts and know the patient, whereas in this example I am just making things up.

Then once you have a long and incredibly compelling list, you can ask, “Well, given all of those positives, why would you want to press that Magic Button? If you push it, all these positives will go down the drain at the same time that your negative thoughts and feelings disappear.

Then you resolve the patient’s dilemma with the Magic Dial.

All this is done AFTER E = Empathy (you have to get an A from your patient) and BEFORE using any M = Methods, like externalization of voices.

If you do this skillfully, the Externalization of Voices technique will go way better, because the person will be determined to reduce the anger and other negative feelings. But if the patient says he or she does not want to change, and wants to be intensely angry, that’s fine, too!

If this is not clear enough, you could also get some paid case consultations from someone at the Feeling Good Institute, which could be invaluable. This is the most challenging and valuable tool of all!

Not sure how much training you’ve had in TEAM.  There are online classes that are excellent. Also, on my workshop page you can check out my upcoming workshop with Dr. Jill Levitt on resistance.

There are podcasts, too, on resistance / paradoxical agenda setting as well as fractal psychotherapy.

Thanks!

David

5. Is there a cure for Obsessive Compulsive Disorder (OCD)?

Hi Dr. Burns,

I have been suffering from OCD and depression post the delivery of my daughter and have been on antidepressants for the last 7 years. I have recently start going for counseling too with a psychologist. In fact, she is the one who recommended your book which I am finding very useful. Your website is very helpful too.

I had just one general question: Are OCD and Depression 100% curable or are they only controllable and one has to be on medicines for the rest of their lives?

Reason why I am asking this is the last time we tried to taper down the medicines I ended up having a worse relapse. I want to know if I can plan for a second pregnancy.

I know you do not reply to personal messages but would really be grateful if you could reply to this mail

Looking forward to hearing from you

Regards

"Betsy"

In my dialogue with Rhonda, I emphasize that I rarely use medications in the treatment of anxiety and depression, including OCD, and I would urge this listener to use the search function on my website to search for podcasts and blogs on antidepressants, anxiety, OCD, and Relapse Prevention Training, and you will find lots of specific resources. For example, if you type in OCD, you will find the Sara story (episode 162) plus lots of additional great resources on OCD, including podcasts 43 - 45 (this page provides links to all the podcasts), and more.

Also, my books, When Panic Attacks, and the Feeling Good Handbook, could be very helpful, and you can link to them from my books page. I use four models in the treatment of OCD, and you can find them if you listen to the basic podcasts on anxiety and its treatment. They are the Hidden Emotion Model, the Motivational Model, the Exposure Model, and the Cognitive Model. All are crucial important for recovery, and clearly explained in the podcasts on anxiety.

Thanks for listening today, and thanks for all the kind comments and totally awesome questions!

David and Rhonda

Secrets of Overcoming Romantic Rejection

Part 1 of 2

In today’s podcast we are proud to interview Dr. Kyle Jones from the Feeling Good Institute in Mountain View, California.

Kyle Jones, PhD is a clinical psychology postdoctoral fellow affiliated with Feeling Good Institute in Mountain View, California where he provides individual psychotherapy in a private practice. He co-leads a monthly consultation group with Maggie Holtam, PhD where therapists can get help with exposure methods for anxiety. He has recently become an Adjunct Professor of Psychology at Palo Alto University - teaching Clinical Interviewing in the clinical psychology PhD program.

Kyle wrote: “Here are some questions from patients of mine for our podcast today - we don't have to go through all of these bust just some talking points!"

We will publish part of the questions in today's podcast, and several more next week. There are even more questions, so let us know if you would want a Part 3 on this topic at some time in the future.

Below you will find the list of questions with some responses by David and Rhonda BEFORE the podcast. To get the true scoop, listen to the podcast, as most of the comments below were simply ideas that popped into our heads prior to the podcast.

Although we focus on romantic rejection in these two podcasts, the idea really pertain to rejection in all segments of our lives.

1. Why do you think it’s so hard for us humans to handle rejection/why do you think we are so afraid of it?

David

THE LOVE ADDICTION SDB. LOOKING TO EXTERNAL SOURCES FOR FEELINGS OF SELF-WORTH AND HAPPINESS. THE CBA IS CRUCIAL, SINCE PEOPLE MAY NOT WANT TO STOP LINKING SELF WORTH WITH LOVE.

Rhonda

Plus, it hurts.  And our brain is wired to experience pain when rejected.  We are wired that way.

Evolutionary psychologists believe it all started when we were hunter gatherers who lived in clans. Since we could not survive alone, being ostracized from our clan was basically a death sentence. As a result, we developed an early warning system to alert us when we were at risk of being rejected by our tribemates. People who experienced rejection as more painful were more likely to change their behavior, remain in the clan, and pass along their genes.

Kyle

Getting dumped sucks! We aren’t really taught how to handle rejection very well in our culture.

2. Are we capable of overcoming the fear of rejection and how do we accomplish that? 

David

You can face your fear with REJECTION PRACTICE. The FIRST SECTION OF INTIMATE CONNECTIONS IS ON OVERCOMING THE FEAR OF BEING ALONE.

Rhonda

Is part of the fear of rejection also a fear of being alone?  You can use the “What If” technique to uncover more about those fears.  Then put the thoughts in a Daily Mood Log, and challenge them with a variety of techniques you can select for a Recovery Circle. You can also face your fears with Rejection Practice and/or Exposure.

3. When it comes to getting dumped do you guys believe there is a good way to approach it communicating wise?

David

YOU CAN USE FIVE SECRETS TO FIND OUT WHY THE OTHER PERSON IS REJECTING YOU. OR, PERHAPS BETTER, YOU CAN TURN THE TABLES ON THE REJECTOR, SINCE IT IS PART OF A CHASE GAME.

Rhonda

If you want to know more about why you were “dumped,” will you trust the other person to be honest with you?  Will you believe them when they respond?  You might want to do a Cost Benefit Analysis to decide whether or not you even want to ask them to explain why you were “dumped.”

Kyle

It depends on the situation. If you have gone through a divorce and have children, you may still need to talk with you ex-partner. Generally, I don’t think it’s a good idea to stay in touch and keep chatting with an ex who dumped you!

4. If we are caught off guard with the breakup and don’t see it coming and all of a sudden one day our partner decides to end the relationship, how do we not let our emotions get the best of us in that moment in that very moment?

David

WHEN YOU SAY, “GET THE BEST OF US” IT SOUNDS LIKE YOU’RE NOT ACCEPTING YOUR FEELINGS. IS IT OKAY TO FEEL FEELINGS? THIS QUESTION SOUNDS LIKE EMOTOPHOBIA.

Rhonda

It’s perfectly reasonable to be sad, to cry, to be shocked and angry.  Why not have those feelings?  You also don’t have to expect to respond with a “perfect 5-Secrets.”  Maybe you need to take a break from each other, breathe, walk, calm down, and then meet again to talk talk, if that is what you want to do.

Kyle

If you get blindsided by a breakup it can really be shocking and overwhelming. It’s okay to feel how you feel in that moment I would think.

5. When it comes to recovery after being broken up with, how do you fight the urge to go back to your ex?

David

THIS URGE IS DUE TO THE BURNS RULE: WE ONLY WHAT WE CAN’T GET, AND NEVER WANT WHAT WE CAN GET. ALSO, CAN DO A CBA ON CHASING.

Rhonda

Also, look at the thoughts that are leading you to want to get back together.  What do they say about you that is awesome?  Then examine them for Cognitive Distortions, and talk back to them with Dbl Standard or Ext of Voices.

Do a “Time Projection,” see yourself in 5 years, in 10 years, in 20 years.  Have a conversation with your future selves to talk about what you want, what kind of person you want to be with, how you want to be treated in the future.

Practice “Distraction,” when you start thinking about your “ex” distract yourself by concentrating intensely on something else, music, work, friends, cooking, another hobby.

Kyle

Come back to reality and remember all the crummy ways an ex may have been treating you, instead of letting your mind ruminate on how great things were during the first few weeks of dating. Come up with all the good reasons to continue wishing/hoping you and your ex will get back together and talk back to those.

My book, Intimate Connections, will help you with dating and rejection issues!

Stay tuned for Part 2 next week.

Today's Ask David features four terrific questions.

1. Kevin asks: Why is the concept of worthwhileness and worthlessness so important to people and their emotional health?
2. Vallejo asks: Does the statement, "WHY AM I ALWAYS THE LAST ONE TO FIND OUT ABOUT ANYTHING?” correspond to overgeneralization, or self-blame? I’ve been listening to the early podcasts on the ten positive and negative cognitive distortions.
3. David P asks: Do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log?
4. Harvey asks: I don’t see how Positive Reframing actually contributes to the therapy.

1. Kevin asks: Why are the concepts of worthwhileness and worthlessness so important to people and their emotional health?

Hi David,

I have a quick question about the concept of being a worthwhile human being. Suppose a person believes they are unconditionally worthwhile, what are the implications of this? Why are the concepts of worthwhileness and worthlessness so important to people and their emotional health?

Best Regards,

Kevin

Hi Kevin,

Thanks! That’s a very important question. However, it is abstract and philosophical. I have found that philosophical discussions tend to go on endlessly with resolve. In contrast, when someone asks for help with a specific moment when she or he was upset, then I can usually show that person how to change the way she or he is feeling. And when that happens, the person generally suddenly “sees” the solution to some very profound philosophical or spiritual questions.

All that being said, I’ll take a crack at it. The goal of TEAM therapy is not to go from thinking that you’re a worthless human being to thinking that you’re a worthwhile human being, but to give up these concepts as nonsensical. Specific activities, talents or thoughts can be more or less worthwhile, but a human being cannot be more or less worthwhile. We can judge specific events, actions, and so forth, but not humans. At least I am not aware of how to validly judge a human being, or a group of humans. We can only judge their actions, attitudes, thoughts, and so forth.

Unconditional self-esteem is definitely better than conditional self-esteem, since you don’t have to be perfect or a great achiever or a great anything to be “worthwhile,” but you are still focused on being "worthwhile."

I'm not sure what that means, but there is a downside, to my way of thinking. If you think you are worthwhile because you are a human being, does that mean that you are more worthwhile than animals? Lots of people abuse animals, hunt animals, and so forth, which many people find immensely disturbing. These are some of the consequences of thinking that animals are less worthwhile, for example.

Not sure that helps, but like your line of questioning!

David

Kevin follows up: What is the implication then of giving up these concepts at all? I assume that thinking that you have unconditional worthwhileness because you are alive or to drop these concepts entirely have the same emotional implications for people. What are these implications? For example, if I think that worthwhileness and worthlessness are meaningless concepts, so what? What’s the point? What do I gain?

Hi Kevin,

Let me start by saying, once again, that I am not an evangelist spreading the “gospel,” so to speak. My goal is simply to help people who are struggling with feelings of depression, anxiety, and self-doubt. So, if your way of thinking about things is working for you, there’s no reason to change.

But my focus is always on someone who is suffering, and that’s where these concepts can sometimes be important.

I can tell you what I gained by giving up the idea that I could be, or needed to be “worthwhile” or “special.” I gained a great deal of joy. It was a lot like escaping from a mental prison. It freed me to find incredible joy in the “ordinary” events of my daily life. It also freed me from fears of “failure” or not being “good enough.”

Depression always results from Overgeneralization--you generalize from failing at something specific to thinking you are a failure as a human being. Without Overgeneralization, I think it is safe to say that it is impossible to be depressed.

For example, if you measure your worthwhileness based on your achievements and success, you may feel excited when you succeed and devastated or anxious when you fail, or when you are in danger of failing. I'm not sure if this addresses your excellent question!

A young woman told herself that she was "unloveable" when she and her boyfriend broke up after two years of going together. Can you see that she thinks she has a "self" that can be "loveable" or "unloveable?" This thought was very disturbing to her, as you might imagine.

Relationships do not break up because someone is "unloveable," but because of specific factors or events that drive people apart. Once you zero in on why the relationship failed, or more correctly, why the two of you broke up, then you can pinpoint the causes and learn and grow so you can make your next relationship even better. There are tons of specific reasons why people break up!

But if you think that you’re “unloveable,” or tell yourself that the relationship was “a failure,” then you may get stuck in a morass of negative feelings. But it’s not even true that the relationship was a failure.” That’s All-or-Nothing Thinking, since all relationships are a mixture of more or less successful aspects. You could even tell yourself that a “failed” relationship was a partial success, since you successfully learned that this isn’t the person you’re going to spend the rest of your life with.

What’s in it for you to give up Overgeneralization and All-or-Nothing Thinking, as well as the concepts of being a “worthwhile” or “worthless” human being? That’s a decision each person can make. There are benefits as well as problems with these ways of thinking.

For example, let’s say you’re depressed and think of yourself as “defective.” This is a common negative thought, and it is based on the idea that a human being could be more or less worthwhile, or thinking that your "self" can be judged or rated.

So, you could do two Cost-Benefit Analyses.

1. 1. First, you could list the advantages and disadvantages of thinking of yourself as a “defective” human being. Then balance the advantages against the disadvantages on a 100-point scale, assigning the larger number to the list that seems more important or desirable.
   2. Second, you could list the advantages and disadvantages of thinking of yourself as a human being with defects, and once again balance the list of advantages against the disadvantages on a 100-point scale.

This is just a subtle change in semantics, but the emotional implications can sometimes be pretty powerful.

As I mentioned at the top, philosophical debates are just debates. Fun, perhaps, but not terribly useful.

I’m more interested in magic, or miracles. That’s what happens at the moment of profound change, which can ONLY happen by focusing on one specific moment when you felt upset and needed help. When you do that, everything becomes radically different, and real change can occur. And at that magic moment of change, the solutions to all of the problems of philosophy will often suddenly become crystal clear. Or, to put it differently, the philosophical debates will suddenly become, without meaning to sound harsh, almost a waste of previous time.

Our current semi-feral cat loves my wife, but is only starting to trust me, so I’ve been working at gaining her trust and learning to understand her non-verbal and somewhat complex efforts to communicate. Yesterday she roller over on her back and stretch out her front and back paws to expose her tummy to the max, and she let me pet her tummy for quite a long time, purring loudly the whole time.

I don’t care if she’s “worthwhile,” or if I’m “worthwhile,” and have no idea what those terms could even mean. But petting her tummy—now, that’s something that’s REALLY worthwhile!

david

Hi David,

You and Albert Ellis are my heroes. Without your books, I always wonder what path I would have taken in life! Thank you.

I had a quick question about self-acceptance. One of the reasons I feel that I’m fully unable to embrace it (and I think this is common) is that I’m afraid that I will lose out on motivation to work hard towards my goals. I think this partially true because my conditional self-esteem has caused me to work hard on a lot of things including CBT!

Do you have any good ways to combat this exact notion, that if I accept myself I will simply become complacent and therefore I can’t?

Looking forward to Feeling Great!

Best Regards,

Kevin

Hi Kevin,

There’s a lot of truth in what you say. Early in my career I also had a tendency to base my self-esteem on my achievements and productivity, both in my research and in my clinical work as well. I did accomplish quite a lot, but things were a bit of a roller coaster. When I thought I was doing well, I felt terrific, but when I thought my research was failing, or when I was stuck with a patient, I got quite anxious and frustrated. These feelings didn’t always foster positive outcomes.

Now I no longer feel that my “worthwhileness” as a human being depends on my successes. In fact, I don’t even have the concept anymore.

Now, I think my writing skills are very good, especially my skills in explaining complex ideas in fairly simple terms. But I do not think this makes me “more worthwhile.” Sometimes my writing, or my interactions with people, or my jogging, and many other things I do aren’t very good. But I don’t think these problems and flaws make me any less “worthwhile.”

Take our little adopted feral cat, Miss Misty, that I mentioned in my last email. Misty does not care how “worthwhile” I am. However, she’s totally delighted if I pet her, let her out in the back yard to explore, or give her a piece of cat candy, or if I play with her.

She is enlightened because she judges what I “do,” not what I “am.”

Will you become less productive or unmotivated when you give up these concepts of “worthwhileness?” That has not been my experience. I am the busiest and most productive now than at any previous time of my life. I’m now 78, and life is a ball. I have tons of fabulous colleagues to collaborate with and we’re working on all kinds of super-exciting and challenging projects.

When we don’t have “selves” that we need to protect, or feelings of “worthwhileness” that we need to defend, we can listen to criticisms and collaborate without feeling threatened, and use the information to improve what we’re doing!

Hope that makes sense!

david

* * *

2. Vallejo asks: Does the statement, "WHY AM I ALWAYS THE LAST ONE TO FIND OUT ABOUT ANYTHING?” correspond to overgeneralization, or personalization cognitive distortion? I’ve been listening to the early podcasts on the ten positive and negative cognitive distortions.

Hi Vallejo,

Rhetorical questions are technically not considered Negative Thoughts because they contain no distortions. However, this question is actually a Hidden Should Statement, and a great example of Other Blame as well.

You need to change rhetorical questions into statements, like: “It’s unfair that I’m always the last one to find out about anything. This shouldn’t happen all the time!” And, as you point out, it is also a gigantic Overgeneralization.

Thanks, Vallejo!

On the podcast, David will talk about some of the rules for generating Negative Thoughts.

* * *

3. David P asks: Do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log?

Dr. Burns, I'm a big fan of your work, and have now finished "Feeling Great" and loved it. I know you approach depression from a clinical background, but do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log? It seems like my negative thoughts are automatic, and I have to work to counter them. Maybe, if I have to force myself to think of a few things I really am grateful in my life, instead of only focusing on countering the negative automatic thoughts, it would be beneficial? Also, is there a role for altruistic volunteering in alleviating depression? Thank you.

david p

Hi David P,

Anything that works for you is strongly recommended. I do a lot volunteer teaching, and also treat therapists and students for free, and i enjoy that a great deal!

So go for it and let me know if it is effective! I often feel grateful for a lot of things, and people, and animals, like our cat, who "almost" loves me!

As for me, I never use non-specific, formulaic approaches that one practices over time, hoping some good will come from it. So I never prescribe meditation, a daily gratitude log, prayer, aerobic exercise, dietary considerations, vitamins, and so forth. You can do these things if you like, but they are not “therapy” to my way of thinking. I only use specific techniques to crush a patient’s unique negative thoughts of dysfunctional ways of communicating with others during conflicts.

Therapy is a lot like learning to play the piano, or going to a tennis coach to improve your game. Specific practice is needed, not prayer, gratitude journals, or the like. And my focus is on high speed, total and lasting change right now, if possible.

david

* * *

4. Harvey asks: I don’t see how Positive Reframing actually contributes to the therapy.

Hi Dr Burns:

Thank you for this great podcast.

I was particularly impressed by and related to the idea of “Beating Up On Yourself.” I think it is so easy to fall into that trap.

My question is that I don’t see how the positive reframing aspect of TEAM actually contributes to the therapy.

Once you did the reframing with Neil, you didn’t seem to go back to it. So why is that a necessity thing to do?

I understand that the positive side of negative thoughts could cause resistance to give up the negative thoughts, but that didn’t seem to be dealt with.

Thank you so much for these podcasts and I have just started to read “Feeling Great”.

Maybe you go into the positive reframing aspects and benefits more in the new book.

Thanks,

Harvey.

Hi Harvey,

The session you are referring to was a while back, but by memory my thinking was that the Positive Reframing was not a particularly powerful tool for Neil, and I think he thought that also. It is not the case that any one tool--and I have created / learned more than 100 methods--will be effective for everyone.

That's why it's so great to have a huge palette of tools and techniques, so you can find the path forward for many patients, and not just a few! Some people think that if a technique is not helpful for one patient, then it is no good.

Some people also think that one technique, like meditation, or exercise, or medication, should be "the answer" for everyone. My experience is radically different, and it is hard for me to even comprehend how people can get sucked into some of these notions--but they do!

Positive Reframing is one of the great breakthroughs in TEAM-CBT, and it opens the door to ultra-rapid recovery. In fact, I usually (but not always) see a complete or near-complete elimination of negative feelings in one extended (two-hour) therapy session.

Here are some reason why Positive Reframing can be helpful:

• • • When you see that your negative feelings are the expressions of your core values, rather than your defects, this reduces feelings of shame, so you might feel a little better right away.

• • • You don’t have to shoot for perfection, or complete recovery, but rather a reduction in your negative feelings. This is pretty sensible, and more realistic and relaxing than shooting for total change. In addition, you are no longer fighting against your negative thoughts and feelings.

• • •  Your resistance to change will diminish because you can honor your negative thoughts and feelings, and work to reduce them rather than thinking you have to change completely.

• • • You’re in control—the therapist is not trying to “sell you” on something. “Selling” nearly always triggers fairly strong resistance.

• • • You may suddenly see the benefits of many of your negative thoughts and feelings, so you no longer feel so “broken” or defective.

• • • When you "listen" and finally hear what your negative thoughts and feelings are trying to tell you, the volume and intensity of your negative thoughts and feelings will suddenly diminish, like a balloon with a hole in it.

Thanks for listening today!

Rhonda and David

Corona Cast 8: Live Therapy with Dan. How Could You Treat an “Existential Depression” in the Midst of a Pandemic?

Today David and Dr. Jill Levitt feature live work with Dan, a licensed clinical social worker who’s been struggling with an “existential depression” for 15 years, but it has been recently exacerbated by the COVID-19 pandemic. The session took place in one hour and forty minutes on a Tuesday evening on July 23^rd, 2020, in David’s and Jill’s Tuesday training group at Stanford.

Live personal work is one form of training that is vital to professional growth and learning, so it is extremely beneficial for the person who volunteers for the role of “patient.” At the same time, the live work also provides superb learning for those observing the process, since you can see what is really happening during a T.E.A.M. therapy session. Hopefully, you will learn a great deal as you listen to Dan’s live and uncensored therapy session.

Jill and I feel very grateful to Dan for allowing us to publish such an intensely painful and personal experience. You will likely feel grateful to Dan as well!

All live therapy sessions tend to be dramatic and illuminating from a variety of perspectives. Today’s session is unique in that the A = Assessment of Resistance was outstanding and unique. The remarkable changes that occurred would not have been possible without outstanding E = Empathy and A = Assessment of Resistance, which were stellar.

However, the M = Methods portion of the session was also strong, especially in the use of humor and role-reversals during the Externalization of Voices to blast Dan’s Negative Thoughts out of the water. That portion of the session confirmed by the three basic tenants of cognitive therapy:

1. You FEEL the way you THINK.

All of your negative feelings are caused by your thoughts in the here-and-now, and not by the actual events in your life. In other words, the COVID-19 pandemic cannot “cause” anyone to feel depressed or anxious.

2. Depression and anxiety are the world’s oldest cons.

When you’re depressed, anxious, or angry, the Negative Thoughts that upset you will not be valid. They’ll be distorted and illogical. Depression and anxiety are the world’s oldest cons. You can see the ten cognitive distortions I first published in my book, Feeling Good, at the bottom of Dan’s Daily Mood Log (link).

3. You can CHANGE the way you FEEL.

The very instant you stop believing your distorted thoughts, your feelings will change. Recovery is not a long, drawn-out process that requires weeks, months, years or decades, as so many people believe, including the majority of mental health professionals. Recovery happens in a flash, an unexpected “ah-ha” moment when your perceptions of the world are suddenly transformed. You will witness such an event in today’s session.

Now let’s see what actually happened!

T = Testing

Take a look at Dan’s Brief Mood Survey (BMS) at the start of the session. He was feeling moderate to severe depression, no suicidal impulses, and just a little anxiety and anger. His Happiness score was quite low, only 7 out of 20, paralleling his depression score of 12, and his satisfaction with his relationship with his wife was a perfect 30 out of 30. He indicated he’d been doing a lot of psychotherapy homework.

This, by the way, is the latest version of the BMS. We’ll ask him to complete it again at the end of the session to see what changes occurred during the session. Because the BMS asks how Dan is feeling “right now,” it’s like an emotional x-ray machine, allowing therapists to see exactly how much, or how little, a patient is changing at every therapy session. The patient’s scores at the start of the next session also allow the therapist to see exactly what happens between sessions in multiple dimensions.

At the end of today’s session, Dan will also fill out the Evaluation of Therapy Session (ETS), and rate Jill and David on Empathy, Helpfulness, and Session Satisfaction, and indicate how willing he is to do psychotherapy homework, whether he had unexpressed negative feelings during the session, and whether he had difficulty filling out any of the survey questions honestly.

The BMS and ETS are invaluable tools that have been game-changers in psychotherapy. To my way of thinking, it is difficult, if not impossible, to do good therapy, much less outstanding therapy, without these powerful and extremely accurate tools. They have the potential to radically transform clinical work and have been an important key in the evolution of TEAM.

E = Empathy

After briefly reviewing Dan’s starting scores on the BMS, Jill and David empathized while reviewing the Daily Mood Log that Dan filled out prior to the start of the session. The upsetting event was sitting at home on a Friday night with nothing to do, since his wife was studying for an upcoming exam. He points out that when he’s busy doing therapy, he generally feels fine, but sometimes when he has nothing specific to do, intense negative feelings suddenly hit him and take all the joy out of life. As you can see, his feelings on his Daily Mood Log are similar to his feelings on the Brief Mood Survey but some are far more intense, since he’s focusing on a moment of angst.

If you look at his Negative Thoughts, you will see that they all revolve around a common theme that life has no meaning, since people are suffering and dying all over the world, and since all of us will also die one day. He says, “the good things that happen are just like dust in the wind,” and tells himself that “life is unfair.”

Dan explains that in the last couple of years he’s experienced several painful events. He got married, but got divorced after just three months when things did not work out with his wife. But he’d sold his condo, and his practice was not going well, and he could barely pay his bills, so he had to move back home with his mother, who then died of cancer.

Then, right after she died, things suddenly took a turn in a far more positive direction. He began dating and found an extremely loving and wonderful woman in 2017, whom he married last October, and his clinical practice began to blossom around the same time, so he and his wife were able to purchase a new home.

But still, the Negative Thoughts kept popping unexpectedly into his mind, and they can turn feelings of joy (“Wow! I really came back”) into despair in an instant (“I’ll probably lose everything again, and it makes no difference because I’ll eventually die.") David pointed out this is a little like PTSD, when you’re suddenly reminded of a previous trauma and get overwhelmed by angst. And the frequency and intensity of these sudden despair attacks have increased since the start of the pandemic.

Dan gave Jill and David an “A” on empathy after about 30 minutes of listening without trying to “help,” and this was a sign that we could move on to the next portion of the session.

A = Assessment of Resistance

Jill asked Dan if he wanted help tonight, or needed more time to talk and vent. He said he was ready to roll up his sleeves and get to work. His goal was to reduce or eliminate his negative thoughts and feelings, if that was possible.

Jill asked if he’d press a “Magic Button,” if that would cause all of his negative thoughts and feelings to instantly disappear completely, with no effort, and he said he would. Almost everyone says they’d push it—which is completely understandable. When you’re in great pain, we all want relief!

Jill indicated that we did have powerful tools, but weren’t convinced it would be such a good idea to use them to eliminate Dan’s feelings, and suggested we might first make a list of indicating:

1. What each negative thought and feeling showed about Dan and his core values that were positive and awesome.
2. How his negative thoughts and feelings might be helping him.

Doing this skillfully is an art form, since it is radically different from the inept “cheerleading” so many therapists and family members attempt when a loved one is feeling down.

You will hear this process unfolding when you listen to the audio of the session. Notice how Dan’s memories of the death of his older brother when he was just three years old and the recent death of his mother bring tears to his eyes, and help him change the way he thinks about his angst, not as something “bad,” but as something beautiful that honors his mother and his brother who passed away.

But this is just the tip of the iceberg, as a long list of positives emerges during this portion of the session, which is designed to melt away subconscious “resistance” to change. The A = Assessment of Resistance is really the secret key that opens the door to the possibility of rapid, profound, and lasting change.

David and Jill make it look easy, but it is, in reality, quite challenging to learn, because it goes against the very grain of our human inclination to try to “help.” Instead, Jill and David are assuming the role of Dan’s resistance, and showing him, in a gentle and loving way, that his negative thoughts and feelings are not actually symptoms of a defect or “mental disorder, but are really the manifestation of something positive and beautiful about Dan. David and Jill are selling Dan on the status quo and are still NOT trying to “help.”

Paradoxically, this procedure typically has the opposite effect of greatly intensifying the patient’s determination to change.

But now, the therapists have put Dan into a confusional state, and bind. On the one hand, he desperately wants to change. He doesn’t want to continue throwing cold water on the cherished positive moments in his life. But at the same time, if he presses the Magic Button, all of the positives will go down the drain along with his negative feelings.

This is resolved with the Magic Dial. David and Jill ask Dan if he’d be willing to dial his negative feelings down to some lower level instead of lowering them all the way to zero. You can see his goals for each negative feeling on the “% Goal” column of his Daily Mood Log.

M = Methods

Now David asks Dan which Negative Thought he wants to work on first. He chooses this one:

“It’s pointless in life to strive towards anything, because, in the end, we are all going to die.”

 Dan believes this thought 80%.

While identifying some of the many distortions in this thought, he comes up with this Positive Thought:

“Some things are worth striving for!”

This thought is 100% true, and his belief in the Negative Thought suddenly drops to 10%, as you can see on his Daily Mood Log (Daily Mood Log.)

Next, he wants to work on this thought, which he believes 60%:

 “People are dying in the world right now, so I don’t deserve to relax and have fun.”

After identifying five distortions in this thought, he challenges it with this Positive Thought:

“Although the deaths of so many people are tragic, it isn’t my fault that people are dying all over the world.”

Dan rates his belief in this thought at 100%, and his belief in the Negative Thought drops to zero.

Then he decides to work on this thought:

“I’ve had so many good things happen in the last several years, but I can’t enjoy them, since it’s inevitable that I’ll lose those things.”

He adds, “After all, what goes up, must come down!”

After a couple of rounds of Externalization of Voices with Jill, he still couldn’t completely crush this thought, so David steps in to give it a try, with Dan playing the role of the Negative Thoughts and David playing the role of Dan’s Positive Thoughts. David interrupts Dan’s verbalization of this thought with some irreverent Buddhist humor. At that moment, Dan suddenly “gets it,” and the floodgates open up as Dan crushes the thought.

Some people have called this “ah-ha” moments the “cognitive click.” It’s like waking up from a trance or nightmare, and the patient suddenly sees the world in a radically new and far more realistic light.

Jill and David complete the M = Methods portion of the session by challenging the rest of Dan’s Negative Thoughts using Externalization of Voices, including role-reversals with the Self-Defense Paradigm and the Acceptance Paradox. I think you will find these exchange fascinating, and you will hear the tides coming in and the tides going out as Dan sometimes struggles and then defeats all of his Negative Thoughts.

You can review Dan’s end-of-session mood ratings on his Daily Mood Log as well as his end-of-session Brief Mood Survey and his ratings of Jill and David on the Evaluation of Therapy Session.

The Necessary and Sufficient Conditions for Emotional Change

If you look at Dan's Daily Mood Log at the end of the session , you will see that the belief in each Positive Thought was high, and that his belief in the corresponding Negative Thoughts was drastically reduced. This is exactly why his feeling suddenly changed so dramatically. Cognitive Therapy (including TEAM) is NOT about telling yourself positive things or uttering positive affirmations. Instead, it's about crushing the distorted thoughts that trigger all of your negative feelings. The very moment you stop believing your Negative Thoughts, your feeling will instantly change.

At the end of the session, Jill gives Dan a critically important “homework” assignment. Listening to the audio of a session and doing written work with the Daily Mood Log are vitally important aspects of TEAM. What happens between sessions is just as important as what happens within sessions!

Thank you for listening today, and a HUGE thanks to Dan!

I hope you learned a ton, on many different practical plus philosophical levels, and enjoyed today’s live therapy session!

The Tuesday group at Stanford is free to all Bay Area mental health professionals as well as graduate students in some form of mental health training. The only “fees” involve a commitment to consistent attendance and the willingness to use the BMS and ETS with all patients, plus the willingness to do homework between Tuesday groups so you can really learn and master the very challenging TEAM techniques.

Rhonda and David

How to Change a Self-Defeating Belief (SDB)

Many of you have expressed an interest in my free Tuesday training group for mental health professionals. Today, you can attend, thanks to the generosity of our group in allowing the group to be recorded on Zoom, and thanks Zeina, the group member who courageously volunteered to have us work on her “Achievement Addiction.” I also want to thank my beloved and brilliant co-teacher, Dr. Jill Levitt, who always adds tremendously to our group, on so many different levels.

Last week, we taught the group members how to pinpoint Self-Defeating Beliefs that trigger depression and anxiety, and we promised to show them how to challenge and modify a Self-Defeating Belief in the group you’re about to “attend.” We decided to focus on the Achievement Addiction, which is the belief that your worthwhileness as a human being depends on your achievements and productivity.

Perhaps you share this belief! Most people do.

Here’s how a Self-Defeating Belief works. Let’s say that you base your self-esteem on your achievements. As long as you think you’re achieving and being successful, we would predict that you’ll feel happy and contented. But we would also predict that you may experience episodes of depression, anxiety, and self-doubt when you fail or fall short of your goals and expectations. That’s when you’ll be most likely to start beating up on yourself with distorted negative thoughts, like “I’m a loser,” or “I shouldn’t have screwed up,” or “I’m not good enough.”

So, in short, the combination of an SDB (“My worthwhileness is based on my achievements”) plus a negative event, like a perceived failure, triggers distorted thoughts (like “I’m a failure” or “loser”) which trigger negative feelings, like depression, anxiety, shame, inferiority, or even suicidal thoughts. In addition, cognitive therapists believe that if you modify the SDB, it will not only help you in the here-and-now, but it can also make you less vulnerable to painful mood swings in the future. But how in the world can you do that?

If you like, take a look at the list of 23 common Self-Defeating Beliefs and see if you can find any of yours!

Zeina said she wanted help with her tendency to base her feelings of happiness and self-esteem on her accomplishments. In the group, we demonstrated four techniques for changing this or any SDB, including:

1. The Cost-Benefit Analysis.  You list the advantages and disadvantages of the belief you want to change. You can find the one we worked on with Zeina during the group if you click this link. If you want a blank one you can work with, you can find one on page 2 of this link.
2. The Semantic Technique. This involves change at the intellectual level. if the SDB is not working to your advantage, could you modify it so you can keep all the advantages you listed while getting rid of most if not all of the disadvantages. This is a bit of practical personal philosophy exercise with significant emotional implications.
3. The Feared Fantasy. Here's where change at the gut level begins, and you also can begin to challenge the idea that high achievers really are more worthwhile.
4. The Double Standard Technique. Here's where change at the gut level continues, and you can hear a beautiful example in Zeina's dramatic interaction with Dr. Levitt.

In today's part 1 podcast, we completed the Cost-Benefit Analysis. I would urge you to do your own CBA while you're listening. When you're done, balance the advantages against the disadvantages on a 100 point scale. Put two numbers in the circles at the bottom to show whether the advantages or disadvantages are greater. For example, if the advantages of this belief greatly outweigh the disadvantages, you might put 80 - 20 in the two circles. If the advantages and disadvantages of this belief are about equal, you can put 50 - 50 in the two circles. And if the disadvantages are somewhat greater, you might put 45 - 55 in the two circles.

When you do your own weightings, please note that the number advantages or disadvantages is not important--that's because one advantages could outweigh several disadvantages, and vice versa. Instead, look at the lists as a whole and ask yourself how they feel, and how this belief is working for you.

In addition--and this is super important--remember that you are NOT evaluation the advantages and disadvantages of achievement. There probably aren't any disadvantages of achievement! Instead, you are evaluating the advantages and disadvantages of basing your self-esteem and feelings of worthwhileness on your achievements and productivity.

At the end of the group work with the CBA, I emphasize that the goal of the CBA is simply to find out if you (or in this case Zeina) want to change your SDB. This is a motivational question. If the advantages and disadvantages are about equal (50 - 50), or if the advantages out weight the disadvantages (eg 60 - 40), then there may be no reason to change the belief. But when the disadvantages outweigh the advantages, you can then change the belief so that all the disadvantages diminish or disappear entirely, while at the same time you keep all the advantages.

That sounds like a pretty good deal! In next week's podcast, you'll learn how to make this happen with the help of the Semantic Technique, Feared Fantasy, and Double Standard Technique!

There are a great many additional techniques for challenging and modifying any SDB as well. The four I listed above are just a kind of “Starter Kit” for SDBs to give you a feel for how some of the techniques work. If you like this podcast, we may focus on other SDBs as well, such as the Approval Addiction, the Love Addiction, and more. Let us know if you’d be interested, and which beliefs interest you the most. We’ve already done a podcast on perfectionism, as well as a popular Live TV program on perfectionism on Facebook that features Jill and me, but there are tons of beliefs we haven’t yet addressed.

To make today’s podcast more dynamic, you can do your own Cost-Benefit Analysis while you watch, and make sure you do your own weightings at the bottom, just like the therapists in our Tuesday training group. I think you’ll enjoy it, and it might nudge your thinking a little, too!

Please let me know if you've enjoyed "eavesdropping" on my Tuesday training group, and if you'd like more Feeling Good Podcasts like this in the future. Let me know, too, if you'd have an interest in attending a weekly TEAM therapy training group for therapists or for the general public.

My new book Feeling Great, is now available on Amazon (see the link below) as a hardbound volume or as an eBook. It features all the new TEAM therapy techniques, and is geared for therapists as well as the general public.

Rhonda and David

David, Matt, and Rhonda Answer Your Questions!

1. How can I help my depressed son?

2. What can you do on a boring first date?

3. Are depression and anxiety genetic and hopeless?

4. What do scary, intrusive thoughts mean?

The answers to this week’s questions were written by David prior to the podcast. The live discussions will add greatly to the comments below.

Get consent on first question, or change name. In fact, I’ll just change her name to Henrietta.

1. Henrietta asks how she can help her son who’s been severely depressed for nearly 20 years and rejects all suggestions.
2. Julia asks what to do on a boring first date.
3. Negar asks if anxiety and depression are genetically caused and therefore hopeless .
4. Negar asks about scary intrusive thoughts.

1. Henrietta asks how she can help her son who’s been severely depressed for nearly 20 years and rejects all suggestions.

Dear  Dr David

I discovered you years ago due to my son’s depression.   I purchased your book for him, but he not reading it.  He thinks he is too far gone for any self help and has been on anti depressants for years.

I appreciate all your hard work , the blogs and the app.   I have my hopes up that one day he will listen to you or download the app.   This depression has been going on more than 18 years now.

Do you have any ideas on how I could get him to listen to you on You tube?  God bless you and your team.   Keep  up the good work!

Best  regards

Henrietta

David’s reply

Hi Henrietta,

I’m so sorry he’s struggling. I do have a clear recommendation, clearly spelled out in the podcast of a couple years ago, “How to help. And how NOT to help.” You can easily find it on the list of podcasts on my website.

I’m sure that his depression has been heart-breaking for you. But there is a radically different strategy / direction one can pursue when efforts to “help” are 100% rejected.

LMK if I can use your question on an Ask David podcast. Then you’ll get input from several of us.

Warmly, david

2. Julia asks what to do on a boring first date.

Dear David

Just saw that you published a podcast about how to give negative feedback, absolutely cannot wait to listen to it.

I’m afraid I fall in the category of people who tend omitting opinions and this is going to be of great help!

Now to my question: how do I get more excited in dates with guys ?

I would like to date more and have a more active sexual life but I find myself getting bored in dates and this affects also my libido.

I will have thoughts like:

1. this is boring
2. he is not that attractive
3. I won’t be turned on
4. sex won’t be good

I obviously then don’t end up having sex with the guy and try to have a date with someone else.

In the date I don’t feel anxious but I’m not excited physically and mentally. The anxiety plays a role before I go to the next scheduled dates, because with time I start thinking this feeling of boredom will never go away.

I have tried to work on the thoughts myself with little results and I was wondering if you had any suggestions on how I could be less bored and anxious and enjoy myself.

Thanks you for your answer and your amazing work!

Best wishes,

Julia

David’s Reply

Great question, and I have an answer. Can we include this in the next Ask David, using your first name or a fake first name?

Thanks, Warmly, david

You are viewing dating as a shopping expedition, trying to “find” the best item to purchase, and finding your shopping boring, which it is. But you are forcing it to be boring because you are not being open with your feelings. You are foolishly trying to hide your feelings of boredom, whereas they are really the door to fascination and a most interesting and dynamic exchange. Let me show you what I mean.

You can, instead, view dating as forming a relationship, being open, and genuine, and a little flirtatious, and seeing how things unfold. So, or example, you might say something along these lines, “You seem like a really neat and interesting person, but I notice that our conversation is not very open, or vulnerable, and that makes it way less interesting. Have you notice that, too? Tell me how you’re feeling.”

If you express this, things will instantly get very interesting! You are not trying to hurt their feelings, but rather open up a conversation about feelings, by encouraging them to be real. They may also be feeling bored, or anxious, or whatever.

As a psychiatrist, I find that when I explore the feelings and insecurities of my patients, it is always interesting. And when there is tension, including boredom, I acknowledge it to find out what’s up, and how is my patient experiencing the session and our interaction, and that is interesting 100% of the time, without exception.

Warmly, david

Dear David,

Thank you for such an amazing answer!

I have listened to the podcasts so many times and I am familiar with the concept of sharing the tensed feelings like boredom, to not force the other person to be boring.

However I had never thought to apply it to dating!! It is such a foreign concept to how all my friends approach dating, that I will need first to experiment with it.

I’m curious to see if I’m going to be brave enough to take this leap!

Cannot wait to hear the podcast!

All the best,

Giulia

3. Negar asks if anxiety and depression are genetically caused and therefore hopeless .

Hello, my kind father🦋💙, I hope you are well💝. I have a question. Many people I see who suffer from panic attacks and experience anxiety and major depression believe that they have a family and genetic background.

That is why they do not have much hope that psychotherapy can help them and believe that the defective gene for causeless anxiety and panic is turned on in the nucleus of their cells.

What do you think? Is it possible to deactivate these defective genes with psychotherapy sessions, meditation, etc.?!🥲

David’s Reply

There is evidence that anxiety is inherited, and my mother had fear of heights, for example. I also got fear of heights and more than a dozen other forms of anxiety: fear of blood, dogs, vomiting, social situations, public speaking, cameras, panic attack once, and much more. But I have found that the techniques I use in therapy have helped greatly. I got over my fear of blood, for example, in twenty minutes working in the emergency room of a hospital and treating a severe trauma patient covered in blood. Everything about humans is genetic. We are born unable to speak a language, and yet we learn.

So, to me, the argument is kind of silly and naïve. Just because something is influenced by genetics, and everything is, how does it follow that we cannot grow and learn? The whole notion seems to me to be ridiculous.

Now, there are some genetic things that cannot be changed. For example, how tall you are, or the color of your hair (of course you can dye your hair if you want.) So everything has limits.

The belief that you cannot change the way you feel will act as a self-fulfilling prophecy, since you won’t try, but that doesn’t make it true!

Here’s something that IS true: Your feelings constantly are changing, at every minute of every day from the moment of birth. So anyone who argues that feelings CANNOT change is just wrapped up in a complete delusion! But people are welcome to believe whatever they want, of course. I believe strongly in freedom of thought. I also believe that people have the RIGHT to be WRONG!

Best, david

Will use as another excellent Ask David question if okay.

Thanks for the great photo. Do you want me to include it in the show notes for that podcast episode?

PS I will soon publish a video on my YouTube channel showing a 5 ½ minute cure for a woman with ten years of extreme panic attacks every week. Panic is probably the easiest thing to treat.

4. Negar asks about scary intrusive thoughts.

Hello my kind father
I hope you are in a good mood and continue to be full of energy as always
I had a question
I see in some people that they say that we have scary and useless thoughts
This case is interesting for me too, because sometimes I have absurd and meaningless thoughts
But since I meditate and do mindfulness exercises, I came to the conclusion that these are just thoughts.
Did you have such an experience?😉

David’s Reply

Yes, I have treated many people with frightening, intrusive thoughts and images, common in OCD / intense anxiety. Often, something is happening in that person’s life that is bothering them, but they are not dealing with itself, instead they sweep their feelings, of anger or whatever, under the rug and try to avoid them. Result = obsessions. There’s a whole section on this in my book, When Panic Attacks, and you can look up my podcasts on the Hidden Emotion Technique.

Best, david

In this podcast, Drs. Fabrice Nye and David Burns discuss an exciting breakthrough in psychotherapy.

Leave your questions and comments below. Also, let us know if you’d like to see certain topics addressed in future podcasts.

David emphasizes that the goal of the RJ is not simply to learn how to transform troubled, adversarial relationships into loving ones, but also how to achieve Interpersonal Enlightenment, which is the empowering but shocking realization that we are creating our own interpersonal reality—for better or worse—at every moment of every day! And although the reward of the RJ is greater love and joy in your daily living, the price is steep—it requires the death of the ego, which the Buddhists have called “the Great Death!”

Together, David and Fabrice walk you through the five steps in the RJ, using real examples of individuals David has worked with in his workshops for the general public or for mental health professionals. One vignette involves a woman who complained bitterly that her husband had been relentlessly critical of her for 25 years. She said she came to the workshop because she wanted to know why men are like that. She found out why her husband was so critical, but the answer was not the one she expected!

The other vignette involved a minister’s wife who complained that her husband was overly “nice” and unable to deal with negative feelings. As a result, she said their marriage was superficial and lacking in intimacy. She discovered precisely why their relationship was superficial—but it wasn’t exactly the answer she was looking for!

Fabrice and David are pleased to chat with Dr. Taylor Chesney who is an expert in the treatment of children and teenagers with TEAM-CBT. Taylor was a member of Dr. Burns’ Tuesday group at Stanford and his Sunday hiking group for two years before returning to her home in New York in 2014. She opened the Feeling Good Institute NYC, where she and her colleagues offer individual and intensive treatment as well as training for mental health professionals (in person and online). Today she reveals the inside scoop on how to use TEAM-CBT with children and teenagers, and their parents.

Rhonda and David are joined today by Dr. Michael Greenwald, who was in the studio following his recording of last week’s podcast. We address a fascinating question submitted by a podcast fan:

Sally asks” “How can I help my depressed husband who is leaving me?”

Hello Dr David,

My husband is going through severe depression and anxiety. He blames me frequently for all the bad decisions he made, and he says he married the wrong woman.

He regrets almost every decision he made and says he made the decision [to marry me] under my pressure. Our marriage of 20 years is almost leading to separation.

I don’t want to separate, but I don’t know how I can improve the situation. He doesn’t want to go to any doctor.

Do you think if I decide to go to TEAM certified therapist, they can work on me to get him out of his depression? If yes, how many sessions will it take?

Sally

David, Rhonda and Michael discuss this sad and difficult situation that Sally describes. Feeling loved and cared about is vitally important to nearly all of us, and when an important relationship is threatened, it can be extremely painful.

It sounds like Sally's husband may be on the verge of leaving her. David describes a powerful and paradoxical strategy he described in Feeling Good: The New Mood Therapy, that he has often used to help abandoned wives. The approach is the opposite of "chasing," and is based on experimental research on the most effective ways of shaping the behavior of rats!

It also sounds like Sally and her husband have some significant difficulties communicating in a loving and supportive way, like nearly all couples who are not getting along, and certainly some couples therapy or consultation might be a useful step. However, the prognosis for couples therapy isn't terribly positive unless both partners are strongly committed to each other, and willing to work on their own problems, as opposed to trying to change or “fix” the other person.

We place a strong emphasis on the Five Secrets of Effective Communication, especially the listening skills, when criticized by a patient, family member, colleague, or just about anyone. If Sally committed herself to learning to use these skills—which are NOT easy to learn—she might be able to develop a more loving and satisfying relationship with her husband, whether or not they separate or stay together. David expresses the opinion that her fixation on “helping” or “fixing” him might be misguided, and might actually irritate him and drive him away.

Rhonda, Michael and David illustrate David’s “Intimacy Exercise,” which is a way of learning to use the Five Secrets, and they practice with three of the criticisms Sally has heard from her husband:

1. “You pressured me into marrying you.”
2. “You’re to blame for all the bad decisions I’ve made.”
3. “I married the wrong woman.”

After each exchange, the person playing Sally’s role receives a grade (A, B, C, etc.) along with a brief analysis of why, followed by role-reversals. These role play demonstrations might be interesting and useful for you, too, because you’ll see how this exercise works, and your eyes will also be opened to just how challenging it can be to respond to a painful criticism in a skillful way, and how mind-blowing it is when you do it right. You will also see that trained mental health professionals often make mistakes when learning these skills, and how you can increase your skills through this type of practice.

David emailed Sally with some additional resources that could be helpful to her.

Hi Sally,

Thank you so much for your question, and for giving us the permission to read and discuss your question on a podcast. We will, however, change your name to protect your identity.

For referrals for treatment, you can check the referral page on my website,  or go to the website of the Feeling Good Institute. There may be some excellent therapists in your area, too.

I would recommend the recent Feeling Good Podcast on “How to Help, and How NOT to Help.” . The idea is that listening is sometimes far more effective and respectful than trying to “help” someone who is angry with you.

Also, the podcasts on the Five Secrets of Effective Communication, starting with #65, could be helpful, along with my book, Feeling Good Together. There’s also search function on almost every page of my website, and if you type in “Five Secrets,” you’ll get a wealth of free resources.

Your husband might benefit from my book, Feeling Good: The New Mood Therapy, available on Amazon for less than $10. Research studies indicate that more than 50% of depressed individuals improve substantially within four weeks of being given a copy of this book, with no other treatment. However, the depressed individual must be looking for help, and it’s not clear to me whether the treatment is more your idea, or his idea.

You seem to be asking for training in how to treat your husband. Perhaps, instead, you could learn to respond to him more skillfully and effectively using the Five Secrets. Learning how to do psychotherapy requires many years of training, and since he is not asking you for treatment or for help, that plan does not seem likely to be effective, at least based on what I know.

In fact, trying to “treat” someone who is clearly annoyed with you runs the danger of creating more tension and anger, but this is not consultation, just general teaching. You would have to consult with a mental health professional for suggestions. Obviously, we cannot treat you or make any meaningful treatment recommendations in this context.

But there is no doubt in my mind that there are many things you can do to improve the way you communicate with him and relate to him, if that would interest you. But this would require looking at your own role in the relationship, as well as lots of hard work and practice to learn to use the Five Secrets.

Sincerely,

David D. Burns, M.D.

Thanks for listening to today's podcast!

David

Helping the Poor in Heart, featuring Victoria Chicurel and Silvina Carla Bucci

One of my favorite New Testament quotations comes from the “Sermon on the Mount” by Jesus: “Blessed are the poor in heart, for they shall see God.” Matthew 5:8. I’m not 100% sure what this means, exactly, but it seems to me to suggest the values of compassion and humility, as opposed to self-aggrandizement.

I once had the chance to speak to a Catholic priest with a PhD in philosophy who had just returned from several years working with the indigenous people in Paraguay. He said that although the people were poor, and sometimes experiencing the effects of repression from the government, he said they were mostly happy and supported one another.

He also said that when he flew into Miami and walked through the airport, he was shocked to see so many overweight and visually unappealing people, after living for many years in Paraguay among the “poor.”

Who, really, is “poor,” and who, in contrast, is “wealthy?” That’s kind of the meaning I attribute to the Biblical quotation from the book of Matthew. I looked him up on Google, and apparently he worked as a tax collector in Copernicium prior to becoming a preacher in Judea.

At any rate, today’s podcast features two women who are working with the poor in Mexico and in the Pomona Valley in Southern California. Victoria Chicurel and Silvina Carla Bucci and working to promote TEAM-CBT in Mexico and Victoria is working with a group of Mexican women immigrants, some un-documented, most with limited English-language skills in the Pomona Valley teaching them a simplified version of TEAM-CBT.  Victoria calls these women, Promotoras.

In a pilot study sponsored by an organization called Common Good, Victoria has trained a group of approximately ten women in the ten cognitive distortions as well as the Five Secrets of Effective Communication and other simple cognitive therapy techniques, so they can teach these skills, called “psychological first-aid,” as coaches, to women without access to mental health care. These lay coaches trained are paid $15 per hour by Common Good, and the clients are treated for free. They were very enthusiastic about the results of their informal study. (The director of Common Good is Nancy Minte, the sister of one of our esteemed colleagues, Daniel Minte, LCSW.)

Victoria described a shame attacking contest organized by Daniel Minte, a Level 5 TEAM therapist. Shame-Attacking Exercises were developed by the late Dr. Albert Ellis from New York City, one of the founders of cognitive therapy,. Shame-Attacking Exercises are designed to help people with social anxiety get over their fears of looking foolish in front of others. You intentionally do something bizarre in public so you can discover that the world doesn’t come to an end when you make a fool of yourself. . The goal of the contest was to do the most weird and courageous Shame Attacking Exercise.

The winner was a woman who was one of the promotoras working with Victoria who suffered from severe social anxiety and who was greatly helped by a “Shame Attacking Exercise.” In one of her English classes, she stood and announced she was going to do something ridiculous to overcome her fear of making a fool of herself in public, and warned them that she had a terribly singing voice. She then burst into song, singing the national anthem of Mexico, and received enthusiastic cheers from her classmates at the end. This experience changed her life!

Prior to her experience, she had been so shy that she was afraid to express her opinions in public. After the exercise, her shyness instantly become a memory and she won first place in the competition!

Many others have been helped, too. I mentioned the experience of Sunny Choi who worked for years with Asian immigrants in the SF Bay area. He said that these patients did not expect long term treatment, and often responded in just four or five sessions, even if they were struggling with very severe problems. Victoria said they were seeing the same thing, and described a woman struggling with perfectionism who recovered in just five sessions.

The coaches in the program use my Brief Mood Survey, translated into Spanish, to track progress, and have access to the Spanish version of my first book, Feeling Good.

Silvina is working to promote TEAM-CBT in Mexico and other Spanish speaking countries like Ecuador, Peru, Spain, and Columbia. She has even created a TEAM-CBT licensing program for Spanish-speaking mental health professionals.

She says that her biggest challenge is one I have run into in my efforts to teach in the United States as well: The therapists are skeptical and have an attitude of “prove it to me.” In addition, they have difficulties learning to use the Five Secrets in their clinical work and personal lives, especially “I Feel” Statements and the Disarming Technique, as well as the paradoxical techniques of TEAM-CBT.

For me (David) personally, I welcome skepticism, but find the arrogance behind some if it to be hugely annoying! Sadly, I think that our field of mental health / psychotherapy consists, to a great extent, of competing “cults” that are not based on science, or on data-driven treatment, but rather the teachings of cult-leaders, like Freud and the hundreds of others who have started this or that “school” of therapy.

I often say that TEAM is NOT another new therapy , or “cult,” but rather a research-based structure for how all therapy works. I would love to see the gradual disappearance of schools of therapy and the continued emergence and evolution of data-driven therapy.

I applaud the efforts of Victoria and Silvina in their work with the “poor in heart.” In the mid-1980s, I developed a large scale cognitive therapy program for the residents in our inner-city neighborhood at my hospital in Philadelphia. It was a group program based on my book, Ten Days’ to Self-Esteem, and the therapists were simply people from the neighborhood who received some training in CBT and followed the Leaders Manual for The Ten Days’ to Self-Esteem groups they were directing.

The program was largely free and very successful. Many of our patients could not read or write, and some were homeless. Most had few resources, and many might be considered among those are “poor in heart.” But they were definitely not poor in spirit! Our hospital had “Feeling Good” days every six months, and they even had a Feeling Good jazz band. That program was the most successful and gratifying program I have ever been associated with.

Rhonda and I are very proud of these two fantastic women! If you would like to learn more about their work in Mexico and in the Pomona Valley, please feel free to contact them at www.TEAM-CBTMexico.

Thanks for tuning in today!

Rhonda, Victoria, Silvina, and David

Announcements: Feeling Great Book Club

We're excited to announce a Feeling Great Book Club for anyone in the world, supporting people in reading and learning from David Burns' powerful and healing TEAM-CBT book Feeling Great with questions and answers, exercises and discussions in large and small groups.

It will meet online for an hour at a time for 16 weeks on Wednesdays starting March 17 at 9am and 5pm Pacific Time - which should allow for fairly reasonable hours from anywhere in the world.

Note that the group is intended to provide education but NOT therapy or treatment. Cost is 8$ per session paid in advance, but people will be able to pay whatever they can comfortably afford and no one will be turned away for lack of finances. The group will be primarily led by Brandon Vance, a psychiatrist who is a level 4 TEAM therapy trainer who has studied with David Burns since 2011.

Please go to https://www.feelinggreattherapycenter.com/book-club to find out more and to register.

Your Book Club Teacher: Brandon Vance, MD

Upcoming Virtual Workshops

February 28, Self-Defeating Beliefs: How to Identify and Modify Them, a one day workshop for mental health professionals. 7 CE credits. Featuring Drs. David Burns and Jill Levitt, sponsored by FGI, Mt. View

Click here for more information including registration!

March 24, 2021, Feeling Great: A New, High-Speed Treatment for Depression and Anxiety. A One-Day Workshop by David Burns, MD. sponsored by Jack Hirose & Associates, Vancouver

Click here for more information including registration!

April 7, 2021, Bringing TEAM-CBT to Life in Real Time, by David D. Burns, MD. A Half-Day Live Therapy Demonstration Sponsored by Jack Hirose & Associates, Vancouver

Click here for more information including registration!

Today's Questions

Brian asks:

1. Can negative thoughts lead to high blood pressure? Thank you

Jim asks:

2. I’m having panic attacks! What should I do?

Adam asks:

3. Shouldn’t we get rid of the terms, “Positive Thoughts” and “Self-Defeating Beliefs?”

Phil asks:

4. Hi David and Rhonda! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions?

Nandini asks:

5. How do I get your Decision-Making Tool for help with habits and addictions?

A man from France asks:

6. After listening to Podcast 003: E = Empathy — Does It Really Make a Difference?: “How do we do when the person, we are having a conversation with does not feel comfortable in sharing his/her feelings and thoughts, or does not know how to deal with feelings and thoughts when hearing them?

Thomas asks:

7. What would you say to a person who wants more ego strength.?

* * *

1. Brian asks: Can negative thoughts lead to high blood pressure? Thank you

Thanks Brian. I don’t know the answer to your excellent question. One big problem is that much, if not all, of this type of research is of pretty poor quality. When I review research articles, my focus is not on “what are the implications of these findings,” but rather on “what are the flaws in this research study?”

Usually, the flaws are so severe, at least to my way of thinking, that the findings are not worth interpreting.

I apologize for this answer, as it is way less exciting than speculation!

On minor point would be that if you believe negative thoughts, you will experience feelings like depression, anxiety, anger, and so forth. So the real question would focus on whether elevations in negative feelings are associated with increases in blood pressure.

One common phenomenon is that some people get very anxious when their blood pressure is measured, and this, it appears, can lead to temporary blood pressure elevations. So, sometimes the doctor or nurse will ask the patient to sit quietly for a little while, and will then repeat the blood pressure measurement.

So, it might be the case that people who are more prone to feelings of anxiety would have more fluctuations in blood pressure. But the question then might be—are these temporary fluctuations associated with generally elevated blood pressure?

I don’t think they are, but I’m not up on the latest thinking on this topic.

david

Brian adds: David Burns Last night, I was having stressful thoughts about family and I checked my blood pressure and it was way up, so I think it does. 🙂

Cool, nice research! You can also see if changing those thoughts and feelings leads to a reduction in BP! d

Dr. Burns i did and my stress lowered and so did my blood pressure

Way to go, Brian! Kudos! david

* * *

2. Jim asks I’m having panic attacks! What should I do?

Dear Dr. Burns,

I recently bought copies of Feeling Good, Feeling Great, and The Feeling Good Handbook, and studying them has been remarkably helpful so far. Thank you for writing them!

I hope this is not too forward, but I am struggling with one immediate difficulty: within the past two weeks, I have had two panic attacks that brought on heart palpitations, and it's created a cycle of anxiety that I can't seem to break.

My central issue is that I can't seem to isolate a thought that brings on the initial feelings of worry (followed by flushing of the face and then skipped heartbeats) The first attack happened in the car after visiting a store, and the second happened while waiting on line at a store.

I have seen a cardiologist, and so far all my blood work and EKGs have come back normal.

Whatever help you can give or resources you can share would be sincerely appreciated.

Thank you,

Jim

David responds by emphasizing:

• My book, When Panic Attacks, will give you great tools for understanding and overcoming panic.
• I use four models in treating all forms of anxiety, including panic:
  • the cognitive model
  • the hidden emotion model
  • the motivational model
  • the exposure model

You can find podcasts that detail all of these approaches.

• I describe the kinds of thoughts that typically trigger panic, and how to defeat them!

* * *

3. Adam asks: Shouldn’t we get rid of the terms, Positive Thoughts and Self-Defeating Beliefs?

I have a few questions about some of the Semantics on the Daily Mood Log and the Self-Defeating Beliefs list:

1. On the Daily Mood Log, there is a section for positive thoughts. My understanding is that the goal isn't necessarily to think positively, but instead to correct distortions so that the person is thinking realistically. A lot of the thoughts I hear reframed on the podcast aren't necessarily positive, but instead capture a more realistic or balanced perspective. If I'm understanding correctly, positive thinking may actually cause your thoughts to be distorted in the opposite direction. My experience has been that often times when you speak with people about positive thinking, they will end up in the territory of positive distortions. I'm wondering what you would think about calling this column 'Realistic Thoughts'?
2. One of my favorite tools that I've used both for myself and for my clients is the list of Self-Defeating Beliefs. So often when I use the "Downward Arrow" technique with a client, it leads to one of these beliefs, and it is really helpful to have clients identify the beliefs on their own accord.

With that being said, one thing that I personally feel some reservation about is calling the beliefs "Self-Defeating." Similar to positive reframing, it often seems like the goal of these beliefs is to protect the person or give them some benefit, and that the side-effect of that protection is the self-defeating part.

For instance, being perfectionistic may be intended to protect people from criticism (protective and helpful), however never allows them to see that it's okay to make mistakes (unhelpful and self-defeating).

This is often revealed through the cost-benefit analysis, and I like the idea that the individual gets to decide if the belief is self-defeating or not after the CBA. In that way, I wonder if calling them "Self-Defeating" from the start may bring up resistance, as it assumes the belief is more unhelpful than helpful before the client has really done the work to decide that. I've had a harder time thinking of another name that captures this, but I'm wondering what you think about the term possibly leading to resistance?

As always, I appreciate the effort that you and Rhonda have put into the podcast and I'm looking forward to what you have to offer in the next year!

Be well,

Adam Holman, LCSW, SUDS

Hi Adam.

Thanks for your ideas! I’m kind of sticking to the current wording for many reasons. One problem is that any terms you might suggest will have tons of positive and negative aspects, and the art is in the delivery of the therapy, and not so much in the names of things. I have not run into any resistance with SDBs, but rather enthusiasm from most (nearly all) folks. Still, your ideas are all correct. SDBs have huge positives, absolutely.

In Philadelphia, we started with “Automatic Thoughts” and “Rational Responses,” which were Beck’s terms. However, 25% of the patients at our inner city hospital had not made it through the fifth grade, and they found these terms intimidating. But they DID understand Negative Thoughts and Positive Thoughts!

People used to think the term “psychotherapy homework” was aversive and people would be more compliant ii if we changed the name to “self-help assignments.” But the name was NOT the issue, motivation was the issue, and the term “psychotherapy homework” is actually way more useful, as it lets the patient know what will be required if they want this type of treatment.

If they do want a form of therapy that requires “homework,” then I am not the therapist they are looking for!

Semantics are important, and different people will perhaps want their own words and terms for things!

Sincerely, david

* * *

4. Phil asks: Hi David and Rhonda! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions?

Hi Dr. Burns,

First of all I want to wish you and Rhonda a very Happy New Year. We are off to a rocky start, but things will get better soon!

I loved the podcast on jealousy and anger as it really showcased a ton of TEAM techniques and tools. I had a question that perhaps you'd be willing to answer. Or not!

1. Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions. At least mine do! Obviously writing down the distortions will certainly reinforce the fact that you can pinpoint the distortions at hand, but will it make a big difference either way?

Also, way back when I requested and received a few free chapters in your new Feeling Great book and received the chapter on the Decision-Making Tool which I thought was terrific. I can't for the life of me find the email/link which contained the blank Decision-Making Tool but if you could direct me to find it I would very much appreciate it. I knew you said you were planning an App for it so perhaps that's where it might reside.

I loved working with you, Jeremy and Alex on the Beta Testing. It was a lot of fun and if there is any more way I can help out, let me know.

Keep up the great work!

Phil McCormack (Philomablog!)

Thanks, Phil,

Identifying and explaining the distortions is a great help to many. But if you’re super experienced, you can often take short cuts!

When you’re doing this for the first time, it is necessary to write them down, however.

David

* * *

5. Nandini asks: How do I get your Decision-Making Tool?

Hi Nandini,

The free chapter(s) offer is at bottom of the home page of my website.

d

* * *

6. A man from France asks, after listening to Podcast 003: E = Empathy — Does It Really Make a Difference?: “How do we do when the person, we are having a conversation with, does not feel comfortable in sharing his/her feelings and thoughts or does not know how to deal when hearing them?

Hello Dr. Burns,

Many thanks for this podcast. It's been really helpful. And I do agree that practicing the 5 key of Effective Communication is extremely important.

I would like to have your opinion with regard to the 5 Key to Effective Communication.

I had a really mild argument with my teenage 17year-old son, last night. I bought him an M size jacket instead of an S size. When I asked him if the jacket suited him, he replied "why don't you ever listen to me! I asked you to get me an S size, but still, you buy me an M size!

I replied I got him an M size because the website warned that the clothing size fit small.

Then he went back to his room... whereas, I, ran to my Relationship journal and started to work on this little argument I sure did feel bad, and worthless as I wasn't able to get him what he requested.

I decided to use the 5 key to Effective Communication and did my best to include the 5 steps, and when I expressed my feeling with regard to what he had said, he snapped right back at me saying "oh, stop acting as if you were a victim there !

Though it is very difficult to express my feelings (as I was taught from childhood to hide them/put them aside), I also can understand how difficult it can be, to hear someone expressing his/her feelings.

My son was able to hear the empathy I had towards his thoughts and feelings, but was not ready to hear how I felt about my feelings.

Where did I do wrong?

How do we do when the person, we are having a conversation with, does not feel comfortable in sharing his/her feelings and thoughts or does not know how to deal when hearing them?

Your insights would be greatly appreciated.

Warm regards,

From France

Hi man from France,

Send me your Relationship Journal and all will be revealed. That’s the only way to get a handle on the errors you made in the interaction.

Thanks!

David

In the podcast, I emphasize the role of blame in relationship problems. The man in France appears to be blaming the other person for not being comfortable sharing feelings, but in my experience, we are creating the problems in our relationships, and the answer is to examine your own errors. Read Feeling Good Together and do the written exercises if you really want to learn.

* * *

7. Thomas asks: What would you say to a person who wants more ego strength.?

Thanks Thomas! I would say, “what time of day would you like it,” and ask them to fill out a Daily Mood Log for that moment of insecurity!

I focus on specificity, and avoiding big words and abstract concepts.

d

How to Give Critical / Negative Feedback

In a Loving, Constructive Way

AND

How to Avoid the Common Traps

Today’s podcast features Dr. Jill Levitt, Director of Training at the www.FeelingGoodInstitute.com in Mountain View, California and co-leader of David’s weekly TEAM-CBT training group at Stanford. Rhonda and I are psyched, because every podcast or teaching event with Jill is almost certain to be fabulous. And this podcast is no exception!

Rhonda asks members of her Wednesday training group (see below for contact information of you think you might want to join) to take turns teaching the group.  One week she was puzzled because almost no one filled in their feedback forms, and when she asked them why, they said that they had some concerns about the teaching but didn’t feel comfortable criticizing the person who taught.

Some of the criticisms they share with Rhonda were:

• It was boring.
• I didn’t learn anything new.
• The teacher didn’t explain anything in a way that I could understand.

Is this a problem that you have as well? Do you find it hard to criticize others, and keep quiet on the assumption that saying nothing is better than opening your mouth and saying something hurtful?

If so, I have some good news and some bad news for you. First, the bad news. Tonight, you’ll discover exactly why and how saying nothing is actually a pretty hostile and mean thing to do.

But here’s the GOOD news. You’ll also learn the secrets of how to deliver criticism in a way that’s loving, authentic, and helpful if—and that might be a big IF—that’s something you’re willing to do!

A sage—cannot remember who—once said that “When you say nothing, you’re actually shouting quietly.

What in the world does THAT mean?

And Robert Frost, in his famous poem, Fire and Ice, wrote:

Some say the world will end in fire,

Some say in ice.

From what I’ve tasted of desire

I hold with those who favor fire.

But if it had to perish twice,

I think I know enough of hate

To say that for destruction ice

Is also great

And would suffice.

Essentially, Frost is saying that if you’re angry, there are two classic ways of being aggressive; you can be fiery and agitated and attack the other person, verbally or physically, or you can be cold and withdraw, saying nothing, so as to freeze the other person out. These are opposite extremes but are equally destructive. And, for most of us, difficult impulses to resist.

But there’s a third alternative, which might be, according to Robert Frost, the “road less traveled by.” You can express your negative feelings, including anger, in a respectful, or even loving way. And that’s the focus of today’s show.

My show notes will only give an overview, but the richness of this particular podcast is in the actual dialogue and role-play demonstrations with critical feedback. We began with an overview of some of the key techniques when giving someone negative feedback, including stroking and “I Feel” Statements, but emphasized that your tone, goal, and spirit is the entire key to how you come across, and how the other person responds.

Jill told a moving and dramatic story of an interaction with her mother, who has been quite ill, and she’d been having a really hard week. Her mom sent Jill a lengthy text outlining all of her problems and ending with, “you guys don’t really know how I’m hurting,” and the implication was, “you don’t know--or care.” This was understandably hurtful to Jill.

Jill’s about the most awesome daughter any mother could have. Jill wanted to clear the air and tell her mom how she’d felt, rather than keeping her negative feedback hidden. Her mom clearly felt lonely, so when Jill saw her in person, she said something along these lines: “I know you’ve been struggling, but I felt hurt and discounted when I read your note. I felt like the things I’ve done didn’t matter, and I felt hurt.”

Her mom began to cry and said, “the last thing I want you to feel is that I don’t appreciate you.”

This conversation was challenging, but brought them much closer together.

The podcast crew discussed the important question of our mixed motivations about sharing our feelings, and our confusion about how to do this in an effective, loving way, if you do decide to open up.

Rhonda confided that she’d never had those kinds of open conversations with either of her parents, and that these kinds of difficult conversations can come from a place of love.

You can review the Five Secrets of Effective Communication if you click HERE. The Five Secrets are all about talking with your EAR: E = Empathy, A = Assertiveness, and R = Respect. However, there’s a lot of intense resistance to using the Five Secrets, so I promised to include my list of 12 GOOD Reasons NOT to

• Listen (E = Empathy)
• Share your feelings (A = Assertiveness)
• Treat the other person with respect (R = Respect)

That makes 36 reasons in all! You can link to the list HERE.

People want to feel understood, and the best way to make that happen is by giving what you hope to receive. And you can learn how to listen more skillfully If you read my book, Feeling Good Together, and do the written exercises while reading. You’ll learn a ton that can change your life and greatly enhance your relationships with the people you love.

Thanks for listening today!!

Jill, Rhonda, and David

Podcast 289: A Case of Social Anxiety: Featuring David with Dr. Stirling Moorey (Part 1 of 2)

Today, David is joined by one of his first students, Dr. Stirling Moorey, for co-therapy with Anita, a woman struggling with social anxiety. You may remember Stirling from Podcast 280. Stirling was one of David's first cognitive therapy students, and they spend a month doing cotherapy tether in 1979 and again in 1980. David described the magic of their work together in his first book, Feeling Good, and today they are reunited as a therapy team again for the first time in  more than 40 years!

I, David, am super excited about working with Stirling again, and hope you enjoy our work with Anita. Rhonda, Stirling, and I are very grateful for Anita's courage and generosity in letting us share this very personal and real session with you!

Anita is a member of the Wednesday International TEAM Training group run by Rhonda and Richard Lam, LMFT.  She lives in Nairobi, Kenya, and has a Master’s Degree in Counseling. Here is how she introduces herself:

I am Anita Awuor from Nairobi, Kenya.  I have worked as a therapist for 20 years but only recently been introduced to the TEAM Model which has changed the way I work. I work with couples, individuals and families. And recently I worked with an NGO part time.  It’s an honor for me to be here to work with David, Rhonda and Stirling.

Dr. Stirling Moorey had the good fortune to be trained by two founders of Cognitive Behavioral Therapy, Dr. Aaron Beck, and our own, Dr. David Burns. Stirling and David worked together in 1979, when Stirling was in medical school in London and came to Pennsylvania for an elective with Dr. Beck. Once he arrived, Dr. Beck asked David if he would work with Stirling, and then, history was made as David created the 5-Secrets of Effective Communication after watching Stirling provide deep empathy to the patients they worked with together.

Stirling is currently a Consultant Psychiatrist in Cognitive Behavioral Therapy and was the Professional Head of Psychiatry for the So. London & Maudsley Trust from 2005-2013. He is currently the visiting senior lecturer at the Institute of Psychiatry, Psychology and Neuroscience in London. He is the co-author, with Steven Greer of The Oxford Guide to CBT for People with Cancer, and co-edited the book, The Therapeutic Relationship in CBT, published by Sage Publishing.

T = Testing

If you click here, you can take a look at Anita’s initial Brief Mood Survey, which was completed just prior to her session with Stirling and David. As you can see, her depression and anxiety scores were in the moderate to severe range, but her anger score was minimal, only 1 on a scale from 0 to 20. Her Happiness score was extremely low, and here marital satisfaction score was fairly good, but with some room for improvement, especially in the category of “resolving conflicts.

E = Empathy

You can take a look at the first of two Daily Mood Logs that Anita sent to us just prior to the session. It describes her anxiety while driving to a support group. As you can see, her suffering was intense. She also brought in a second Daily Mood Log which described her feelings after receiving a poor evaluation from one of her supervisors at work. The supervision did not involve her clinical work but some management work she was doing.

Stirling, with backup from David, did explored and summarized Anita’s feelings. She explained that

“Sadness has been a part of my life. I’m sad more often than I’m happy. Sometimes, the negative feelings are hard to live with. . . Problems in relationships often trigger my negative feelings, especially when others criticize me, and I’ve been down the last several days because of a poor evaluation I received from one of my supervisors at work. . . I don’t like criticisms or conflicts, and sometimes I tell myself that I’ll never be comfortable in groups.”

Stirling asked about Anita’s negative thoughts when criticized:

1. I’ll never be good enough.
2. What’s wrong with me?
3. It’s all my fault.

She described a sequence where her negative thoughts about the situation lead on to more general self critical thoughts like “I’ll never be comfortable in groups” and she then ruminates about her perceived shortcomings. She said, “when I have these kinds of thoughts, the feelings of sadness, anxiety and worthlessness get very high.”

David read her two Daily Mood Logs (LINK) and she described the criticisms she received from her supervisor, who suggested that Anita’s efforts had not been helpful. Anita felt hurt and angry, especially since this was the first time she’d received criticisms from her supervisor.

Anita added that when she goes into a negative spiral, everything becomes ‘huge,” and she also tells herself, “I’m a bad mom.”

Stirling asked what she does to cope when she’s in pain:

“I cry a lot. I beat myself up. And sometimes I share my feelings with my husband, but sometimes I just hold it all inside. Sometimes sharing with my husband helps, but sometimes it doesn’t.”

David asked Anita how she was feeling now, and she said that her anxiety had already gone down a lot.

To bring closure to the Empathy phase of the session, David asked Anita to grade us on Empathy and she gave us As, and Rhonda had the same idea, scoring us as A +.

I commented on the idea that Stirling's superb empathy skills were based, in part, on the "nothing technique." He systematically, skillfully, and compassionately summarized her words and acknowledged the pain they conveyed, without trying to make interpretations, and without trying to help or rescue. In other words, he gave her nothing but tremendous listening, which was exactly what she needed!

Although this sounds simple, and nearly all therapists will think, "Oh, I do that, too," in my experience, this skill is actually quite rare. it can be taught, and that's on eo the goals of our two free weekly training groups for therapists. But learning genuine and effective use of the Five Secrets of Effective communication requires tremendous humility, dedication, and hard work on the part of the therapists who hopes to learn.

End of Part 1. Next week, you will hear the exciting conclusion of the live therapy session with Anita!

How would you treat excessive worrying? a listener asks.

David describes a new patient who had struggled with 53 years of failed therapy for excessive, relentless worrying, and describes how she was "totally and irreversibly cured" in just two therapy sessions, which was the "good news." The Hidden Emotion Technique was the key to her remarkably rapid recovery. David explains that the "even better news" was that her relentless worrying would come back over and over in the future, and that this was actually a really good thing!

David also emphasizes the importance of using all the four models, along with a Daily Mood Log, when treating any form of anxiety: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. To learn more about how these four powerful treatment models work, you can listen to Podcasts 022 through #028.

The DSM5 is the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. It is used to assign diagnoses to patients. David critiques the DSM5  diagnostic criteria for "Generalized Anxiety Disorder" (GAD) and emphasizes that while worrying exists, and can easily be treated in most cases, the "mental disorder" called Generalized Anxiety Disorder does not exist, and is simply a fantasy made up by the psychiatrists who have created the DSM.

Soon, David and Fabrice will launch a series of five podcasts on the Five Secrets of Effective Communication, focusing on one technique each week. Say tuned, because these podcasts could change your life and show you the road to more loving and satisfying relationships with friends, patients, colleagues, and family members--and "enemies" as well!

297: Yuck! Homework!

In today’s podcast, we discuss the important but dreaded topic of psychotherapy homework, and our featured guest is Alexis, whom some of you know from her fabulous work organizing beta tests for the Feeling Good App. Today, Alexis brings us a very special gift, by showing us how she "walks the walk."!

At the beginning of the podcast, we discussed the two major reasons to do psychotherapy “homework:” First, the homework gives you the chance to practice and master the techniques you’re learning, so you can keep growing and strengthening your skills. And second, because it's an expression of motivation; motivation alone can have powerful anti-depressive effects and lead to rapid recovery.

I also talked a research study I did with a friend and colleague who got depressed following the breakup of his relationship with the woman he’d been dating for several years. Each night he would partially fill out a Daily Mood Log, including a brief description of the upsetting even or moment. Then he would circle and rate his negative feelings on a scale of 0 (for not at all) to 100 (the worst), for how he was feeling at that very moment. Then he recorded his Negative Thoughts and indicated how strongly he believed them on a scale from (not at all) to 100 (completely).

He was telling himself that he’d never find anyone to love, that he’d never find work, and so forth.

Then he’d flip a coin to decide on one of two courses of action. If heads, he would jog for 30 minutes or so at a fairly fast clip and then re-rate his belief in each negative thought as well as the intensity of each type of negative feeling on the same scales of 0 to 100. If tails, he would work on his Daily Mood Log for 30 minutes and then rerate his belief in each negative though and the intensity of each type of negative feeling.

He did this for several weeks and I was thrilled to see that he recovered on his own from a pretty severe bought of depression without any psychotherapy or medications. However, I did give him a little coaching on how to challenge various kinds of distortions.

Once he recovered, we analyzed the data using Structural Equation Modeling. We discovered that the jogging had no effects whatsoever in reducing his belief in his negative thoughts. This finding was not consistent with the popular idea that exercise boosts brain endorphins and causes a “high.” I was not surprised, since jogging has never elevated my feelings, either, although some people do report this effect.

In contrast, on the nights that he worked with his Daily Mood Log, there were massive reductions in his belief in his negative thoughts as well as his negative feelings. This finding was consistent with the idea that psychotherapy homework is very important, whether or not you are receiving treatment from a human shrink. The study also confirmed the idea that distorted negative thoughts do, in fact, cause depression and other negative feelings like anxiety, shame, inadequacy, and hopelessness, and that a reduction in your belief negative thoughts triggers recovery.

Anecdotally, I would like to add that he maintained his positive mood and outlook following his recovery. His career flourished, and he got married. I showed him his negative thoughts years later, and he was shocked. He found it hard to believe that he was giving himself and believing such harsh and distorted messages at the time he was depressed.

I’ve often said that there is a kind of hypnotic aspect to depression, anxiety, and even anger. You tell yourself, and believe, things that are simply not true! Recovery is a little (or a lot) like snapping out of a hypnotic trance!

Here is another implication of the study of exercise vs the Daily Mood Log, as well as other studies that have confirmed the critical importance of psychotherapy homework in recovery from depression and anxiety. Because we know the importance of homework, if we are not asking our clients to do homework, then we may actually be impeding their progress rather than supporting them.

That’s why I let people know prior to the start of therapy that the prognosis for a full recovery is very positive, but homework will be required and is not optional. If they feel like they don’t want to do the homework, I don’t encourage them to work with me. This is called the Gentle Ultimatum and Sitting with Open Hands.

Oddly, enough, this approach seems to enhance patient motivation as well as patient compliance with homework between therapy sessions. The homework, in turn, speeds recovery and reduces patient drop-out.

When I’m doing research, I try to create mathematical models that reveal causal factors that affect all human beings, and not some finding that only applies to this or that school of therapy. Therefore, it would seem to follow, that doing “homework” is just as important if you are working on your own without a therapist. And it would seem like it should be important in our app, as well.

These hypotheses have been confirmed. Practice, and doing specific exercises that I’ve created, are just as important to the degree of recovery in beta testers who are using our Feeling Good App, as well as in people who are working on their own without a therapist. Today, we are joined by Alexis, who works on her own negative thoughts whenever (like the rest of us) she feels stressed out or upset.

Alexis described an example of her homework, starting with this upsetting event at the start of the pandemic:

Daily Mood Log

Next, Alexis recorded her negative feelings:

As you can see, she felt intensely guilty, anxious, inadequate, and lonely, and had a few additional feelings that were somewhat elevated.

Then she pinpointed two negative thoughts, along with her percent belief in each one.

1. I’m a bad daughter. 100%
2. I should move back in with my mom. 50%

Then she identified the distortions in her thoughts, and explained why each distortion will not map onto reality. This technique is called “Explain the Distortions.”

Explain the Distortions

NT: I’m a bad daughter 100%

All-or-Nothing Thinking. I’m focusing on the idea that I can be 100% good or bad , which doesn’t make sense, since nothing in this world is completely good or bad.

Overgeneralization I’m calling myself a ”bad daughter,” as though this is label described my entire being.

Mental Filtering Instead of focusing on some of the positive things that I do. I’m focusing on the idea that I’m not doing enough.

Discounting the Positive I’m not thinking about all the loving things that I do for my mom and that I enjoy doing for her and with her.

Mind-Reading I’m telling myself that my mother thinks that I am a bad daughter, but I don’t actually have any evidence for this.

Fortune-Telling I am telling myself that I’ll never be good enough.

Emotional Reasoning: I feel like a bad daughter so I think it must be true.

Magnification and Minimization: I’m magnifying how important my conduct is to my mother (big ego).

Should Statement: I’m telling myself that I should be a better daughter and that I shouldn’t have moved back to the city where I prefer to live.

LAB: I’m labeling myself as “bad daughter.”

Self-Blame: I am blaming myself for being a “bad daughter.”

Other-Blame: I might be blaming my mother for expecting so much.

NT: I should move back in with my mom. 50%

All-or-Nothing Thinking. I’m telling myself that I’m either there 100% or not there 100%, which doesn’t really make sense. Even if I don’t live with my mom, I can still visit often and stay as long as I like.

Mental Filtering I’m focusing only on my duty to a parent and not on my commitments to myself.

Fortune-Telling I’m telling myself that something bad will happen to my mother and that she will be unable to care for herself.

Magnification and Minimization: I’m magnifying my importance (ego!!!)

Emotional Reasoning: I feel like I should live with her so it must be true.

Should Statement: I am shoulding myself.

Self-Blame: I’m blaming myself for leaving and for wanting to live on my own.

Other-Blame: I am secretly blaming my mother for making me feel this way.

Straightforward Technique

You just try to challenge your negative thought with a positive thought (PT) that fulfills the Necessary and Sufficient Conditions for emotional change:

• The Necessary Condition: The PT must be 100% true, and not a rationalization.
• The Sufficient Condition: the PT must significantly or greatly reduce your belief in your Negative Thought.

Negative thought: I am a bad daughter (I should move back in with my mom.)

Write down a more positive and realistic thought:

My mom is in average health for her age and can take care of herself. She has the financial resources to maintain her lifestyle without my help.

Ask yourself:

Is this negative thought really true?

Maybe. I love my mom more than just about anyone. I do lots of things for her and with her and enjoy her company immensely.

Do I really believe it? I do.

Socratic Method

When you use this technique, you ask yourself questions to lead yourself to the illogic of your negative thought.

NT: I am a bad daughter

Questions:

Are you sometimes a good daughter? Yes

Do most adult children feel like they are a bad kid sometimes? Yes

NT: I should move back in with my mom

Questions:

Should adult children live with their parents? Not if they don't want to!

Worst, Best, Average

With this technique, you list the qualities of the opposite. Since you’re calling yourself a “bad daughter,” you can list the qualities of a “good daughter.” Then you can rate yourself in each quality, thinking of when you’re at your worst, when you’re at your best, and your average.

When you’re done, you can review your ratings. If there’s one area where you need to improve, you can put together a 3 or 4 step plan for changing. Sometimes, as in Alexis’ case, you’ll realize that you’re actually doing just fine, and no change is needed!

This technique was the icing on the cake, and Alexis decided that her thought, “I’m a bad daughter,” wasn’t actually true.

These were her feelings at the end.

As you can see, Alexis put in some time and effort to challenge the negative thoughts that were triggering her unhappiness. We are indebted to Alexis for being so open and vulnerable, and for showing this how it works.

Is it worth it? That was a lot of “homework!”

That’s a decision you’ll have to make for yourself, of course. The Dalai Lama said that happiness is the purpose of life. That’s not entirely true, but there’s a lot of truth in it, for sure!

So, the question might be, what would some greater happiness be worth to you?

If you are interested in beta testing the Feeling Good App, you can sign up at www.feelinggood.com/app.

Thank you Alexis for the very special gift of your knowledge, tremendous skill, and vulnerability!

Until next time—

Rhonda and David

Featured photo is Mina
as a child (more pics below!)

374 Anger, Part 2

You Have Always Hated Me!

In the Anger Part 1 podcast (371 on November 20), Rhonda, Matt and David discussed the fact that when you’re feeling angry, there’s always an inner dialogue—this is what you’re saying to yourself, the way you’re thinking about the situation—and an outer dialogue—this is what you’re saying to the other person.

In Part 1, we focused on the inner dialogue and described the cognitive distortions that nearly always fill your mind with anger-provoking inner chatter about the ‘awfulness” of the person you’re mad at. Those distortions include All-or-Nothing Thinking, Overgeneralization, Labeling, Mental Filtering, Discounting the Positive, Mind-Reading, Fortune Telling, Emotional Reasoning, Other-Directed Should Statements, and Other-Blame.

That’s a lot—in fact, all but Self-Blame. And sometimes, when you’re ticked off, you might also be blaming yourself, and feel mad at yourself at the same time.

Matt suggested I add these comments on Self-Blame or it's absence::

Another possible addition would be when you identify the absence of Self Blame when we’re angry. For me, it’s been easier to think of that as a positive distortion, because you are blind to, or ignoring, your own role in the problem. In other words, when I’m blaming someone else, it’s me thinking my poop smells great and tit's all the other person's fault..

I’ve wondered if we fool ourselves like this because of the desire to have a special and perfect “self,” which we then defend. Because nobody’s perfect, our "ideal self," as opposed to our "real self," is just a pleasant, but potentially destructive, fantasy.

Still, we try to preserve and project the fantasy that we are free of blame and the innocent victim of the other person's "badness," , and we imagine there we have a perfect “self” to defend. Or, as you’ve said, at times, David, “anger is often just a protective shell to hide and protect our more tender and genuine feelings.”

We also discussed the addictive aspect of anger, since you probably feel morally superior to the “bad” person you’re ticked off at when you’re mad, and this makes it fairly unappealing to change the way you’re thinking and feeling. Your anger also protects you from the risk of being vulnerable and open and genuine.

Today we discuss the Outer Dialogue, and how to express angry feelings to another person, as well as how to respond to their expressions of anger. The main concept is that you can express anger in a healthy way, by sharing your anger respectfully, or you can act out your anger aggressively, by attacking the other person. That’s a critically important decision!

Toward the start of today’s podcast, Rhonda, Matt and David listed some of the distinctions between healthy and unhealthy anger. The following is just a partial list of some of the differences:

To bring some dynamics and personality to today’s podcast, Mina, who’s made a number of noteworthy appearances on the podcast, agreed to describe what she learned on a recent Sunday hike. (I’ve started up my Sunday hikes again, but in a small way now that the pandemic has subsided, at least for the time being. I’m struggling with low back pain when walking and that severely limits how far I can go.)

Mina began by explaining that when she was talking to her mom on the phone. Her mom described a conflict with woman friend who seemed angry with Mina’s mom. Mina said, “I can see why that woman got angry with you.“

Mina explained that her mother, who is “conflict phobic,” paradoxically ends up with conflicts with a lot of people. However, Mina’s mother sounded hurt by Mina’s comment, and said, “You’ve always hated me since you were a little girl! You always looked at me hatefully!”

Here are some of Mina’s "angry" childhood photos:

Mina explained how she felt when her mom said, "You’ve always hated me.”

My jaw dropped when she said that! It was such a shock. I’ve always felt like she was my best friend! . . .

I hate feeling angry. It makes me every bit as uncomfortable as anxiety. If I express my anger, it goes away, and I feel better. But I don’t usually express it, and then it comes back disguised as weird neurologic symptoms.

And that, of course, is the Hidden Emotion phenomenon that is so common in people who struggle with anxiety. When you try to squash or hide negative feelings your think you’re not “supposed’ to have, they often resurface in disguised form, as phobias, panic, OCD symptoms, chronic worrying, or any type of anxiety, including, as in Mina’s case Health Anxiety—that’s where you become convinced you have some serious neurologic or medical problem, like Multiple Sclerosis.

Matt suggested that I might remind folks of my concept that “anger allays get expressed, one way or the other.” He’s found this idea to be both true and incredibly helpful for “us nice folks who think we can get away without expressing our anger, thinking we can avoid conflicts, entirely. This always backfires, in my experience!”

On the recent Sunday hike, Mina practiced how to talk with her mom, using the Five Secrets of Effective Communication. After that, she used what she’d practiced on the hike to talk to her mom about their relationship, and then got an “I love you” message from her mom the next morning.

This made Mina very happy, but because she had a full day of back to back appointments, Mina decided to spend time crafting a thoughtful reply at the end of the day, when she had a little free time. But when she went back to her computer at the end of the day to send a message to her mom, she discovered that her mother had deleted the loving message she sent early in the day, and Mina felt hurt.

When Mina asked her mom about it, her mom said that deleting the message was just an error due to ‘old age.” However, Mina did not really buy this, and thought her mom probably felt hurt and angry because Mina had not responded sooner.

In the podcast, we practiced responding to mom using the role-play exercise I developed years ago. Essentially, one person plays the role of Mina’s mom, and says something challenging or critical.

Mina plays herself and responds as skillfully as possible with the Five Secrets, acknowledging the other person’s anger and expressing her own feelings as well.

We practiced responding to mom’s statement, “You’ve always hated me.” Matt played the role of mom and Mina gave a beautiful Five Secrets response. You’ll enjoy hearing her response, and Matt’s and Rhonda’s helpful feedback, when you listen to the podcast.

Then Mina asked for help responding to another statement from her mom, who had also said:

All of the kids your age are angry, because you were neglected a lot of the time because of the war in Iran, and your dad and I were busy doing what we had to do to survive and avoid being arrested. All of my Iranian friends with children your age are experiencing the same thing.

Matt and Rhonda did more role plays with Mina, followed by excellent feedback on Mina’s Five Secrets response. Again, I think you’ll enjoy the role-playing and fine tuning when you listen to the podcast.

One of the obvious take-home messages from today’s podcast is to use the Five Secrets of Effective Communication when you’re feeling angry and talking to someone who’s angry with you as week, As a reminder, these are the Five Secrets.

LINK TO 5 SECRETS

And to make it simple, you can think of talking with your EAR:

E = Empathy (listening with the Disarming Technique, Thought and Feeling Empathy, and Inquiry)

A = Assertiveness (sharing your feelings openly with “I Feel” Statements)

R = Respect (showing warmth and caring with Stroking)

However, here’s the rub: People who are angry will usually NOT want to do this! When you’re ticked of, you will almost always have a huge preference for expressing yourself with the Unhealthy Anger described above.

Matt urged me to publish my list of 36 reasons why this intense resistance to healthy communication. LINK HERE for the LIST

• 12 GOOD Reasons NOT to Empathize
• 12 GOOD Reasons NOT to Share your Feelings
• 12 GOOD Reasons NOT to Treat the Other Person with Respect.

So, as you can see, there’s a lot more to skillful communication of anger than just learning the Five Secrets of Effective Communication, although that definitely requires tremendous dedication and practice. But motivation is the most important key to success or failure.

When you’re upset with someone, you can ask yourself, “Do I want to communicate in a loving, or in a hostile way?”

The reward of love are enormous, but the seduction of hostility and lashing out is at least as powerful! This battle between the light and the dark is not new, but has been blazing for tens of thousands of years.

And, of course, the decision will be yours.

Thanks for listening today,

Mina, Rhonda, Matt, and David

Rhonda and David address five fascinating questions in today’s podcast, including these:

1. “I’m incredibly shy. How do you talk to girls?”
2. How did you get over your fear of vomiting?
3. Do you still use behavioral techniques like Exposure?
4. Should I try to include the E and A of TEAM when trying to crush my negative thoughts on my daily mood log? And how would I do this?
5. Please give us a podcast on how to express anger.

Nandini writes:

I have zero experience dating and talking to girls. I don't know how to even make girl as friend.

Whenever I talk to a girl, the next day I think “How should I talk to her?”

Should I go to her because now she wants me to talk to her?

Which makes me very nervous.

And also. if am talking to a girl I think about when I will have to go to her next time. When I’m doing my work, I think should I go to her, because she works in our office.

Means I don't know how to do that! Can you help?

Rhonda and David respond with some simple advice, but encourage all listeners to use the search function on his website to get lots of great links to helpful material on just about any mental health topic, including flirting, dating, shyness, or just about anything.

In additon, my book, Intimate Connections, could be really helpful to Nandini, as well as my books, When Panic Attacks and The Feeling Good Handbook, that all have extensive sections on anxiety. You can find all of them at my books page (https://feelinggood.com/books/).

In addition, we’ve recently featured several podcasts on shyness and social anxiety, including:

128: Intense Social Anxiety–I’m Losing Control! What Can I Do?

134: Smashing Shyness: Part 1

135: Smashing Shyness: Part 2

169: More on Social Anxiety–the Case for Vulnerability

142: Performance Anxiety: The Story of Rhonda, Part 1

143: Performance Anxiety: The Conclusion

088: Role-Play Techniques —Feared Fantasy Revisited

2. How did you get over your fear of vomiting?

DB,

I know you probably don't remember me because it's been years since we emailed, but you helped me via your Ask The Guru section of your old website years ago and we occasionally emailed back and forth after that. Which reminds me to once again thank you for your books and how you've dedicated your life to your work. It has made a difference in my life and I would imagine literally millions of others. What a wonderful thing.

I stumbled upon an article about you in the Stanford Magazine from 2013 and learned something I didn't know -- you suffered at one time from a fear of vomiting. I've dealt with that since I was a kid. It's not as severe now as it once was, but I'm wondering what CBT methods might be useful for that particular issue. (No chance I'm taking ipecac syrup!).

I know you're busy so I understand if you can't answer, but wanted to reach out anyway.

Thanks in advance,

Steve 

3. Do you still use behavioral techniques?

Dear Dr Burns,

I really appreciate your efforts in this area cognitive behavioral therapy, but your efforts and techniques are so powerful and you use them so efficiently that almost no time you have to use the behavioral part of it as patients seem to be relieved enough with cognitive work.

One thing I am curious about is that if you can't get enough response with cognitive work, and if you have to use the exposure model, and the patient is afraid of exposure because he or she goes into a severe state of anxiety, depersonalization or derealization symptoms and feels like gonna go crazy and lose control, would you still push him or her to the cognitive exposure and are there any risks of it?

Thank you very much.

Jordan 

4. Should I try to include the E and A of TEAM when trying to crush my negative thoughts on my daily mood log? And how would I do this?

Dr. Burns,

It would be impossible for me to heap sufficient praise over you and your podcasts because I've really gained an intangible amount of benefits and continue to learn something actionable from both on a weekly basis. I'm currently finishing Feeling Good Together and am finding the experience transformative.

I wanted to see if I could ask you a question regarding the Daily Mood Log and crushing negative thoughts. I'm completely on board with the notion of fractal psychotherapy and the idea that all of our negative emotions will be captured in a single negative thought and by crushing it, we will feel substantial relief and even euphoria.

I've been using the Daily Mood Log to inconsistent effect. I write down my negative thoughts, identify the distortions and then identify statements to attack that thought that are 100% true. Perhaps I am rushing through the exercise too quickly, as I try to make it a daily habit. But is it possible I'm missing an element?

I've noticed in your live therapy that you allocate a sizable chunk of time to Empathy and Agenda Setting. Is it possible that the E and A in TEAM's absence in my Daily Mood Log is stunting my progress? Is there a way and should I be implementing both into the exercise?

I would appreciate any input you have on this question and I look forward to continuing to listen to the podcast as new episodes come out, along with your new book and App!

Best regards,

Tommy

Dr. Burns,

Thank you! I’d be happy for you to use my first name. I’ll look out for it in the upcoming podcasts. Have a great rest of the week.

Tommy

5. Please give us a podcast on how to express anger!

Hey Dr. Burns, I’m loving the podcast, and my favorite podcasts are the Ask David and Live Treatment ones! Also, I can’t wait for the new app and book!

I did have a question, which I can go into more detail if need be. Specifically, what podcasts and book would you recommend for anger? I’m unsure how to express anger in a productive way (in my relationship), and would love more guidance and practice prior to trying to use the 5 secrets “live”. Thanks in advance!

Thanks for listening today, and thanks for all the kind comments and totally awesome questions!

David and Rhonda

Why Therapy Fails

One of the most common reasons patients contact me is to find out why the therapy isn't working. They may be TEAM-CBT patients or patients of therapists using other approaches. Therapists also ask for consultations on the same problem--why am I stuck with this or that patient who isn't making progress?

In the Feeling Good App, my colleagues and I have been looking into this as well. Most app users report excellent and often rapid results, but some get stuck, in just the same way they might get stuck in treatment with a therapist. I have tried to organize my thinking on this topic, because if you can diagnose the cause of therapeutic failure, you can nearly always find a solution. Of course, the app is not a treatment device, but a wellness device, but the same principles apply.

So today, Rhonda, Matt and I discuss a couple reasons why therapists and patients alike sometimes get stuck. Matt described a patient who was misdiagnosed with a psychotic disorder who turned out to have sleep apnea. When the proposer diagnosis was made and treated, the patent suddenly recovered.

Rhonda described a patient who jumped from topic to topic and always brought up a new problem before completing work on the previous problem. This problem was solved when Rhonda explained the importance of sticking to one problem for several sessions, until the problem was resolved. The patient then began to make progress.

David described a depressed woman from Florida who was stuck in treatment, and not making progress, and then the therapist said "I just can't help you," This hurt and confused the patient who wrote to me. There were essentially two problems--the patients depression what brought her to therapy in the first place, and her unresolved hurt feelings when the therapist "gave up" on her. This problem reflected many failed relationships is the patient's life. This was resolved when the patient took the initiative to schedule a session to talk about the conflict more openly with excellent results.

In addition, the patient had heard that she "should" accept herself, but didn't know how to accept her constant self-critical troughs and intensely negative feelings. I suggested she make a list of the benefits of her negative thoughts and feelings, as well as the many positive things they showed about her and her core values as a human being.

She came up with an extremely impressive and long list! For example, her criticisms showed her high standards, her humility, her dedication to her work, her accountability, and much more. In addition, she'd achieved a great deal because of her relentless self-criticisms.

I asked her why in the world she'd want to accept herself, given all those positive characteristics

She decided NOT to accept herself, and was delighted with her decision. She said she felt profound relief!

An unusual, but awesome, path to acceptance! In other words, she ACCEPTED her "non-acceptance."

I hope you find today's podcast interesting and helpful. Of course, ultimately therapy is part science and part human relationship art. That's why Rhonda and I offer free weekly training groups for therapists who wish to develop their therapeutic skills. The groups are on zoom so therapists from around the world are welcome. Matt offers a consultation group (free to Stanford psychiatric residents) every other Tuesday for therapists who want help with difficult, challenging cases. To learn more, you'll find details and contact information at the end of the show notes.

When Therapy Doesn’t Work--

And How to Get Unstuck

(for Therapists and Patients) 

By David Burns, MD

Here’s are some of the most common reasons why therapy might fail or appear to be stuck / without progress. Some of them will be of interest primarily to clinicians, while others will be of interest to clinicians and patients alike. And many of these reasons will also apply to individuals using the Feeling Good App who are stuck in their attempts to change the way they think and feel.

But what does “stuck” actually mean? The definition, of course, is subjective. I believe that a substantial or complete elimination of depression and anxiety can typically be achieved in five sessions with a skilled TEAM therapist. I use two-hour sessions, and can usually see dramatic change in a single session, although follow-ups may be needed for Relapse Prevention Training or other problems the patients might want help with.

In my experience, the treatment of relationship problems and habits and addictions usually takes much longer than the treatment of anxiety or depression. The techniques to treat relationship problems and habits and addictions actually work just as fast as the techniques to treat depression and anxiety, but the resistance can be far more intense. For example, someone may be ambivalent about leaving a troubled relationship or giving up a favored habit for many months or years before making a decision to move in a new direction.

And, of course, the treatment of biological problems like schizophrenia and bipolar I disorder will nearly always require a long term therapeutic relationship, often requiring medications in addition to therapy.

The problems and errors I’ve listed below are mostly correctable. And although there are many traps that therapists and patients fall into, the vast majority of therapeutic failure the patient's hidden 'resistance' to change and the therapist's lack of skill addressing it. This is true in clinical practice and in psychotherapy outcome studies, as well.

On the one hand, a great many patients will feel ambivalent about change. For example, a patient with low self-esteem may not want to stop being self-critical and accept themselves, as-is, but to have a better version of themselves, first. Or they may want to overcome their fears without facing them. Or they might want a better relationship but would want the other person to do the changing.

Unfortunately, most therapists lack the skills to address resistance and, in fact, often make it worse by trying to motivate the patient to change, rather than understand their hesitation to change and discuss it with them. This is one area where TEAM training has a great deal to offer, including over 30 skills therapists can learn to address motivation and resistance.

The following list of 37 reasons why therapy fails follows the structure of T, E, A, M.

Errors at or before the initial evaluation

1. Patient is just window shopping
2. Patient does not buy into the cognitive model
3. Incorrect conceptualization of type of problem, so you end up using the wrong techniques. To simplify things, I think of four conceptualizations:
   1. 1. Individual mood problem (depression or anxiety)
      2. Relationship Problem
      3. Habit / Addictions
      4. “Non-problem”: healthy negative feelings such as the grief you might feel when a love one dies
4. Patient is not in treatment out of choice. For example, a teenager might be brought in by parents to be “fixed,” like bringing in your car to the local garage for a tune up, and you don’t have an agenda with your patient. Or a parent might be court-ordered to go to therapy if he wants to have custody of his children.
5. Failure to ask patients to complete the Concept of Self-Help Memo, the How to Make Therapy Rewarding and Successful memo, and the Administrative Memo prior to the start of therapy. These memos fix a great many therapeutic problems that are likely to emerge later on, like homework non-compliance, premature termination, and policies about confidentiality, last minute cancelling of sessions, conflicts of interest (eg patient is seeking disability) and more. Most therapists ignore the use of these memos, only to pay a steep price later on.
6. Failure to mention the requirement for homework and similar issues the at initial contact with the patient.
7. Failure to explore the patient’s motivation for treatment.

T = Testing

1. Diagnostic errors: not recognizing additional problems which patient may have in addition to the initial complaint, such as drug or substance abuse, psychosis, intense social anxiety, past trauma or abuse, or hidden problems the patient is ashamed to disclose. This is easily solvable by the use of my EASY Diagnostic System prior to your initial evaluation. It screens for 50 of the most common DSM “diagnoses” and only takes ten minutes or so out of a therapy session to review and assign the “Symptom Cluster Diagnoses.”
2. Failure to use Brief Mood Survey before and after each session. This error makes the therapist blind to the severity or nature and severity of the patient’s feelings, which cannot be accurately identified by a patient interview or therapy session. As a result, the therapist’s understanding will not be accurate, and the therapist will not be to pinpoint the degree of change (or failure to change) during and between therapy sessions.

E = Empathy

1. Failure to ask patients to complete the Evaluation of Therapy Session after each session. As a result, it will not be possible for therapists to understand their level of empathy, helpfulness, and several other relationship dimensions critical to good therapy.
2. Failure to use the “What’s My Grade” technique while empathizing with the patient.
3. Failure to receive training in the Five Secrets of Effective Communication and the three advanced communication techniques. These techniques are difficult to learn, requiring lots of practice and commitment, but can be invaluable in therapy and in the therapist’s personal life.

A = Assessment of Resistance (also called Paradoxical Agenda Setting)

1. Failure to recognize and deal with Outcome Resistance: There are four distinct types, corresponding to depression, anxiety, relationship problems, and habits and addictions.
2. Failure to recognize and with Process Resistance: There are four distinct types, corresponding to depression, anxiety, relationship problems, and habits and addictions.
3. The “because” factor: I won’t let go of my depression until “I’ve lost weight,” or “I’ve found a loving partner,” or “I’ve achieved something special,” or “I’ve found a better job / career,” or “I’ve achieved my goals at X.” This is another type of Outcome Resistance.

M = Methods--errors using the Daily Mood Log

1. Patient “cannot” identify any Negative Thoughts
2. The way you worded your Negative Thought. The common errors include thoughts describing events or feelings, rhetorical questions, long rambling thoughts, or thoughts consisting of a few words or phrases, like “worthless.”
3. No Recovery Circle / many need many techniques combined with the philosophy of “failing as fast as you can.” This allows you to individualize the treatment for each patient. It is simply not true that there is one school of therapy or method (like meditation, mindfulness or daily exercise, etc.) that will be helpful, much less “the answer,” for all patients!
4. The way you did the technique / incorrect use of technique. Many of the most powerful techniques, like Interpersonal Exposure, Externalization of Voices, Paradoxical Double Standard, Feared Fantasy, and many more require considerable sophistication and training. They can be fantastic when used skillfully, but they aren’t easy to learn!
5. Trying to challenge your negative thoughts in your head / vs on paper or computer. This is associated with Process Resistance for depression—refusing to do the written homework, and it is exceptionally common.
6. Trying to challenge the negative thoughts of someone else or encouraging them to think more positively: won’t work! In my first book, Feeling Good, I spelled out the warning that cognitive techniques are for you, and NOT for you to use on other people, including friends, family, and so forth. It is my impression that many people ignore this warning. When they discover that the person they are trying to “help” does take kindly to identify the cognitive distortions in their thoughts, both end up frustrated.
7. Failure to “get” the Acceptance Paradox / using too much self-defense in your positive thoughts, especially Technique when doing Externalization of Voices
8. Using the Acceptance Paradox in a defeatist, self-effacing way
9. Failure to include the Counter-Attack Technique when doing Externalization of Voices. This techniques is not always necessary, but can sometimes be the knock out blow for the patient’s endless inner criticisms.
10. Not understanding the necessary and sufficient conditions for emotional change when challenging distorted thoughts.
11. Too much focus on cognitive / rational techniques when far more dynamic techniques are needed, such as the Experimental Technique (e.g. exposure) in treating anxiety or the Externalization of Voices or Hidden Emotion Techniques
12. Not recognizing that the patient’s negative thoughts might be valid (I think that my partner is cheating on me) and trying to get your patient to challenge the “distortions” in the thoughts

Other therapist errors

1. Codependency: addiction to trying to “help” / cheer up the patient / solve some problem the patient has
2. Need to be “nice” and refusal to hold patients accountable
3. Narcissism: unwilling to be criticized, unwilling to fail, needing to stay in the expert role
4. Difficulties “getting” the patient’s inner feelings, due to lack of skill with Five Secrets and the failure to use Empathy Scale
5. Difficulties forming a warm and vibrant therapeutic relationship, which can sometimes result from strong (and nearly always unexpressed) dislike of the patient
6. Commitment to a favored “school” of therapy / thinking you are superior to colleagues and have the one “correct” approach
7. Failure to use assessment tools with every patient at every session
8. Failure to make patients accountable for homework
9. Four types of reverse hypnosis: this is where the patient hypnotizes the therapist into believing things that simply aren’t true.
   1. 1. Depression: the patient may really be hopeless or worthless
      2. Anxiety: the patient is too fragile for exposure
      3. Relationship problems: the patient is too fragile for / not yet ready for exposure
      4. Habits / addictions: not making the patient accountable or assuming patient isn’t yet “ready” to give up the addiction, or the patient needs to have emotional / relationship problems fixed first
10. Unrecognize, unaddressed conflicts with therapist that need to be addressed with Changing the Focus. This error often results from the therapist’s fear of conflict or patient anger, and is usually accompanied by a failure to use the Evaluation of Therapy Session, which would send a loud signal to the therapist that something is wrong.
11. Failure to do Relapse Prevention Training prior to discharge.
12. Conceptualization errors. Failure to use or select the most effective therapeutic approach and techniques for the patient’s problem. For example, the Daily Mood Log and Recovery Circle are great for depression and anxiety, although there will be some important differences in the choice of methods for depression vs. anxiety. For example, Exposure and the Hidden Emotion Technique are great for anxiety, but rarely useful for depression. The DML has only a secondary role in the treatment of relationship problems (the Relationship Journal is more direct and useful) or habits and addictions (the Triple Paradox and Habit and Addiction Log (HAL) are far more useful.
13. The therapist may be committed to a school of therapy, like Rogerian listening, without addressing resistance or using methods. Or therapist may believe that psychodynamic or psychoanalytic therapy, or ACT, or traditional Beckian cognitive therapy, will be the “answer” for everybody. The schools of therapy function much like cults, causing feelings of competitiveness (our guru is better than your guru) and sharply limiting the critical thinking and narrowing the consciousness of the faithful “followers.”
14. Conflicts of interest. The therapist may subconsciously want to keep the patient in a long-term “talking” relationship due to emotional or financial needs.
15. The therapist may have been taught that therapeutic change is inherently slow, requiring many years or more. This belief will always function as a self-fulfilling prophecy.

Thanks for listening!

Matt, Rhonda, and David

Podcast 224 Ask David January 11, 2021

Ask David featuring more challenging and interesting questions.

1. Josh asks: What are the most effective types of psychotherapy homework assignments?
2. Hassam asks: How would you treat my severe OCD? Exposure doesn’t seem to be working! And Joe asks: Would you say that the secret to overcoming OCD is willpower?
3. Ted asks: Does any psychiatric disorder result from a chemical imbalance in the brain?
4. Brian W. asks: Burns, could you do a video on how to use CBT for stress? Thanks.
5. Clarity asks: Is it too late to be a beta tester for your app?
6. Simon asks: Is there a podcast that you can recommend for general depression, and how to find out what is wrong?
7. Stephanie asks: My patients don’t recover as rapidly as your patients. Am I doing something wrong? I’m feeling a lot of anxiety and self-doubt!

* * *

1. Josh asks: What are the most effective types of psychotherapy homework assignments?

Hi David, thanks for all your work. It has been very helpful.

You mention That doing homework is essential to recovery from anxiety and depression. Any homework you recommend? I am going to buy a few of your books and have the worksheets from the Neil Sattin podcast. Anything else that will benefit?

Josh

Hi Josh,

It depends on the type of problem you are working on. I can work up an answer, perhaps, if you want to tell me!

I did not hear from Josh, but Rhonda and I summarize the best kids of psychotherapy homework for:

• • depression
  • anxiety
  • relationship problems

* * *

2. Hassam asks: How would you treat my severe OCD? Exposure doesn’t seem to be working!

Hi David,

I love your work on the podcast. I have not yet found a copy of any of your books in Lahore (where I live), but I have grown to understand your philosophy through your podcasts.

Episode 162 disturbed me a little. I suffer from severe OCD and its cousin, depression.

And the "high-speed cure" in the title really attracted me.

But I had buyer's remorse.

Why? Because it does not work like that for most people. The guest on your show, had a few exposures, and BAM, cured.

I have tried exposure many many times, and it very minimally helps in lowering the threat of the obsessions.

I feel that this was a Magic Pill kind of account, and at the risk of judging a person's pain, I think your guest had a relatively mild (as compared to me) OCD.

I would really love it if you could talk about Pure OCD (the type I have), and how it can be resistant to exposure. The intrusive thoughts/obsessions continue to be extremely, EXTREMELY, painful. This "high speed cure" idea seems dismissive of the seriousness of my condition.

Please keep up the great work. And I hope to read your books one day.

Thanks

Hassam

(Therapist in training)

Thanks Hassam, sometimes, therapy is much harder, as you say! Good point.

I often get slammed when I present patients who recover rapidly, especially patients who have had incapacitating symptoms for years or even decades of failed therapy. This is disappointing to me, as my goal is to bring hope to people that rapid and meaningful change IS possible.

To be honest, I don’t like it when I get slammed for presenting cases of rapid recovery. Some people think I am a con artist! Yikes!

Of course, everyone is different, and some people will be more challenging to treat. One thing I learned when I was in private practice is that you can never tell ahead of time who will recover rapidly and who will take much more time.

I’ve had patients I thought would be super easy to treat who responded much slowly than I predicted, and many who I thought would be nearly impossible to treat who responded almost overnight.

You’ve mentioned that exposure has been of limited value for you. I totally agree and saw that early in my treatment of anxiety that exposure alone is often quite ineffective.

That’s why I argue so strongly that exposure is not a treatment for OCD or for any form of anxiety. It is just one tool among many I use in the treatment of anxiety. I use four very different treatment models with every anxious patient:

1. 1. The Cognitive Model
   2. The Motivational Model
   3. The Hidden Emotion Model
   4. The Behavioral (Exposure) Model

Unless you understand and use all four models, the prognosis might be somewhat guarded, as you’ve discovered. In contrast, when you use all four strategies, your chances for success increase tremendously. For example, prior to using Exposure in the episode you listened to, I spent about 25 minutes with Sara using the motivational and cognitive models, which really helped.

Focusing on one method alone will often not be terribly effective, especially if you’re looking rapid, complete, and lasting recovery. However, occasionally one method will work, so therapists and patients alike get focused on some single approach they’ve learned, thinking they’ve found “the answer.”

There’s a great deal of information on the treatment of anxiety disorders using these four models on my website, www.feelinggood.com.

I often urge listeners to use the search function on my website, and everything will be served up to you immediately. You can learn all about these four powerful models.

In addition, if you were looking for more techniques, you might want to take a look at my book, When Panic Attacks, which describes 40 potent anti-anxiety techniques. You can order it from Amazon.

My psychotherapy eBook, Tools, Not Schools, of Therapy, might also be helpful for therapists who want to learn more about the treatment of depression and anxiety with TEAM. It is an eBook, and order forms are available on my website, www.feelinggood.com, in the resources tab, and also in my store.

Thanks for your excellent question!

david

And Joe asks: Would you say that the secret to overcoming OCD is willpower?

In reply to Joe.

I use four treatment models in the treatment of all anxiety disorders, including OCD. Certainly, the willingness to use Exposure is required, but Exposure is only one of many helpful methods for OCD. You can search for anxiety treatment on my website, and you’ll find many good podcasts. Also, there is a free anxiety class on my website. My book, When Panic Attacks, is another great resource with more than 40 techniques to combat all forms of anxiety, including OCD. You can find all my books on AMAZON, or on the books page on my website.

david

* * *

3. Ted asks: Does any psychiatric disorder result from a chemical imbalance in the brain?

Hi Dr. Burns,

It says in your book, When Panic Attacks, p. 49, 3rd paragraph, you said that there's not a shred of evidence that there's any chemical imbalance for any psychiatric disorder. Does that include schizophrenia or bipolar or OCD?  Haldol works for me for schizoaffective....controls dopamine in brain?

Ted

Hi Ted,

There are likely one or more biological factors that contribute to schizophrenia as well as full blown bipolar disorder (with true manic episodes.) We do not yet know what those causes are.

However, the brain is not a hydraulic system of chemical balances and imbalances, or perhaps more like a supercomputer. I am not aware of any neuroscientists who believe in the crude “chemical imbalance” theory. We simply don’t know what the causes are.

Meds can definitely help with the symptoms of schizophrenia and mania as well. This tells us nothing about causes. Aspirin can help with a headache, but headaches are not due to an “aspirin deficiency” in the brain. Computers often crash, but I’ve never heard of a computer problem that was caused by a “silicon imbalance” in the chips.

Hope that helps. Psychotherapy can definitely help with feelings of depression and anxiety, but is not a cure for schizophrenia or mania. I would hate to have to treat any psychiatric problem with drugs alone! I like to treat humans, not “diagnoses,” but it can helpful to be aware of diagnoses like schizophrenia, or schizoaffective, or bipolar I, for example.

Hope that is helpful! And just my thinking, too, not “written in stone.”

david

* * *

4. Brian W. asks: Burns, could you do a video on how to use CBT for stress? Thanks.

Hi Brian, Thanks!

One point is that people are often looking for “formulas” or general solutions to buzzwords like “stress.” The key to TEAM is to focus on one specific moment, and to work with it in an individual way, never using non-specific solutions like exercise, meditation, deep breathing, dietary changes, and so forth.

But as you can see, this is tough for many people to grasp. The failure to understand the importance of specificity is one of the big problems in our field, and it is a problem for therapists and patients alike. There are no very good solutions in the clouds of abstraction, because we are all unique.

I asked Brian for specific examples, and he wrote: “Work pressure, obnoxious bosses, nagging family members, drug addicted family members, and inability to pay bills are a few.”

I responded,

Thanks, these are all totally unique with different solutions. Perhaps you can focus on one and provide a couple details. david

Brian responded,

Thanks. Whichever one you think is best. Stressful thoughts. Also how to change stressful thoughts when they're automatic.

Hi Brian, There an infinite variety of "stressful thoughts," and they all have unique, non-overlapping solutions. Could you tell me about one thought you had at one specific moment?

david

During the podcast, I made some additional comments on dealing with stress using TEAM:

• Stress is a fairly non-specific word for feeling upset or distressed. I like to use and measure specific emotions in my patients, like depression, anxiety, guilt, shame, inadequacy, hopelessness, frustration, anger, and so forth. But for some people, “stressed” may be more acceptable than words like “depression,” which may carry more stigma.
• However, there is a somewhat specific meaning to stress, which means overwhelmed by having too much to do and not enough time to do it all. This can sometimes result from taking on too much, and having trouble saying no. Reasons for this difficulty being assertive include:
  • Conflict Phobia
  • Excessive Niceness
  • Submissiveness / Pleasing Others
  • Fear of missing out on something cool and exciting to do
• NY TV story on “stress” and my ten distortions
• General tools for dealing with patients who feel “stressed out.”
  • Daily Mood Log
  • Relationship Journal
  • Brief Mood Survey
• You can take a thought on a DML and do a downward arrow—you will typically come to several common Self-Defeating Beliefs, such as
  • Perfectionism
  • Perceived Perfectionism
  • Approval Addiction
  • Submissiveness
  • Worthlessness schema
  • Conflict Phobia / Anger Phobia
  • Superman / Superwoman
• Specific Tools
  • Positive Reframing
  • “No” Practice

* * *

5. Clarity asks: Is it too late to be a beta tester for your app?

Hi Clarity, Thanks! You can sign up at www.feelinggood.com/app

* * *

6. Simon asks: I have a question for you. I am very depressed at the moment, and I don't know what is wrong, or I have difficult to find out what thought is giving me the down-feeling ☹ Is there a podcast that you can recommend for general depression, and how to find out what is wrong?Thanks for the sooooo great in inspiration.

Thanks Simon. I will include your question in an upcoming Ask David, but here’s a start. Focus on one moment you were upset, and tell me how you were feeling and thinking at that specific moment, and record the information on a Daily Mood Log. If you listen to live therapy on the Feeling Good Podcasts, or read one of my books, like Feeling Good or Feeling Great, you will get a step by step introduction to TEAM therapy. Thanks! d

PS There is at least one podcast on how to identify your negative thoughts and generate a Daily Mood Log. You can use the search function on the website to find those or podcasts on any topic, but here’s the link since the search function is not working properly at the moment so I’ll have to fix it. (https://feelinggood.com/2018/03/05/078-five-simple-ways-to-boost-your-happiness-5-you-can-change-the-way-you-feel/)

PS PS I want to thank Simon for creating time codes for all 50 techniques on podcasts 93 (https://feelinggood.com/2018/06/18/093-fifty-ways-in-fifty-minutes-part-1/) and 94 (https://feelinggood.com/2018/06/25/094-50-methods-in-50-minutes-part-2/) entitled, “Fifty techniques in fifty minutes.” His time codes allow you to find the description of any techniques of interest.

* * *

7. Stephanie asks: My patients don’t recover as rapidly as your patients. Am I doing something wrong? I’m feeling a lot of anxiety and self-doubt!

Hi David,

I hope this is the right address to which to send an "Ask David." I am a huge fan of your work and cannot thank you enough for making your therapy techniques so accessible. And thank you for taking audience questions!

I am in the process of learning TEAM and notice myself getting more skilled, slowly but surely.  There are times I hear you help patients recover in a single session. So far, I have not found myself able to help patients that quickly. I've felt disappointed about this, and it's led to anxiety and self-doubt ("I need to learn TEAM faster so I can help my patients as quickly as possible," "This should be happening quicker.").

I am wondering how logical it is for me to expect myself to help patients recover in a single session. Is it reasonable to assume I may have to practice TEAM for some time and go through several training experiences before I can help patients change that quickly?

Thank you again!!

Stephanie

David and Rhonda discuss ways of improving over time and reducing the pressure on yourself if you are a therapist.

Menopause--

The End? . . . or the Beginning?

Rhonda starts today’s podcast, as usual, with a warm endorsement from Sally, a podcast fan who really liked Podcast 355 on the topic of “Relationship Problems: Be Gone!” She said the role-play demonstrations were “incredible” and especially helpful. We’ll keep that in mind and see if we can do some more role-playing demonstrations in future podcasts, along with instructions so you can practice at home, as well.

This can be extremely helpful if you want to master the techniques we describe. They may sound simple, but they’re not! In our recent podcast on free practice groups (put LINK), you can find many virtual practice groups you can join from home to practice many of the techniques in TEAM-CBT with like-minded colleagues and become part of the growing TEAM-CBT community. We now have many excellent and free practice groups for the general public as well as and training groups for shrinks.

Today, Mina returns to the show with a new problem—pre-menopausal symptoms that are scaring her and casting a shadow on her future as well as her marriage with her husband, Maurice.

Menopause is a topic that freaks many people out, due to feelings of anxiety and shame which can sometimes be intense. Today, menopause will be out in the open and front and center. However, Meina is confused because so many problems and feelings are swirling around in her head, and she doesn’t quite know where to start.

At the start of the session, Mina's Brief Mood Survey indicated mild depression, severe anxiety, moderate to severe anger, and greatly diminished feelings of happiness and relationship satisfaction, thinking of her husband, Maurice.f

If you review Mina’s Daily Mood Log. you can see that the Upsetting Event is irregular periods due to menopause. You can also see that Mina is struggling with fairly feelings of depression, anxiety, shame, inadequacy, loneliness, embarrassment, hopelessness, frustration and anger, and she’s giving herself some intensely negative messages, like “My body is falling apart,” and “My husband will leave me,” and “I’ll get osteoporosis and die in pain like my grandmother,” and more.

During the initial Empathy phase of the session, Mina described quite a lot of personal and professional concerns, as well as somatic complaints of various kinds. Sometimes, in the past, Mina has developed numerous somatic complaints that terrify her, because she has interpreted them as possible serious diseases, like multiple sclerosis. However, excellent physical evaluations rarely or never provide any medical evidence or explanation for her symptoms.

This pattern of obsessing about somatic symptoms is actually quite common. Many general practice doctors report that as many as a third of their patients complaining of pain, dizziness, and so forth do not have any medical disease that could possibly explain the symptoms. In fact, in his classic book, Caring for Patients, the late Dr. Allen Barbour from Stanford reported that about half of these types of patients experience a disappearance of their somatic symptoms when they identify some conflict or problem that they've been avoiding, and then take steps to express their feelings or solve the repressed problem.

Pretty much every time, this has been true of Mina, too. It often turns out that she is upset about something she is sweeping under the rug, and the Hidden Emotion Technique has proved extremely helpful in pinpointing the hidden feeling or conflict. Then, as soon as she acts on this information, and expresses her feelings, the somatic problems immediately disappear.

So, our first task in today's session was to see if the same thing was happening. It turned out that she was quite upset with her husband, Maurice, so we did a Relationship Journal to see if we could get a better understanding of what was going on. Her complaint was that Maurice did not want to talk about “difficult feelings.” Instead, he suggests they go for a nature walk or watch a movie. So, she felt sad, anxious, rejected, hurt, frustrated, and alone.

But, as is the case nearly 100% of the time, when we examined a brief interaction between them—what did he say and what did she say next—it became clear that she was actually pushing him away and putting him down. This was understandably painful for Mina to see, and a bit embarrassing, but she was super brave, and saw how she could use the Five Secrets to respond to Maurice in a radically different and more inviting manner.

As an aside, the person who seeks treatment for a relationship problem will nearly always discover that they have actually be causing the very problem they’re complaining about. If Mina’s husband had come to us for help, he would have made the exact same shocking discovery—that HE was causing the problem he was complaining about.

I call this strange but fascinating phenomenon the “theory of interpersonal relativity.”

Mina feared abandonment, but discovered that her real problem was that she was rejecting her husband, and forcing him to reject her!

Although this type of sudden insight can be tremendously painful, it is also liberating at the same time. That's because people discover that they have far more power than they thought. Mina felt helpless, but was actually pulling the strings. Once you “see” this, you have the option of moving in a radically new and more rewarding direction. Mina promised to send a follow up once she’s had the chance to try a new approach during her interactions with Maurice. We have our fingers crossed!

In addition, we worked with Mina's negative thoughts and feelings on her Daily Mood Log, starting with Positive Reframing, which she found helpful. What did her negative thoughts and feelings show about her that was positive and awesome, and how were they helping her?

Then we did several rounds of Externalization of Voices and she was quickly able to knock her negative thoughts out of the park, with incredible results that you can see if you examine the emotions goal and outcome columns on her emotions table HERE. As you can see, there was an immediate and dramatic reduction in all of her negative feelings.

We publish these TEAM-CBT sessions because we believe that the vast majority of mental health professionals do not know how to trigger rapid and extreme changes in how people think, feel, and interact with others. It is our hope that these podcast live therapy sessions, in conjunction with our weekly training groups, will make mental health professionals aware of what’s now possible, and how TEAM-CBT actually works. We try to make it look simple, but it requires tremendous training, practice, and commitment.

Rhonda and I have strong, tender feelings toward our dear colleague, Mina, and we are deeply indebted to her for making herself vulnerable in a public forum so that we can all learn and feel much closer to one another. Personal work is one of our finest teaching tools.

In addition, feelings of respect, love, and connection are so often missing in our embattled and hostile political and world environment these days. We cannot change the world, but we can definitely make our own small ripples in the pond, and work on changing ourselves.

If you'd like, you can take a look at Mina's Brief Mood Survey and Evaluation of Therapy Session at the end of the session. 

Thanks so much for listening today!

Rhonda, Mina, and David

"Overcoming Toxic Shame"

Join Dr. Jill Levitt and me 

at our fabulous new workshop

Sunday, February 5th, 2023

8:30am - 4:30pm PST - 7 CE units

Click here for information and registration

In today's podcast, David and Jill describe their new workshop on Overcoming Toxic Shame. This workshop will feature video snippets from a fantastic session with a beloved colleague named Melanie who struggled with intense feelings of anxiety and shame for more than 8 years. You will see her transformation from utter despair to joy in a single therapy session lasting roughly two hours, and you will get the chance to learn and practice the techniques that were so transformative for her.

Most mental health professionals also struggle with feelings of shame because of their belief that they aren't "good enough" and from fears of being found out. You will have the chance to heal yourself while you master cool new techniques to transform the lives of your patients!

In today's podcast, David and Jill do a live demonstration of a couple of the many techniques they will illustrate on February, which will include the Paradoxical Double Standardl Technique, Externalization of Voices, and the Feared Fantasy. You will not only witness a remarkable change in Melanie, as well as a sudden, severe and unexpected relapse half way through the session. David ang Jill will ask, "If you were the therapist, what would you do right now?" What follows is AMAZING!

Jill practices and serves as the Director of Training at the Feeling Good Institute in Mountain View California. She is also co-leader of my Tuesday evening weekly training group at Stanford (now entirely virtual). This group is totally free and is available to mental health professional in the Bay Area and around the world.

You can reach Dr. Burns at david@feelinggood.com.

For the past couple months, Fabrice has asked me to set up a live therapy session to illustrate how to treat troubled relationships using TEAM-CBT. I was fortunate to get an email request from a colleague named Lee who wanted help with his marriage. He explained that his wife was very controlling and critical of him and attributed this to the fact that she had a controlling mother. This is very typical in troubled relationships, most of us are convinced that the problem is the other person’s fault. Of course, Lee told us that his wife, in turn, blames back and feels that Lee is the one who needs to change.

Lee initially thought we’d do couples therapy, but in TEAM-CBT we actually prefer to treat just one person in a troubled relationship.

Two weeks ago, Jill and I sat down with Lee on a Saturday morning, linking to each other on the internet since he lives abroad, for a three-hour treatment session. The session has been broken down into three separate podcasts plus commentary from Fabrice, Jill and David on each of the three segments.

By way of disclaimers, Lee is a colleague who does coaching for individuals with alcohol addiction problems. We are not entering into a formal treatment relationship with Lee. Instead, he has offered to help us illustrate a therapy technique, using a real person problem, as part of his training and personal growth. We are deeply grateful to Lee for letting us share his intensely personal “session” with you!

Today, you will hear the first segment on T = Testing and E = Empathy. Lee will tell his story. Jill and I will listen without trying to “help” or “rescue” Lee. On the Brief Mood Survey, he indicated no depression or suicidal urges. He was mildly anxious and slightly angry. His Positive Feelings Survey indicated that he was quite happy except in two areas: He felt only moderately close to people and only slightly connected to others. You will also hear him say that he felt like one of the loneliest people we would ever meet toward the end of the empathy phase of the session.

Amy and her "fab fiancé," Randy Kolin!

Secrets of Flirting, Sex Appeal

and True Love!

Today Rhonda and David interview Amy Berner, who has fallen in love and has quite a story to tell! Today is Valentine’s Day (we recorded this on February 14, 2023), so we thought a love story would be a ray of joy for all of you, whether you are in a loving relationship or still looking for one!

But first, Rhonda and David briefly interview Jeremy Karmel, the co-CEO of David’s Feeling Good App. Jeremy tells his dramatic personal story that led to the creation of the app, and solicits for people who might want to join us for beta testing, which has gotten very busy of late.

David also present some amazing data from a small, four-week beta test in December involving around 45 beta testers. The findings appeared to indicate that beta users experience far greater warmth and understanding from the app than from the people in their lives, which is on the sad side, since at the time users applied for the app, they only estimated 55% (on a scale from 0 to 100) warmth and understanding from the people in their lives, and roughly 85% from the digital “David” they interacted with in the app.

We’ll see if those amazing findings hold up in two larger replication studies now in progress.

If you think you might be interested in being a beta tester, please sign up at www.feelinggood.com/app.

Rhonda also gave an endorsement for the upcoming second World Congress on TEAM-CBT in Warsaw, Poland this year, March 30-April 2, 2023. It sounds exciting. I will be there is a variety of capacities including conducting a personal session with Jill Levitt, PhD. Please check it out!

And, as usual, she read a compelling comment from one of our regulars, Irish Brain, who wrote: “Another amazing podcast for the collection!”

Amy Berner is a licensed marriage and family therapist who works with adults and teens online in California. She loves helping her clients heal from heartache, depression, and anxiety. You can find her at the FeelingGreatTherapyCenter.com.

Amy’s love story started at a women’s group that Rhonda was also in more than a year ago. It turns out that Rhonda is quite the match-maker, and has arranged dates for large numbers of her friends and colleagues, including Amy. However, Amy was feeling insecure, as so many of us might, before this date.

To help her, Rhonda suggested the Feared Fantasy Exercise, and asked Amy to list some of the things she was afraid her blind date might be thinking, but not saying, when they met. When you do the FF, one person plays the role of the “Date from Hell” who not only thinks these awful things about you, but gets right up in your face and says them.

This list of awful things the Date from Hell might say included:

• “I’m just doing Rhonda a favor in dating you.”

• “You look a lot older than your picture!”

• “I haven’t gotten over my last relationship yet.”

• “You’re not smart enough.”

• “You’re just not very interesting.”

We demonstrated the FF on the podcast, and Amy knocked them out of the park, using humor plus the Acceptance Paradox. She said that when they’d done that at the women’s group, in greatly reduced Amy’s fear and trepidation prior to their first date.

Amy said she was also greatly helped by being in my small practice group the following Tuesday at our weekly psychotherapy training group. We were working on the “Interpersonal Downward Arrow,” a technique I developed that quickly illuminates the roles people play in problematic relationships.

Amy discovered that she was playing the role of the inadequate, inferior, insecure person, and this was illuminating. One bad thing about this role is that it quickly becomes a self-fulfilling prophecy because if you see yourself as inferior, you will chase, and come across as insecure, and that will cause the other person, in most cases, to reject you.

David suggested a technique he described in his book, Intimate Connections (which you can see below). called the Queen Bee Phenomenon. Instead of playing the insecure role, you give yourself all kinds of positive messages about how sexy and awesome and desirable you are.

Once you get into that mind-set, this mind-set can also act as a self-fulfilling prophecy. That’s because of the Burns Rule, which states that in any relationship, especially at the start, one person will be the pursued, and the other person will be the pursuer. The pursued person has all the power, and the pursuer is usually rejected.

So why not utilize the Queen Bee Phenomenon and let the guys chase you?

This idea was transformative for our wonderful Amy, who is now happily, giddily, engaged, and she tell her story today with her typical wit, humor, and charm.

She emphasized another important concept from Intimate Connections. Self-love has to come first. Once you chose to love and like yourself, your fear of being alone disappears, and you discover that you can be incredibly happy when you’re alone.

Then, you will no longer “need” men; and as a result, men will need and chase you. That’s another expression of the Burns Rule which states: Men (all people actually) ONLY want what they CAN’T get, and NEVER want what they CAN get.

So, if you don’t “need” other people, they will have to chase you!

And that’s what happened!

Rhonda, Amy, and David also reviewed the principles of effective flirting.

1, Be playful, and not heavy or serious.

2. Have fun.

3. Give playful, specific compliments.

Amy has developed a game called “Flirty Dice” which helped her and many others. It is suitable for anyone 14 years or older and can be obtained at the Feeling Great Therapy Center.

At the same time that her love life zoomed into orbit, her clinical practice did the same. This is common—when you become a source of joy, others just naturally are attracted to you. Kind of like human magnetism.

Amy sees people virtually from all over California. She practices TEAM-CBT and specializes in the treatment of depression and anxiety, and of course, dating and relationship issues.

So, if you want to give your love-life a kick-start, or recovery from rejection, contact her at babyfreud@gmail.com

Thanks for listening today! Last month, (January 2023), we broke our one month download record (>182,000 downloads), so thank you for that. We will surpass 6 million downloads shortly.

Rhonda, Amy, and David

This is the fourth in our podcasts series on the best techniques to crush each of the ten cognitive distortions from my book, Feeling Good: The New Mood Therapy. Today, we focus on Mental Filtering and Discounting the Positive. (This will be the last Episode recorded remotely with poor sound quality.  We thank  you for your perseverance listening to it, and guarantee better sound quality in the future with our new recording equipment.)

1. Mental Filtering, You focus on something(s) negative, like a mistake you made, and ignore or overlook the positives. This is like the drop of ink that discolors the beaker of water.
2. Discounting the Positive(s). this is an even more spectacular mental error. You insist that the positives about yourself or others don't count.  In this way, you can maintain a uniformly and totally negative view of yourself, the world, or other people.

David and Rhonda discuss the fact that humans can be very biased in our perceptions of things that are emotionally charged. For example, if you are firmly committed to some belief, you might look for evidence that supports your belief, and discount evidence that contradicts your belief.

Similarly, if there is someone you strongly admire, you may selectively focus on the positive things they do or say, and discount or dismiss things they do or say that might be quite offensive. And when you're ticked off at somebody, you probably focus on all the things they do or say that turn you off (mental filtering) and discount the positive things that they do or say. For example, when they say something kind or supportive, you might think, "S/he doesn't mean it," or "isn't being genuine. They're just acting fake." In this way, you convince yourself that he or she really is "bad."

When you're depressed or anxious, you'll do this to yourself as well, thus intensifying your negative thoughts and feelings. For example, a teenager with extremely intense depression, strong suicidal urges, and anger told me that human beings were inherently selfish, insensitive, and bad. When I asked her how she'd come to this conclusion, she described seeing some kids in her dormitory who were joking in a cruel, insensitive way about girl with depression, and said that if you're looking for her, you can probably find her sitting on the edge of her dormitory window, meaning that she's probably about to jump.

She also described seeing a homeless man on her way her therapy session, and said that no one really cared about him. Of course, these observations were at least partially valid, since human beings certainly DO have the capacity for great self-contentedness, insensitivity, and cruelty. But was she involved in Mental Filtering, and focusing only on the negatives?

I asked her if she could think of any times in the past several weeks when someone had been cruel or insensitive to her. She couldn't think of a single instance.

David and Rhonda provide additional examples, some personal, of Mental Filtering and Discounting the Positive, and suggest techniques that can be helpful when combating these distortions, including Positive Reframing, Examine the Evidence, the Straightforward Technique, and Double Standard Technique.

David tells a moving story that he also told on his Tedx talk in Reno, about an elderly Latvian immigrant who made a suicide attempt because she thought she'd never accomplished anything worthwhile or meaningful.

In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Jumping to Conclusions.

David D. Burns, MD / Rhonda Barovsky, PsyD

The Feeling Good App: Part 2 of 2--

The Surprising Basic Science Findings--

How Does Psychotherapy REALLY Work?

And Why Did Everything Change So Fast?

Feeling Good Podcast Special Edition #2: March 07, 2022

Today’s special podcast features the second part of the recording with David and Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the basic science findings most recent beta test, which included 140 participants. David uses an advanced form of statistics, called Structural Equation Modeling (SEM) to identify causal effects and to learn more about how the app actually works. This information has immense practical and theoretical implications.

Here's a portion of what we’ve discovered so far.

1. All seven negative feelings are high correlated because they all share an unknown Common Cause (CC) predicted by David in one of the top psychology research journals in the late 1990’s. Here’s the reference2

Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473.

2. The CC accounts for most of the variance in all seven negative feelings, with R-square values ranging from 66% for anger, and 98% for Anxiety. Since there has to be some error variance in the estimates of the negative feelings, there is practically no room left for any significant additional causes.

If you would like to see the standardized output of the SEM model, click here.

3. The CC also has causal effects on Happiness, but these effects are much smaller, with an R-square of only 30%. This proves that Happiness has its own causes that are completely different from the factors that trigger depression. Happiness, in other words, is NOT just the absence of depression.
4. The radical reductions in all seven negative feelings were mediated by the reduction in the user’s belief in their negative thoughts, as predicted by cognitive therapists, like Albert Ellis and Aaron Beck, as well as the Greek Stoic philosopher, Epictetus, nearly 2,000 years ago. This is the first proof of that theory!
5. At least three components of the app have been isolated which appear to have substantial causal effects in the Common Cause, which in turn triggers simultaneous changes all negative feelings as well as happiness. Those three components include:
   1. A cognitive variable: the user’s belief in his or her negative thoughts.
   2. A motivational variable: measured with extremely precise and sensitive instruments.
   3. the user’s liking of the app.

The magnitude of all three causal effects was large. However, the motivational variables and user’s liking did not have direct effects on changes in depression and other negative feelings. The changes were ALL mediated via reductions in the user’s belief in his or her negative thoughts. This finding is consistent with the hypothesis that it is impossible to reduce negative feelings without change the belief in the negative thoughts that trigger those feelings.

6. The SEM models were replicated in two independent groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The fit of the model was outstanding in both groups, and there were few or no significant differences in the parameter estimates. This indicates that the findings are valid and do not represent capitalization on chance.
7. David has reported extremely rapid changes in all negative feelings in his single-session treatment of individuals using TEAM-CBT. Some people have suggested that this is because he often treats mental health professionals as well as individuals who are very acquainted with his work.

CLICK HERE FOR THE FULLL REPORT

However, data from the beta test indicates this is not likely to be true. Mental health professionals did not respond any differently from non-professionals. In addition, the Familiarity with David or with TEAM variables did have modest effects on the degree of liking of the app, but no direct causal effects on changes in depression or the Common Cause.

The basic research is just beginning and ongoing. David believes that the research potential of the Feeling Good App may be as significant as the healing effects documented in the outcome findings with the app in the previous podcast.

If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training module, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques for the first time to find out if the improvements last.

Research on more than 10,000 sessions by human therapists using TEAM indicates that a portion of the gains patients make during individual sessions dissipates between sessions, but the “staying power” of the gains is facilitated by the patient’s homework between sessions. As a result, patient gains tend to reach a steady state after four or five sessions.

We anticipate that something similar may be documented in longitudinal studies with the app, and are eager to see what we can learn in the next study which will extend beyond one day.

So, hopefully, the new study will be pretty cool, too! And who knows what we’ll discover, with your help! Make sure you sign up if you’re interested in being one of our beta testers!

David and Jeremy

Rhonda, Jeremy, and David

The three basic principles of CBT:

1. Negative feelings, like depression, anxiety, and anger, do not result from what happens to us, but rather from our thoughts about what’s happening. In fact, our thoughts, or “cognitions,” create all of our emotions, positive and negative.
2. When you’re depressed or anxious, the negative thoughts that trigger your distress, like "I’m no good," or "Things will never change," are distorted or illogical. In fact, depression is the world’s oldest con.
3. When you change the way you THINK, you can change the way you feel.

293: The Five Secrets with

Violent and Angry Individuals,

Featuring Heather Clague, MD

Heather Clague MD is a Level 5 TEAM therapist and trainer with a practice in Oakland, California and consult-liaison psychiatrist at Highland Hospital in Oakland. In addition to running an online consultation group for TEAM therapists, she is faculty for All Things CBT,  teaches for the Feeling Good Institute, and has taught the Five Secrets of Effective Communication to medical staff. Her writing can be found at psychotherapy.net.

With Dr. Brandon Vance, Heather co-leads the Feeling Great Book Club, a book club for everyone, everywhere who wants to learn the magic of TEAM.

In today’s podcast, Rhonda and David speak with Dr. Heather Clague who describes her working in the psychiatric emergency room at Highland Hospital in Oakland, California, and other emergency facilities including Fairmont Hospital in San Leandro, California, interacting with hostile and psychotic individuals who often have to be held against their will because they are a danger to themselves or others, or unable to care for themselves.

Although today’s podcast will be of special interest to mental health professionals, it will also be of great interest to anyone having to interact with strangers, friends or family members who are angry and abusive.

She explained that

In these types of settings, we often have to give patients the opposite of what they want. For example, if they’re involuntarily hospitalized for dangerous behavior, we have to restrain them, or keep them in the hospital, when they desperately want out. Or, if they want to stay in the hospital, we may have to discharge them. Many of these patients are psychotic and lack judgment, so they may shout and act out in anger and frustration.

The Five Secrets (LINK) have been a godsend, and when it works, the results are amazing. For example, if a patient is screaming for us to release them, the natural instinct to get defensive just agitates them more and is rarely or never effective. If in contrast, you say, “You’re right, we are holding you against your will and you have every right to be angry,” they usually feel heard and calm right down.

In one recent case, an agitated and confused homeless woman needing dialysis was near death because she was refusing treatment and refusing to take her medications. She was manic, agitated, and talking rapidly, non-stop.

I said, “I think you’re really upset because we’re keeping you against your will.”

The patient shouted “Yes!”

Then I said, “And you’re telling us that you do have a place to go to if we let you out.”

The patient said, “yes,” in a softer voice, and let the nurse come in and give her her medications, which she took.

Heather described phrases she uses to get into each of the Five Secrets in high-secrets situations when you don’t have much time to think and have to respond quickly, including these:

For the Disarming Technique: “You’re right,” followed by a statement affirming the truth in what the patient just said.

Thought Empathy: “What you’re telling me is” followed by repeating what the patient just said. This is helped greatly by writing down what the patient said.

Without writing things down, this technique tends to be impossible for mental health professionals OR the general public. In spite of this, most people refuse this advice!

Feeling Empathy: “Given what you just told me, I can imagine you might be feeling X, Y, and Z” where X, Y and Z are feeling words, like “upset,” “anxious,” or “angry,” and so forth.

Inquiry: Heather emphasizes two productive lines of Inquiry:

“Am I getting it right?”

“Can you tell me more about how you’re feeling?”

“I Feel” Statements: “I’m feeling X, Y, and Z right now,” where X, Y, and Z are feeling words like sad, concerned, awkward, and so forth. When done skillfully, this technique adds warmth and genuineness, and facilitates the human connection.

Heather cautions against saying “I feel like you . . . ” since this ends up not as a statement of your own feelings, but a criticism of the other person. “I feel that . . . “ has the same problem.

Stroking: This conveys caring, liking and respect, but cannot be done in a formulaic way. You might say things like “I care about you and I’m really concerned that you’re struggling right now,” or ‘What you are saying is very important, and I want to understand more.”

For example, you might say this to an angry patient being held against his or her will:

“You’re right, I am holding you against your will, and insisting that you stay, and I don’t like it either. But I’m very concerned that if I let you out now, you might get hurt, or do something to hurt yourself, and your life is precious. I don’t think I could forgive myself if I did that.”

Of course, all of this has to come from the heart and has to be done skillfully, or it will not work.

Heather described other inspiring stories of challenging patients she’d worked with, and we took turns modeling Five Secrets responses to ultra-challenging patients, including one who was brought into the ER by police on a gurney in leather restraints who took one look at her doctor and said, “Boy, are you ugly!”

On another occasion, she walked into the room of a male patient, introduced herself, and asked if they could talk.  He replied provocatively, “Sure, if you get into bed with me, baby.”

Rhonda and Heather reminisced about their meeting at one of my four day intensives for mental health professionals several years ago at the South San Francisco Conference Center, and became best of friends. They have traveled together to India and Mexico teaching TEAM-CBT and spreading the gospel according to Burns!

I also reflected on my two years of internship and residency training at Highland Hospital, and my profound gratitude and admiration for that hospital and the many dedicated and talented health professionals who serve there.

Thanks for tuning in today!

Heather, Rhonda, and David

First in a series of podcasts on how to transform troubled relationships into loving ones—if that's what you want to do!

David begins with the story of how he got into working with troubled couples as well as individuals with troubled relationships shortly after his first book, Feeling Good, was published. Because cognitive therapy was beginning to generate excitement worldwide as the first drug-free treatment for depression, everyone thought it might also be effective for other kinds of problems, including troubled relationships.

And there were fairly good reasons to suspect that cognitive therapy might be helpful. When you’re in conflict with a loved one, friend, colleague or stranger who you can't get along with, you’ve probably noticed that you will usually have negative thoughts like these running through your brain:

1. It’s all his fault. (Blame, All-or-Nothing Thinking)
2. She’s a jerk. (Labeling, Should Statement, Mental Filter, Hidden Should Statement)
3. He’ll never change! (Fortune Telling, All-or-Nothing thinking, Discounting the Positive, Emotional Reasoning)
4. All she cares about his herself. (Mind-Reading, Discounting the Positive, Mental Filter, Over generalization)
5. I’m right and he’s wrong about this! (Blame, All-or-Nothing Thinking)
6. She shouldn’t be like that. (Should Statement, Blame)

Sound familiar?

And as you can see, these thoughts contain all the same kinds of cognitive distortions that depressed individuals have, as I've indicated in parentheses. If you're familiar with the cognitive distortions, you may be able to pinpoint even more than the ones I've listed. The only difference is that when you're in conflict with someone, the distortions will usually be directed at the person you’re not getting along with, rather than yourself.

Although these thoughts will usually be distorted, you may not realize this (or even care) when you're upset. You'll probably be convinced that the person you're mad at really is a jerk, or really is to blame, or really is wrong. In addition, these thoughts will tend to function as self-fulfilling prophecies. For example, if you think someone is a self-centered jerk, you will usually treat him or her in a hostile or unfriendly way, and then he or she will get defensive and hostile, and will look like a jerk. Then you'll tell yourself, "See, I was right about him (or her)!"

David got excited about these insights and wrote a draft of a book called Couple in Conflicts, Couples in Love, and sent it to his editor in New York to see what she thought. The new book was about how to modify the distorted thoughts and self-defeating beliefs that trigger and magnify relationship problems. David's editor called the next day with an offer of a large advance, exclaiming excitedly that the book was sure to be a #1 best seller.

David was ecstatic, and set out to edit the book for publication. In the meantime, he was using the new approach with troubled couples as well as individuals with relationship conflicts. But after six months of repeated treatment failures, he concluded that cognitive therapy was not at all effective in the treatment of relationship problems. The approach sounded great on paper, but it didn't work in the real world.

David sadly returned the advance to his publisher and cancelled the contract. He promised that if he could figure out why cognitive therapy didn't work for troubled relationships, and if he could find a better treatment method, he’d write another book. Figuring it out took 25 years or research and clinical experience, and the name of the book he eventually did publish is called Feeling Good Together, now available on Amazon.com.

David and Fabrice then discuss some of the most popular theories about the causes of relationship problems:

1. The skill deficit theory: We want loving relationships, but don’t have the communication and negotiation skills to get close to the people we’re not getting along with.
2. The barrier theory: We want loving relationships, but something gets in the way, such as unrealistic expectations or distorted thoughts about the person we’re not getting along with. Other barrier theories include the idea that women are from Venus and men are from Mars popularized by John Gray, Deborah Tannen, and others. According to this theory, women use language to express feelings, and men use language to solve problems, so they both end up frustrated and not understanding one another. Another popular theory is the idea that we project childhood conflicts with our parents onto others, and thus recreate the same dysfunctional patterns repeatedly in every new relationship.
3. The self-esteem theory: You can’t develop loving relationships with others if you don’t know how to love yourself.
4. The motivational theory: We have troubled relationships because we WANT them!

David emphasizes that the first three theories are all very optimistic--they all are based on the idea that human beings are basically good and want loving, peaceful, joyous relationships. But something gets in the way, such as a barrier of some type, or the lack of communication skills, or the lack of self-esteem. And they are all very hopeful, since we can teach people better skills, or remove the barriers to intimacy, or help people develop better self-esteem.

David also emphasizes that these theories have only two problems. First, the theories that they're based on are false. Second, the treatments that have evolved from these theories are not effective. David and Fabrice describe research on the validity (or total lack of validity) for these theories as well as the effectiveness (or lack of effectiveness) of the treatment techniques and schools of therapy that have evolved from these theories.

David then discusses the motivational theory which is much less optimistic about human nature, and emphasizes that humans have competing positive and negative motives.

In the next podcast, they will discuss the basics assumptions of the new treatment approach David has created for relationship problems, based on the motivational theory.

Check it Out! 

The September, 2022 Podcast Survey 

Dear Podcast fans. Thank you for your responses to our podcast survey yesterday, asking about your likes and dislikes, as well as your suggestions for the future of our podcast.

The following report is based on 355 responses we received the first day of the survey. A link to the survey report will be included in spots so you can examine it for more information!

LINK TO SURVEY RESULTS

Thanks So much!

Rhonda and David

PS Rhonda is now our official Host and Producer!

Demographics

Gender: 58 / 42 = female / male

Age: 21 to >70. None under 21.

Education

• Grad school: 64%

• College: 29%

• High school, grammar school, other: the rest

Comment: high average education level is likely due to high number of therapists

Therapist

• No 56%

• Yes 33%

TEAM certified therapist

• Yes 15%

• No 85%

Podcast Interests

Listen to improve your therapy skills?

• Yes 47%

• No 53%

Listen for personal healing?

• Yes 90%

• No 10%

How many episodes have you listened to?

• All 26%

• A lot 37%

• About half 16%

• Just a few 21%

What elements do you value the most?

• Teaching Therapy Techniques 86%

• Live Work 72%

• Story Telling 58%

• Critical Thinking 57%

• Inspiration 54%

• Warmth 46%

• Laughter 42%

• Guest Interviews (36%)

• Under 30%: Tears (23%), Banter (29%), Controversy (17%),

What types of podcasts appeal to you the most?

• Therapy Methods 194

• Live work 184

• Anxiety Help  168

• Ask David 163

• Self-Help  158

• Depression Help 156

• Relationship Problems 154

• TEAM Training 126

• Habits and Addictions 107

• Procrastination  94

• Guest Experts 88

• Weight Loss 51

Other

What do you think about paid ads?

• Hate it 28%

• Love it 20%

• Unsure 52%

Would you recommend the podcast to a friend?

• Yes 96%

• No 4%

What grade would you give the podcast?

• A 77%

• B 20%

• C 3%

• D 0%

• F 0%

Written Responses

Elements you like the best (selections 356 responses)

• Learning about techniques to help patients from experts in the field! Realistic and humorous portrayals and disclosure

• Always pick up a new concept

• Brilliant teaching and great techniques

• The idea that long- lasting change can happen quickly

• The use of Paradox

• There is done sort of therapy by proxy that seems to happen during live therapy work. Even when situations are different, amazingly meaningful.

• I enjoy the Q&A podcasts where you cover 4 to 5 great questions. Having Rhonda and Matt (and, of course, Dr. Burns!) give their viewpoints on topics that can be helpful to everyone is very useful.

• Learning how to retool my brain.

• I love the feeling of comfort I get from hearing your stories, both personal and from guests. I was particularly touched by Rhonda’s openness when she first joined the podcast and worked through her feelings of inadequacy. I think about those episodes a lot because I relate to them.

• Feel less alone

• The live therapy sessions. Hearing Dr. Burns, Jill, Rhonda and others do externalization of voices, positive reframing, and other techniques is SO incredibly powerful.

• Hundreds more! (link)

Elements you like the least (selections 356 responses)

• The long intros sometimes before the topic gets started

• Boasting, rambling on and on.

• Sometimes the attitude towards other practices and theories is condescending and fails to appreciate the contributions different approaches make to understand and alleviate suffering.

• endorsement emails

• Something I've noticed in live coaching is that there seems to be a strong focus on externalization of voices as a method. In Feeling Great, I love your 50 methods - but I wonder why it feels like 80% of the time you focus on externalization of voices vs other methods.

• Honestly, that's super nit-picky. But I felt like I had to include something in the "liked least" section. Otherwise, I think the Feeling Good podcast is A+++

• Not a fan of the hokey -- the weird Hello Rhondas, etc. Ditto for the four letter words. IMO these detract from the content, dumb down/lessen the credibility of the presenters and content. Distracting and make me cringe. I won't quit listening... just unprofessional and low class.

• Hard to complain about something this good

• Hundreds more (link)

What other topics might interest you?

• Trauma work. Meaning - I find that MANY people are talking about "Childhood Trauma" as if it's a separate thing. "Trauma-Informed Therapy" seems to be a new hot topic. Wondering what you feel about trauma and this seeming growth in trauma-focus.

• Use 5 secrets in relationship with someone with borderline personality disorder

• 5 secrets training

• How to make friends

• How TEAM principles can help you raise happy/healthy kids!

• Discussion of how to manage anxiety when it’s hard to pinpoint the direct cause, making it hard to challenge our thoughts. Also topics on panic attacks.

• integrating the buddha dharma with cbt

• Definitely PTSD (I have PTSD from finding my partner dead after a suicide), body image, more about dating and relationships.

• How to treat low self esteem.

• How to increase happiness. How to make touch decisions about careers or other things that have pros and cons. For example, doing the decision making form and having the scores be around 0 or both negative scores.

• How to heal after a break up and how to manage rejection while dating (e.g., someone rejects you after a few dates)

• I would love to see more episodes on habits and addictions and also a life episode on shame attacking exercises!

• Hundreds more (link)

Comment: Some of these excellent suggestions have been covered already, and you can find them on my website by using the search function and / or the list of podcasts with links. For example, we’ve already had a five part series on boosting happiness (link) as well as boosting self-esteem (link) and how to use each of the 5 secrets (link), and much more. Take a look! (link to list of podcasts)

What other topics might interest you the least?

• Anything related to organized religion. (Disorganized religion, I'm okay with!) lol) ;)

• Weight loss/eating disorders

• promoting other therapists

• "worried well" privileged patients.

• Anxiety and phobias

• Can’t think of any

• Why TEAM CBT is superior to all other forms of therapies.

• Nothing it is all helpful to make me realize I am not alone and we all have our own internal struggles

• I love it all

• Therapist workshop announcements

• Hundreds more (link)

Suggestions for improving the podcast (194 responses)

• Keep doing listener questions and answers and case examples.. the Buddhist perspective of not having a self and bigger picture etc

• Hidden emotion technique examples ongoing as I think that helps to know what common pressures people have experienced in Davids practice that we might also see etc.

• Maybe fewer judgy comments, including more guest speakers, more inclusivity. Always love the live work

• Keep bringing in therapist from around the country in the world to talk about what they do with team

• No, just please keep making it.

• DON'T CHANGE A THING!

• I mention above but I think getting David out to more of the enormous self-help podcasts would really help spread the word and open a lot of people’s eyes. A big one that I think would be a great fit is the Tim Ferriss podcast

Comment: Thanks. I’d love to be on any podcasts with large audiences. Please contact them and tell them to invite me! I’m not comfortable and don’t have the time to do this or the resources to hire a PR / marketing person, but they might respond to suggestions from listeners.

• It seems like a majority of the live therapy patients are TEAM CBT therapists so sometimes that can make me wonder if the techniques are as helpful to someone who doesn't already believe in the efficacy of the treatment. I'd like to see more treatment with people who are unfamiliar with TEAM CBT, although I realize that may not be possible.

Comment: I do not generally work with the general public because that would be tantamount to entering into a therapeutic relationship and would expose me to liability issues. Since I work for free, I cannot and will not take this chance, and liability insurance is costly. When I work with therapists, it is personal work in the context of their training, and is not construed as the start of a therapeutic relationship.

• I have done extensive research with large numbers of people, comparing the ease and nature of treating shrinks vs the general public, and there is absolutely no difference in the types of problems they have, the intensity, or the speed of recovery.

• If anyone would like to volunteer to indemnify me, which would be immensely costly for you, I’ll happily work with anyone!

• Hundreds more (link)

Why would you or wouldn’t you recommend it to a friend?

• I already have multiple times. Because the advice is different to what I hear elsewhere, it’s compassionate, blunt, and takes an inward look with a huge dose of kindness.

• It can change the way you live life

• Rhonda and David are so genuine together, smart, funny and informative

• It would help them, especially friends with depression or anxiety

• It is the highest quality methodology delivered by the highest quality therapists!!

• It helped and encouraged me

• too much advertising and plugging

• Because it offers real practical information that could be useful to anyone

• It helped me get out of a black hole

• It’s entertaining and informative.

• Life skills everyone should learn!

• Read both Feeling Good and Feeling Great. Dr. Burns’ content has saved my life! The five secrets has rewired my brain and helped me save my relationship, too! And Dr. Burns’ personality and sense of humor is just the icing on the cake.

• Hundreds more (link)

Thank you to all who responded!  We appreciate you!

David and Rhonda

Crushing Negative Thoughts

In this third and final podcast featuring live therapy with Marilyn, David and Matt move on to the M = Methods phase of the session along, and encourage Marilyn to challenge the Automatic Negative thoughts on her Daily Mood Log using techniques such as Identify the Distortions, the Paradoxical Double Standard Technique, the Externalization of Voices, and Acceptance Paradox. Marilyn emerges as a powerful partner and begins to crush the negative thoughts that had seemed so real and overwhelming at the start of the session.

David emphasizes that the perceptions of therapists can often be way off base, so even though Marilyn appeared to change—fairly dramatically—during the session, David, Fabrice, and Matt will not know for sure until they review Marilyn’s end of session ratings on the Daily Mood Log, Brief Mood Survey, and Evaluation of Therapy Session.

David defines a relapse as one minute or more of feeling lousy. Given this definition, all human beings will “relapse” frequently, including Marilyn. But relapses following recovery do not have to be a problem if the patient is prepared for them ahead of time. You will hear David and Matt doing relapse prevention using a number of techniques, including the Externalization of Voices.

Fabrice, Marilyn, Matt and David discuss the session, and what it meant to Marilyn from a personal and spiritual perspective. You can view this session as a powerful psychological experience—a “mind-blowing” single session “cure,” if you will—or as a profoundly healing spiritual experience: the emergence, resurrection, or rebirth from the “Dark Night of the Soul.” And you can ask yourself—did a genuine miracle happen here today?

Marilyn DML, end of session, mood only
Marilyn BMS before and after, v 1

I, David, am very indebted to Marilyn for making this phenomenal and intensely personal experience available to all of us. What a gift! Thank you, Marilyn. We love you!

I also want to thank my co-host, Fabrice, for making these podcasts happen! What a joy it is to work with you every week, Fabrice.

And I want to thank my fantastic co-therapist, former student, and colleague, Matthew May, MD, for support and friendship over these many years! Matt, as you know, I often sing your praises in my workshops around the country, telling people how amazing you are. Now they will see what I mean first-hand!

I hope that through these three podcasts, Marilyn will touch large numbers of people for years, even decades, to come. If you were touched by these recordings, please let your friends and colleagues know, so that they might have the chance to “tune in” as well.

In the first session with Marilyn, I mentioned the highly controversial theory that our pain usually results from our thoughts, and not from the circumstances of our lives. What do you think now?

Feeling Down?

Try the Feeling Great App for Free!

The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it  out at FeelingGreat.com!

Is the Universe One? Is the Universe Real?

Is the Universe Real?

These two philosophical problems used to seem nonsensical to me, and certainly not relevant to much of anything in my life—or anyone’s! But now the picture has changed a bit!

When I was a student at Amherst College, I majored in the philosophy of science. On this show, I’ve often talked about my hero, Ludwig Wittgenstein, who attempted (successfully in my opinion) to “solve” all the problems of philosophy. He wanted to help those of us who were “afflicted” by an attraction to philosophical problems to see through them and understand precisely how and why they were nonsensical. He hoped to provide a “treatment” for philosophers so we could give up the need to obsess about nonsensical philosophical problems.

Once you see through the these problems, they become kind of like a joke, and you can use jokes to help other people see through them. For example, here’s a kind of lame joke about the question of whether or not the universe is “real.” Wittgenstein said that before we try to answer questions like that, we might want to ask ourselves if these questions even makes sense! And if it a philosophical problem doesn't make sense, it isn’t a real question, so we won’t need to deal with it. In other words, questions that don’t make sense don’t need to be answered because they’re not real questions.

Take the question, "Is the universe real?"

You could ask, “Well, what would it be like if the universe weren't real? What would that look like? How would things be different?” If you can't answer that question, the question might not make sense.

To most of us, philosophical questions wound nonsensical because we are taking words, like “real,” out of the contexts in which it DOES make sense. For example, we can ask : “Is this painting real? Or is it a fake?” That question does make sense. It has an obvious meaning, since many valuable paintings are copied and are fakes, and they try to pass them off as the “real” thing.

But what would a "real" or "fake" universe look like? How would it differ from our universe?

Now let’s think about another example that is mildly humorous. Let’s imagine you’re driving through Iowa in the summer, and you spot a farmer working in his corn field. You’re interested in speaking to him because you are writing a story about your travels in Iowa, and want to talk about the lives of farmers.

So, you pull your car over to the side of the road and shout, “Howdy! What are you doing in the field?”

The farmer seems pleased and grabs a gorgeous stalk of corn and holds it up and proudly shouts, “I’m growing corn, and it is real!”

Well, that’s great that he's happily growing corn, but what does the tag-on, “and it is real” mean? It doesn’t actually mean anything, because farmers don’t grow “unreal corn.” So, in this context, the word has no meaning.

Now, if you were on a movie set, they might actually be using artificial corn as a prop, so now the contrast between real and unreal corn becomes meaningful.

This is a very humble point, but it’s the very heart of what Wittgenstein was trying to make us aware of. Philosophical problems kind of sound meaningful and puzzling, but most of the time, they are simply a kind of nonsensical use of language.

Now, in personal relationships, we might also have a notion of when people are being “real” or fake. And we often act fake because we don’t think we’re good enough just the way we really are. So, for example, you may hide your shyness in social situations because you’re ashamed, and telling yourself that your shyness is incredibly weird and abnormal, and makes you “less than” other people.

One method of helping people overcome shyness is simply to disclose it to others. This TEAM-CBT  technique is called "Self-Disclosure." Instead of hiding your shyness and feeling awkward and ashamed in social situations, you share your feelings openly. Shame depends on hiding, so when you open up, the feelings of shame will often disappear.

For example, in a recent podcast of a dramatic, live therapy session, a man named Chris revealed many troubling things about his teenage years that he’d been hiding for years. When he opened up, he began sobbing intensely, thinking he’d let his father down with his wild behavior when he was a high school student.

His grief, he was incredibly compelling, and his courageous self-disclosure was appealing to most of us who were privileged to witness that session. Showing us his “real” self became his path to enlightenment, joy, and deeply meaningful relationships with himself and with all of us who witnessed that amazing session.

So, although the question, “is the universe real” is silly and nonsensical, the question, “are we being real with each other,” is definitely NOT silly or nonsensical. Being real and vulnerable is an important key to connecting with ourselves as well as other human beings.

Is the Universe One?

How about “Is the universe one?” This philosophical question also seemed nonsensical to me for years, although I was intellectually aware that some Buddhists make claims that the universe IS one and that the failure to “see” this is the basic of all evil. That's because if you see other humans, for example, as being "external" to yourself, you may feel you have the right to abuse and exploit them.

However, for years I thought the idea that the universe is "one" seemed like sheer nonsense. For example, I am sitting in a chair typing, and there is a cup on the desk. People have never call that cup “David,” and no one has ever called me a coffee cup (although lots of people have sad some pretty bad things about me!) So, I concluded that the cup and I are not “one,” and so the whole thing about the universe being one seemed nonsensical and silly.

But when I began to think about it in the context of my work with patients, my thinking suddenly changed. For example, the TEAM interpersonal model I’ve developed was based on research I did early in my career that suggested that Blame was one of the main causes of troubled relationships, and perhaps the most important and powerful cause.

And this is certainly true in my personal life and in my work with individuals with troubled relationships who are unhappy in their marriages or people who are angry with their neighbors, or family members, or anyone. We almost always see ourselves as victims, and the other person as the one who is to blame for the problem. This triggers feelings of frustration, anger, and moral superiority, and can easily and often lead to arguments, mistrust, divorce, hostility, and violence, murder, and even war.

Now, I’m beginning to see that the idea that we are separate from others, who are doing something TO us, does, in fact, lead to hostility, and arguably to evil. And once you “get it,” the same insight applies to our relationships, not just with loved ones, friends, and other people in general, but also our relationships with animals, with the environment, and with the planet earth. If we think of them as “other,” then we may conclude that it is okay to exploit or use them for our own advantage.

In the interpersonal TEAM model, we focus more on circular causality, or interpersonal connectedness and ask the question, how do we actually shape and cause the very behavior in the other person that we complain about so vigorously? I have developed a fast, powerful tool that allows any to pinpoint their own role in a relationship problem very quickly and with reasonable accuracy. It’s called the Relationship Journal (RJ), and we’ve talked about it often on this show.

Essentially, it’s simple to use the RJ, but it can be startling and illuminating but incredibly painful. All you have to do is write down ONE thing another person said to you that you found upsetting, and EXACTLY what you said next. Choose an interaction that did not go well; otherwise, it’s a waste of time.

Then, the RJ will take you through a step by step analysis of your response, and it's implications.

When you discover how you are actually forcing the other person to treat you shabbily, it can hurt. This is one of the four ‘Great Deaths” of the self, and it’s the most painful of all, in my experience. This is the "Great Death" of the angry, blaming "self."

I hate this great death! But if you have the courage to use it and take a look, it can be incredibly illuminating and liberating, and can put you on the path to far more loving relationships.

As an exercise, I will list a number of common complaints that people have about loved ones, friends, or family that they find irritating. Your job will be to show how you could FORCE them to do the exact thing you are complaining about. The other person could be your partner, friend, son or daughter, etc. Your complaint about that person might be that they

• Refuse to talk to me.
• Can’t (or won’t) open up and express their feelings
• Constantly whine and complain, and ignore and resist my good advice.
• Constantly argue, and always have to be right.
• Won’t listen.
• Are relentlessly critical.
• Always have to get their way.
• Doesn’t treat me with respect.

In each case, see if you can figure out how you could FORCE the other person to do that exact thing. We will discuss a couple of these on the show and lustrate solutions to give you a feel for how this works.

Rhonda’s and Matt shared their wise and interesting thoughts on both of these philosophical questions, and how you can understand them in the context of your own lives, and, if you're a shrink, how you can use them in your work with patients.

Thanks for listening today!

Matt, Rhonda, and David

272 Ask David, with Special Guest, Dr. Matthew May: Shoulds, Free Treatment, Blame, and More!

Here are the questions for today’s Ask David, featuring special guest, Dr. Matt May, and, of course, Dr. Rhonda Barovsky!

1. How can I turn off my Shoulds!?
2. Is there a downside to treating people for free?
3. What’s the difference between Feeling Great vs Feeling Good?
4. Isn’t it important to blame the other person when that person really IS to blame? 

How can I turn off my Shoulds!?

Nice podcast! (Maurice is referring to Part 2 of “I want to be a mother.”) It’s refreshing to see that we sometimes mix our needs with wants.

I also have a huge problem with regret and shame, saying to myself

• “I should be far more ahead in life.”
• “I should have dated more.”
• “I should have used my energy to create art and being productive.”

I pinpointed the moment in my daily mood log, and it occurs usually when I compare myself with people online or with people in my friend group who seem to be far more ahead in life than me in terms of career and achievements or that they used their energy of their younger years more constructive than me because they didn’t deal with depression.

I tried the semantic method to soften my thoughts regarding my should statements but telling myself “I wish I did xyz,” is carrying the same weight of regret as when I “should” myself.

These thoughts also seem very realistic to me and pinpointing the distortions in them is not helping me much because there is so much resistance and weight to the thought, plus the positive thought that I subsequently come up with does not crush the negative thought.

I often ask myself: ”Am I really a failure?”

Maurice

David’s Reply

Thanks, Maurice

You are struggling with resistance, which is the cause of virtually all therapeutic failure. You can use Search on my website to look up podcasts on Positive Reframing, Assessment of Resistance, and Paradoxical Agenda Setting.

I usually select ten to fifteen or more methods to crush any Negative Thought, but would only use them after the resistance issue has been successfully addressed.

For example, we could use “Let’s Define Terms,” as one of 15 or 20 potentially helpful techniques. It might go like this:

Is “a failure” someone who fails all the time, or someone who fails some of the time.

If you say, “some the time,” then we’re all “failures,” so we don’t need to worry about it.

If you say, “all the time,” then no one is a “failure,” so we don’t need to worry about it.

If that technique is not effective, we’d have tons more to try.

You can read one of my books, like Feeling Good or Feeling Great, to learn more about the Assessment of Resistance and the use of various techniques to crush distorted thoughts.

Might also use this on an Ask David. Can use a fake first name, too, if you like. Please advise.

david

Is there a downside to treating people for free?

Dear David and Rhonda,

I live in England, and I’m close friends with a team CBT therapist in Bristol (Andy Perrson), and I’ve been listening to your podcasts for the last year. I have found them to be stimulating, thought-provoking, often really humorous but above all enormously helpful in helping me journey with other people.

I have just embarked on counselling training and would love to steer myself down the same avenues as my friend Andy. I’d also like to use your methodology at a later date.

In the meantime, I have a question for you.

I am conscious that almost all of your work now is done on a free, pro bono basis. I think that would be my preference as well especially as I have managed to cover the economics of life from other things and it would remove any feeling of conflict, or ambiguity around my motivations in helping people.

But, I am also aware that there are so many advantages in there being a financial commitment from clients. Sadly, things that are free and that spring from generosity are not always valued by the recipient, things like commitment and timekeeping become relaxed. It can be awfully irritating for the therapist (a bit like making someone a cup of tea and them not drinking it), and probably a waste of time for the client. A bit like the example you often give around the outcomes for clients who don’t do homework.

I would be very interested in your view on this and on balance whether it is better to charge or not charge for treatment, in the scenario where a therapist does not have a desire to charge.

David comment: I think the word “therapist” in the line above was supposed to be “patient.”

I hope that makes sense.

Thank you again to you and Rhonda for all your hard work.

Kind regards

Brad Askew

(Bristol, England)

David’s Reply

We can reply live on the podcast. The thrust might be that you can make patients accountable even if you treat them for free.

What’s the difference between Feeling Great vs Feeling Good?

Dear Dr Burns,

First of all, thanks for the great work that you do and also all the podcasts you did,

I am planning to order a copy of Feeling Great, your latest book. I have a quick question below.

I have been searching the answer on the web but still can't find the answer. Does Feeling Great cover ALL the key concepts that were discussed in your previous book, Feeling Good? Or does one need to read BOTH books to get a fuller picture?

I already own a copy of Feeling Good. However, if Feeling Great already covers all the concepts discussed in Feeling Good and also comes with updates, i may just order Feeling Great and start with that instead.

Thanks.

Best,

Calvin

David’s Reply

It really depends on the intensity of your interest. There is some overlap, but also significant differences. Even though Feeling Great is way newer, there are still tons of gems in Feeling Good.

David

Isn’t it important to blame the other person when that person really IS to blame?

Hi David,

I’ve been listening to the show for awhile. Thank you for everything you do.

I just listened to episode 254, and I’m not quite sure what to think about it in the context of my situation. I think it makes sense that people are afraid to look at their own faults and what brings them to a relationship and what they contribute to a situation. And that they tend to want to blame the other person to avoid working on themselves.

But what about situations of more extreme abuse? How do you not blame the other person?

I recently got out of a relationship where I was raped. While in the relationship, there was a lot of coercive sex where he ignored my signals to stop and then afterwards told me that things happened because I had wanted them to. Eventually his behavior escalated to the point where he drugged and raped me while I was unconscious.

It’s only been 2 months since I figured out that the relationship was too unhealthy for me and left it. I’ve been in counseling 2-3 sessions per week since then. So at least I am working on myself. And I have no contact with him.

Does that mean there is not a point in using the 5 secrets? Is that only for use on other people? But the things you said about blame rang true to me. I think I avoided working on my own issues for a long time, but this situation was like a giant neon arrow saying “work here!”

I think I blame myself and him both. But I also worry about blaming myself too much—I think me blaming myself is one of the reasons I felt trapped and unable to leave the relationship in the first place. Because I felt at fault and ashamed of that, I didn’t tell anyone for a long time and that normalized his behavior and allowed the relationship to continue and escalate to its extreme.

By not placing enough blame on him, I also didn’t consider that he might be acting selfishly, lying, or not have my best interests at heart. Which also led to the relationship continuing longer. So I am wary about where and how to place blame.

Anyway, I don’t know what else to say about this except that it has all been very emotionally difficult and I never want it to happen again, so I am diligently working on myself and looking for help in all the places.

Thanks,

Rachel

David’s Reply

The thrust of the response could focus on the idea that Self-Blame and Other-Blame are both dysfunctional. I prefer the concept of accountability, and talk about this in Feeling Good Together, which might be helpful.

I think Rachel is doing well to get help for herself and her own tendencies toward Self-Blame, and think that a lot of practice with the Five Secrets could also be tremendously helpful, especially for future relationships.

David

Rhonda, Matt, and David

Podcast 221 Ask David December 21, 2020

Today’s Ask David features five challenging questions submitted by listeners like you!

1. Sumaya asks: I recently bought Feeling Great and can’t find the chapters on Habits and Addictions in the book. Could you please clarify?
2. Jay asks: Can you provide more specific information on the contrasts between Feeling Good, The Feeling Good Handbook, and Feeling Great?
3. Rizwan asks: How would you use the Five Secrets to respond to a truly irate patient?
4. Casey asks: How do you treat resistant autism patients with All-or-Nothing Thinking?
5. Debby asks: What’s your definition of a violent person?

Today’s podcast begins with season greetings for people of all (or no) religious faiths. Rhonda reads a moving email submitted by a listener who was helped by the recent two-part Sunny series on the Approval Addiction. David gives a plug for his upcoming workshop with Dr. Jill Levitt on “Defeating the Beliefs that Defeat You and Your Patients” on February 28. 2021 (include link.)

We also give a shout for Sunny’s recently opened private practice, which offers super rapid treatment and a user-friendly fee schedule.

Sunny can be reached at:
Sunny Choi, LCSW
sunny@bettermoodtherapy.com
Better Mood Therapy

rhonda's exciting new Feeling Great Treatment Center is now open for business as well. She can be reached at rhonda@feelinggreattherapycenter.com.

And now—your cool questions!

* * *

1. Sumaya asks: I recently bought Feeling Great and can’t find the chapters on Habits and Addictions in the book. Could you please clarify?

David explains that the two “lost” chapters on habits and addictions are available for free on the homepage of www.feelinggood.com. I had to cut about ten chapters from Feeling Great due to length, but put them on the homepage since the techniques for treating habits and addictions are new, innovative and powerful, and may help some folks.

* * *

2. Jay asks: Can you provide more specific information on the contrasts between Feeling Good, The Feeling Good Handbook, and Feeling Great?

Dr Burns

Is it possible for you and Rhonda to do a podcast about Feeling Great book and Feeling Good and Feeling Good Handbook? I sat down to hear the similarities and differences and target audiences etc. Very in depth etc but podcast 213 seemed to me to get derailed into the four ego deaths of the therapist and the four ego deaths of the patient.

I am not minimizing the value of discussing Ego deaths. But it seems like you never really addressed the similarities and differences in the three books.

One thing I have not heard you discuss is that powerful section in Feeling Good on preventing setbacks. Love addiction etc. Addressing the core beliefs that trigger recurrent depression in some people.

Also the expectations of doing a two-hour session vs doing the daily mood log for 15-20 minutes per day over a few months ( in the Self Esteem section of Feeling Good.)

I thank you

Sincerely

Jay

Thanks, I DO meander! Both a curse and a blessing, as my mind works like that, with new ideas popping in all the time.

First, here are the differences between the three books:

Feeling Good is a beautiful presentation of the basics of cognitive therapy, including how to crush distorted thoughts and modify self-defeating beliefs like the Achievement, Love, and Approval Addictions, as well as Perfectionism and Perceived Perfectionism. The books focuses on depression, including suicidal urges. This book was published in 1980 and has sold more than 4 million copies worldwide. It has received a number of awards and has been named the top depression self-help book, from a list of 1,000 books, by American and Canadian mental health professionals.

The Feeing Good Handbook has more exercises and a broader range of topics, including depression, anxiety, and relationship problems, as well as a special section for therapists on how to help challenging, difficult patients. This book was published in 1988 and has sold roughly two million copies.

Feeling Great was published in September of 2020. It updates all the tools and techniques in the prior two books, but also includes powerful new techniques to overcome therapeutic resistance. It also includes a section on more spiritual (but still practical) techniques, including the four “Great Deaths” of the self.

Feeling Great has a special section on how to crush each of the ten cognitive distortions, plus many real case examples with links to the actual therapy that you can hear online in my Feeling Good Podcasts. This is important because some readers may not believe that people with chronic and severe depression and anxiety can recover more or less completely in a single, two-hour therapy session.

Toward the end there of Feeling Great there is a special chapter by the famed neuroscientist, Professor Mark Noble from the University of Rochester, on how TEAM quickly modifies specific circuits in the brain to achieve ultra-rapid recovery.

The stance of the therapist has changed significantly in Feeling Great, as compared with the earlier books. Instead of trying to “help,” the therapist becomes the voice of the patient’s subconscious resistance, and makes the patients aware that their symptoms of depression and anxiety are not the result of what’s wrong with them, like a “chemical imbalance in the brain,” or a “mental disorder” described in the DSM, but rather what’s right with them. And the moment the patient suddenly “sees” this, recovery ill be just a stone’s throw away.

Feeling Great was based on 40 years of research on how psychotherapy actually works and more than 40,000 hours of therapy with depressed and anxious individuals, including many with severe and chronic problems. TEAM is not a new school of therapy, but a structure for how all therapy works.

* * *

3. Rizwan asks: How would you use the Five Secrets to respond to a truly irate patient?

Dear David

I suggest one imaginary statement from an irate patient: “Your therapy is not working. In last one year I paid you $1500. And I am nowhere near completing the therapy successfully with you. I am broke. I can’t pay you anymore. I need to quit. How you could you do such a thing to me?”

How would a therapist reply to this using 5 secrets?

Rizwan

David and Rhonda emphasize the importance of session by session testing so this unfortunate situation does not develop, and role play how to respond effectively using the Five Secrets. The importance of the Disarming Technique is highlighted, and training methods are illustrated, along with the philosophy of "learning through failure" or "joyous failure."

* * *

4. Casey asks: How do you treat resistant autism patients with All-or-Nothing Thinking?

I am a behavior support specialist working with people with Autism, all across the spectrum of the diagnosis, as well as with people with intellectual disabilities, cerebral palsy and down syndrome. Not to be confused with an ABA therapist, I am more of a traditional therapist who uses eclectic strategies and methods to help the people I support. I also work mainly with adults because, sadly, the system often forgets them and they do not have as many services as children.

Because I work on helping people change their behavior, it is a logical conclusion that I have to help them work to change their thoughts first. Thankfully my graduate school program was very CBT focused (Go IU School of Social Work!). Since then I have found your podcasts and books immeasurably helpful in enhancing my practice and use the methods you teach whenever possible.

When working with people with Autism I often run into All or Nothing thinking, catastrophizing, and unfortunately a lot of treatment resistance because most of the people I support are “Involuntary” clients who have been sent to therapy by their family members.

I have two questions: First, what is the most powerful method for defeating All-or-Nothing Thinking?

Second: I know you talk a lot about agenda setting to combat treatment resistance. How do you balance the wishes of the parents (or guardians) vs. the willingness on the part of the patient to change? I struggle with this daily and could use some advice.

Thank you and Rhonda so much for the amazing podcast, the books, and the wealth of information about TEAM-CBT. I have also attended several of your trainings and plan to attend more this year because our annual conference was cancelled, so I’m left to get 10 CEUs on my own and your trainings have been very helpful in fulfilling this need!

Also, Rhonda: You are amazing and I hope you know it!

Casey

P.S. I also promoted you a lot on my Instagram channel @passionplanhappiness when I did a series on unhelpful thinking styles. I couldn’t find an Instagram page for the podcast so I just mentioned it by name. Do you have an Instagram channel?

Hi Casey,

Thanks, I can include this in an Ask David, and you might also want to try out one of the introductory 12 week TEAM classes sponsored by FGI, feelinggoodinstitute.com, as a lot of practice is usually needed to grasp and implement techniques and ideas that might seem simple. I do not ever treat people against their will, who are involuntary. This is not treatment in my opinion, and is rarely or never effective. However, I would offer to treat the parents if they wanted help with parenting skills for the child.

Also, you might want to check out the podcast on the best techniques to treat AON! Use search function on my website.

All the best, david

David D. Burns, M.D.

David and Rhonda talk about techniques to combat All-or-Nothing Thinking as well as how to set the agenda and sit with open hands with patients who are in therapy involuntarily.

* * *

5. Debby asks: What’s your definition of a violent person?

Hi Doctor Burns,

I have a question on what you consider a” violent person” to be. For example, If someone feels like punching someone out, doesn’t does that make them a violent person just for feeling it? I would say no because they never acted on it.

Debby

Hi Debby,

You may be trying to define something that does not exist. Violent urges exist in varying degrees at varying times in all human beings. Violent thoughts, feelings, urges and actions exist. But a “violent person” does not exist. My thinking only, and many will undoubtedly “violently” disagree, and not even comprehend, perhaps, what I am saying. Humans have a dark side, and the extent is on a bell-shaped curve.

The denial of the dark side is arguably worse than the dark side, since violence is generally carried out in the guise of some religious principle, or some kind of “truth.”

david

Hope you enjoyed today's podcast!

Rhonda and David

Secrets of Overcoming Romantic Rejection

Part 2 of 2

In last week's podcast we interviewed Dr. Kyle Jones on the topic of how to overcome romantic rejection, and answered five of your questions. Today we publish Part 2 of that interview. Rhonda, Kyle and David will tell you how to stop obsessing about someone who has rejected you, and whether you can "heal completely,"and how you can get your confidence back, and more!

6. Do you have any tips for moving on and realizing that maybe your ex isn’t as great as you think they are?

David

20 qualities I’m looking for in an ideal mate.

Rhonda

Time, patience, space away from each other. Make lists of qualities you liked about your ex and qualities you wish were different.  Fill out the form: “20 Qualities in An Ideal Mate” and review how many of these qualities your ex had.

7. Since cheating is something that happens so often in relationships, what would you recommend (techniques wise) for someone who’s been cheated on in trying to get their confidence back?

David

YOU CAN USE THE DAILY MOOD LOG, DOUBLE STANDARD, ETC. OVERCOME FEAR OF BEING ALONE. ETC. Examine the Evidence; Worst, Best, Average.

Kyle

Cheating can be really devastating if you and your significant other were in a monogamous relationship. What are the negative thoughts you have about yourself after you’ve been cheated on? Practice talking back to those.

8. How can we boost our confidence back up after a breakup in general even if we haven’t been cheated on?

David

SAME ANSWER.

Rhonda

Do things you love to do with people who love you:  go dancing, go to the beach, go hear music, read, etc.

Daily Mood Log on the thoughts that lead to your lack of confidence.

9. Do you guys believe in the notion that you are capable of “healing completely from your ex (aka completely being over them and all the pain the breakup brought you)” or do you believe that it’s not possible.

David

I MEASURE THINGS. YOU CAN DO WAY BETTER AS YOU GROW. IS THERE A CLAIM THAT THERE IS NOW AN INVISIBLE BARRIER ON YOUR SCORE ON THE BMS. THIS IS SUCH, EXCUSE MY CRUDITY, HOGWASH! HOPEFULLY, YOU’LL NEVER AGAIN FIND SOMEONE JUST LIKE THE PERSON WHO REJECTED YOU!

Rhonda

You may never be exactly the same, why would you want to be?  Every experience in life gives you the opportunity to grow (as cliche and kind of yucky as that sounds).

Maybe you need to acknowledge and examine your role in the breakup, come to a place of humility or maybe even compassion, but definitely understanding. Interpersonal Downward Arrow to look at the Roles and Rules in your past relationships.  Relationship Journal to see how you have contributed to the relationship problems.  Maybe do Reattribution to see what you contributed to the relationship problems and what they did.

10. What are some realistic expectations to have coming out of a breakup, recovery wise, and what are some unrealistic expectations?

David

I DON’T IMPOSE MY STANDARDS AND AGENDAS ON OTHERS! THAT’S LIKE MISSIONARY WORK, TRYING TO GET SOMEONE TO ADOPT YOUR STANDARDS. I TRY TO LISTEN (EMPATHY) AND THEN SET THE AGENDA WITH THE PATIENT, AND THE NEGOTIATION STEP IS SOMETIMES IMPORTANT. I ALSO USE STORY TELLING TO ILLUSTRATE A RADICALLY DIFFERENT REALITY FROM WHAT THE PATIENT “SEES.”

Rhonda

I can’t add anything to that, except, after examining your role in the relationship, you may see the expectations you want to eliminate and the ones you want to maintain.

11. Do you guys feel that you shouldn’t date for a while after getting your heart broken?

David

THIS CAN BE A GREAT IDEA. I ALWAYS INSIST, AS PART OF NEGOTIATION PHASE OF AGENDA SETTING, THAT THE PERSON OVERCOME THE FEAR OF BEING ALONE BEFORE DATING, WHETHER OR NOT A REJECTION HAPPENED.

Rhonda

This is a very personal decision.  Have you had time to heal before getting into a new relationship?  Have you had time to examine your role so you can make changes if you choose, so you won’t repeat the same mistakes in the next relationship?

12. Do you have to move on from your ex to go back out into the dating world again and to possibly be in a relationship again? Do you guys feel that “jumping” from relationship to relationship can be a bad thing? Why or why not?

David

THESE THINGS ARE ALWAYS ON AN INDIVIDUAL BASIS. I THINK IT CAN BE HEALTHY TO DATE A VARIETY OF PEOPLE AND NOT GLOM ONTO THE FIRST PERSON WHO EXPRESSES AN INTEREST IN YOU. THAT WAY, YOU CAN COMPARE A VARIETY OF RELATIONSHIPS AND IN ADDITION, YOUR DATING SKILLS WILL IMPROVE. THE “20 THINGS I’M LOOKING FOR IN AN IDEAL MATE” CAN BE VALUABLE.

Rhonda

“Jumping from relationship to relationship” sounds so judgmental.  Are you finding yourself in relationships where you have similar complaints from your last relationship, repeating patterns that you dislike?  Then I would pause and take time to heal and learn before starting another one.

Kyle

What does be “moved on” really mean here? Would you have to never have a thought about your ex again before dating? That might be impossible! I don’t think there’s anything wrong with dating multiple people or starting and stopping relationships with some frequency – especially if you’re looking for a good fit and it’s not working out with someone.

13. How do you overcome your trust issues when getting into another relationship after your heartbreak?

David

PATIENT WOULD HAVE TO GIVE ME A SPECIFIC EXAMPLE, AND NOT DEAL WITH THIS OR ANYTHING “ABSTRACTLY.”

Rhonda

Daily Mood Log work, starting with a specific event that led to the lack of trust.

Let us know if you would like a third podcast on how to deal with romantic rejection at some point, since we have a number of remaining questions. Thanks!

My book, Intimate Connections, will help you with dating and rejection issues!

You can contact Dr. Kyle Jones at

kyle@feelinggoodinstitute.com

End of Part 2

People in the featured photo for today's podcast. Back row: Amir, David, Rhonda, and Dave. Front row: Steve and Barb

This will be our first podcast of 2020, so we wanted to make it a really good one!

Rhonda, Dave and I are very proud to welcome Steve Reinhard and his wonderful wife, Barb, on today’s podcast. Steve and Barbara flew in from Colorado to join the Sunday hike and do this podcast in the “Murietta Studios” following the hike. Steve is a former electrical contractor and lay minister, and is the first certified life coach to be admitted into the TEAM-CBT certification program at the Feeling Good Institute in Mt. View, Ca, (link).

The following is a heart-warming email I received from Steve prior to the show.

Subject: Re: looking forward

Hi David,

Woohoo! We are partners in crime! I'm feeling super comfortable now.

Thanks David for your generous invitation! I'm happy to jump on any of the 3 options you suggested for the show. I'd love to hear your stories, especially those of undistorted sadness where you celebrated with tears, aware of the suffering we folks tend to keep hidden.

I cry a lot these days, laugh a lot too. In that regard I'd love to have my own personal Ask David session. David, I love the old, demented, weak human guy, while admiring the pioneering, genius who teaches so clearly & humanly. My questions wouldn't be so much for me to learn or be taught but to connect with you. I'm crying as I write. As a listener I want to connect with the human, David. May or may not be something you want to do. We have loads to interact with.

Yep, I take a "spiritual " approach & would love to interact with you being anti-religious. Listeners might find this helpful & it sounds fun to me. A great opportunity for me to experience a death of the ego & the acceptance paradox which I have found liberating before I knew what it was called.

I'd love to talk about what it's like to be diagnosed with blood cancer and holey bones & some of the nutty things we say to each other when we don't know what to say. Empathy in the Five Secrets way is extremely rare from my distorted perspective. Aging & being willing to challenge the many shoulds & shouldn'ts that accompany things being different than they were last year would be fun to talk about.

I can't keep track of the # of times folks repeat "getting old is hell", same with cancer, vision problems, walking problems, drug side effects. I would love to hear your stories & experience as an old demented guy who can't walk as fast as he did a couple years ago.

Thanks for your generous invitation. I still find it surprising that I get to have this experience with you all. I'm really looking forward to today’s show.

Steve

We began the podcast with a discussion of the role of lay therapists in the field of mental health. Coaching is newly emerging field of counseling that does not require graduate work in psychiatry, psychology, social work, or counseling. In the past, coaches have not been permitted to enter the TEAM-CBT certification program. However, Dr. Angela Krumm, who is the head of the FGI certification program changed that policy specifically so that Steve—and now, other certified coaches as well--can be certified in TEAM-CBT, and I applaud this change.

The role of lay therapists has always been highly controversial. I can recall that when I was in college in the 1960s, there was a lively debate about so-called “lay psychoanalysts.” Previously, you had to be an MD to be a psychoanalyst, but over time, non-MDs were permitted to become psychoanalysts. To my way of thinking, this debate has always been more about power and the protection of territory than about skill or the capacity to heal.

Now we are seeing the same questions being raised about certified life coaches. In my experience, graduate training doesn’t always guarantee that someone will be a skillful therapist, and sometimes the opposite is true. In fact, in my experience, the LESS previous training therapists have, the easier they are to train in TEAM-CBT, because they don’t have so much training they have to “unlearn.” The Buddhists say that an empty cup is better than a full cup, because the full cup spills over when you try to pour the wine.

Of course, there’s a downside, too, since therapists can also be sometimes exploitative and can be hurtful to patients. This includes coaches as well as mental health professionals with graduate training.

Next, we asked Steve about the role of spirituality in his TEAM-CBT counseling, since he is a also a lay minister. I am convinced that the spiritual dimension can be important and powerful in therapy, and that at the moment of our deepest change, the change is not only psychological, emotional, and behavioral, but also spiritual, because we may suddenly “see” things from a much deeper perspective. Much in TEAM-CBT is easily integrated with spirituality. For example, the Acceptance Paradox is an inherently spiritual technique that can play an important role in recovery from depression and anxiety.

One of Steve’s motives I doing this podcast was to have his own Ask David session, and one of his questions was, “What is it like to be regarded by many people as a guru?” I described the blessings as well as the occasional curses and problems that come with this moniker!

Then the conversation turns to Steve’s devastating diagnosis of blood cancer—multiple myeloma—just over a year ago, and how hard and frustrating it has been for Steve to get people just to listen and provide support, including his doctors, and how incredibly meaningful it is when people express simple compassion and love.

Steve also talks about how he has decided to accept his cancer, and not to “fight it” or to go to war with his body. And acceptance does not mean refusing treatment—Steve is receiving chemotherapy for his multiple myeloma. The acceptance we are describing is more of a mind-set of peacefulness. We also talked about the fact that the problems of aging are not unique, but are simply the problems of living, problems we can encounter at any age. The whole basis of cognitive therapy is that our feelings result from our thoughts, and not the circumstances of our lives. This is a very optimistic message because we often cannot change the facts of our lives, but we can do a great deal to change the way we think and feel.

I ended the podcast by raising the question of “Sadness as Celebration.” I asked whether tears and feelings of sadness in response to the suffering of others might actually be one of the highest experiences a human being can have, and is perhaps the deepest meaning of spirituality. I described a somewhat bizarre experience I had on the Nevada desert when I was a Stanford medical student in the 1960s—it was an experience I have kept secret for nearly 50 years, and talk about for the first time on this podcast.

After the podcast, I emailed Rhonda to get her “take” on the show. Usually, we focus on specific techniques our podcast fans might want to learn. But this time, we just kind of were “hanging out” together, so I was concerned and feeling a bit self-critical. I was also concerned that I may have sounded like a loony at times on the show, since my personal story was perhaps over the top.

Here’s how Rhonda replied:

Hi David,

As I was listening to the Steve podcast, it struck me that it was really friends talking, getting to know each other, sharing stories and joking around and being serious sometimes. That's why I thought it was really lovely.

I listened to Steve's podcast after dinner. I loved it!

You are so charming, and tell sweet stories that open up your life to the listener. I think everyone will love how endearing you are.

Steve was articulate, vulnerable and open. While it's not an episode where you are teaching anything specific, it is a lovely podcast and I think regular listeners will love the opportunity to get to know you.

Rhonda

So, let us know what you think!

Thank you, Steve and Barbara, for your generous appearance on today’s show.

And we also thank YOU for tuning in today!

Rhonda and David

PS After the show, Rhonda and I got this great email from Steve:

Hi David and Rhonda,

Just getting back to communicating after a full & thrilling trip to California! Arrived home Monday evening, then off to Chemo center most of Tuesday & now regaining energy.

I like your show notes David—mucho.

Really enjoyed the hike, lunch, getting to sit in on Amir's podcast, then to interact with David, Barb, & Rhonda. Loved your stories, David, and the whole experience of tears and celebrating sadness. Oh yea, and the big kiss on the lips!

A lot of other ideas & questions have popped into my thinking since the podcast. One being that us Christians are pretty judgmental. This is supremely true, and is probably one of the best-selling points of religion that's kept hidden behind the smoke and mirrors.

It's so much fun to judge folks, look down on everyone else and have that feeling of moral superiority! Probably better than LSD I'm guessing.

What bugs me about "religion" most is how many folks suffer under the whip of having to improve and become better and jump over impossible standards. Of course, they could move on to the Acceptance Paradox and right into celebrating sadness in a split second if they wish.

What wonderful time it was with you all.

Feeling grateful to share life with each of you.

Love you,

Steve

Second PS: If you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. See below for details and links!  David

The Hidden Side of Depression, Anxiety, Defectiveness, Hopelessness and Rage

We nearly always think about negative feelings, such as moderate or severe depression, as problems that an expert must try to fix, using drugs and / or psychotherapy. There are a multitude of theories about why humans become depressed, including, but not limited to:

• We get depressed because reality sucks. We believe our mood slumps result from the circumstances in our lives, such as being alone following a rejection, experiencing the loss of a loved one, not having enough money, education or resources, social prejudice, or (as in Marilyn’s case) facing some catastrophic circumstance, such as severe illness.
• We get depressed because of insufficient love and nurturing in childhood, or because of traumatic childhood experiences.
• Biological factors. We get depressed because of our genes, or diet, or because of a chemical imbalance in our brains.

Certainly, there can be some truth in all of these theories. Reality does kick us all in the stomach from time to time, and the pain we feel is understandable. My wife and I lost her father to Parkinson’s Disease a few years ago. We loved him tremendously, and his loss was extremely painful for everyone in our family.

And most of us have experienced less than ideal circumstances when growing up, and many have even been victimized by horrific and tragic circumstances, such as child abuse. And clearly, some severe psychiatric illnesses, such as schizophrenia, do result from some kind of brain abnormality.

But the problem with all of these theories is that they put us at the mercy of forces that are largely beyond our control—since we often cannot do much to change reality, rewrite our childhoods, or modify our brains short of taking this or that medication.

In this podcast, Matt and David take a radically different approach, and argue that Marilyn’s intense feelings of depression and anxiety are not “mental disorders” that reflect some defect in Marilyn, but rather the expression of what is most beautiful and awesome about her. They also argue that there are large numbers of advantages, or benefits, of feeling the way she does, using several Paradoxical Agenda Setting techniques such as the Miracle Cure Question, Magic Button, Positive Reframing, and Magic Dial. The results are stunning and unexpected. Or, as Marilyn put it, this portion of the session was “mind-blowing.”

The third and final podcast next week will include the M = Methods phase of the session along with the end-of-session T = Testing and wrap-up, including Relapse Prevention Training.

Marilyn DML with goal column

The Night My Childhood Ended, Part 2

In today’s podcast, we present the second half of the therapy session with Todd, who did personal work focused on the impact of a traumatic event that ended his childhood when he was eight. Last week, we presented the T = Testing and E = Empathy phase of the session. Today we present the A = Assessment of Resistance, M = Methods, final testing, and teaching points.

A = Assessment of Resistance

Todd’s goal was to be able to feel more vulnerability by the end of the session.

During the Positive Reframing, we listed the positives that were embedded in Todd’s negative thoughts and feelings.

1. My sadness shows my humanity.
2. My sadness shows my commitment to family.
3. I put others before me and value the time people are taking by listening to this session.
4. I challenge myself to work on myself.
5. My negative thoughts and feelings make me a more loving husband and parent, and a more committed and effective therapist.
6. I love my mom and want to protect her.
7. I have high standards.
8. Although I feel like I was and still am “a frickin’ coward,” sharing this shows tremendous courage.

As you listen, you’ll see that it was incredibly difficult for Todd to see anything positive in the fact that he was that calling himself a coward. He kept thinking that he “should” have gone in earlier to try to help and save his mother, and that this might have changed the entire trajectory of his life. At the same time, he conceded that he was just a little guy, and that his father was an incredibly frightening and intimidating figure.

You can see Todd’s Daily Mood Log at the end of A = Assessment of Resistance (link). As you can see, he wanted to reduce all of his negative feelings quite dramatically, but he wanted his sadness to remain at 100%, because he wanted to be able to feel this emotion and grieve.

M = Methods

Jill and I tried a variety of techniques during the Methods phase of the session, including a new version of the Double Standard Technique. I played the role of the 8-year old Todd, and he played the role of himself. I verbalized all of his Negative Thoughts, “But isn’t it true that I rally was a frickin’ coward?” and challenged him to crush them.

This helped Todd get in touch with his compassionate and realistic self.

You can see his final Daily Mood Log. As you can see, there was a dramatic reduction in all of his negative thoughts except sadness, which fell to 80%. You will recall that his goal for sadness was 100%.

There were lots of positive messages for Todd throughout the session in the chat box. There were many outpourings of love and admiration for Todd's courage and vulnerability. We sent those messages to him after the end of the session, and that was when the tears finally came.

Here’s an email we received from him after the session.

What an evening! I just saw the video again and I was so blown away from the amazing love and support I felt from all of you last night. I also was able to tear up a bit when I was reading all of the heart felt chats that Alex had shared with me. I would give all of you an A+ on empathy for sure. Finally, I'm so grateful to JIll and David for their compassion, and for helping me reconnect with little Todd and feel much closer to all of you. What an awesome night and group!

Brandon Vance MD sent a link to a song one of his students created, and Todd responded to it:

Last night, it was so awesome to listen to the musical recording that your student so beautifully shared with us. I'm not one to cry very easily, but I was so moved by the lyrics and the emotions in that song. I've been so amazed at how you continuously evolve TEAM in so many wonderful and creative ways. Kudos!

Here's the link to the song if you'd like to listen! I also found it moving and beautiful.

Cassie Kellogg is the performer and songwriter, and her song is called Double Standard, which is the method that proved so helpful for Todd. Some interesting information about Brandon and Cassie, as well as the words to her song, appear at the bottom of the show notes.

There were also tons of positive comments about the session in the teaching evaluation at the end of the session, with overwhelming outpourings of love and appreciation for Todd. Time after time, the personal work we sometimes do while teaching seems to make the most positive emotional impact on our students. And, of course, the teaching value can be tremendous.

Teaching Points

1. T = Testing is crucial.

If you met Todd, you would have no idea how he feels inside, and if you were his therapist, and you did not use the Brief Mood Survey at the start and end of every session, and the Evaluation of Therapy Session at the end of every session, you would also be partially “blind” to how Todd was feeling, and how dramatically his feelings changed at the end of the session.

Most therapists still are not using session by session assessment, and they are at a severe disadvantage that they are not even aware of. I am convinced that it is impossible to do great, or even excellent therapy with these, or similar, instruments.

2. Sometimes you have to slow down to speed up.

During the empathy portion I made and corrected an error, with Jill's help, of jumping in prematurely with a method that fell flat. It is easy to give in to hunches and try methods prematurely, prior to doing careful and skillful E = Empathy and A = Assessment of Resistance.

One good thing about TEAM is you can easily "right the boat" when it tips, and get back on track. TEAM works way better as a systematic package. Some therapists who learn about TEAM may try to "borrow" this or that M = Method, and incorporate it into their current approach, but that is generally far less effective.

3. A = Assessment of Resistance can be challenging.

Positive Reframing can be quite difficult because you have to "see" something obvious that is almost invisible to the naked eye. Initially, Todd had tremendous trouble seeing any value in his self-critical thought that he was "an effing coward” when he and his older brother hid out during his parents’ brutal and terrifying fight.

TEAM is not a cookbook, formulaic, treatment manual type of therapy. It requires “insight” on the part of the therapist, and the skills to lead the patient into seeing what you. therapit, (hopefully) have seen.

4. Childhood traumas can often be reversed--quickly.

Another important teaching point might be that even traumatic childhood events that have totally rocked someone's world and self-esteem for decades can often be "undone" quickly using TEAM. Joy and self-esteem are possible for every human being.

5. Hopelessness is a cruel illusion.

If you’re depressed, you have a deep (and misguided) incredibly painful belief that things are hopeless when they aren't. These feelings of hopelessness are common, but demoralizing at best and dangerous at worst.

More about Brandon and Cassie:

Dr. Brandon Vance writes:

Cassie was an outstanding student of mine when I was teaching CBT last fall at CIIS in San Francisco (California Institute of Integral Studies). My final project was on sharing CBT with the public and suggested that the students could do a creative project or a paper.

Cassie was inspired by the Double Standard technique personally and professionally, as she's studying to be a Marriage and Family Therapist. She wrote this song for her final project.

Although she has had some experience singing, this was the first song she ever wrote (and she taught herself piano recently). I played the song just before the Feeling Great Book Club one week. and then read the words out loud in the book club. My voice cracked as I was tearing up reading them.

As a musician, I am blown away at the power of the words, how well-crafted the song is, and Cassie’s singing and performance. Even the old record-like quality of the recording, with the slightly out-of-tune piano, and faint sounds of kids in the background, adds to the atmosphere!

Here are the beautiful words to Cassie's song, Double Standard:

You get so down on yourself

Convinced you don’t need help

What would you say

If the reflection in the mirror

Was someone you loved

Would you say, babe, you’re worth it

It’s okay not to be okay

Would you help her up and remind her

Of her strength

And don’t you deserve the same grace

So when you’re down on yourself

Convinced you don’t need help

Remember what you’d say

if the reflection in the mirror

was someone you love

tell yourself that you’re worth it

it’s okay not to be okay

hold yourself up and remember

all your strength

you deserve all the grace

so when you’re down on yourself

convinced you don’t need help

remember what you’d say if the reflection

in the mirror

was someone you love

because the reflection in the mirror

is someone

who deserves

love

Thanks Todd! Thanks Cassie! Thanks Brandon! You have touched all of us!

If you would like to contact Todd, you can reach him at: todd.daly@gmail.com

Warmly,

david and rhonda

In this podcast, David and Fabrice answer several fascinating questions submitted by listeners:

1. Jackie asks where our distorted thoughts come from, since they are so often irrational and distorted, and inconsistent with the facts. Why do we sometimes beat up on ourselves relentlessly with negative thoughts?
2. Tyler asks if it possible to do TEAM-CBT in conventional, 45 minute sessions. And if so, how? It seems my patients are just warming up by the end of the session, and then we have to start all over again the next week.
3. Jess asks if it is possible to use the Five Secrets of Effective Communication in non-therapy settings. For example, if you are in a position of authority, like a high school teacher, will your students lose respect for you if you use the Five Secrets? Could you use the Five Secrets if you are working with violent gang members?

Special Announcement #1

Attend the Legendary Summer Intensive

Featuring Drs. David Burns and Jill Levitt

August 8 - 11. 2024

Learn Advanced TEAM-CBT skills

Heal yourself, heal your patients

First Intensive in 5 years!

It will knock your socks off!

Limited Seating--Act Fast

Click for registration / more information!

Sadly, this workshop is a training program which will be limited to therapists and mental health professionals and graduate students in a mental health field  Apologies, but therapists have complained when non-therapists have attended our continuing education training programs. This is partly because of the intimate nature of the small group exercises and the personal work the therapists may do during the workshop. Certified coaches and counselors are welcome to attend.

Special Announcement #2

Here's some GREAT news! The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it

Today's Podcast

Practical Philosophy Month

Part 2, Do Humans have “Selves”?

This is our second podcast in our Practical Philosophy Month. Last week, in our first episode, we focused on the “free will” question. As humans, we all feel like we have “free will,” but is it just an illusion, especially if all our actions are the result of the physical processes in our brains and the laws of the universe?

The Bible certainly dealt with this in the book of Genesis, where we learn that the first humans, Adam and Eve, were given a wonderful Garden of Eden to live in, but they had to choose whether or not to obey God’s rule NOT to eat the forbidden fruit from the tree of knowledge of good and evil. They chose to eat the fruit, implying that humans have free choice. But the philosophical arguments rage on.

In today’s podcast, we are joined by two beloved and brilliant colleagues, Drs. Matthew May and Fabrice Nye, as we explore the question of whether or not the “self” exists. We all feel like we have a “self,” but is this real or just an illusion? When you try to define your “self,” you may run into problems.

For example, you might think that the “self” has to be the part of us that does not change from moment to moment, and is always ‘the same.” For example, I might think back on my childhood and feel convinced that I was the “same David Burns” then that I am now. And, if you are religious, you might also be comforted by the idea that your “self” is the same as your “soul,” and that you will therefore live on after you die. This concept of a “soul” is a core belief in many religions.

But are we fooling ourselves? And what was the Buddha thinking about 2,500 years ago when we talked about enlightenment as resulting from the “Great Death” of the “self.” He seemed to be hinting that something wonderful can happen when you give up the idea that you have a “self.”

In the original draft of my book, Feeling Great, I had a chapter on entitled, “Do you need a “self?” Join the Grateful Dead.” I tried to persuade readers that the existence of a “self” is nonsense, based on the philosophy of Ludwig Wittgenstein in his famous book, Philosophical Investigations. But readers found the chapter so upsetting that I decided, on their urging, to delete it from the manuscript, which I did. My goal is not to disturb people, but to provide a path to joy and to loving connections with others.

But to this day, I still get emails from people asking me to offer that chapter, or to deal more deeply with this concept of the “self” vs “no self” in a podcast. So, here is my attempt today.

I will start with my own take, and then summarize some of the views about the self that were expressed by Fabrice, Matt, and Rhonda during the show.

Here’s my thinking. There are many key questions you could ask about the concept of the “self?” including:

1. Do we have a “self?”

2. And if so, what is it?

3. Does the first question even make sense?

I’m sure you would agree that if a question doesn’t make sense, then it isn’t a “real” question, and there really isn’t anything to talk about. Then we can just stop feeling frustrated and perplexed, and move on with our lives.

That is the precise position that the late Wittgenstein would probably have taken. He stated that words have no ultimate or “true” meaning outside of the various contexts in which we use them in daily life. Most words have many meanings, because they are used in different ways, and you can find most of the meanings in any dictionary.

So, if you think of the word, “game,” you will quickly realize that it does not have one “true” or essential meaning. It can mean a sports competition, with two teams competing against each, like soccer. But you can have two teams competing in some way other than a sport.

And you don’t even need two teams to have a “game.” For example, some games are played by one individual, like solitaire with a deck of cards.

Or you can think about the “dating game,” or refer to “game birds,” or a “game boxer.” In short, there is not some single “correct” meaning to the word, “game.” Some uses have overlapping meanings, and some uses do not overlap at all with other uses.

So, there is no point in trying to figure out if “games exist,” or what the ultimate or essential meaning is of the word, “game.”

Now, how do we use the word, “self,” and what does it mean in each context?

You might tell your child to behave themself. This simply means that they are misbehaving and will be punished if they don’t behave more politely. You do not have to tell the child that their “self” also has to behave better, because that would be meaningless. We already told the child to change their behavior.

You could ask friends, as I did this morning, if they are planning to join me on the Sunday hike. Two of them confirmed and said that “they” would join me today on our hike. I did have to ask them if they would be bringing their “selves,” because I just do not know what that would mean! They already told me they’re coming to the hike. (They did come and we had a lot of fun.)

In my extremely challenging freshman English class at Amherst College, we had to write two or three papers per week on odd topics. The teachers were relentlessly critical in their feedback, and would nearly always point out that we sounded incredibly phony and need to find our true voices, which came from our real selves, as opposed to the false fronts we often used to try to impress people. Almost every student got dumped on constantly!

The professors weren’t referring to some metaphysical “true selves.” They were just referring to the fact that our writing didn’t sound natural, compelling, or vulnerable, and so forth. Our writing was, for the most part, an enormous turn-off. Most of us never could figure out quite what that class was all about, but it was useful as I became more sensitive to the “tone” or “voice” in any writing.

I would have to concede that it was a sobering but helpful class. But they were not referring to some mystical “true self” we had to find. They just wanted us to stop writing in such a sucky way!

So here is my point, which you might “not get.” When you keep the word, “self,” in the context of everyday life, it is obvious what it means, and it never refers to some metaphysical “thing” that we could “have” or “not have.” It is just a vague, abstract concept that is devoid of meaning when it’s all by itself. A “self,” just like “free will,” is not some “thing” that we might, or might not, have.

The question, “Does the self exist,” according to Wittgenstein (or his big fan David) has no meaning and so we can just ignore it. It’s not a real question. It is, as Wittgenstein was fond of saying, “language that’s out of gear.”

Now, does this discussion have anything to do with emotional problems, or TEAM therapy? It absolutely does. That’s because nearly all depression results from some version of “I’m not good enough,” including:

• I’m inferior.
• I’m a loser.
• I’m a “hopeless case.”
• I’m a failure.
• I’m unlovable.
• I’m a bad parent.
• I’m defective.

And so forth.

If you buy into these “self” condemning proclamations, thinking that they mean something, you’ll probably feel depressed, ashamed, inadequate, hopeless, and more. As you can probably see, all these self-critical thoughts contain tons of cognitive distortions, like All-or-Nothing Thinking, Overgeneralization, Labeling, Mental Filtering, Emotional Reasoning, Self-Blame, Hidden Shoulds, and more

And to put it in a nutshell, they ALL involve the belief that you have a “self” that’s broken, or simply not “good enough.” And all of those statements are meaningless.

My goal in therapy is NOT to persuade you that you ARE worthwhile, or “a winner,” or a “good” parent, but rather to show you how to let go of these meaningless but painful ways of belittling yourself. I might use techniques like Empathy, Positive Reframing, Explain the Distortions, Let’s Define Terms, Be Specific, the Double Standard Technique, the Externalization of Voices, the Downward Arrow, and many more.

That’s because the VERY moment you suddenly “see” that these kinds of statements are both untrue and unfair, and you stop believing them, your feelings will instantly change. So, you could say that TEAM really IS a “Wittgensteinian” therapy.

And when people ask me how to develop better self-esteem, I would not try to get them to discover how to have some magical and wonderful “thing” called self-esteem, because that concept is just as nonsensical as the concept of a “self.” You might say that “self-esteem,” if you want to use the term, is more about what you DO.

And there are two things you can do if you want to change the way you feel. First, you can stop beating up on yourself with hostile criticisms like the bulleted statements listed above, and talk to yourself in the same encouraging way you might talk to a dear friend or loved one who was hurting.

And second, you can treat yourself in a loving way, in just the same way you might treat your best friend who was coming for a visit. In other words, you can do nice things for yourself.

The day my first book, “Feeling Good,” was finally published, my editor called me with some bad news. She told me that the publisher, William Morrow and Company, loses money on 9 out of 10 of the books they publish, so they decide which ones are most likely to sell, and those are the only ones they’ll promote. The rest of the books go on a “loser list,” and the company does little or nothing to promote them.

She said my book was #1 on their “loser list,” since the president of the company felt it had no commercial potential, and that very few people would be interest in a long book on depression. She added that the one thing they did do was to send my book to ten popular magazines for first serial rights. That means they get to publish an excerpt from your book as an article, so that stirs up some media interest in your book. Sadly, she said that all ten had turned them down.

She said that I’d have to be in charge of any further marketing of my book, so I asked what I should do. She said to call all ten magazines right away and persuade them to change their minds.

In a panic, I called them all, including Ladies’ Home Journal, Reader’s Digest, and on and on. Every magazine said the same thing—they did not want my book, had turned it down, had zero interest in it, and to please top calling since authors shouldn’t call them and they considered it a form of phone harassment since they’d already made a decision.

Yikes! No fun!

When I jogged home from the train station that night, I shouted, “You’re a loser, you’re a failure.” That didn’t sound so good so then I shouted, “No, you’re not! You’ll figure out how to make it happen! Just keep plugging away.”

That sounded a lot more loving, so when I got home, I told my wife that the book at just been published and that I’d been turned down by all ten magazines for serial rights, and the publisher decided not to spend any money on marketing or advertising, so we needed to go out and celebrate.

She why we would celebrate?

I said, “You don’t need to celebrate when you win, because you already feel great. But when you lose, that’s when you need to celebrate, because you’re feeling down. So, tonight we’ll celebrate!”

We went out for a fancy dinner and celebrated and had fun. And the rest, they say, is history. I just kept trying and getting turned down by newspapers, radio stations, television programs, and more. But eventually, the tide started to turn. To date, Feeling Good has sold more than 5 million copies and it achieved best-seller status. And the reason was that researchers discovered that the book actually had antidepressant properties, so excitement about it spread by word of mouth.

I am hopeful that the new Feeling Great App will help even more people.

Fabrice made some interesting and wise comments on the notion of the “self.” He said that the idea that we have a “self” is a sense that we nearly all have. Some people feel like the “self” that is located somewhere behind the eyes or in the middle of the head. But, he emphasizes, there is no such “thing” as a “self.”

He has quoted someone who has “said it all,” but the statement only makes sense IF you “get it!” Here’s the quote:

“No Self? No Problem!”

This is actually the title of a book by Chris Niebauer, PhD, and the subtitle is How Neuropsychology Is Catching Up to Buddhism. If you want to check it out, here’s a link to it on Amazon: https://www.amazon.com/No-Self-Problem-Neuropsychology-Catching/dp/1938289978

Fabrice emphasized that the concept of “self” is “nebulous.” He asked, “Is there a ‘David’?” He explained:

You wouldn’t be able to prove this in court. Well, you could show ID, but that would not be proof. Where does the information on the ID come from? Birth certificate? Who wrote the information on the birth certificate? Probably some doctor back in 1942. And where did he get that information from? Probably some caregiver said “Write ‘David’ here.” Was that from a credible source?

Not at all. That info was made up on the spot!

Now, you can say that there’s a “sense” of a David going around, and that there are some patterns that show signs of “David-ness,” but there is no “David.”

Matt added that your body is not your “self.” When you break your arm, you don’t say that you have broken a part of your “self.” You just say, “I broke my arm.”

Rhonda raised the question of whether the “self” is just the same as “consciousness” or “awareness.”

Someone in our group added that the “self” is what we DO, and not what we ARE. And, of course, what we are doing is constantly changing from moment to moment.

My understanding of all of this is that once you let go of the notion that you have a “self,” you will no longer worry about whether or not you are “good enough” or “special,” or whoever. You can focus instead on living your life and solving the problems of daily living and appreciating the world around you. If you screw up, you can focus on what specific error you made, rather than obsessing about your inferior or defective “self.” You can actually welcome failure as just another teacher, so you can grow and learn, and simply accept your screw ups, or both.

In fact, two of the most popular TEAM techniques for challenging the distorted thoughts in bullets above are called “Let’s Define Terms” and “Be Specific.” These techniques are right out of Wittgenstein’s playbook, and they are prominently featured in the “Learn” section of the new Feeling Great App. If you’re feeling depressed, and thinking of yourself as a “loser” or as being “inferior” or even “worthless,” the goal is NOT to “become a ‘winner,” or more ‘worthwhile,’ but rather to give up these notions as nonsensical.

But once again, many people cannot “get it,” or “see it,” and that’s where a caring and skillful therapist can help. Some people wrongly think that letting go of the notion that you could be “worthwhile” would mean a huge loss of something precious.

Many people who don’t yet “see” what we’re trying to say are terrified of the “Great Death” because they think that giving up the notion that you have a “self” means giving up all hope for improvement, for joy, for intimacy, and so forth. But to my way of thinking, the truth is just the opposite. When your “self” dies, you and your world suddenly wake up and come to life. When you accept yourself and your world, exactly as they are right now, everything suddenly changes. Of course, that’s a paradox.

I believe that leading our patients to the “Great Death” of the “self” is like giving them the understanding and courage they need to throw some garbage in the trash instead of carrying the garbage around with them all the time!

I hope some of this makes a little sense, but if not, don’t worry about. Sometimes, it takes a little time before you suddenly “see it!”

Thanks for listening today. We love all of you!

Rhonda, Fabrice, Matt, and David

Rhonda and David discuss two challenging questions submitted by listeners like you. 

Question #1: Cindy asks: My suicidal daughter refuses to talk to me! What can I do?

Comment: Dear David,

I stumbled upon you teaching in another podcast a few months ago. Immediately I was stunned by how much your words echoed in my mind. I have listened to your book three times in Audible and many of your podcasts. You Changed my life!!!

I am much more relaxed now and I can sleep!!! I talked about you with my massage therapist and she bought your book for her daughter (who has anxiety attacks) and her niece. Her daughter is an aspiring artist who said that she would buy your book and give them away to teens when she becomes famous.

I now ask you to change another life, that of my daughter's. She has been depressed for more than 20 years, suicidal (bought a noose, watches suicide movies, talked about ways to kill herself) and no therapists could help. We went to therapy together this past summer and it only ended that she abruptly canceled and is no longer responding to me by any means: phone, text, card, or email. The last time I saw her was late August and she was very down and had very poor personal hygiene. I have since sent her a loving text at least every other day, I offer to drive to her city (an hour away) to have dinner with her, I sincerely apologized for everything I could think of that I have done wrong since she was a child, I sent gifts to her by mail, I invite her to come for holidays, I ask her cousins to call (she did respond to them). No response to me at all. I am wondering how to communicate with a loved one who just totally shut you off.

Always your fan,

Cindy

Thank you, Cindy. Sorry to hear about your daughter, very concerning. My heart goes out to you. Our own daughter had a rough time as a teenager, too, but now is doing great. I hope things evolve with your daughter, too.

This podcast may help: https://feelinggood.com/2019/10/28/164-how-to-help-and-how-not-to-help/ as well as this one:

https://feelinggood.com/2019/02/04/126-how-to-communicate-with-someone-who-refuses-to-talk-to-you/

The first podcast highlights common errors in trying to “help” someone who is hurting, and emphasizes how to respond more effectively, using the Five Secrets of Effective Communication.

The second podcast illustrates how to get people to open up using one of the advanced secrets called “Multiple Choice Empathy / Multiple Choice Disarming.

My book, Feeling Good Together, explains these techniques in detail, with practice exercises, and includes an entire chapter on how to talk to someone who refuses to talk to you. You can learn more on my book page. (https://feelinggood.com/books/). Some support from a mental health professional might also be helpful to you, as these techniques sound simple, but are actually challenging to master.

Your daughter might also benefit from my book, Feeling Good: The New Mood Therapy (https://feelinggood.com/books/). It is not a substitute for treatment from a mental health professional, but research studies indicate that more than 60% of the people who read it improve significantly in just four weeks. It is inexpensive, and I’ve linked to it if you want to take a look.

All the best,

David

Question #2: Lorna asks: How can I deal with my jealousy?

Comment: Hi David,

I've recently discovered your books and your podcast and CBT has really been helping me in my personal life. I really want to thank you for all the amazing work you do!!

The issue I'm having however seems to still really get my moods down and I was wondering if perhaps you could offer some general advice via the podcast.

I'm in a great relationship but the ex-girlfriend of my partner has recently moved back to the city where we live and now we are in similar social circles. They were together for a very long time and now I'm really struggling with the prospect of spending time with her.

When we all spend time together, it’s actually fine, but afterwards I really struggle with thinking about them together, getting to know her and thinking about her personality and how we compare.

I think most people would find this uncomfortable, but it really has triggered a downward spiral for me. My partner and I argued about it and I struggle to let things go that were said in arguments.

Do you have any advice on dealing with a situation of an ex-partner being on the scene and perhaps how to not dwell on things that were said during arguments?

Thanks,

Lorna

Hi Lorna,

Thanks, might work. What does this mean: “Do you have any advice on dealing with a situation of an ex-partner being on the scene and perhaps how to not dwell on things that were said during arguments?”

The rest of the email seems to suggest feelings of jealousy, insecurity, and so forth, as if she is a threat to your current relationship. is this correct?

David

Hi David,

Thanks so much for getting back to me!

I don't actually think she is a threat to our relationship, and don't feel that they have feelings anymore for each other, but it just makes me super uncomfortable to think about how long they spent together.

I'm always comparing our relationship to what I think their relationship was like in the past. I know I should stop thinking about those things but I really struggle to stop!

I know my partner and I are very much in love but I keep having thoughts like

• “It’s not fair that I have to spend time with her,” or
• “I feel really guilty because he wants to be friends with her but can't due to how I feel about the situation.”

I also feel like he blames me.

I was hoping you could shed some light on what you think in general is a good strategy for dealing with situations where an ex-girlfriend/boyfriend of your partner is on the scene and you all have to spend time together.

I do have feelings of jealousy and insecurity but I struggle to understand why as I don't believe they want to be together anymore at all.

We had a few arguments about it initially where he said things like “you are just angry that I have an ex-girlfriend” or “what's the big deal about it all?”

I was so hurt by the way he made my feelings seem petty and trivial. We have both apologized but I keep remembering what he said and how hurt it made me feel.

Do you have any advice on letting go of past arguments when the 'problematic situation' (ex-girlfriend being around) is still on-going?

Thank you so much!

Lorna

David and Rhonda discuss this question, and include David’s story in Intimate Connections as a medical student when David had a broken jaw and the ex-boyfriend of Judy, the girl he was living with in Palo Alto, charged into his house with a tough-looking friend and demanded to see Judy. David called the police, and the two fellows left and set, "we're going to get you!" David was terrified, since his jaw was still broken, and got some jaw-dropping advice the advice from his buddy, Sergio. You will be surprised to hear about what happened next!

In addition to learning to "let go" of jealousy, Rhonda and David discuss many additional strategies for dealing with jealousy, including:

1. Use of Self-Disclosure
2. Positive Reframing: do you really want to give up your jealousy and vigilance?
3. Cost-Benefit Analysis: Is it worth the hassle of constantly being suspicious, as opposed to simply deciding to trust and let the chips fall here they may?
4. Downward Arrow: What are you the most afraid of?
   1. Love Addiction
   2. Fear of Rejection
   3. Fear of Being Alone
5. Overcoming the fear of being alone and the “need” for this man’s love, or any man’s love, is discussed in the first section of Intimate Connections.
6. Exposure: You could fantasize the two of them together, making yourself as anxious and jealous as possible, until the feelings diminish and disappear.
7. Self-Monitoring: Counting your thoughts about them on a wrist counter or cell phone for four weeks. David describes his work with an intensely jealous law student after his girlfriend broke up with him so she could date another fellow in his class.
8. Understand the frequent ineffectiveness of apologizing, and why it doesn’t work! This is really important. David describes a powerful vignette about a troubled couple, where “I’m sorry” was CLEARLY a way of saying “shut up, I don’t want to feel about how hurt and angry you feel.” The Five Secrets of Effective Communication are a vastly more effective way of dealing with negative feelings. David and Rhonda contrast effective vs. dysfunctional “apologizing.”

While it can be important to say "I'm sorry," this formulaic response is usually insufficient because it often ends the conversation but the difficult or hurtful feelings remain. What's important to add is talking about the other person's feelings, thoughts and experiences of the conflict and sharing your own thoughts and feelings.

 When you say, "I'm sorry," it's sometimes insufficient because it often ends the conversation, but the difficult or hurtful feelings remain.

What's important to add is talking about the other person's feelings, thoughts and experiences of the conflict and sharing yours.

After David emailed Lorna with the outline for the podcast, Lorna replied:

Hi David,

Thank you sounds great! Can’t wait to listen to the episode. I think I will definitely order your book - I think it’s the only one missing for me to have the complete collection. Thanks again!

Lorna

Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast.

See below for details and links!

David

How would you overcome the fear of aging?

Can you use TEAM for sports psychology?

Describe your typical day, David--
do you ever get down or anxious?

Hi Listeners:

Thanks for your many and awesome questions. I love to answer them! And there will be more to come in future podcasts. Your questions are GREAT! 

1. Vipul: Tell us about your new book, Feeling Great. How will it be different from Feeling Good? And can people with schizoaffective disorder be helped? (story with Stirling Moorey)
2. Guy: What’s a nervous breakdown?
3. Rob: How would you treat a field goal kicker who’s afraid of missing the winning field goal? Would you use positive visualizations?
4. Michael: How would you treat someone with the fear of aging? I turn 60 in a few months, and have been experiencing anxiety around not be able to do some of the things I love as I age.
5. Hidem: How fast is fast? I notice your frequent use of the term "High Speed Recovery" (and even Warp Speed) when describing the benefits of TEAM CBT. How rapidly does the average patient recover?
6. Brittany: I had an idea that I think would benefit a lot of us. I’d like you to do a podcast on a week or a day in your life. The ups & downs of your moods, triggers, etc., & most importantly how you deal with them. Do you write out your own Negative Thoughts a Daily Mood Log?

Thank you for all of your great questions, comments, and testimonials! Rhonda and I really appreciate that!  

David and Rhonda

PS Here's a great question we did not get to today. We'll do it in a future Ask David, as it's really important. 

1. Rubens: What can you do when you can’t identify your negative thoughts? I get anxious, but don’t seem to have any negative thoughts. Is it really true that our feelings always result from negative thoughts?

The third uncovering technique is called the “What-If” Technique, developed by the late Dr. Albert Ellis. The What-If Technique can will help you identify a terrifying fantasy under the surface that fuels your fears. David brings this technique to life with an inspiring story of a woman from San Francisco suffering from more than 10 years of mild depression and paralyzing Agoraphobia—the intense fear of leaving home alone. You may be surprised when you discover the Negative Thoughts that triggered her fear of leaving her apartment alone, as well as the core fantasy at the root of her Agoraphobia. David and Fabrice also discuss the dramatic techniques that helped her completely defeat her fears and overcome her depression.

Below, we have included a PowerPoint presentation for you so that you can follow along when David and Fabrice do the What-If Technique together on the podcast.

In the next podcast, David and Fabrice will discuss Shame-Attacking Exercises. This is a powerful and bizarre exposure technique that can helpful in the treatment of shyness--but there’s a hook. Therapists must be willing to do Shame Attacking Exercises themselves before they can ask patients to do them! And that can be intimidating!