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!

What are the distortions in the thought, “I should be a better mum”?

 

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

Cost-Benefit Analysis Self-Defeating Belief: I should be a better mum to my daughter

Advantages of this belief
(How does believing this help me?)

Disadvantages of this belief
(How does believing this hurt me?)

This thought motivates me to:

• Put myself out.
• Push myself to give what I have.
•  Find ways to advance her development.  Find ways to involve her in everyday life.
• Invest myself into her and her life as much as I can, physically, emotionally and time wise.
• Try to find ways that my daughter can have a fulfilling life.
• Try hard to connect to her, her pain, her needs, her sadness and her frustration.
• Try to make her life as easy as possible.
• Try my hardest to see her world through her eyes and gain deeper understanding of how she feels.
• Try to understand what is upsetting her when she throws a tantrum.
• Stay healthy and fit to have energy for her.
• Try to make her life rewarding and meaningful.
• Fulfill my duty as a mum to my daughter who needs my support.
• I can feel good about myself.
• I satisfy other people’s expectations of me.
•  Protects me from criticisms from my husband

 

 

 

 

 

 

 

• I am a prisoner to my daughter.
• No matter how hard I try I don`t seem to make a meaningful difference to her life and to her development.
• I am a “Siamese Twin” to her. I cannot move or do anything if she doesn`t want to.
• I reason with my emotions instead of thinking rational at times.
• I let my daughter get away with “murder”.
• I find excuses for her behaviour.
•  I find excuses for her why she cannot behave differently.
• I beat up on myself when I feel I failed her.
• I take all responsibilities away from My daughter and make them my own.
• I blame myself when I cannot motivate her to do something.
• I blame myself when she is bored and unhappy.
• I feel guilty doing my own things.
• I feel guilty when I do not involve her in my activities.
• I feel guilty when I expect her to do entertain herself for a while.
•  I cannot live my own life.
• I cannot be myself at times.
• She rules my life, and she lives my life.
• I feel trapped and frustrated.
•  I feel I need to constantly entertain her.
• I feel responsible for her happiness.
• I feel responsible when My daughter is sad and frustrated.
• I feel exhausted and overwhelmed at times.
•  I feel unhappy and unfulfilled.

 

 

 

 

 

Advantages: 20 Disadvantages: 80

 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

Ask David: What’s Self-Esteem? What’s Self-Acceptance?

In today’s podcast we address six common questions about self-esteem, including:

• What is Self-Esteem?
• How does it differ from self-confidence?
• How does it differ from self-acceptance?
• What’s the difference between conditional and unconditional self-esteem?
• What’s the best way to develop self-esteem?
• What do you mean when you say that once you develop unconditional self-esteem, you should get rid of it as fast as possible?

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

Brandon Vance and Heather Clague begin today’s show with a pitch for their upcoming Feeling Great App Group, an 8 week experience that will begin in September. If you use the Feeling Great App, or plan to get it, this group would be an inexpensive and incredible enhancement, so you can meet with like-minded people once a week to schmooze, practice the techniques in the app, and get your questions answered by compassionate and personable experts.

For more information go to www.FeelingGreatTherapyCenter.com/appgroup.

Feeling Great App Group Sept-Nov 2024

Led by Brandon Vance MD and Heather Clague MD, meets online for 80 minutes for 8 weeks, offered Mondays 4-5:20pm Pacific Time, September 23rd - November 11th. Cost is $12 per session ($96 total) plus the cost of the app ($99 per year after 7 day free trial). Sliding scale for both the group and the app are available. No one turned away for lack of funds.

Feeling Down? Try the Feeling Great App for Free!

It's now in the IOS and Android app stores, and you can check it out for free. It's works super fast. Let us know what you think! Thanks!

Rhonda, Matt, and David appreciate your support. Keep your questions and testimonials coming. They mean a lot to us!

Ask David Unfairness Worthwhileness Erasing Depression with Lasers TEAM in the UK What's the Most Powerful Technique?

We have lots of great questions today. The answers in the show notes were written prior to the podcast, and the answers in the live podcast as we discussed these questions may differ somewhat or amplify the written materials in these show notes.

We love your questions. Remember to send them to David@feelinggood.com.

Special Announcement 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.

But there's some good news, too! 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!

Today’s Questions

1. Kiernan asks about “unfairness” and the connection between worthwhileness and achievement.
2. Brittany asks: Can you “erase” feelings of sadness and depression by shining lasers in the patient’s eyes?
3. James asks about the use of TEAM methods in the NHS in the UK
4. Brian asks: Is positive reframing the most successful technique you have used with your patients?

1. Kieran asks (slightly edited for clarity): How would you talk back to negative thoughts like this one: “It's not fair that I can't afford quality food when there are millionaires that will have access to better food and a healthier lifestyle which has an effect on overall health and longevity'”? Or what if you feel like it’s unfair that you should have to pay a lot of money for an expensive dental treatment that you can’t afford? Kieran also asks (slightly edited by david): What if worthwhileness is not based on achievement but there are still things you would like to have and enjoy? They would buy and own things that they happen to like and not to impress others.

Hi David and Ronda, and if Matt is on

I have been listening to your wonderful podcast for about the last 3 years as I drive to work. It has really opened my eyes about how your thoughts create your interpersonal reality. Loved the podcasts on jealousy addiction, perfectionism, achievement addiction and many more.

My questions would be: What about if someone wants to achieve more but it isn't based on worthwhileness? They would buy and own things that they happen to like and not to impress others.

Let's say they wanted to be able to afford a nice house, healthier higher quality food and water. As the quality does have an effect on health especially in the US as the regulations are not the greatest.

However, the fact that they couldn't afford to buy these upsets them? Thoughts: 'It's not fair that I can't afford quality food but there are millionaires that will have access to better food, lifestyle which has an effect on overall health and longevity'

Or if someone has to pay for unexpected expensive dental treatment.

Thoughts: 'It's not fair that I have to pay £14,000 for this treatment'. 'It should be more affordable to lower income households, as it is essential to have functional teeth'

I hope I have explained this well, I would love to hear your thoughts. Keep doing what you are doing and all the best.

Kieran

 

David’s response

Sure Kieran, if you like I will make this an Ask David question for a podcast. LMK if that’s okay, and if it is okay to use your first name.

Great question, and has to do with the theme of acceptance: should I or shouldn’t I?

Here are the quick versions, but we can discuss in more detail on the live podcast. First, I do not find it useful to base my worthwhileness on my achievements or on my failures. I do work hard and like creating things that are helpful to people, and I enjoy earning money to support my family. I can be motivated to work hard to get things we want or need, but I don’t base anyone’s worthwhileness on how much money they have, or anything, to be honest.

In fact, I could also easily accept wanting to buy something really cool, not just because I like it, but because it might impress others, or because they might find it fascinating, too! I don’t try to regulate my life with a lot of shoulds and shouldn’ts, and find that I am happier and more peaceful without lots of shoulds.

In the Feeling Great App I have created a class called “Your PhD in Shoulds.” You might enjoy it!

Second, you can say that it is unfair that some people have more money and resources than other people if you like. And you have every right to feel angry if that’s what you want, as well.

Acceptance is more of a decision than a technique. Take the fact that lions kill deer when they are hungry. You can say, “they should not do that. It’s unfair!” But that won’t stop a hungry lion.

You don’t have to LIKE seeing a lion kill an innocent deer, but you can accept it. Again, that’s a choice. The behavior of a lion is dominated by millions of years of evolution. Humans are no different.

One thing that sometimes helps is to make a list all the REALLY GOOD reasons NOT to accept the “unfairness” in the world. I’ll bet you could come up with at least ten to fifteen strong reasons.

Then you can ask yourself, “Given all those good reason NOT to accept the fact that some people have more and some people have fewer resources, maybe I should just stay good and angry! Why in the world would I want to change?”

Also, when you find an injustice, you can use your energy being good and angry, and complain about it, or you can use your energy to do something about it. Or, you can also work to change yourself, instead of complaining about the world.

I also have a new class on acceptance. It’s called, “Accept this shit? Hell NO!” You might like it as well.

I am babbling so will stop.

Warmly, david

 

2. Brittany asks: Can you “erase” feelings of sadness and depression by shining lasers in the patient’s eyes?

Hi David,

My husband’s boss was telling him she’s going to be doing some laser therapy to “cure” her depression. She had to undergo 9 hours of testing to see if she’d be a candidate.

Apparently, they plan to shine lasers in her eyes to “erase” her sadness.

Obviously, I assume this is a load of garbage. But have you ever heard of such a thing? Is this just hypnosis?

Best, Brittany

David’s Reply

Hi Brittany,

Probably. As they say, follow the money! There is a placebo effect if you believe something will help, so tons of garbage gets served up as costly gourmet food.

You can read up on this on the internet I suspect. Let me know what you learn!

Best, david

Brittany responds to David

Love your answer! I was looking into it and read they use a cold laser in the eyes which allegedly releases endorphins. I already know from you that just like with exercise and that study about the endorphin blockers, it made no difference. People just feel better because they think they are doing something good for their body by exercising.

They also allege that the lasers aid damaged neurological tissue. They claim it has helped many patients but there is no data backing it up that I see.

They really lost me when I read that lack of activity, stress, and maternal deprivation cause depression in the first place.

Thanks! Brittany

David adds

As it turns out, I know two laser experts who are regulars on my Sunday hikes. Dr. Alexander Makowski is a brilliant scientist who is involved in the research and development of lasers and their marketing. Here is his email, along with some terrific links to articles about the hype of “low light lasers.”

Hope you enjoy the email and links from Alex:

Hi David,

I'll chime in too! From a different angle.

Zak knows some great doctors who are doing real work, but the general field of low-level laser/ light therapy (LLLT) for medical issues has been fraught with charlatans for some years.

(David note: Zak is a laser expert at the Stanford Medical School and is currently preparing a blog on the topic of LLLT. I will include a link to her blog when it is published, likely in a couple weeks. She is awesome and also often joins our Sunday hikes!)

Dr, Alex Makowsy continues

Good work by Tiina Kaaru (https://www.spiedigitallibrary.org/profile/Tiina.Karu-8010) and Juanita Anders (https://www.usuhs.edu/profile/juanita-anders-ms-phd) on mechanisms behind using light to stimulate our mitochondria or deactivate infectious bacteria are well documents

However, the good work done by the few was overshadowed and worse, was perverted for many years into crackpot devices using bad stats and poorly designed studies. Or sometimes just straight preying on vulnerable people. It is the great shame of the laser industry. Worse yet, some of these devices were actual lasers that led to people getting hurt.

I can't recommend in good conscience that lasers be shone into eyes at any time other than diagnostic devices meant to diagnose the eye itself. It may be that some day soon a good scientific body of evidence changes my stance but not yet...

The story starts in the origin of my journey into light and lasers. I got involved in this field in 2005 while taking an elective class on optics and lasers when I got a call from my mom that she was seeking a laser therapy for her fibromyalgia.

My mother's desire to get her fibromyalgia treated with a "cold laser" pulled me into this field since I was taking a class with a professor who later became my doctoral mentor. A full semester of my free time disappeared as I tried to source out of print articles and do a deep dive on whether this was real or garbage.

A research term paper and a conference visit later I could finally see the same trends you saw with medication. I talked her out of the potentially dangerous unproven device usage.

[As you may have suspected, In fact my mom was having significant issues in her marriage and life and a very good doctor set her straight. My mom divorced and is now happily remarried, about 95 pounds lighter, no fibromyalgia or serious insomnia. If only we had known you back then she would have recovered in a session or two rather than 3 years]

However, in the process, I dug into some of the real research that small doses of light can affect our bodies in ways we don't understand fully due to lack of research.

Fast forward several decades and some of the best researchers survived the public scandal of LLLT and found a scientific mechanism (cytochrome c oxidase activation) to explain observed changes in mitochondrial activity. However, the scientists don't claim to cure everything or anything. Then they published this mitochondrial activation and suddenly:

This, of course, proves that blogablum does in fact exist and now the truth about the panacea is available for all!!

David note: “blogablum” is a fake nonsense word I made up that refers to nothing meaningful. Now continuing with the Alex email:

This is a good review of the history and current evidence about it : https://www.mcgill.ca/oss/article/medical-critical-thinking/hype-around-photobiomodulation

But if you want the real goods, the hard truth about cold lasers has been out there for over 15 years:

Introducing the New Low Level Laser Treatment!

youtu.be

The following search on YouTube will reveal the secrets of the universe:

"cold laser before:2009"

Warmly,

Alexander J Makowski, Ph.D.

Dr. Matt May’s reply

Hi David,

Thank you for forwarding this question to me.  I am very concerned and wonder if this may fall under the category of 'malpractice'.

For one, I am unaware of any FDA approved treatment for depression that involves shining lasers into people’s eyes to erase their sad memories.  For a list of FDA approved treatments for depression, you could refer to:

https://www.ncbi.nlm.nih.gov/books/NBK559078/

It's possible that there is new evidence I'm not aware of, but I searched online for studies of light in treatment of depression and was unable to find any placebo-controlled trials.  This is a problem because placebo responses can be so high in the case of depression and anxiety.  There were some studies on light therapy, but nothing fitting the description of 'shining lasers into eyes to erase sad memories'.

Other concerns I have relate to the high cost of such an extensive “evaluation”, as well as possible risk of shining lasers into someone’s eyes.  In the absence of evidence supporting the treatment, it seems like a high cost, and potential risk, to the patient, hence my concern for malpractice.

It's pretty common for people with depression to feel a sense of desperation, especially after many failed efforts to address their symptoms.  This group of individuals are likely to be extremely susceptible to scams and purveyors of 'snake oil' (sham treatments).

It's also concerning to me because the theory behind the idea of shining light into people's eyes to erase sadness doesn't make logical sense to me.  It's a potentially-testable hypothesis, but it's such an absurd hypothesis that I don't see it as worth testing or entertaining.

If we are defining depression as some combination of worthless, hopeless, ashamed and guilty feelings, then the hypothesis that such feelings could be meaningfully addressed by such a crude instrument as a laser or a pill or an electrical impulse is absurd.

This is because our feelings arise from our thoughts/perceptions.  I've never met a single person or patient who was suffering from depression but had healthy positive thoughts about themselves.  I've also never met someone who had patterns of negative thinking, but felt fine, up-beat and positive.

The idea that a pill, a laser, a magnetic pulsation or electrical current could selectively alter the specific thoughts that cause depression doesn't make sense with what we know about the brain and thoughts and feelings.  How could a pill, for example, which crosses the blood-brain barrier and impacts every neuron in the brain, selectively target only the neurons that give rise to depressed thinking?  It's like imagining that we could carpet-bomb a city but only kill the murderers and rapists.

I'd encourage all potential clients who are receiving treatment for depression or other conditions to ask their providers for literature that documents the effectiveness of the treatment and to get a second opinion if they are unsure.

These are my 2-cents on the topic and I could be completely wrong about it all.  Hoping to hear from others what they think.

Also, David, I saw several other people included in the invitation to respond to this question but I didn't see them cc'd.  Perhaps they were bcc'd?

Wishing you the best,

fondly,

Matt

David’s reply to Matt

Thanks, yes, I have a fantastic response already in the show notes from Dr. Alex Makowski who does research and development of lasers with valid medical applications. His thrust is similar to yours.

Our field is littered with junk “scientism” intended to fool and exploit people, similar to the snake oil salespeople who use to go from town to town in America selling magical “elixirs” that “cured” just about everything!

But people are endlessly gullible, and con artists are still in endless abundance these days, it seems!

Best, david

Will add your kind and thoughtful comment to the show notes!

 

3. James asks about the use of TEAM methods in the NHS in the UK.

Hi Rhonda,

I hope you are well. I had a couple of questions for an 'ask David' on the podcast if that's okay. A bit of background....

I am Level 1 Team and have attended David's training in Atlanta. I live in the UK and have recently changed career to work in the NHS delivering CBT interventions for patients because David's work inspired me so much.

The NHS uses specific interventions for particular diagnoses and because I am in training I have to try and stick to this. I do use the TEAM materials and approach when I can and have already seen some great results.

The NHS uses 'Behavioural Activation' for certain patients with Depression and I just wondered what David thought about the effectiveness of this (perhaps compared to Cognitive Restructuring). I believe Beck introduced this into the CBT model as he thought it was useful.

Another question was regarding treatment of GAD and whether dividing worries between hypothetical and practical, and then using a certain time to actually worry rather than letting the worries dominate throughout the day was something he thought was useful or had heard about.

Thanks so much for all the great work you are all doing and inspiring people all over the world!

Kind Regards James Bibby.

David’s response

Hi James,

Thanks for the great questions. In today’s recording of an upcoming Ask David podcast, we can address:

1. 1. The history of “Behavioral Activation,” including the pros and cons of this approach.
   2. The history and pros and cons of “Worry Breaks.”
   3. The idea of matching a “technique” to a “diagnosis,” as opposed to learning to treat the whole patient with TEAM.
   4. The results of our latest research with the Feeling Great App, and whether it might have some value for patients struggling with depression and anxiety disorders in the UK.

Best, David

Matt’s Thots:

Great question! I’m looking forward to discussing.

There are certainly some techniques that are more effective, than others, for addressing specific negative thoughts. Meanwhile there are a number of problems that come up when we are, as clinicians, throwing solutions at diagnoses, rather than treating the human being who is suffering.

Studies on the treatment of PTSD at the VA, for example, showed veterans often got worse after this approach, in which their diagnosis was matched with a method, ‘prolonged exposure’, without any agenda-setting. This just retraumatized lots of veteran!

Similarly, if someone is secretly blaming, and haven’t experienced the ‘death of the blaming self’, they might be assigned ‘communication skills training’, only to see this backfire, because their intent is still to try to change someone, rather than accept them.

You might tell a patient with depression that they should go exercise, only to cause them to resist you, ‘you don’t understand, I can’t even get out of bed!’. In short, most therapy fails or even makes patients worse because it doesn’t consider the good reasons to continue to blame, give up, criticize ourselves, etc.

4. Brian asks: Is positive reframing the most successful technique you have used with your patients?

I can see how it would cure someone in 2 hours!

Feel free to use my question and do and use my name if you wish. I'd be honored.

Best,

Brian

David’s reply

Hi Brian,

Thanks. Great question! It’s one of the latest powerful techniques, but Ext of Voices might still be the “champion.” Using them in the T, E, A, M sequence is especially powerful. Positive Reframing often gets them closer, but not quite all the way to enlightenment.

Externalization of voices (EOV) often gets them over the finish line, especially if you know how to use it skillfully, incorporating Self-Defense with the Acceptance Paradox and Counter-Attack Technique! In fact, you can incorporate many of my > 100 techniques when using EOV, such as Be Specific, Semantic Technique, Examine the Evidence, and a host of other.

Best, david

Matt’s comments

I agree, Positive Reframing and Externalization of Voices are incredibly powerful and it’s often what we’re doing when we see recoveries. What works for a given individual, however, is quite hard to predict, in advance and there’s a ‘process’ to therapy, such that we can’t really skip steps, except in some unusual circumstances.

Some other super-powerful methods include Externalization of Resistance, Double Standard, Flooding, Feared Fantasy, and the Hidden Emotion Technique. I’m probably forgetting some.

Thanks for listening today!

Matt, Rhonda and David

313: People who “yes-butt” you. People who resist exposure. Does God exist? Does the “self” exist? How to you justify Ellis?  "Should" we care about Putin's war on Ukraine?

"

1. Rhonda asks: How can you respond to someone who yes-butts you? 2. Thomas asks: Do we have a self? Does God exist? 3. Thomas also asks: Ellis said we should upset ourselves over someone else’s problems, but how about Putin, and Russia? Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. 1. Rhonda asks: How can you respond
to someone who yes-butts you? David’s Reply Thanks, Rhonda. We can demonstrate this with Matt on the podcast recording later today! Matt’s Reply: The answer is to fall back to Empathy and try to see how we are creating the problem.  For example, when we are giving advice, we may have fallen into a trap, in which we are getting ahead of their resistance and would want to get behind it. As often happens, the question, and its answer, went in an unexpected direction. Rhonda, like many therapists, noticed that one of her social anxiety patients was subtly resisting exposure—facing her fears. Matt and Rhonda model how to respond to patients who keep putting off the exposure. This answer illustrates how therapists and the general public alike can improve your use of the Five Secrets of Effective Communication (LINK) with the use of “Deliberate Practice,” with role reversals and immediate feedback on your technique. Rhonda starts with a low grade, and then rapidly achieves an A grade! Click here for the Five Secrets of Effective Communication 2. Thomas asks: Do we have a self? Does God exist? Thank you for giving me your time and attention. I appreciate it, even if we don't agree. I have talked about whether or not God and the self exist. David Hume made the argument about not having a self, only perception. Of course, questions arise if we don’t have a “self.” Thomas Thomas also comments on Nathaniel Brandon: Why do we use the words who? Him? Her? He she they.?? I certainly don't believe Nathaniel Brandon’s horseshit. He talks about a teenage self, a father self, and a child self And all that is just horseshit. But do we have any self? David’s response: Hi Thomas, Thanks for your question! You ask, “But do we have any self?” You ask about God, too. People have been asking for my chapter on the “Death of the Self,” and my efforts to debunk the idea of a “self.” I have not had the time and motivation to bring that chapter back to life, since it is so hard for people to “get” what I’ve been trying to say, which is exactly what Wittgenstein and the Buddha were trying to say. But I will try to share one idea with you, in the hopes that it might make sense. As I have previously suggested, these questions about some “self” or “God” have no meaning. For example, how about this question: ‘What would it look like if someone had no ‘self?’ What, exactly, are we talking about? I know what this question means: “So you think Henry is too high on himself.” This means that we think some person named Henry is arrogant or narcissistic, something like that, and we want to know if someone agrees with us. I understand this question, it makes sense. There is a distinct difference between people who are quite humble and folks who are overly impressed with themselves. So, we are talking and using words in a way that has meaning and makes sense. However, I cannot answer the following question because it does not make any sense to me: “Does Henry have a ‘self’?” So, this question, to me, is language that is out of gear, like a car in neutral gear. No matter how hard you press on the accelerator, it will not move forward or backward. If you cannot “see” or “grasp” the difference between my examples of a meaningful question and a nonsensical non-question, that’s okay. In my experience, few people can grasp or “get” this. But to me, the difference is quite obvious. Is it okay if I use your email as a somewhat edited “Ask David?” I can change your name if you prefer. I don’t think people will “get” my answer, but hope springs eternal! David Matt’s Response Many brilliant minds have addressed this question in more eloquent and thorough ways than I could, including the Stanford-trained neurologist and philosopher, Sam Harris, in his book, ‘Free Will’ and Jay Garfield in his book, ‘Losing Ourselves’ There’s very little I can say, about this topic, that hasn’t been said more eloquently by individuals like these and many others. Meanwhile, I’m glad that this question has arisen on the podcast because I see clinical utility in the implications of this question, including in the treatment of depression, anxiety, anger, narcissistic pride and relationship problems. For example, I might be thinking, ‘I’m so mad at my (bad) self for eating all those cookies’.  Or, I’m so proud of myself for making a million dollars’.  I might start to think I deserve more, because of my special self and feel superior and angry, ‘that persons (bad self) shouldn’t have cut me off in traffic!’. When we take the ‘self’ out of the equation, we realize that these thoughts don’t make sense.  If our brains are just following the laws of physics, without any self, jumping in there to influence the process, then we couldn’t have done differently, with the brains we had, and neither could anyone else. Hence, the idea that people have ‘selves’, which can be good or bad, make decisions and the like, is a setup for suffering.  In the cookie example, I would have to train my brain, through practice with therapy methods, to develop a different set of habits, rewiring of my brain, to reach for a salad rather than a cookie.  I can’t simply insist that my ‘self’ rewire my brain for me.  I’d have to practice and do my TEAM therapy homework! Anger and Narcissism are some of the hardest-to-defeat problems.  However, realizing other people are simply doing what their brains are programmed to do, takes away the anger and blame.  Just like we wouldn’t hold a grudge for years against a wild animal that bit us, we could also forgive and accept a person who bit us.   and we can’t feel unnecessarily superior or proud of our ‘self’ if we accomplish something wonderful, because we don’t’ have a ‘self’ that did those things, just a brain and the right environment, neither of which we can take credit for. This approach is called ‘reattribution’ in TEAM, which is useful for defeating ‘self-blame’ and ‘other (self) blame’. Here are some other methods to leverage the no-self concept and free your mind of this hazardous way of thinking: 1. Experimental Technique:  Try to define what a ‘self’ is.  Then conduct an experiment to see whether the self is capable of doing the things you think it can do.  For example, can your ‘self’ stop understanding the words you are seeing on this page?  Or does your brain helplessly decipher the shapes of these letters into meaningful sounds and language?  Can your self exert its free will to decide to focus exclusively on one thing for one minute, like your breath or a point on the wall?    It can’t.  If your self can’t do such simple tasks, what can it do?  One can see meditation as a kind of ‘experiment’ to see whether our ‘self’ is calling the shots, using its free will, or if our brains are just doing what brains do. 2. Socratic Questioning: You can ask questions that can’t be answered to show that the ‘self’ is more like a ‘unicorn’ than a cat.  For example, how big is the ‘self’?  What’s it made of? Where is it located?  Can you see it on a MRI?  No radiologist has ever visualized a ‘self’ and you probably realize you can’t answer these questions, any more than you can, ‘what do Unicorns like to eat?’, bringing us closer to understanding that it’s probably a made up thing. 3. Examine the Evidence: What evidence is there that there’s a Self?  What evidence is there that there is no self? On the latter side, Consider Occam’s Razor, which suggests that the better hypothesis is the simpler one which still explains the observations.  One hypothesis is we have a brain generating consciousness.  Another hypothesis is that we have a brain that generates consciousness and a self that is having those experiences, operating the brain.  Based on Occam’s Razor, the better hypothesis is the former, that we have a brain creating consciousness. 4. Outcome Resistance: People get scared off by the idea that there’s no self or free will, that their brain is making decisions, without a self intervening.  In Christian Tradition, for example, Thomas Aquinas essentially invented the concept of ‘free will’ so that God’s punishment of Adam and Eve could be explained, morally. Otherwise, God would seem rather cruel, to create a system where he knew that would happen.  This is an example of how ‘free will’ and the ‘self’ are linked to blame and anger. Even if you don’t believe in God, you might be concerned that the idea that there is no free will would mean that the criminal justice system would fall apart.  Criminals could say, ‘I had no choice’.  Talking back to these elements of ‘resistance’ could help free one’s mind. For example, without free will, it’s true that blaming other people and retaliatory justice wouldn’t make sense.  However, one could still enforce laws, only in a compassionate way, for the sake of protecting others making the same mistake.  A murderer, if they realized this, could mind meaning in fulfilling their sentence, realizing they were doing a service to humanity, rather than being punished for their bad self.  Instead of seeing other people as having ‘bad’ selves, we can have a sense of sadness, connection and concern, even with a murderer, when carrying out justice, understanding that, ‘there but for the grace of God, go I’. David mentions, in passing, a mild red flag with the concept of "free will." He points out that this is another concept, like "God" or the "self," that has no meaning, if you really grasp what Ludwig Wittgenstein was trying to say in his classic book, Philosophical Investigations. One way to "see" this, although it is admittedly almost impossible to "see:" because it is so simple and obvious, would be to ask yourself, "What would it look like if we "had" something called "free will?" And what would it look like if we "didn't?" The question is NOT "do we have free will," but rather, "Does this concept have any meaning? Once you suddenly "see" that the answer is no, you will be liberated from many philosophical dilemmas. But as they say, enlightenment can be a lonely road! the Buddha, as well as Wittgenstein, ran into this problem that people could not "grasp" the simple and obvious things they were trying so hard to say! As humans, we get spellbound by the words we using, thinking that nouns, like "self," must refer to some "thing" that either exists or doesn't exist! To my way of thinking the question is NOT "Does god exist" or "do human have free will," but rather, do these questions make sense? Do they mean anything? The answer, to my way of thinking (DB), is no. However, . . . you might not "get" this! 3. Thomas also asks about Dr. Albert Ellis Hi David, Do you agree with Ellis that one is better off without making oneself upset over other people's problems? What about Putin and Russia and all the violence, another mass shooting, and trump running for president again? Ellis didn't think one should be disturbed about these things. Or at least upset. What do you think? David’s reply Hi Thomas: Here’s my take. Healthy and appropriate negative feelings exist! One SHOULD be upset by horrific war crimes. I suspect that if Beck and Ellis, were they still alive, they would both strongly agree, but of course, I cannot speak for them! Thanks for listening today! Matt, Rhonda, and David!

How to Master the Five Secrets: If You Dare! In our recent podcast surveys, one of the highest rated show topics was learning therapy techniques, both for therapists and for the general public. That’s why today we’re going to take a deeper dive on some of the fine points of the Five Secrets of Effective Communication. We’ll show you how to use them with individuals who are angry and hostile, including some patients with Borderline Personality Disorder as well as kids who may be ticked off at a parent. These topics were specifically requested by people who completed the podcast survey. Link to Five Secrets The Five Secrets are like a fantastic musical instrument, capable of working magic for troubled relationships. You can’t just sit down at a fine grand piano and pound on the keys and expect great music to emerge. You’ll just get cacophony. To learn the Five Secrets, you need:

• Great determination and desire
• The willingness to endure the “Great Death” of the “self,” or pride.
• Tons of ongoing practice with immediate feedback and deliberate practice involving role reversals until you get it “right,” or receive an “A.”

To get started, Rhonda and David made a list of a few of the most challenging criticisms a therapist might hear from a patient, or a parent might hear from a teenager. Criticisms from patients included:

• You don’t care about me!
• I’m not getting better. You’re not helping me!
• You charge too much!
• All you care about is your darn techniques.
• That’s not my child’s name! You’re not listening to me!

And this one, from a first time patient referred by the courts:

• I got anxious last night and masturbated to your image, which I found on the internet, and it really helped!

These are some criticisms from kids:

• Stop nagging me!
• Stop giving me advice. I don’t want any advice!

We demonstrated the “Intimacy Exercise” I have created for our training programs. You can use this exercise to work on conflicts with patients and conflicts with loved ones. It works exactly the same way in both situations. You’ll need someone to practice with. Step 1. One of you agrees to play the critic and the other plays the role of the person being attacked (therapist or parent, for example.) Step 2. The person playing the role of the critic verbalizes the hostile comment. Step 3. The person playing the role of the therapist / parent responds as effectively as you can, using the Five Secrets of Effective Communication. Now you must STOP. The exchange is done. No further interaction in the role playing format is permitted. Step 4. The person who played the role of the therapist / parent gives himself / herself a grade between A and F. Ask yourself, “How well did I do just now?” Step 5. The person who played the role of the critic gives the therapist / parent a letter grade, and then provides the following specific kinds of feedback using Five Secrets language. Positive Feedback: Here’s what you said that worked pretty well. Your Thought Empathy was great, and your Disarming Technique was fairly good. Your Stroking was excellent, especially when you said X, Y, or Z. Negative Feedback: Here’s what you said that needs a little fine tuning: Your Feeling Empathy was completely missing—you did not acknowledge how the other person was feeling. Your “I Feel” statements were also missing, and there was no Inquiry at the end. Then you can suggest ways to include the Five Secrets elements that were missing or “off,” and demonstrate how you might improve the response to the criticism with a role reversal, followed by another round of grading and positive and negative feedback. Continue using role-reversals until both parties can get an A on the exercise, always using the same harsh criticism that you’re trying to learn how to master. Don’t try something new until you’ve mastered the thing you’re working on. The practice is powerful but hard, and requires the philosophy of “joyous failure.” This means welcoming the chance to get immediate feedback about your skills, or lack of skill, instead of getting blown away, defensive, or “yes-butting” the person who’s trying to correct your technique. You will hear some pretty dramatic examples of this on today’s podcast! The Five Secrets can be life-changing, but the price of learning is fairly stiff. If you want the rewards, the exercise we demonstrate in today’s podcast can be incredibly helpful—but scary! Also, you can read my book, Feeling Good Together, and do the written exercises while reading if you’re a therapist or a general citizen. This helps a lot. Dr. Jill Levitt said she kept Feeling Good Together on her nightstand for more than a year when she first joined by training group at Stanford. Her dedication and hard work have clearly paid off for her. If you’re a therapist, you can also read the chapters on E = Empathy in my Tools, Not Schools, of Therapy book, and make sure you do the written exercises while reading! Thanks so much! And good luck if you’re brave enough to try our “Intimacy Exercise!” David and Rhonda  

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

 

Smashing Shyness-- Shame-Attacking and Beyond Come to our Full-Day Workshop on Sunday, October 2, 2022 For therapists and lay people alike Click here for registration and more information Today we interview our beloved Jill Levitt, PhD who will be joining me in teaching the upcoming social anxiety workshop on October 2nd. Jill is the co-leader of my weekly psychotherapy training group at Stanford, and is the co-founder and Director of Training at the Feeling Good Institute in Mountain View, California. Social anxiety was one of the most frequent problems that patients sought help for when I was in private practice in Philadelphia. Because of my own severe and persistent social anxiety since childhood, it’s my favorite problem, too. Whatever you’ve had, I can tell you that I’ve had the exact same thing, too, and know how sucky it can be. I can show you the path to freedom from that affliction, and what a joy that will be! According to the DSM5, there are at least five types of social anxiety:

1. Shyness
2. Public Speaking Anxiety
3. Performance Anxiety. This a broad category that can include athletic or musical performance, or any time you have to demonstrate your skills in front of people who might judge you. For example, I had a severe camera phobia since I was a child, and only got over it a couple years ago!
4. Test Anxiety
5. Shy Bladder / Bowel Syndrome

In addition, other negative feelings typically go hand-in-hand with social anxiety, such as shame and loneliness, as well as depression and feelings of inferiority and even hopelessness. This workshop will focus on therapists looking for training. However, the general public are also included, since you will get the chance to practice and work on your own fears during the workshop. I (David) have noticed that feelings of social anxiety, especially performance anxiety, are almost universal among therapists, at least judging from those who attend our weekly TEAM-CBT training group at Stanford. So, come to heal yourself AND to learn how to heal your patients and loved ones. We will be covering not one, but four treatment models for social anxiety in the workshop: 1. The motivational model: Nearly all anxious individuals resist exposure, which is a crucial part of the treatment. Most therapists also resist exposure for a variety of reasons, thinking the patient is too fragile, or the technique will be too dangerous or upsetting for their patients. This is unfortunate, since this pretty much dooms the treatment to failure, especially if you are aiming for a “cure” rather than endless talk and hand-holding. 2. The Cognitive Model. Although usually not completely curative, the Daily Mood Log is essential to treatment, so you can find out exactly what patient are thinking and feeling at one specific moment when they were feeling anxious. I present the case of Jason, a young man feeling shy and anxious while standing in line to check his groceries one Saturday morning at the local grocery store. Many cognitive techniques are incredibly important and useful in the treatment of social anxiety, including Explain the Distortions, the three types of Downward Arrow (uncovering) Techniques, the Double Standard Technique, Externalization of Voices, the Feared Fantasy, and more. Although these methods are helpful and illuminating, they will rarely or never be quite enough for a complete cure. For that you will need: 3. The Exposure Model. In the workshop, we will be teaching:

• Smile and Hello Practice: In today’s podcast Jill discussed the purpose of this technique, how to introduce this technique to your patients, and how to implement it. This is an example of the many techniques we will teach on October 2. David provided a dramatic example of how this humble technique changed the life of a young man from India.
• Flirting Training
• Talk Show Host
• Rejection Practice
• Feared Fantasy: We role-played how I used this humor-based technique in my work with Jason
• Self-Disclosure
• Survey Technique
• Shame-Attacking Exercises.

We will also explain how to use several techniques crucial to the reduction of the patient’s resistance:

• Dangling the Carrot
• Gentle Ultimatum
• Sitting with Open Hands
• Fallback Position

However, many therapists have intense resistance to making patient accountable with these techniques that are absolutely central to TEAM-CBT, thinking they are cruel or crude or narcissistic, or some such thing. In the podcast, Jill illustrates a beautiful and gentle but firm way of introducing these techniques to patients, and emphasizes that they are actually ethical, therapeutic, and necessary for a good outcome. She also emphasizes, and I totally agree, the importance of going with the patient into the real world to do the Exposure Techniques. I have used extreme exposure techniques on hundreds of occasions when treating anxious colleagues on Sunday hikes for example, urging them to stop hikers we meet and disclose their own shyness, for example. The advantages of doing this type of thing in the real world include the ability to coach the “patient” with the best examples of how to use whatever technique you’re advocating, and to be there to support the patient during and after the experience. 4. The Hidden Emotion Model. This technique is often extremely helpful in the treatment of any form of anxiety, but is perhaps less often used in the treatment of social anxiety. I can think of one example when it was extremely helpful. This was a woman whose boss kept pressuring her to give presentations about their company locally and to groups in other locations as well. She opted out because of her social anxiety. But lurking behind her symptoms were her feelings of resentment about being asked to do too much. Once she brought these feelings to conscious awareness, she decided to discuss his expectations, her feelings, and her compensation with her boss. This worked well, and her public speaking anxiety magically disappeared. Although this pattern is not common, it is always worth consideration in your treatment plan, because family and friends often pressure people with social anxiety to confront their fears, and this typically does trigger feelings of resentment and resistance. We also discussed two Self-Defeating Beliefs that are nearly universal in individuals with social anxiety: the Spotlight and Brushfire Fallacies. In the podcast, I give examples of several techniques that were life-changing for patients. Jill emphasizes that one of the underlying treatment themes is how to “wake up” from your trance so you can learn not to take yourself so seriously and begin to have fun and enjoy yourself and others way more. Improvement is not the goal of treatment. The goal of treatment is word that many mental health professionals fear and resent: CURE! In the podcast, I describe the difference between a 100% cure for any form of anxiety, and a 200% cure. Do you know the difference? I give an example of my own fear of heights when I was in high school. Of course, that’s a phobia, and not a form of social anxiety, but you can also have a 200% cure for social anxiety, too! In a 100% cure your fears go to zero. You are no longer particularly anxious about talking to strangers, or public speaking, for example. In a 200% cure, you come to LOVE the very thing that terrified you in the past. Rhonda, Jill and I think this will be a powerful one day experience. We will focus on a common problem that is usually treatable fairly quickly, and often with fabulous and life-changing results. We hope you can join us! For registration information, please go to: CBTforSocialAnxiety.com Thanks! Jill, Rhonda, and David

Professor Mark Noble Shares his Thinking on the Uptick in Loneliness. Rhonda starts today’s podcast with a beautiful podcast endorsement from Eduardo, a fan who loved our recent podcast 303, featuring the dramatic, humble, and inspiring Jason Meno, a data scientist and software engineer who is making superb contributions to the Feeling Good App. Eduardo was especially interested in how to bring non-verbal, difficult-to-access negative thoughts to conscious awareness with the Stick Figure Technique. Today we interview Professor Mark Noble on the topic of loneliness. Mark is best known for his pioneering research on stem cells, but he has become an active and beloved member of the TEAM-CBT community since joining one of my Sunday hikes back in (date?) Mark is currently an active member and small group leader in Rhonda’s Wednesday TEAM training group. He generously wrote brilliant chapter for my most recent book, Feeling Great, and has also written the Brain Users Guide to TEAM CBT which you can download for free from https://www.feelinggreattherapycenter.com/resources Mark begins by dedicating today’s podcast to listeners who may be struggling with feelings of loneliness, and explains that loneliness appears to be on the increase, along with virtually all types of negative feelings, especially since the onset of the pandemic. He emphasizes that there are many roads to loneliness, including:

• Loss of a loved one, including friends, family, colleagues, or even a beloved pet
• Betrayal by someone you trusted
• Being trapped in an abusive relationship
• Being abandoned or neglected as a child
• Not being accepted by your family due to sexual orientation, religious preference, choice of life partner, or other factors
• Feelings of isolation due to COVID
• A dead marriage
• Infidelity
• And more.

Of course, Social anxiety is one of the most common causes of loneliness, and last week we interviewed two individual, Cai Chen, MD, and Chan Mary Soeur, RN, BSN, who have fallen in love. Both were lonely and struggled for years with social anxiety. Their work with TEAM-CBT has not only helped them greatly with their anxiety and loneliness, but has brought them intense romantic love! Not bad! People struggling with loneliness often think there’s something “wrong” with them. For example, you may feel unlovable, and fear that you’ll be alone forever. In addition, the belief that we “need” love to feel happy and fulfilled often leaves the lonely individual feeling like they’re doomed to endless unhappiness and a lack of fulfillment if they’re alone. Mark explains that the scientific definition of loneliness is the distress you feel when you think that your ”needs” for connection and relationships differ from what you have. In addition, he believes that loneliness is not abnormal, but is rather an indication of healthy brain function that has been important to the survival of the human race. For example, feelings of loneliness motivate us to connect with others. In fact, feelings of loneliness prompt babies to cry for their mothers when they feel hungry, hurt, or alone, and this process begins within seconds of being born. We raised the question of whether the cure for loneliness is internal or external. The internal solution involves changing the way you think, and your relationship with yourself. The external solution involves trying to find a loving partner or becoming more involved in activities with others. Although this is the solution most people pursue, it often falls short. David emphasizes the important of the internal solution, and discovering that you can feel completely happy and fulfilled when you’re alone. In fact, this is the first step in overcoming loneliness that he emphasizes in his book, Intimate Connections. Mark, Rhonda and David also discuss some of the paradoxes of TEAM-CBT, and how the “need” for love often drives others away, since you are asking people to give you something you can only give yourself. In contrast, when you feel happy within, and no longer “need” the love of others, love will often pursue you. We hope you enjoyed today’s podcast, and want to thank our buddy, Professor Noble, who has made so many in our TEAM-CBT community feel less lonely and more connected! Warmly, Mark, Rhonda, and David

Swimming in the River of Love Rhonda starts today’s podcast with a beautiful podcast endorsement from a fan named Vicky, from Australia, who was thrilled with the two recent live therapy podcasts with Nazli (podcasts 301 and 302). She wrote that she felt so lucky to hear someone with the exact same negative thoughts, and same feelings of depression and anxiety, that she’s had since she was 10 years old. I have often said that when therapists have the courage to do their personal work in public, you not only heal yourself and learn cool techniques first-hand and experientially, but you also heal many others who are touched and inspired by you. Thanks to all of our fans for your frequent loving comments and cool questions for future Ask David podcasts. We then give a little promotion for several upcoming group events, involving:

• May 2, 2022. Dr. Jill Levitt and I will be teaching an exciting, full-day workshop on “Smashing Social Anxiety: Shame-Attacking and Beyond.” It will be open to shrinks and the general public alike. The focus will be on learning to treat social anxiety, including your own! For registration and more information, please go to CBTforSocialAnxiety.com.
• September 13, 2022: Drs. Brandon Vance and Heather Clague start two new Feeling Great Book Clubs. For registration and more information, please go to www.feelinggreattherapycenter.com/book-club.
• September 14, 2022. Drs. Heather Clague and Brandon Vance will start their weekly “Deep Practice” group for training in the Five Secrets of Effective Communication. This type of practice is absolutely needed if you want to use these fantastic techniques to greatly boost your clinical effectiveness or enhance your relationships with the people you care about. For registration and more information, please go to www.feelinggreattherapycenter.com/5-Secrets.
• Date (to be announced). Zeina Halim soon begins the first-ever book club for When Panic Attacks. This terrific group could be helpful if you’ve ever struggled with phobias, social anxiety, chronic worrying, panic attacks, OCD, PTSD, and more. For registration and more information, please go to https://feelinggood.com/2022/08/08/anxiety-book-club/
• Date (to be announced). Zeina Halim will collaborate with our Feeling Good App development team in an experiment to test a month’s use of the Feeling Good app with or without a weekly practice group to supplement your work with the app. This exciting project is currently in the planning stage, but if you think you might be interested, please contact Zeina at Zeina Halim so she can contact you once we’re ready to start.

As an aside, the app will be free since we’re still involved in beta tests, but the weekly practice groups will involve an additional charge. Today we feature a love story involving Dr. Cai Chen, a young psychiatrist who did his residency training in Texas and now has moved to California to be with his love, Chan Mary Soeur, RN, BSN. Both have been members of my TEAM-CBT training group at Stanford. Cai practices at the Feeling Good Institute in Mt. View, California, and Chan Mary who is pursuing a master’s degree as a Psychiatric Nurse Practitioner. Cai explains that he’d felt socially anxious and lonely for used, and used the tools in my book, Intimate Connections, when he got tired of dating sites. One crucial thing he learned is that you have to stop “chasing” if you want to find love. Then he met Chan Mary in one of the breakout groups in our weekly training group. Chan Mary said, “I also used to struggle with social anxiety. Even now, on this podcast I have thoughts that I won’t be as impressive as Cai. Cai is much better at expressing himself and being vulnerable in front of others. “I’ve been on a personal journey to get over my intense social anxiety. I’ve always held back in groups, and have never been the first one to reach out. “After listening to the Feeling Good Podcast’s episode on how to overcome social anxiety, I decided to challenge my fears and reach out to Cai. I contacted him and told him I really admired the courage he was showing in his transparency about his feelings, and in his courage to challenge his fears with the many Interpersonal Exposure Techniques we were learning about in our training. “I also decided to try another technique, Flirting Training. I told him that I thought everything he was doing was inspirational, and that I felt close to him.” Rhonda asked about the importance of taking risks if you struggle with social anxiety. Chan Mary explained it like this: “I was extremely anxious about reaching out to someone I didn’t know. For me, a simple thank you email and introducing myself was anxiety provoking because I had never done that before. I was also worried about asking too many questions because I didn’t want to come off as intrusive or even bothersome.” Chan Mary continues: “After conquering my initial fears of reaching out, I went even further, I invited him to join me for a week in Hawaii as our first date in 2021 for my vacation. I usually went on a medical mission to Cambodia, but couldn’t because of the pandemic. So I did the boldest thing ever—I met him in person in Hawaii!” Cai describes the fears he had: “I was scared. I thought, ;what if we get too close and our relationship falls apart.’ In fact, after accepting the invite, I called and told her that I’d changed my mind. She got angry, and I realized I had mixed feelings, so I turned to David’s Decision-Making Tool. (You can get it for free at the free chapter link on the bottom of the home page of David’s website.) “This tool helped me see why I was stuck, so I called Chan Marie back and asked for her forgiveness. I’d been hiding my feelings, so I told her I really liked her and had been afraid of ruining a great relationship.” Chan Mary said: “I was scared, too. But I told myself to trust myself, and that it felt safe to trust him, too.” The rest, as they say, is history. The date was terrific, and after some initial hesitation, Cai decided to move from Texas to California to be with “the love of my life!” Was it all roses from then on? All relationships, I’m pretty sure, have difficulties, and Cai and Chan Mary explained that they both have trouble expressing negative feelings. Cai explained it like this: “I always try to be nice, so I push my negative feelings down, and automatically sweep them under the rug. Chan Mary helps me with this. She pushes me to tell her what I’m upset about. And although it’s frightening at first, once we express our negative feelings they kid of fizzle out. Chan Mary has become an expert in David’s five Secrets of Effective Communication, and that has helped tremendously.” Chan Mary explained her difficulties with negative feelings like this: “The Hidden Emotion Technique has been helpful for me when I start to feel anxious or upset. I have to reflect and ask myself, ‘What’s the deeper issue here?’ Often, I don’t even know what I’m upset about!” Chan Mary added: “Thank you to David and Rhonda and everyone who made the Feeling Good Podcast possible. I’m just like many of your listeners, and this podcast has been life-changing. The techniques, you shared on the podcast have transformed my life! If I did not take the steps to conquer my social anxiety, Cai and I probably would not be here today.“ Cai and Chan Mary are delightful, and their obvious love is an inspiration in this time of increasing violence in the world and such intense political divide and hatred here at home. I asked where their relationship is heading and Chan Mary hinted that Rhonda and David might be getting invitations to a wedding one day soon! Cai and Chan Mary are two of my favorite people in the whole world. It’s a privilege and a blessing to know them and share a little of their lives. This is Rhonda…. "I love Cai and Chan Mary, too. I was in the Tuesday Stanford TEAM Training group for years with Chan Mary, and feel really close to her for lots of shared experiences. I am lucky enough to see Cai every Wednesday in our International TEAM Therapy Training Group, and I always look forward to reading the wise comments he writes on the TEAM certified listserve. Next week, we’ll look at the other side of the coin, as Professor Mark Noble leads a discussion on the recent rise in loneliness, which is often associated with social anxiety. Warmly, Cai, Chan Mary, Rhonda, and David  

TEAM-CBT Celebrates Diversity Today's featured image is Sean Williams, co-founder of the BAD Group Rhonda starts today’s podcast with a terrific endorsement from Steve, from England. He really liked Feeling Great, and said he benefited from the personal work with Dr. Mark Taslimi that we published as the first live therapy on the Feeling Good Podcasts (see podcasts 29-25 and 141.) Steve wrote that the live work, and the teaching points that Dr. Jill Levitt and I made during the podcasts to explain our strategies, is the best learning by far. Rhonda and I strongly agree, and I feel fortunate to have been able to publish many additional live TEAM-CBT sessions since that time. It is my hope that some day these live therapy podcasts will be used in teaching graduate psychology classes so that future practitioners can pick up where we left off and benefit from the rapid treatment techniques we’ve developed. Today we interview Amber Warner, LCSW, Sean Williams, LCSW and Chelsea Dorcich, MFT. Amber is a Level 3 certified TEAM therapist, living and working in Lake County, where she provides mental health care in a rural community. She has a private practice that includes a virtual practice for anyone in the State of California. Amber has been a member of our Tuesday TEAM-CBT group for the past year. Chelsea is also a Level 3 Certified TEAM therapist with a private practice for anyone in the State of California. Both Chelsea and Amber work at the Feeling Good Institute in Mountain View, California. Sean is a Licensed Clinical Social Worker and also Level 3 TEAM-CBT therapist and co-founder of the TEAM CBT Clinicians of BAD, for Black African Descendants, along with Amber and Chelsea. He is a long-time and beloved member of the Tuesday training group at Stanford. He currently resides in Colorado and works for the Ohio State University where he works with active duty and retired soldiers regarding their PTSD suicidal ideation and trauma. He treats patients and also supports the Ohio State University’s research. He also has a part-time private practice for people who live in Indiana. Amber got our podcast going by saying: “My introduction to TEAM-CBT was in 2017, while at a Sunday workshop about 1 1/2 years ago. I’d been struggling with grief after accidently finding out my employer had hired others at a higher salary, so I started a Daily Mood Log and did a downward arrow (this is an uncovering technique) using one of my negative thought. I discovered that my Self-Defeating Belief (SDB) was not included in David’s list of 23 common SDBs. “I felt like all the weight of the world was on my shoulders because my employer had hired white people with less experience at higher salaries. I asked myself what I was going to do. “Do I care to stand up for myself? It felt like a heavy dilemma. I decided to face my fear and talk it over with my employer. It took some time, but things eventually turned out in my favor.” Way to go, Amber! Amber mentioned that Philip Lolonis, LCSW, a member of our TEAM-CBT community, urged us to create and teach an introductory TEAM-CBT course for African-American clinicians in 2021. Amber reached out to Sean and Chelsea and asked if they'd be interested in creating a “Clinicians of Color” group on Facebook. And that got the ball rolling. Rhonda asked, “What kinds of challenges have you faced?” Sean said that one barrier was the whole process of getting licensed. It requires a lot of time and money, nearly always meaning large loans and years of training. One goal of their group is to assist interested people through from initial training through the licensing clinicians, as well as introduce TEAM therapy to the larger therapeutic community. There are very few Black mental health professionals within the TEAM community. Amber explained that one of their goals is to provide support and encouragement to young Black men and women who might want to enter the counseling profession by attending medical school, or a doctoral or graduate school in counseling or psychology, or obtaining a certified coaching diploma. Amber also stated that TEAM-CBT has made a powerful impact on her, Chelsea and Sean, so they formed an affinity group, TEAM CBT Clinicians of B.A.D. Their primary goal is to support and encourage clinicians of color to learn and practice TEAM-CBT and explore culturally responsive methods to enhance the therapeutic alliance and improve treatment outcomes. Sean explained that he was introduced to TEAM and David’s work around the year 2000. He was looking at books in the self-help section of a Barnes and Nobles bookstore, but most of them were too expensive. He said, “Most of them were too expensive, but then I saw Feeling Good lying on a table, and it was only $8.95, so I purchased it and read about the list of cognitive distortions that David had created. That book changed my world view and changed me as a clinician. I realized that I really wanted to disseminate this information to clinicians of color.” Sean explains why he resonated with Feeling Good: “Many of the cognitive theoretical principles were extremely empowering to me. In “Feeling Good” there was a diagram of a man where it demonstrated how human beings process their experiences through thoughts, beliefs and assumptions. The whole idea of my thoughts impacting my emotions and behaviors was mind blowing to me and still is. It made me recollect on all my past struggles such as relationship break ups, job losses, public speaking anxiety, and so forth, and my reactions towards those situations unbeknownst to me at the time were primarily based on my thoughts about those events. I believe that it’s important that all people have access to these powerful therapeutic interventions regardless of race, ethnicity or culture. The reason why it’s important to disseminate these powerful tools to people of color is because people of color are reporting high rates of psychological distress but are less likely to get treated for it. “According to webmd.com ‘…African Americans are more likely to report feelings of sadness, hopelessness, and worthlessness than are adult whites. Still, in 2018, 18.6% of white Americans received mental health services, compared to less than 9% of African Americans.’ “I think TEAM-CBT can even help alleviate suffering related to racial stress. Although racism is a non-distorted reality the concepts in “Feeling Good” and the whole TEAM framework can orient a person to adopt the healthiest possible perspective when moving through those realities.” Chelsea said she learned about TEAM-CBT when she moved to the Bay Area in 2017. She says, "I also found that TEAM was a roadmap and a blessing. I could really connect. This is an amazing framework for everybody!” We also discussed one pitfall that some clinicians fall into. The idea that our thoughts, and not events, create all of our feelings can be liberating. But it can also be used to invalidate genuine, healthy anger. Racial bias and cruelty are real. "They are NOT cognitive distortions," she says. "Racial bias is very real. But TEAM-CBT can free us from the inner prison of depression and anxiety and self-doubt that results from distorted perceptions. Of course, sometimes perceptions are totally valid, and sometimes it’s time to fight and stand up for what’s right." David added that "We had to do a lot of fighting and protesting in the 1970s, when the Viet Nam war was waging, and the forces of darkness were powerful and destructive. Now, it seems, we have many more battles to fight, and we are lucky to have crusaders like Chelsea, Amber, and Sean. "Thank you for what you are doing!" Thank you all for listening today. Chelsea, Amber, Sean, Rhonda, and David Following the show, Sean kindly emailed me with some information addressing some of my questions about black people and the mental health system in the United States. He wrote: Although I was super anxious, I really enjoyed doing the podcast with you two. I used the “Dare to be Average” principles in Feeling Good to help me relax and it worked! Here’s a few additional notes about black people and our mental health system. I hope it helps! Insights into Diversity By Sean Williams, LCSW Why is it important to disseminate TEAM-CBT to people of color? Data from the American Psychiatric Association (APA) shows that only 2 percent of the estimated 41,000 psychiatrists in the U.S. are Black, and just 4 percent of psychologists are Black. On college campuses, close to 61 percent of counseling center staff are White, and 13 percent are Black, according to a 2020 Association for University and College Counseling Center Directors survey. he shortage of psychiatrists and counselors of color has severe implications for all Black individuals needing treatment. A 2019 survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) found nearly 5 million, or 16 percent, of Black Americans reported having a mental illness. However, only one in three Black adults who needs mental health care receives it. Because of the scarcity of mental health professionals of color, it can be difficult for Black Americans to find a practitioner with whom they feel comfortable enough to share any race-related trauma. One 2016 study in the Journal of Black Psychology found that African American therapists and their patients often had relationships marked by a “distinct sense of solidarity … as evidenced by having a better understanding of the context of Black clients’ lives. For more information, see https://www.insightintodiversity.com/addressing-the-lack-of-black-mental-health-professionals/

306: Ask David: Featuring Matt May, MD 1. Kevin asks: Hi David, Is it possible to have a healthy relationship with someone who can be classed as “Borderline Personality Disorder”? 2. Brittany asks: How do you deal with the injustice of people who rip you off without giving you credit? 3. Paul asks: Is there a way to know if I have done the Hidden Emotion Technique correctly? Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. 1. Kevin asks: Hi David, Is it possible to have a healthy relationship with someone who can be classed as “Borderline Personality Disorder”? Hi David, Is it possible to have a healthy relationship with someone who can be classed as “Borderline”? What are keys to being in a relationship with someone that exhibits some of these characteristics? Is it a lost cause? Is borderline personality disorder bullshit and simply a result of assumptions such as “I need love to be worthwhile” as indicated in your books? Best, Kevin David’s reply Great question, here are a couple brief responses off the top of my head: "Healthy" exists on a continuum. In my experience, the therapeutic relationship with a patient diagnosed with BPD exists on a continuum, it is not all-or=nothing, and you can have excellent interactions, but this often requires great diligence and skill in the use of the five Secrets of Effective Communication. I have not observed any unique relationship between the Love Addiction and BPD. That's because the "need" for love is pervasive in our culture, and is, in fact, one of the most common Self-Defeating Beliefs. I do believe that Other-Blame (along with Self-Blame) is a common feature of BPD, along with the unwillingness to be accountable and to have tow work hard and consistently for recovery. I have had a number of patients with BPD threaten suicide if I asked them to do psychotherapy homework, for example. At my clinical in Philadelphia, we diagnosed the ten personality disorders prospectively, at the intake evaluation, and depressed patient with and without BPD improved at almost the same rate during the first 12 weeks when treated by the forerunner of TEAM-CBT, when controlling for severity of initial depression. I published this surprising finding in the top journal for clinical psychology research, the JCCP, but it got little attention for some reason, and some of the reviewers of the article were critical of this finding which they found difficult to believe or accept. DBT has been the "go-to" method for BPD, and BPD therapists may think that CBT / TEAM-CBT would or could not be helpful. Still, I am grateful for DBT welcoming such patients and helping them, when so many therapists avoid these patients! At my clinic in Philadelphia, something in the range of 28% of our patients were diagnosed with BPD at intake. david Matt’s Reply: I’m really just guessing, but perhaps Kevin is feeling quite sad, worried and hopeless, about his relationship. Perhaps he’s been treated badly and is also angry and scared that this will continue to happen in his current relationship. If so, he might be having thoughts like, ‘This relationship will always be terrible’ or ‘They will continue to hurt me and disrespect me and treat me badly’ of maybe, ‘This is their fault, they have Borderline Personality!’. This is only a guess, but if it were the case, I would imagine Kevin could use a great deal of empathy and listening, right about now. It is possible he has been treated terribly or even abused. His partner may indeed meet the criteria for BPD, in which case they would be tremendously sensitive and frequently reactive and prone to unhealthy expressions of anger. Perhaps Kevin has displayed tremendous patience and tried very hard in the relationship, which would be admirable, but only amplify his disappointment when the same hurtful patterns continue. Kevin may even feel worthless, if he believes that the way he is being treated by others is an indicator of his worth as a person. I feel for you, Kevin, and hope you’re getting the Empathy you need. I think there is a lot we could offer someone in this situation, in addition to Empathy, as well. We certainly have the technology, in TEAM, to alleviate the worthless feelings, the anxiety and worry, the feelings of anger and hopelessness, etc. and to replace these with a sense of confidence, joy and optimism. We could also offer skills that that one could use to substantially improve the quality of their relationship. Meanwhile, there are many reasons why someone would prefer to maintain very high levels of hopelessness, anger and worry and low self-esteem in this context. For example, as a protection against getting hurt again. Or they might not want to like and admire themselves if their partner is dissatisfied with them. We’ve also discussed, on the podcast, how tempting and seductive Blame can be. When we tell ourselves, ‘It’s their fault, they have Borderline Personality Disorder’, this type of thought can give us pleasant feelings of superiority. Kevin may not have any of these thoughts or feelings. My point is that, before trying to ‘help’ someone in Kevin’s shoes, I’d certainly want to explore all the good reasons he would want to continue to feel extremely upset and all the good things this says about his sensibilities and values. In addition to Empathy and an exploration of Resistance, one tool that is sometimes helpful in this situation is the Decision Making Form. This is a simple but powerful tool, available online, thanks to David’s generosity, which one can use to compare and consider, with great care, the three options they have in a relationship: continue the status quo, end the relationship or take personal responsibility for improving the relationship. There would be pro’s and con’s to each of these options. Meanwhile, you will notice that there’s one option that is NOT on that list, which is to change the other person. Trying to change the other person, blaming them, is the cause of relationship problems and another version of the ‘status quo’. For the sake of argument, let’s imagine Kevin, or someone like him, is convincingly talking back to the resistance. Maybe he also does the ‘Relationship Journal’ and he experiences the death of the blaming self, witnesses how his behavior is causing the problem, etc., this would be a tremendous achievement, but, I would still have some questions: Would they want to feel better, now, or would they want to wait until after they have a better relationship? Would they want to embrace and accept and love their partner, now, flaws-and-all … or would they prefer to keep their guard up, until things improve? Are they still needing the other person to change, in some subtle way? The reason I’d have to ask these questions is because of my own limitation: I can only help someone feel better in this moment, the way things are, right now. Similarly, I can only help someone improve their relationship, in this moment, while their partner is still treating them badly. When people are open to these terms, their lives and relationships can transform in beautiful ways. They can come to appreciate and love themselves and others, just as they are. David, you’ve said that’s the paradoxical first step towards improvement, I think. 2. Brittany asks: How do you deal with the injustice of people who rip you off without giving you credit? Hi Dr. Burns! I hear you say often how it upsets you that people use your work and don’t give you acknowledgment or credit for it. I wondered how you deal with your thoughts like the unfairness or injustice of it. Or maybe you don’t want to deal with those thoughts because the anger helps you in some way? Like it motivates you to create more content & host more trainings etc. so people know the ideas come from you. I was just curious. I deal with similar issues at work where I work really hard for an outcome and then once it happens other employees will take credit for it or just plain ignore the fact that I played any role. I think hearing how you deal with not getting acknowledged would help me too. Thank you, Brittany David’s reply Thanks, Brittany, and good to hear from you again! Maybe we can make this an Ask David. I've been ripped off so much that I try to ignore it, since it would consume a great deal of energy. We may take legal steps once we raise money for our Feeling Good App. For the most part, I always have so much to do, and try to keep moving the ball forward. But yes, I DO get ticked off at people. Plagiarism was considered a severe violation when I grew up, and I still view it that way. Of course, all around the world we can see a tremendous amount of horror and evil being perpetuated by humans. I once asked Dr. Albert Elis a similar question, since Wayne Dwyer ripped him off. His answer was: "I just tell myself that Wayne Dwyer was an asshole, so he was just doing what he SHOULD do, since that's what assholes do! David D. Burns, MD Matt’s Reply: This question is for David, not me. However, I would like to express my deepest and most sincere gratitude to David. David has dedicated his life in the service of improving the lives of others. He has published over a hundred scientific articles and revolutionized the practice of psychotherapy in the form of the TEAM model, as well as publishing at least 12 books, including Feeling Good, the most-prescribed book for depression. He has traveled the globe to offer training seminars to therapists, as well as offering free training to countless students, trainees, residents, PsyD’s and psychologists in his groups, including his ongoing Tuesday training group. It is disturbing and upsetting that someone like David, who has offered so much, would be a target for plagiarism and theft and I admire him for continuing his work, despite all of that. 3. Paul asks: Is there a way to know if I have done the Hidden Emotion Technique correctly? Hi Dr. Burns, It blows my mind how simple yet logical TEAM CBT is. And I am really excited about potential of the app, and I sincerely hope that this will be a revolution in field of psychology and psychotherapy. I really enjoy reading Feeling Great, but some techniques I find complicated. I would like to ask, is there a way to know if I did Hidden Emotion Technique correctly ? Also, I would like to ask if fear of mental illness does count as hypochondriasis as well. At the end I would like to say, that I really appreciate your work Dr. Burns, and I hope that your work will spread around the world and get recognition it deserves, so even more people can be healed. Paul David’s reply Thanks for the kind words, Paul. I will try to include this in an upcoming Ask David segment! Matt’s reply You asked if you did the Hidden Emotion technique correctly. They say that the proof is in the pudding. Do you feel better? Are you experiencing relief? Keep in mind that the Hidden Emotion technique is one of many and may not be the correct method for some individuals. Also, for it to ‘work’ will require not only revealing the hidden emotion, but discovering how to address that emotion. Will you use cognitive techniques to untwist the thinking that is causing this emotion? Will you use the 5-Secrets to respectfully communicate that emotion in a productive way? Will you make a decision about your future that will correct the problem? There are lots of options, but the outcome, if the Hidden Emotion is successful, will be relief. You also asked if worrying about having a mental illness counts as hypochondriasis. The nice thing about this model is that I get to admire you for having all kinds of hypochondriacal worries about your mental health and point out how it’s a ‘solution’ rather than a ‘problem’ and how such worrying speaks highly of you, how responsible you are, how much you care and how much you value your mental health. I’d need you to convince me that it’s a problem!

Ask David: Featuring Matt May, MD 1. Nick asks: “What if you want a positive relationship with someone who does not want the same thing?” 2. Debbie asks: Hi David, I can't stop ruminating and obsessing about weird states of minds or when I was afraid of harming someone or remembering. Everyone says to let go but why do I hang on. Where in your book can you help me? 3. Dean asks: I’m having trouble sleeping. What should I do? 4. Kathy asks a question about social anxiety / panic and the hidden emotion technique. Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. 1. Nick asks many general relationship problems that all need specific examples. Dear David, Thank you for all the amazing work you do. Your books and podcasts have helped me to understand and start to transform a lot of negative and unwanted frames that I carry around. I'm also working with a Level 3 therapist who I found through the Feeling Good Institute. One area I'm working on is building my empathy skills using the Five Secrets model. I see how powerful it is in situations where both people are open to a positive relationship. But I struggle with the idea that each of us creates our own interpersonal reality, and can always create a positive outcome regardless of the other person. Can you help me understand how to apply the technique to some challenging situations? - What happens if you want a positive relationship with the other person, but they fundamentally do not? I find that this situation leads the other person to react to the Five Secrets with anger or indifference. Or they view you as weak for exposing your emotions and vulnerability, and try to exploit them for advantage over you. Is it even worth trying to have a positive relationship with such a person? David’s reply I try not to impose on people who do not want a positive relationship with me. You could also provide a specific example, as I always insist on having! These vague questions to my ear are kind of useless. Matt’s reply David, you’ve said that the cause of all relationship problems is Blame.  I agree with this and sense that Nick’s question is driving at that point, as well.  If someone doesn’t want to participate in our definition of a ‘positive’ relationship, the approach that is most in line with the 5-Secrets and Empathy is to let go and stop demanding the other person change.  That’s the cause of the problem:  trying to force people to do things, our way, regardless of what they want.  This will cause them to resist and will damage the relationship. David, you have also talked about the opposite mindset of blame, where we can wield 5-Secrets honestly and effectively, the concept of ‘Open Hands’.  When we have the attitude of ‘Open Hands’, we can welcome other people and receive them or gracefully let go. This mental state avoids conflict and the ‘blame game’ in a healthy, non-avoidant way. For example, if someone says, “I don’t want to have a relationship with you”.  We might reply, using the 5-Secrets, ‘You’re right, I’ve been disrespectful and inappropriately pushing you too hard in the direction of having a relationship with me.  I appreciate your letting me know, clearly, that this isn’t something you want.  While I can imagine you might be angry with me, I’m sure you don’t want to talk about that, but prefer, instead, to end the relationship as quickly as possible.  I’m feeling awkward and would like to get out of your hair as soon as possible, too.  What can I do to facilitate ending this relationship in a way you would be satisfied with?” To put it another way, while you can maximize your chances of having a positive interpersonal experience with someone, using these communication skills, the 5-Secrets, they are not ‘mind control’ and trying to use them that way will only make matters worse, hence the importance of the internal mindset of ‘open hands’, accepting others’ preferences and being willing to let go, perhaps grieve, refocus our attention elsewhere, if that’s not what they want.  Otherwise, we are in the ‘chasing’ and ‘blaming’ role, which is doomed to fail, as has been discussed on previous podcasts. It may also be useful to consider whether it’s actually possible to ‘not have a relationship’ with someone.  My sense is that there is, in fact, a relationship, even between total strangers and between people who have decided, mutually, to end their relationship.  We could point out how those two types of relationships might differ, say, if you were to bump into each other in a grocery store.  In the latter example, you might be expected to try a bit harder to avoid contact, with an agreed-upon, ‘ex’ than you would, with a stranger.  There are rules and expectations and ways in which both people think about the other person and define their ‘relationship’, even if you are saying that it has ‘ended’.  The conflict comes when we don’t have the same agenda and don’t agree on the terms and rules of the relationship. There are many other related topics, including the ‘gentle ultimatum’, ‘interpersonal decision making’ and ‘blame CBA’ which could be useful for Nick. Nick continues - What if you believe the other person does have a fundamental desire for a good relationship, but they are so attached to their anger, fear or depression that their only reaction is hostility and defense? Perhaps such a person can't or won't admit to their emotions, and rejects the empathy. Should you keep trying, and at what point if any should you give up? David’s reply Need a specific example! I may have mentioned that! Matt’s reply:  A specific example sure would help!  The problem seems related to the ‘blame game’ which we just talked about.  We are demanding the other person change, and stop being so hostile and defensive.  Instead, consider using Interpersonal Decision Making and look at the three options that are available, in any relationship.  If you decide to take responsibility for the relationship, try the Relationship Journal, so you can see through the blame that is causing the problem.  You could also use positive reframing to admire their hostility, defensiveness, anger, fear and depression. Nick continues: Perhaps there are mistaken or lying about the facts, and unwilling to admit it. Or you disbelieve what they say because it doesn't match their actions or is calculated to deflect blame. For example, you may have a conflict over who cleans the house. The objective fact is that you do this 80% of the time and have done it the last 5 times in a row, while the other person has consistently left garbage lying around. Yet the other person says "I feel like you never do housework and I am always the one cleaning, and I'm sick of it". How can you find truth in such a statement? David’s reply Work this out on a Relationship Journals. Write down what you said next, and follow th steps clearly spelled out in Feeling Good Together. Or, I could send you one. Matt’s Reply Disarming is really challenging because it requires us to let go of our version of the ‘truth’, at least temporarily, in order to see the other person’s truth.  People often don’t want to do that, even for a moment!  Furthermore, if the other person is angry, they are likely to distort the truth in their statements, for effect, to be more persuasive.  The problem with this, is that it will call our attention to the lies they are telling, tempting us away from seeing their truth.  Without knowing more about the situation, I could only guess at what their ‘truth’ is.  Here are some possibilities, though:  Is it possible that they have some reasonable expectation for us to do more of the cleanup than them?  Are they offering something else in the relationship that offsets their lack of cleaning?  Do they do the majority of the cooking?  Do they do the shopping?  Do they pay more of the bills?  Also, were they the last one to do the cleaning?  When they clean, do they spend more time on it or do a more thorough job?  When they clean, do they clean up their things as well as yours?  Do you do that?  You stated that they leave their ’garbage lying around’.  Is that how they see it?  Is it possible that they put their things precisely where they wanted them to be and didn’t want you ‘tidying up’? The point is that disarming requires seeing the bigger picture, not just the one data point that best supports your blaming them.  Try to see past this and, if you can’t, considering Interpersonal Decision making and the Blame CBA, where you would write down the good reasons to blame the other person and insist that your version of the truth is complete and correct and that theirs is wrong and bad. Nick carries on - What should you do in situations where you both have attachments to other incompatible goals? In Lee's case on episodes 96-98 of your podcast and Chapter 27 of Feeling Great, both Less and his wife had the same fundamental values with regard to raising their daughter. So once he applied the Five Secrets, they were able to move past their ego defenses and share the same perspective. But what if there is a zero-sum situation where both of you have different core values? For example, choosing a grade school for your child. One parent sincerely believes in their core values that their child will benefit from attending a rigorous school where they will be challenged and grow. The other parent sincerely believes in their core values that children should be in a relaxed environment where they can play as much as possible. Can the Five Secrets help with this type of conflict? David’s reply Read the chapter in Feeling Good Together on the idea that the attempt to solve the problem IS the problem, and the refusal to solve it is the solution. I think you’ve got some work to do! Now we’ll see if you do it! Matt’s Response In this case, you could agree to disagree and let a professional decide what would be best for your child.  Studies conducted longitudinally by Chess and Thomas showed that no one parenting style was ‘best’ overall, but rather that outcomes for human being were determined primarily by how well the parenting style suited the child. 2. Debbie asks: Hi David, I can't stop ruminating and obsessing about weird states of minds or when I was afraid of harming someone or remembering. Everyone says to let go but why do I hang on? Where in your book can you help me? David’s reply You can read my book, When Panic Attacks. You can use search function on website for many illuminating podcasts on anxiety and OCD. You can sign up for the free anxiety class. Go for it. Then ask specific questions about something you're working on based on these resources. Matt’s reply Well, you’re not alone!  Nobody can ‘stop ruminating’.  Try a mental experiment, where you try to ‘stop ruminating about a blue-eyed tiger’.  Tell yourself, ‘I must stop ruminating about a blue eyed tiger!  I must stop ruminating about a blue eyed tiger!’.  You will come to realize that it’s Impossible and the harder you try, the more you obsess.  One possible solution is to find something else, something better, to become the focus of your attention.  Imagine a ‘Miracle Cure’ were possible.  What would you most wish to see happen in your life? You could then use the Decision Making Form, to weigh different options, comparing the miracle cure to the status quo, for example.  There are, after all, real advantages to ruminating and obsessing.  You might have a sense that you’re being responsible, protecting others, preventing yourself from going into weird states of mind and harming people.  This is part of your moral nature, doing no harm, being considerate and thoughtful, sacrificing your needs for others.  That’s a good thing!  Also, you might be afraid of committing to pursuing your dreams, for good reason.  There are real disadvantages of doing that.  The risk of failure, humiliation, conflict, disappointment and defeat, for example.  Until you are convinced that you would want some other version of your life, despite the many advantages of rumination and the disadvantages of change, other methods are unlikely to be effective.  If you firmly decide and are committed to change, meaning that you have convinced yourself that this is what you want, on the Decision Making Form, then there are lots of methods that could be helpful. For example, you could use the Get Specific method and an assessment of Process Resistance.  When do I want to be cured?  What would I be willing to do, to have my dreams come true?  What are some small steps I  could take to get there (Anti-Procrastination / Little Steps for Big Feats).  What time will I do these tasks?  Sit down and schedule time in your day to pursue your dreams (Activity Scheduling).  If intrusive thoughts come in, try ‘Self Monitoring and Response Prevention’.  If temptation is especially tenacious, try the Devil’s Advocate Technique.  I’d recommend looking into things like the ‘Hidden Emotion’.  Is ruminating a form of ‘niceness’, an avoidance of a conflict?  For example, who are you angry with?  Have you told them?  If you go live your best life, who would object?  You can also give yourself a certain amount of time, per day, to obsess, wholeheartedly (worry breaks).  How much time would you like to spend ruminating?  Schedule this time and if you’re ruminating outside that time, remind yourself that you have plenty of time to ruminate later.  Again, there are a lot of methods that could help and finding the right ones will be a bit of trial and error! 3. Dean asks: I’m having trouble sleeping. What should I do? Hi Dr. Burns, I picked up a copy of 'Feeling Great' and am excited to start reading it. I have been battling anxiety, depression, and severe chronic insomnia for the past year. Do I start with TEAM-CBT for anxiety/depression and deal with that first, or do I supplement with CBTi-for Insomnia and do both at the same time? I met with the Mayo Clinic last fall and they said the root cause of the Insomnia is some depression. I have been to a lot of doctors, specialists, and therapists and so far no one has been able to help. Thank you! David’s reply I am not familiar with the insomnia app but it can likely give you some of the basics of sleep hygiene in case you do not already know them. TEAM can be helpful, to say the least, for the mood or relationship issues that may be triggering the troubles sleeping. Often, we may have trouble sleeping because we are upset about something. Sleep difficulties are a non-specific manifestation of being upset about something. There is no special relationship with depression, however. It could be anxiety, anger, anything. Let me know what evolves for you! And, of course, sleep difficulties do not always result from emotional disturbance, but this is often the case. For humans, problems don't usually just come from out of the blue, but from your life! David Matt’s reply The best response to the question, ‘How do I get to sleep at night’, that I’ve heard is, ‘try to stay awake’. Meanwhile, I have a couple of thoughts on diagnosis and treatment planning. Having a diagnosis of ‘anxiety’ or ‘depression’ is like having a ‘diagnosis’ of ‘cough’ or ‘fever’.  Our feelings are symptoms, not the source.  g.  if someone has symptoms of a cough and fever, that could be the result of any number of different underlying causes:  bacteria, viruses, fungi, allergic reactions, autoimmune disease, toxin exposures, etc., etc.  To make more accurate guesses about an appropriate treatment regimen, we need greater specificity.  In the treatment of symptoms like depression, anxiety and insomnia, we would need to know much more about a specific moment in time when you were having these symptoms, what you were doing, what you were thinking and details about the feeling state you were in before deciding how to prioritize the methods that would be part of a treatment plan, which we call a ‘recovery circle’ in TEAM. In medical school, they train physicians to ‘cast a very wide net’, when considering all the possible causes of the symptoms a patient is experiencing. This list of possible causes is referred to as a ‘differential diagnosis’ by physicians.  The idea is to organize this list according to what is statistically most likely given all the information we have on hand and to conduct various tests to narrow down these options, in order to prioritize a treatment strategy that is most likely to be effective.  Meanwhile, we want to keep open in our minds that our diagnosis could be wrong and that we will need to monitor the outcome carefully, with frequent testing, rather than assume we know the ‘root’ problem with 100% certainty, so we can modify the treatment strategy based on results. While it’s tempting to try to try to optimize treatment results by matching the diagnosis with a ‘school’ of therapy, (ERP for OCD, EMDR for trauma, DBT for BPD, etc.), there are several problems with this ‘schools’ vs. ‘tools’ approach to therapy. For one, the reality is that people are quite complex beings and diagnostic labels are quite imprecise and limited.  Even when we have an accurate diagnosis, we can’t predict precisely which specific set of methods will be required to help someone recover.  Furthermore, even if someone has the exact same set of upsetting negative thoughts related to their anxiety, depression and insomnia, perhaps their thoughts circle from ‘I must get some sleep, I’ll never get to sleep, I’ll feel terrible tomorrow, Everything will go wrong, I’m a hopeless case, I’m a loser…I must get some sleep (repeat)’, even if the thoughts are the same in multiple different people, we can only make informed guesses, rather than predict, perfectly, what method(s) will suit that individual best.  Will it be the double standard technique, or cognitive flooding, sleep restriction, the hidden emotion, the Socratic technique or memory rescripting, self-monitoring or response prevention, something else? The solution to this uncertainty is the Recovery Circle. The ‘recovery circle’ is a customized list of at least twenty methods, that are selected based on the specific feelings, thoughts or behaviors someone would like to see change.  Each of these methods will have some reasonable chance to help an individual, with their particular thoughts and feelings and behaviors.  The idea is then to ‘fail our way to success’, using trial-and-error, with measurement in between, to discover, scientifically, what is the best method for that individual.  Once we do, we focus on practicing that method regularly to gain skill with it, until our patients are not only cured, but able to recover from relapses on their own, because they know the methods that are most helpful to them. Another consideration is that, in general, folks benefit from an approach that is kind, empathic, respectful, grounded in science and measurement, and attentive to resistance and motivational barriers to change. One reason I would recommend TEAM to a family member or friend is that it contains each of these necessary elements of therapy and also has the greatest diversity of tools to help someone, as well as a customized approach to treatment.  I think that’s why TEAM has been shown to be much more effective than other forms of therapy. All that said, it’s important to realize that TEAM itself is incomplete and we would want to continue to expand up the model and, when you’re in treatment, know that it’s fine to get a second, third or fourth opinion on what methods and approaches are most likely to benefit you. 4. Kathy asks about social anxiety, panic and the hidden emotion technique. Hi Dr. Burns, Thank you so much for all the great information you put out there! I had a question about hidden emotion. If I experienced dizziness in a social setting ten years ago and now I panic whenever I am in a similar situation anticipating the dizziness. Is there still a connection to the original emotion that is still hidden or is it a habit at this point? Thank you so much David’s reply Were you upset with somebody or something in that situation? Matt’s reply: You could use uncovering techniques, like the ‘What If’ Technique and the ‘Interpersonal Downward Arrow’, among others, to figure that out. For example, ‘what if you got dizzy?  What’s the worst that could happen? You can write down your answer, and continue to ask yourself, ‘what if that happened, what would I be anxious about?’.  Then, as yourself, if that happened, what would other people think about me?  How would they treat me?  What kind of people are these people, I’m imagining?  How do I feel about people like that?  

304: TEAM-CBT, Spirituality, and Beyond: Featuring Angela Poch Rhonda begins today’s podcast, as usual, by reading two touching emails from podcasts fans, including Coach Teddy, who said that Podcasts 295 and 296 featuring live work with Zeina were incredible, and Carol who was equally enthusiastic about Podcast 297 (on “Homework—Yuck!). Carol also strongly recommends David’s book, Ten Days to Self-Esteem which is a simplified version of Cognitive Behavioral Therapy that can be used as a manual for therapy or self-help groups.

https://www.amazon.com/Days-Self-Esteem-David-Burns-M-D/dp/0688094554

Today, we interview Angel Poch, a certified life coach, registered professional counselor, and certified Level 4 TEAM therapist and trainer. She lives two hours north of Glacier National Park in British Columbia, but teaches therapists and treats people virtually from around the world. Her new booklet, “The Truth Shall Set You Free,” integrates TEAM-CBT with a Christian perspective and is available for free on her website. https://www.angelapoch.com/. She is a regular in David’s weekly virtual psychotherapy training group at Stanford and assists in the teaching. She has also worked tirelessly and selflessly behind the scenes making David’s work way more accessible to lay people as well as mental health professionals wanting to learn more about TEAM-CBT. For example, she adds links to every new Feeling Good Podcast on David’s website, so you can easily find and link to more than 300 podcasts. Check it out! She has also transformed a massive amount of David’s work into electronic tools for shrinks, accessible in David’s online shop: Recently, she has created two amazing new documents you can link to. One is a spreadsheet that lists 138 of David’s TEAM-CBT tools and techniques, like the “Anti-Procrastination Sheet” and many others, with page links to the descriptions of how to use each tool in David’s books, like Feeling Good, Feeling Great, David’s TEAM-CBT therapist eBook, and many others. Check it out! This data base will be invaluable to interested lay people, therapists, and teachers who want clear instructions on how to use the Daily Mood Log, Relationship Journal, and numerous additional tools and techniques. Derek Gurney and Angela are working on an equally awesome database for the Feeling Good Podcasts: Check it out as well! Angela begins her personal statement in today’s podcast by describing her struggles with depression and irritability, including some very dark days in 2006. Her doctor recommended an SSRI antidepressant, and she went to integrative health program, “Depression: the Way Out” that required participants to read Feeling Good

https://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380810336

Although she didn’t love the book, she resonated with the idea that all of our feelings, positive and negative, result from our thoughts, or perceptions, and her depression cleared up. She liked that when she read Feeling Good, she got many new tools she could use to change her negative thoughts and feelings. She also appreciated the ideas in the book didn’t go against her belief system, which many fear about psychology. David pointed out his own father, a Lutheran minister, worried about this, and was very suspicious of psychiatrists. Angela’s thinking, which resonates with David’s, is that the core ideas of religion and psychotherapy are actually high compatible, and even synergistic. Angela explains that when she was a young child, she didn’t fit in socially or even in her own skin. “I felt like I was a boy in a woman’s body. I felt like I was in the wrong body, and prayed for help.” She started to see in a very limited, childlike way, her thoughts were distorted, that a body was just a body and she could trust God wouldn’t give her more than she could bear. These new realistic, counter thoughts relieved the negative body dysmorphia she’d been struggling with. She reports, “I decided it was okay to be flawed and not fit in.” The rest of her young childhood was mostly joyful. In middle school she was the target of mean-spirited bullying because she was a tomboy. She developed intense social anxiety and was relieved when her mom took her out of school. She was homeschooled for a few years and studied Karate to exercise and develop some confidence. High school brought new challenges. She describes responding with her version of the Five Secrets of Effective Communication to an aggressive bully who threatened her with brass knuckles and challenged her to fight her. However, the girl backed off and started telling people that Angela was her friend! After a bad relationship, Angela started to struggle with depression and described her suicide attempt when she was 18 because “I wanted the pain to stop.” She explains that: I met my husband, moved home, and started reading the Bible. I was impressed by the passage, “the truth shall set you free.” I realized I had to control my own thoughts rather than look for the approval of others, but she still didn’t totally recovery from my anxiety. The cognitive piece in Feeling Good helped Angela a lot. She states, “I pursued a lot of careers, never holding down a job for more than 6 months, and one day someone asked if I’d considered a career in counseling. . .” She went on to take one of David’s four-day live intensives in Whistler BC where she learned TEAM-CBT and hasn’t looked back since! After learning and applying TEAM, Angela was able to crush her social and other anxieties. Angela has a deep love for her Creator and has done a great deal of thought about the integration of her Christian faith with TEAM-CBT. David also has a strong interest in the overlap between TEAM-CBT and virtually all religions and spiritual paths. He described an unusual and overpowerful spiritual experience he had as a medical student crossing the Nevada desert that made a strong impact on him. Angela would like to mention, “I have a profound gratitude for David’s work. He makes things so clear and relatable. His approach is applicable to all faiths or no faith if one is truly ready to give up their negative thoughts and feelings. As we aim for the truth, and let go of the so called “self,” we find peace and joy. I will forever be indebted to him because I would not be able to help people without TEAM and that brings me joy every day!” I, David, would like to thank Angela for her intense and tireless devotion to helping spread the “gospel” of TEAM-CBT in so many ways! Thanks for listening today! Angela, Rhonda, and David I

Ask David Bipolar, the Dark Side, Changing Behavior

We have lots of great questions today. The answers in the show notes were written prior to the podcast, and the answers in the live podcast as we discussed these questions may differ somewhat or amplify the written materials in these show notes.

We love your questions. Remember to send them to David@feelinggood.com.

Announcement: Our awesome summer intensive is returning after a long, five years due to the pandemic. It is typically the most outstanding and rewarding TEAM-CBT training of the year, and it will take place again and the wonderful South San Francisco Conference Center from August 8 – 11, 2025.

You can attend in person if you register soon, since in-person seating will be strictly limited and only a small number are still available. You can also attend the online, live-streamed version of this program at a substantial discount. The online experience and small group exercises will be similar for the in-person and online participants.

Check out the details, including early-bird discounts, at www.cbtintensive.com

www.cbtintensive.com

Hope to see you there!

Warmly, david

Today’s Questions

1. Alison asks: I have bipolar Disorder and I have had trouble challenging my negative thoughts. I’m suffering. What can I do
2. NAME WITHHELD asks: Can or should a person really and truly accept their dark side?
3. Trainor asks: In TEAM there is a strong emphasis on changing the way you think. But is it sometimes also important to change your behavior, or to make real changes in your life, or to help others who need help changing their circumstances==for example, people who are struggling in poverty.

 

1. Alison asks: I have bipolar Disorder and I have had trouble challenging my negative thoughts. I’m suffering. What can I do?

Hi David,

Many years ago I used your book to beat depressive thinking… in the last three years I’ve been diagnosed with Bipolar Disorder and have found my depressive thinking too difficult to budge with your book.

I’m really suffering; any ideas about what I could do?

Thank you for your service to humanity. I always recommend your book.

David’s response

Hi Alison,

A therapist could help. The new Feeling Great App could help. And tons of free resources at www.feelinggood.com.

In addition, can you please give me an example of the negative thoughts you can’t budge. Then we can point things out in the podcast and try to figure out why you’re getting stuck!

I have found that doing cognitive therapy / TEAM-CBT with individuals with Bipolar Disorder is exceptionally helpful during the depressed (not manic) phase, and works pretty much the same way as with anyone who’s feeling down.

Best, david

 

2. NAME WITHHELD asks: Can or should a person really and truly accept their dark side?

Hello David,

My name is NAME WITHHELD and I am doing my PhD degree in Neuroimmunology in LOCATION WITHHELD. I had come across your book feeling good and your podcasts by one of my therapists - they have had an immense impact on my way of thinking.

I really love disarming and using “I feel” statements to connect! I had also realized that by finding some genuine truth in a person’s belief even if it sounds ridiculous, I would automatically develop certain level of respect for that person! I really love that! I feel really happy that I can respect a person even without accepting his/her beliefs!!

I am now working on my distortions. I really love working on my mind that way.

Anyway, I have wanted to ask you if a person CAN accept his/her dark side? I seemed to have loathed myself for quite a long time and couldn’t stand living alone without a partner or a person around. I hated myself for disrespecting my mother whilst growing up.

But, sometime during Dec last year, I had had an epiphany of why things happened the way they did and somehow, I learnt that the reason why I had disrespected my mother was because my father, after their separation, kept filling my mind about how wrong my mother was for breaking up the family and I believed him because I had a good rapport with him, than I had with my mother.

Also, my mother was very awkward in building a relationship with me and I had misconstrued that with her indifference towards me. After that, I stopped hurting myself over it because I had learnt to empathize with myself then. I sobbed profusely that day.

Is it really possible to truly accept yourself? I feel at ease a lot more these days than I used to before. But I also have to battle my distortions too on a regular basis!

Please help me out here! Thank you so much for everything that you have done!! I really love your work!!

Regards,

NAME WITHHELD

David’s reply

Thanks so much. I hid your name and location, and hope that’s okay, and we WILL include your excellent question on our upcoming podcast. My brief reply is that all human beings have a “dark side,” and that we are far better off accepting it, as opposed to denying it and seeing ourselves as “totally good,” because then we might see others as “totally bad,” and feel morally superior. This dynamic is the cause of wars and a great deal pf hatred and suffering.

 

3. Trainor asks: In TEAM there is a strong emphasis on changing the way you think. But is it sometimes also important to change your behavior, or to make real changes in your life, or to help others who need help changing their circumstances--for example, people who are struggling in poverty.

Hey David!

I have asked several questions over the years (I asked about A.I. which I much enjoyed the episode on that!), so feel free to ignore this email if you feel I've overburdened you guys.

Anyway, I had a question about changing thoughts versus circumstances.

You often say that our thoughts create all of our emotional and interpersonal realities. I thought maybe a better or more nuanced definition would be to also mention that events CAN change our feelings but they do so through changing our thoughts.

I have heard Matt May mention this idea in some circumstances as the "low road to recovery." Where you actually get the thing you think you need and as a result feel better.

However, I thought about certain situations where changing the circumstance could also be a valid solution to an individual's problems. Take someone living in poverty, I am certain that CBT could help this person change their emotions around the experience of living in poverty. But would bringing the individual out of poverty be considered a "low road to recovery"?

Or could we say that bringing someone out of poverty is also a valid way of changing their emotional distress? Like sort of how therapists use both exposure and cognitive techniques to quell phobias or certain anxieties.

I personally like this definition because it includes the ability to change your circumstances as a method to change your thinking, without it being the only method. It also makes sense in a world where people want to make changes in society (giving women the right to vote, ending child labor) and create environments that foster positive thinking.

I think so much focus on the cognition (while fundamentally true) makes it feel like people should focus exclusively on changing the way they think about a situation. When, in reality, it seems like we can both change our circumstances and thinking simultaneously to make our lives better. Anyway, just wanted to know what you thought about this idea.

Thanks for everything you do,

Trainor Peters

P.S. I have nearly completed my first year of my psychology undergrad to become a counselor. In great part to you and all the wonderful people on your podcast. So, thank you!

David’s reply.

Thanks, Trainor,

I will add this excellent question to our Ask David list, if that’s okay, and discuss with Matt and Rhonda on a podcast.

My hospital in Philadelphia was located in an inner-city neighborhood, and many (perhaps most) of our patients have very limited resources. Some were homeless, and many had not completed the 5th grade. This gave me abundant opportunities to work with people with “real” problems in addition to their distorted perceptions.

In addition, I have always emphasized that sometimes you need to change the way you behave in the “real” world in addition to changing the way you think about it.

We’ll give these topics a deeper dive on the live podcast discussion.

And, best of luck in your ongoing training! Once you are in a graduate program, you will be eligible, if interested, to join one of our two free weekly TEAM-CBT training groups, which are both virtual.

Warmly, david

Thanks for listening today!

Rhonda and David

Special Announcement 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 long 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.

But there's some good news, too! 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!

The Dramatic Journey of Jason Meno In today’s podcast, we interview the amazing but humble Jason Meno, who has been doing incredible programming for the Feeling Good App for the past year. Like everyone on our app development team, Jason was driven to TEAM-CBT and the Feeling Good App by his own personal struggles, and also by his training in Buddhism and his commitment to doing something to help relieve the enormous suffering endured by so many people in the United States and around the world who are struggling with depression and anxiety. The podcast notes will focus first on how he recently came to join our app team, and then on Jason’s amazing early years in his search for meaning and a solution to his personal suffering and tragedies. Jason’s journey to the Feeling Good App Jason began the podcast by describing how he became familiar with David’s work. Then he described his own personal journey and search for enlightenment. I’ll summarize some of both in these show notes. He said: I was struggling with severe depression in 2020. I felt like my body was falling apart because I’ve been afflicted with type 1 diabetes since I was five years old. I didn’t have the resources to work with a therapist and felt hopeless, so I searched the internet, looking for a way of overcoming depression on my own. I first turned to apps for help, but my experience was not great. I eventually found David’s book, Feeling Good: The New Mood Therapy. Through that book, I discovered that depression and anxiety are cons and that I was tricking myself. However, I didn’t use the tools or do the written exercises in the book. I started listening to the Feeling Good Podcasts and waited for the new book, Feeling Great. Often, when listening to the podcasts I would start crying. I am not a crier, and this often happened in public, so it was pretty embarrassing! I was also practicing meditation every day, but that didn’t provide much help. It does have its benefits and was a solace for me when I had nothing else, but after years of practicing, it still didn’t give me the tools to combat the thoughts that trigger depression and suicidal urges. But then I had an “ah-ha” moment when David talked about resistance and the power of positive reframing. It was a tremendous relief to see that it was reasonable to feel the way I was feeling. I devoured the Feeling Great book but still wanted to die since I was still not doing the written exercises that David repeatedly urges the reader to do. Then, on one of the podcasts, someone said, “you can’t challenge your negative thoughts in your head.” I resisted that message and told myself that I had no negative thoughts. Many of my negative thoughts are quiet since you learn to empty your mind when you meditate. But then I realized that negative thoughts are just the top layer of your consciousness and that the concept of “cognitions” not only includes thoughts like “I’m a loser,” but also your daydreams, beliefs, and perceptions. Then, once I sat down and wrote down my negative thoughts, identified their distortions, and challenged them with more realistic thoughts, I began to feel a lot better within five minutes! If you, the podcast listener, are feeling down, there’s a step-by-step guide in Feeling Great that could be enormously helpful to you. I started following this guide, and then I really started to feel great. After using it a few times, I had the thought, “Wow, this could be a pretty amazing app!” One of the first questions you ask yourself, “do I really want to feel better?” had a massive impact on me and, of course, is one of the unique elements of TEAM-CBT. And although I made mistakes while using the tools on my own, they still helped more than anything else I’ve tried. Eventually, I saw a non-TEAM therapist who provided me with some great empathy and valuable perspectives while I used the TEAM-CBT process and daily mood log on my own. Then I suddenly realized that I had no more suicidal thoughts. TEAM-CBT is a way for you to rapidly train your mind and develop a new mindset that reduces suffering. This is an important ethical issue to me, given all the suffering that remains throughout the world, and it reminded me of my Buddhist vow to help others. So, I signed up to be a beta tester for David’s Feeling Good App. However, I was disappointed in the early version I tested and created a 12-page document listing my complaints. Then I reached out to Jeremy Karmel, the CEO of the Feeling Good App, and he invited me to join the development team. I was so excited that I left my job as a data scientist working on an automated insulin device and joined the app development team. And although I was not familiar with the computer language Jeremy was using, I learned it quickly, and now I’m programming all kinds of cool things for the app! Jason’s early years You may or may not be familiar with Herman Hesse’s famous 1922 novel, “Siddhartha,” which traced the journey of the young Buddha as he was searching for personal enlightenment and unlocking the key to human suffering. (https://en.wikipedia.org/wiki/Siddhartha_(novel)) I have not read many books, because I am a slow reader, but that one is short and has always been one of my favorites. Jason’s intense and dramatic journey reminds me of Siddhartha’s path. Jason’s road to TEAM-CBT, his current passion, was not a direct one at all. Like myself (David), he was raised in a strict Christian home but found himself attracted to exciting and controversial topics when he was in high school, like astral traveling and “lucid dreaming,” which means becoming aware when you are dreaming so you can take charge of your dreams and do things in your dream world that you may not be permitted to do in real life. For example, Jason has been treated for type 1 diabetes since the age of 5 and has to monitor his blood glucose levels 24 hours a day. Things like fresh orange juice are dangerous because they cause a spike in blood sugar, but in a lucid dream you can drink all the orange juice you want! I can identify with Jason’s yearning for fresh squeezed orange juice, because I grew up in Phoenix, Arizona, and we had many orange trees in our yard, so the orange juice was plentiful and incredibly delicious! When Jason was a teenager, there was a magic / occult shop near his high school that he would joyfully and curiously explore after school, but his parents were dead set against it. They told him that he was exploring ideas promoted by the devil and threatened to kick him out of the house! I also identified with these memories, as I also used to hang out in magic stores in Phoenix when I was in high school. But these were more the kinds of shops that sold tricks of various kinds that magicians could use. Although Jason studied biomedical engineering in college, he continued to be fascinated by his more exciting “alternative” occult pursuits, and dropped out of college to join a cult in Sedona, Arizona. The cult members insisted that he could cure his diabetes simply by believing he could, so he obediently stopped taking his insulin and monitoring his blood sugar for one day and nearly died. Jason described that his mother struggled with emotional issues. After running away with him twice when he was 10, she lost custody and disappeared to Santiago, Chile. Jason had not heard from her since. But one day, out of the blue, his brother called him and said that their mom had suddenly returned home, and there was some talk of starting a family bakery. Jason was thrilled and purchased a plane ticket to fly from Indiana to Hanford, California, to surprise his mom after not seeing her for 10 years and offer to help with the bakery. But then right before leaving, his sister called and asked if he had heard the news. At first, he thought she was talking about the family bakery, but his sister said, “No, mom just committed suicide.” Jason was devastated and sadly flew home out for the funeral. Although his mother’s body was not present at the funeral, he looked and suddenly thought he saw her standing in the church during the service. This jolted him, understandably, until it dawned on him that it was his mother’s twin sister. His aunt offered him a new life, a car, and a beautiful home in Carmel-by-the-Sea, California, but he was still obsessed with the cult, so he returned to the cult in Arizona. He spent all his savings of $3,000 for special training to become a cult leader and ended up living as a homeless person in Boulder, Colorado. However. he started running out of his diabetes medications and having panic attacks. He eventually found work in a Buddhist retreat center in the mountains of Colorado and started studying Buddhism, making friends with the monks, and began doing traditional mediation. He said that mediating intensified his negative feelings, and he became suicidal, and even tried a special “suicide meditation” that he’d learned from the cult in Arizona. They claimed that if you did this meditation, you would disappear and end up in a kind of different universe, but after trying it several times, he realized it was all bunk and gave it up, along with the other crazy cult things he’d been taught. However, he did make a sound connection with traditional Buddhism, and lived at the retreat center for about a year. He described a special meditation where you ask yourself, “what doesn’t need to change?” The goal is to discover that the answer is “nothing” since everything is in constant flux, and this meditation is intended to lead to a kind of acceptance. But, he says, “at first I resisted.” He said he did experience feelings of pleasure and euphoria during some of his mediations, but that this was not a permanent cure for his depression. That’s because the meditation was a distraction or escape from his negative thoughts, a kind of temporary trance-like state, but when you finish meditating, you are back to your normal life, so your negative thoughts and feelings return. Jason has become an enthusiastic advocate of TEAM-CBT, and described two ways of challenging negative thoughts based on David’s Externalization of Voices Technique. One approach is highly rational, and it reduces your negative feelings but does not flood you with feelings of joy or enlightenment. The other approach reduces your negative feelings AND energizes you with feelings of joy. The second involves using David’s Externalization of Voices Technique along with the three strategies for crushing negative thoughts:

• Acceptance
• Self-Defense
• The CAT, or Counter-Attack Technique.

David asked Jason to discuss one of the traditional Buddhist definitions of enlightenment. You are “enlightened” if you are free of greed, ignorance, and delusions. However, he sent this delightful email following the podcast recording: Hi David and Rhonda, Thank you so much again for having me on the podcast! It was a blast! I wanted to clarify an important mistake I made: A commonly accepted Buddhist definition of enlightenment is to be completely free of the three root poisons of greed, hatred, and delusion. These are considered to be the source of suffering / negative thoughts / mind states (Buddhists refer to these as Kleshas). I can't remember exactly what I said in the podcast, but I think I may have incorrectly listed the three poisons as greed, delusion, and ignorance. Delusion and Ignorance are considered to be in the same category, so I think I forgot Hatred. Oops! Looks like I'll have to brush up on my studies again! Hopefully, we can help make this clear in the show notes as well. If you or anyone you know is at all interested in learning more about Buddhism, its philosophies, and history, I highly recommend the YouTube channel Doug's Dharma. Candidly, Jason I am very grateful for the creative and life-changing contributions that Jason is making in our Feeling Good App, and I feel tremendously lucky to know Jason on a personal and professional level. His quite humility speaks loudly and boldly about the kind of loving and genuine person he is, and if you decide to beta-test our app, you will have the chance to benefit from his personal journey and his professional genius! If you’re interested, you can sign up to beta test the app at www.feelinggood.com/app. If you would like to contact Jason, you can reach him at asonmeno@feelinggoodapp.com. After reviewing the draft of the show notes, I got this link from Jason: Also, if you are interested in reading a little more of the story, I wrote this article a few years ago about some scary health challenges I had and how I ended up leaving the Buddhist retreat center and returning to school: Buddhist Enlightenment or Just Life with Diabetes?
Thanks for listening today! Thanks! Rhonda, Jason, and David

Today, you will hear the the second half of the live therapy session that Dr. Jill Levitt and I did with Nazli, a young woman from Turkey, at our recent “David Burns Live” workshop on May 22, 2022. Nazli has been struggling with intense performance anxiety and generalized anxiety, and generously who volunteered to be a “patient.” Jill and I are very grateful for Nazli’s courage in sharing herself so courageously with all of you, and hope you enjoy the session and learn from it. Last week, we played the first half of the therapy session, including the initial T =Testing and E = Empathy. Today, you will hear the exciting conclusion, including A = Assessment of Resistance and M = Methods, and final T = Testing. As a reminder, you can review the Daily Mood Log and Brief Mood Survey (BMS) that Nazli filled out at the start of the session. Part 2 of the Nazli Session: A = Assessment of Resistance and M =  Methods After a period of empathizing, Nazli gave Jill and David an A in Empathy, so we moved on to the Assessment of Resistance portion of the session. This often involves the following steps:

• Invitation Step
• Miracle Cure Question
• Magic Button
• Positive Reframing
• Pivot Question
• Magic Dial

Jill issued a Straightforward Invitation, asking Nazli if she was ready to get down to work, or if she needed more time to vent. She said she was ready to go to work, so Jill asked what changes she was hoping for during the session. This is the so-called “Miracle Cure Question.” This helps to focus the session on something specific. Nazli said that her hope was to reduce or eliminate the negative thoughts and feelings that were making her clinical work so stressful. And like nearly everyone, she said she’d eagerly press the Magic Button. Then Jill and David pointed out that although we didn’t have a Magic Button, we did have some powerful techniques that could help, but it might not be the best idea to use them. That’s because there might be some positives hidden in her negative thoughts and feelings, and perhaps we should first take a look. David and Jill asked Nazli these three questions: 1. Given your circumstances, why might this negative thought or feeling be totally appropriate and understandable? 2. What are some benefits, or advantages of this negative thought or feeling? 3. What does this negative thought or feeling show about you and your core values that’s positive, beautiful, or even awesome? This technique is called Positive Reframing. The goal of Positive Reframing is to reduce the patient’s subconscious resistance to change, along with their feelings of shame about their symptoms.. Paradoxically, the moment patients see the beautiful and awesome things about their negative thoughts and feelings, their resistance to change typically disappears. Positive Reframing is one of the unique features of TEAM-CBT and it opens the door to the possibility of rapid change. As an exercise, see if you can find some positives in five of Nazli’s feelings,

• Anxiety
• Ashamed, bad
• Inadequate
• Hopeless
• Angry

Please do this on paper, and NOT in your head, using the blank Positive Reframing Tool you’ll find at the end of the Daily Mood Log. Getting it “right” isn’t important. What is important is trying. This will get your brain circuits firing in a new way. Then, when you see the work that we did with Nazli, you might have your own “ah-ha” moment, as well as a powerful new skill that may be helpful to you as well. Okay. Did you do that yet, or do you plan to look at the answer without doing the exercise? Oh! I see! You’re planning to look at the answer. If you want to learn at a deep level, whether you’re a therapist or lay person, do the exercise first! It may be challenging at first, but it will fire up your brain circuits, so when you look at the answer, you’ll suddenly have a new and deeper understanding of Positive Reframing. When you’re done, you can check this link to see the work that Jill and I did with Nazli. But either way, I’m grateful that you’re listening to these podcasts and reading the show notes! If you click on this link, you can find the Emotions table from Nazli's Daily Mood Log showing her goals for each negative feeling after we use the Magic Dial. After we finished the Magic Dial, we went on to the M = Methods portion of the TEAM-CBT session, and helped Nazli challenge some of her negative thoughts using a variety of techniques including Explain the Distortions, the Externalization of Voices, Examine the Evidence, the Acceptance Paradox, and more. One of the thoughts she wanted to work on first was this one: “If I don’t fix this patient or make him/her satisfied, then she/he will judge me and think poorly about me.” Together with Nazli, we identified a number of distortions in this thought, including a couple more that popped into my mind while doing the show notes:

• Fortune-Telling: Making a negative prediction without good evidence.
• Mind-Reading: Assuming that I know how my patients are thinking.
• Hidden Should Statement: Telling myself I should be doing better.
• Mental Filtering: Selectively noticing the times sessions have not gone well.
• Discounting the Positive: Overlooking the positive feedback I typically get from patients and supervisors.
• Magnification and Minimization: Magnifying the importance or “awfulness” of negative feedback from patients, and overlooking the potential value of processing their negative and positive feedback with them at the next session.
• Emotional Reasoning: Thinking that my feelings of inadequacy and anxiety mean that I really am screwing up with patients
• Self-Blame: Beating up on myself constantly when I’m seeing patients.

Nazli’s belief in this thought went down from 80% to the range of 10% - 20%, since there was some truth in the thought. Sometimes you’ll want to smash a negative thought, so your belief in it goes all the way to zero. Sometimes, it’s okay just to reduce your belief in a thought substantially, but not all the way to zero. We also encouraged Nazli to begin using the Brief Mood Survey (BMS) and Patient’s Evaluation of Therapy Session (EOTS) with every patient at every session so she can get immediate and accurate feedback of how she’s doing, and so she can fine-tune her therapeutic strategies based on this information. This practice is vastly more effective than Mind-Reading, since therapists’ perceptions of how patients feel tend to be wildly inaccurate most of the time. If you are a therapist, T = Testing at start and end of every  is a vitally important key to personal and professional growth, although it takes courage because sometimes—or even often—you will have to confront some information that may threaten your feelings of pride! You can see Nazli’s final ratings of her feelings on the Emotions table her Daily Mood Log at the end of the session. Since the changes in all of her negative feelings were dramatic, we asked Nazli two questions: 1. Are these ratings valid, or are you just trying to please David and Jill? 2. If so, what were the effective ingredients of your session. What, more than anything else, accounted for the significant and rapid changes you experienced? You will hear how she answered these vitally important questions on the podcast, and you can see Nazli’s BMS and EOTS after her session if you click the link. Thanks for tuning in last week and today! Once again, Rhonda, Jill and I want to thank our wonderful and courageous Nazli from the bottom of our hearts! We hope you enjoyed this session, and the chance to look behind closed doors to see how psychotherapy actually works in a real session with a real human being who, like nearly all of us, struggles at times with that ancient belief that “I’m just not good enough!” In fact, we’re all, in many ways, “not good enough,” and will probably never be “good enough.” But that is never the cause of our problems, especially our lack of self-esteem. Do you know what the actual cause is? Do you know what the solution is? Take your best shot, make a guess, and then you can click on this link. Thanks! Rhonda, Jill, Nazli, and David

In the next two podcasts, you will hear the live therapy session that Dr. Jill Levitt and I did with Nazli, a young woman from Turkey, at our recent “David Burns Live” workshop on May 22, 2022. Nazli has been struggling with intense performance anxiety and generalized anxiety, and generously who volunteered to be a “patient.” Jill and I are very grateful for Nazli’s courage in sharing herself so courageously with all of you, and hope you enjoy the session and learn from it. Although the facts of your life are probably quite different from Nazli’s, you may be able to identify with the almost universal theme of feeling like you are not “good enough.” The ultimate antidote to this type of suffering is simple, but so basic that you may not “see it” at first, especially when it comes to your own negative thoughts and feelings. Although we all have many flaws and shortcomings, our inadequacies are rarely or never the cause of our emotional distress. Our emotional distress, in terms of anxiety, depression, inferiority, loneliness, hopelessness, and anger, nearly always results from our thoughts, and not so much from what’s actually happening in our lives. In addition, the thoughts that trigger those kinds of feelings are almost never valid. Instead, they are loaded with cognitive distortions. As you probably know very well, I have often said that depression and anxiety are the world’s oldest cons. And here’s the really good news. The very moment you change the way you THINK, you can change the way you FEEL! Sounds wonderful. But isn’t it just a little, or a lot, too good to be true? And can you really trigger real change at the gut level by changing the way you think? Let’s find out! In today’s podcast, you’ll hear the first half of Nazli’s session, including T = Testing and E = Empathy. Next week, you’ll hear the exciting conclusion of her session, including the A = Assessment of Resistance and M = Methods, followed, of course by the final of T = Testing so we can see if Nazli really changed, and if so, by how much. We’ll also see and how she rated Jill and David on Empathy, Helpfulness, and more. If you’ve followed the Feeling Good Podcasts, you know that doing live therapy to challenge your own demons is part of therapist training in TEAM-CBT This experience greatly deepens your understanding of team and allows you to give this message to your ow patients: “I know how you feel because I’ve been there myself. And it will give me great joy to show you how to CHANGE the way you FEEL, too!” I think of this personal step as the transition from technician to healer. But you cannot take this step with credibility if you haven’t yet done your own “work.” At the start of the session, Nazli explained that she’s struggled with anxiety ever since she was a child, and that’s what triggered her interest in a career as a clinical psychologist. In my experience, this is true of many if not most mental health professionals. Although the general public often have the impression that shrinks have it all together, nothing could be further from the truth. Most went into the field hoping to find a solution to their own suffering, and a great many—probably nearly all—are still searching and hoping to find a their “cure.” After completing her master’s degree in counseling 10 years ago, Nazli got a job at a counseling center, and in spite of the fact that she received consistently good feedback, she quit after 2 and 1/2 years and took a job in administration. This was because of the intense anxiety she experienced during sessions, resulting from the constant and relentless bombardment with negative thoughts that popped into her mind when treating  patients. However, she still yearned to do clinical work, so she decide to go back to clinical work several years ago and has been doing therapy for patients being treated for cancer. But the negative thoughts and feelings still continued to haunt her. You can review them on the Daily Mood Log that Nazli showed us at the start of her session. As you can see, when she’s treating patients, she feels severe depression, anxiety, shame and inadequacy. She also feels humiliated, hopeless, and discouraged, along with some moderate feelings of anger and resentment. Nazli explained that she has no fear of public speaking, but said that when she’s working with a client, she constantly criticizes herself for fear of making a mistake and tell herself:

• I’m not doing a good job.
• This job is not for me.
• Should I just quit?
• My friends are at a better place in life.
• I’m 38 years old and missing out on a lot.
• Why am I like this?

Recently, she went to visit one of her patients, a young woman struggling with lung cancer; but when Nazli entered the room, her patient said: “I don’t want to talk to you!” Nazli said, “I was devastated and felt like crying.” When you review Nazli’s Brief Mood Survey (BMS) at the start of the session, you’ll see that the only feeling that was elevated was anxiety, and that was minimal. However, her score on the Happiness Test was only 8 out of 20, indicating that she didn’t feel very worthwhile, happy, hopeful, motivated, or satisfied with her life. This meant that her negative thoughts and feelings when she was seeing patients were making a huge impact on her capacity for happiness and self-esteem. Her minimal scores on the depression, anxiety, and anger scales on the BMS also reflect the fluctuating nature of anxiety and other feelings for many people. For example, you may have little or no anxiety most of the time, and when you’re having a session with your shrink you may not feel especially anxious, either. But when you encounter the situation that triggers your anxiety, the feelings suddenly spike tremendously, along with a host of other negative feelings, and then the emotional discomfort can be overwhelming. End of Part 1 of the Nazli Session: T = Testing and E = Empathy. Next week, you will hear Part 2: A = Assessment of Resistance and M =  Methods. Thanks! Rhonda, Jill, Nazli, and David

Podcast #300: Celebrating Five Million Plus

 In today’s podcast, we celebrate, thanks to Rhonda and Fabrice, our 300th podcast, featuring some of our most beloved guests since our first podcast on October 27, 2016. We began with Fabrice Nye, who describes the birth of the Feeling Good Podcast, and two of our favorite and most popular guests, Drs. Matthew May and Jill Levitt. The schedule for all of the guests appears below.

The featured guests include Fabrice Nye, Matthew May, Jill Levitt, Angela Krumm, Lorraine Wong, Kyle Jones, Brandon Vance, Heather Clague, Leigh Harrington, Sarah Hester, Brian Wright, Mark Noble, Thai-An Truong, Stirling Moorey, Rose Markotic, Mark Taslimi, Sunny Choi and Elizabeth Dandenell.

Time Featured Guests 1:30-1:45

Fabrice Nye, The father of us all! #177, Research in Psychedelic-Assisted Therapy

Matt May, co-therapist with David: live therapy with Marilyn & me,

Many, many Ask David episodes,

#265, Exposure to Leeches with Danielle Kamis

Jill Levitt, David’s co-therapist doing personal work with David, plus

#146, When Helping Doesn’t Help

1:45-2:00

Angela Krumm (#270-losing weight & flirting),

Lorraine Wong (#155-treating emotional eating &

#257 Intensives),

Kyle Jones (Dating strategies, #151-Treating LGBTQ,

#157-Psychotherapy Training, and #267-Talking to loved ones who criticize your sexual orientation

2:00-2:10

Brandon Vance-

#160 Listening to the Music of TEAM

#161, Music under what someone is saying

#249, Report on Feeling Great Book Clubs

#260, TEAM games (with Amy Spector)

Heather Clague-(All of the above except #249)

2:10-2:20

Leigh Harrington, #279, Goal setting for Habits & Addictions

Sarah Hester,#181, Live therapy, treatment of panic and insecurity, #193, Relapse

2:20-2:30 Brian Wright, #235, Anger in Marriage/5 Secrets Revisited 2:30-2:40

Mark Noble, #100, The New Micro-Neurosurgery,

#167, TEAM and the Brain,

#275, His latest thinking on how the molecular biology of stress & learning are consistent with TEAM, plus his chapbook on TEAM

Thai-An Truong, #178, co-therapist with David at Atlanta Intensive Social Anxiety Be Gone,

#218, Postpartum Depression,

#264, How to get laid with help from the 5-Secrets

#283, The “O” of OCD

2:40-2:50

Stirling Moorey, #280, A Beloved Voice from the past,

#289 & 290, A case of social anxiety, personal work with Anita

2:50-3:00

Rose Markotic, #252 & 253, Sadness as Celebration

Mark Taslimi, #29-35, Live sessions with Mark, “I’m a failure as a father.”

#141, 2-Year follow up “I’ve been a failure as a father.”

3:00-3:10

Sunny Choi, #214 & 215, The Approval Addiction

Elizabeth Dandenell, #240 & 241, struggling with anxiety and fear of poverty.

 

Rhonda, Fabrice and I want to thank all of our guests who have contributed so generously to our efforts, and to all of you, who have supported us!

Most of the guests today have done personal work with David, often with Jill, Matt, or Rhonda as co-therapists, and almost all had some version of “I’m not good enough” when they were upset, and all found solutions to this which expanded their humanness and deepened their skills as TEAM therapists.  Our guests who did personal work were asked how things had been for them since doing that work, and they all reported that the results have been long-lasting, even permanent!

In the following email I just received, Dr. Matthew May shared some feelings about today’s show.

Hi David,

I like the show notes and approve of their humble nature.  Brevity is the soul of wit!

If I were to edit anything, and I’m not sure that I would, it would be to list all the names of all the excellent folks who participated, in the first paragraph.

My sense is that it was their vulnerability, as well as their willingness to do challenging personal work, that led to enduring improvements in mood, relationships and lives.

I thought it was the personal endorsements and descriptions of how TEAM has improved their lives, that were the most compelling themes of the podcast.

Adding to this, it goes without saying, that none of this would have happened without you, David.  You created this model of therapy for one thing.  You also created this community of people.  As you said before the podcast started, the most meaningful and important part of all of this has been the relationships and friendships that have developed as a result of this work.  (I’m paraphrasing and not doing a very good job of it, sadly!).

In any case, I caught myself wondering if this format of therapy, one that is public and open, might be the future.  Meaning, instead of hiding our flaws and insecurities behind closed doors, if we might continue to attack the shame and stigma of “mental illness” by exposing it to the light of day, realizing that there was nothing to be ashamed of or afraid of, only opportunities to connect and be in the good company of other flawed, imperfect souls, just like us.

-Matt

Fabrice replied to Matt:

Early Christians were doing their confessions in public—why not? ☺

Our numbers continue to grow each month, so please continue to tell your friends about us. We do not accept commercial advertising, something Fabrice suggested early in our development, so you are our only marketing team, and we thank you for sticking with us and sending us so many beautiful emails, reporting your responses to our shows, asking questions, and suggesting new topics.

Our audience consists of lay people looking for personal healing as well as mental health professionals looking for new treatment tools as well as their own personal healing.

Warmly, Fabrice, Rhonda, Matt and David

299: Ask David: Retirement blues;
patients who refuse homework
(and the therapists who love them);
ADHD; David's new pooping story; and more!  We regret that our beloved Matt May, MD could not join us today due to an emergency involving his website. We look forward to him joining us next time for more exciting Ask David’s that will include: Does the “self” exist? Does God exist? And MUCH more! We open with two announcements: 1. Return of the awesome Feeling Great Book Club, with Drs. Brandon Vance and Heather Clague, will meet weekly, starting on September 13th. This will be a terrific experience, and only costs $12 per week with a sliding fee scale if you cannot afford it. You will go through the Feel Great book, learn techniques, have fun, and practice in small groups. This is a fantastic opportunity for everyone. For more information, go to:  https://www.feelinggreattherapycenter.com/book-club. 2. The TEAM-CBT World Congress, Warsaw Poland, August 18 - 21. This first of a kind event will take place live and virtually, and will be somewhat like David''s famous Intensives with teachers from around the world, many of whom have been featured on this podcast.  The CONGRESS will feature interactive sessions which participants can learn and practice the elements of the powerful TEAM system while receiving expert coaching on TEAM techniques. This event is organized by Daniel Minte, Mariusz Wirga, and Yehuda Bar Shalom. For more information, please go to:  https://teamcbt.eu Today’s questions: Retirement depression / anxiety; patients who refuse to do exposure or psychotherapy homework; treating procrastination and ADHD; David’s new pooping story, and more! 1. 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. 2. M asks: My patient refuses homework and isn’t getting better. I think I’m a victim of what you’ve referred to as “reverse hypnosis.” What should I do? 3. Heather asks: Hello David! How would you treat ADHD with TEAM-CBT? 4. A asks: Hello sir, Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper? Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. In some cases, I did not have time to polish and edit my responses below. I’ve been super busy developing the Feeling Good App, which is coming along tremendously well. It has the potential to help millions around the world who are struggling with depression and anxiety, but I have to be super careful with my time these days. If interested in beta testing, you can sign up here. 1. 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. David’s reply Have you read the introduction to Feeling Great? Or done any of the written exercises in that book, or in any of my books? Of listened to my free Ted Talk on my website? We can provide more specific information in the live discussion on the podcast. 2. M asks: My patient refuses homework and isn’t getting better. I think I’m a victim of what you’ve referred to as “reverse hypnosis.” What should I do? Dear Dr Burns, Many thanks for your blogs, podcasts, books and TEAM CBT. I have experienced (and I am experiencing) being hypnotized with a Panic Attack patient with Border Line PD- . I know this after the sessions. During the sessions I feel I cannot even think well. I see this client through SKYPE, And cannot see her face to face due to distances. I have try to follow your approach, but she’s resistant, I do include exposure exercises that she never completes. How to do a Shame Attacking Exercise when I cannot go with the patient to the places she needs to in order to do the exposure. I have even been in the phone and she driving, but 2 years later nothing works. Any thoughts will help! Many thanks in advance. M. David’s reply Thanks, great question! Some training or individual case consultation or both, or workshops, would help a lot. We have two free weekly training groups for therapists in California and therapists around the world. For example, the last two weeks in our Tuesday group we have focused on the negative thoughts and feelings therapists have during sessions that interfere with their ability to do excellent work. So your question is very timely and relevant! Also, the www.feelinggoodinstitute.com has free and paid training. Two of the finest teachers are Mike Christensen and Dr. Jill Levitt, and there are many others as well. Jill has just released an introductory recorded class on TEAM-CBT that you can purchase and watch whenever you like. She is a brilliant teacher! And yes, you HAVE been hypnotized during sessions! David 3. Heather asks: Hello David!! How would you treat ADHD with TEAM-CBT? Hi there! It is Heather Donnenwirth, from podcast 267. I hope you are doing well. I really enjoyed being apart of the podcast with you, Rhonda, and Kyle. Thanks again for including me in that experience. I have another question for you about the podcast you did on ADHD. I totally agree with you about ADHD not being a diagnosis and agree that is more helpful to treat the symptoms. Many of the clients that I work with have been diagnosed with ADHD or are convinced that they have it. Procrastination seems to be a common symptom of "ADHD" that people want help with and that can be treated easily with the TEAM model and with the anti-procrastination and motivational tools. The symptom that people ask for help with that I am feel less confident about helping them with is difficulty with focus and distractibility, and would love your thoughts about how to treat these symptoms? I have improved my own focus with motivational techniques and with practicing bringing my attention back to what I want to focus on when my mind starts to wonder. Also, taking notes has helped me to stayed focused, but I am curious if you have any other ideas about increasing focus? Sometimes the people I work with have distorted thoughts about focus as well, such as: "If I'm not interested in something, I can't focus on it," and "I need medication to focus," etc. Anyway, I value your knowledge and opinion and wondered if you have any tools for increasing focus? Also, do you treat hyperactivity and excessive talking? I have also noticed that parents some time play an enabling role with kids diagnosed with ADHD, and don't require their children to do schoolwork that they think is too hard or if they are bored and having a hard time focusing. Sorry this is long!!! I hope you are doing well!!! Warmly, Heather Donnenwirth David’s reply I’d just ask the person to focus on one moment when they had that problem and then do a Daily Mood Log, as you’ve pointed out, and also brainstorm with them on how to solve the problem. But first, would have to do empathy and assessment of resistance, same as with anybody! As you point out, the motivational factors can be enormous. For example, Adderall is just the same as Dexedrine, and highly addictive and euphoric street drug. If I had some right now, I’d be highly excited and write 30 pages of stuff! In addition, I can use ADHD as an excuse for not doing stuff that’s boring. Someone who is motivated can easily find a solution. The summary before college I was lucky to get a job in a bank in Phoenix. My job was filing checks by hand. Boy, that was boring! I made it a bit less boring by trying to find the most unusual names while I was filing checks alphabetically. One of the many unusual (to my young and uneducated ear) names was J. Karekin Moojian! As freshman in college, I found I had trouble concentrating and grasping what the professors were saying in lectures to large classes of a couple hundred or so students. And I had NO IDEA whatsoever what the teacher was talking about! What helped was simply asking another student as we were walking out of the class. I’d say, “What was the professor trying say?” Then the other student, who seemed way smarter than me, would just give a one sentence summary, and I’d suddenly “get it.” So, if you’re motivated, you can find a way! In medical school, I had to memorize gross anatomy. I had little aptitude and no interest. I had never even take a biology class in college, and did not know what was in the “abdomen” or “thorax.” So I made up little games, sitting for hours in the library memorizing stuff. It got me through—just barely1 David   4. A asks: Hello sir, Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper? Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper. Thank you. David’s reply Interesting question! Probably okay either way. No research on this issue! I slightly favor doing it by hand, but that is likely because I have done it that way for 40 + years! d Thanks for listening and reading today! Rhonda, and David

Today we feature Professor Hitendra Wadhwa PhD who has been a fan of David’s work for the past ten years. Hitendra has just published a new book, Inner Mastery, Outer Impact. Hitendra is a Professor of Practice at Columbia Business School and Founder of the Mentora Institute, and his class on Personal Leadership & Success is one of the most popular at Columbia Business School. He believes that the secret of leadership and success in business stems from inner mastery. He also has his own fascinating and skillfully produced podcast called Intersections where he interviews accomplished individuals from different spheres of human pursuit to draw out their insights and stories about the pursuit of success and happiness. One of Hitendra’s aims has been to integrate current psychological trends with  ancient wisdom in order to glean the most important ideas needed for happy and successful lives. He has backed this up with a daily meditation practice he began 20 years ago, seeking answers to the most basic questions about the meaning and purpose of our lives and a philosophy that leads to joy, connection, and productivity. Hitendra gives an example of how inner mastery can lead to outer impact. A colleague named Dan used to relentlessly find shortcomings and point to improved solutions every time Hitendra presented his work when he was first working as a business consultant. He said that he carried a grudge against Dan for several weeks because he was trying to impress his colleagues and felt put down by Dan. Of course, this type of attitude and defensiveness can easily trigger the very adversarial responses we fear. Then we tend to blame the “outer” and overlook how we might be inadvertently creating our own negative external reality. Fortunately, the opposite is equally true. When your attitude suddenly shifts, and your “inner” self changes, your outer reality will nearly always suddenly shift at the same time. One day, one of Hitendra’ s supervisors said to him: You should be more like Dan. He’s trying to help you take your game to the next level, but you don’t take a similar interest in helping him find ways to improve his work!” Hitendra explained the impact of his supervisor’s statement: “This comment suddenly turned on a light bulb in my head. I realized I was viewing Dan as an enemy, so if he criticized me, I thought he was against me, so I viewed him as the “enemy.” Instead, I decided to find the truth in his criticisms and began to view him as an ally, as a teacher, as someone who wanted to help me. “At that point, our entire relationship changed dramatically, and I felt empowered!” Of course, podcast fans will realize this as the Disarming Techniques, one of the Five Secrets of Effective Communication that David has popularized. Hitendra also discussed other themes in his new book, like what it means to “be true to yourself,” and how to discover the crown jewel within yourself, at your core. He also described how to tap into the five sources of core energy within yourself: Purpose, Wisdom, Growth, Love, and Self-Realization. He said that many people are afraid of Love, fearing that it is the same as weakness and will lead them to get taken advantage of. He suggested that in reality, love is a powerful force, and gave examples of the expression of love in a variety of successful business. He told many fun and inspiring stories, including his stuckness when trying to think of a way to honor his father’s 80th birthday. He couldn’t think of what he’d say at the celebration, because he’d always done the opposite of what his father had recommended. But then, while meditating, he saw that he’d been inspired all long by how his father had lived his life. He talked about the concept of transcendence as well as racism, and pointed out that we tend to label people based on some characteristic like skin color. But this can be very misleading, because two people who are Black, for example, will often have radically different backgrounds and life experiences. As an example, he described someone from the Caribbean who had no experience of racial discrimination when growing up. He emphasized that when we label people, we get lazy and do not respond to the reality and depth of who that person really is. Essentially, we are then putting people in “boxes” instead of seeing them for the full richness of who they are. He also said that our human identities are partly shared and partly unique. For example, Martin Luther King, Jr. learned a great deal from Mahatma Gandhi, who in turn was inspired by Leo Tolstoy—indicating a merger of three strikingly different cultures. Using story-telling, Hitendra addressed basic questions like:

• How do we integrate our (partially hidden) inner and outer selves?
• Who am I, really?
• What’s my purpose in the universe?

He said that what many psychologists believe they “discover” is actually not new, but based on ancient wisdom, like the practice of gratitude in meditation, and shifting your mindsets, and tuning in to your capacity for compassion and kindness, and finding the best of yourself. Rhonda and I want to thank Hitendra for his journey and wonderful new book, and all of you as well for tuning in and joining us on our journey! Warmly, Rhonda, Hitendra, and David

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

Upsetting Event or Moment: Pandemic and moving back to my preferred city and leaving my mom to live alone.

 

Next, Alexis recorded her negative feelings:

Feelings Now % Goal % After % Anxious, worried, panicky, nervous, frightened 75     Frustrated, stuck, thwarted, defeated 50     Guilty, remorseful, bad, ashamed 100     Hopeless, discouraged, pessimistic, despairing 20     Sad, blue, depressed, down, unhappy 80     Inferior, worthless, inadequate, defective, incompetent 80     Lonely, unloved, unwanted, rejected, alone, abandoned 75     Angry, mad, resentful, annoyed, irritated, upset, furious 20     Embarrassed, foolish, humiliated, self-conscious 10    

 

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.

Qualities of a “good daughter” Worst Best Average 1.        Calls their parents 80 100 90 2.        Visits their parents regularly 30 100 90 3.        Helps their parents 70 90 80 4.        Is financially responsible for self 80 100 90 5.        Respects their parents 0 90 80

 

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.

Feelings Now % Goal % After % Anxious, worried, panicky, nervous, frightened 75 5 10 Frustrated, stuck, thwarted, defeated 50 0 0 Guilty, remorseful, bad, ashamed 100 0 0 Hopeless, discouraged, pessimistic, despairing 20 0 0 Sad, blue, depressed, down, unhappy 80 5 0 Inferior, worthless, inadequate, defective, incompetent 80 0 0 Lonely, unloved, unwanted, rejected, alone, abandoned 75 0 0 Angry, mad, resentful, annoyed, irritated, upset, furious 20 0 0 Embarrassed, foolish, humiliated, self-conscious 10 0 0

 

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

 

Podcast 296: Forced Empathy: A Master Class--Part 2 of 2

Last week you heard part ! of our work witt Zeina, a young professional woman struggling with a conflict with her mom. Zeina feels like her mother is too critical of her, and she finds the criticisms devastating. In today's podcast, you will hear my co therapist, Dr. Jill Levitt, and I, doing Forced Empathy with Zeina, and you will hear the exciting conclusion of the session. I am including the entiere show notes from last week, in case you have not yet reviewed them.

Show notes from last week commence here.

Today Dr. Jill Levitt and I do live work with Zeina Halim who has been experiencing some intense negative feelings because of her mother’s criticisms of her. Zeina is a member of my weekly training group at Stanford and has appeared on the podcast on several previous occasions (Please provide numbers plus link to podcast page on website.)

Zeina is one of our small group leaders in our Tuesday training group.  She works with teens and adults in-person in her office in Menlo Park and also provides tele-health sessions for clients living anywhere in California.

Dr. Jill Levitt is the co-leader of my Tuesday training group at Stanford and will be my co-therapist today. We hope for some more of the “magic” that frequently appears when we do therapy together. Today’s podcast will illustrate a number of teaching points, including these:

1. Forced Empathy: We illustrate exactly how to use this powerful and sophisticated technique. When I first created this technique many years ago, I thought there would be little interest in it, so I rarely taught it in my workshops or training groups. In the past several years, an intense interest in this technique has emerged, so you will get to see exactly how it works.
2. Five Secrets Resistance: There has been great interest in the Five Secrets of Effective Communication that are featured in my book, Feeling Good Together. When used skillfully, they can have a phenomenal effect on any troubled relationship. I am even aware of a case of a woman who was kidnapped at gunpoint by a violent serial rapist who planned to kill her. Out of desperation, she used the Five Secrets I had presented at a workshop he had just attended, and he let her go and turned himself in to the police. The Five Secrets literally saved her life.

And yet, many of us stubbornly refuse to use the Five Secrets with family, friends and loved ones. Why do we fight against the very tools that would rapidly bring us peace, love and joy? And what can we do about our own internal “resistance”?

1. The “inner” and “outer” solutions: Whenever you are involved in a conflict with someone, there are two battles raging at the same time. One is the “inner battle” with your own negative thoughts, telling you that you’re no good, or that the other person is to blame, and the voice that powerfully urges you to do battle.

We approach the “inner battle” with the familiar Daily Mood Log, that helps you pinpoint the distorted messages you are giving yourself. You will see that those messages—the way you talk to yourself when you’re upset—are loaded with distortions; such as All-or-Nothing Thinking, Overgeneralizations, Mental Filtering, Discounting the Positive, Mind-Reading, Labeling, Should Statements and Hidden Should Statements, Emotional Reasoning, Other-Blame, and more.In today’s session, we do battle with Zeina’s distorted thoughts with the Externalization of Voices, arguably one of the most powerful psychotherapy tools ever created.

1. The EAR Checklist / Relationship Journal. The “outer battle” involves the words you use when you respond to the other person’s criticisms of you. Here we use the Relationship Journal, another super powerful tools that allows you to analyze your own statements with the EAR Checklist and see the shocking reality that you are creating the very conflict that you are complaining about so vigorously. This involves one of the “Great Death” of the self, which can be profoundly painful, but it also leads to liberation from your self-created misery and the chance for renewed love and connection with the person you feel so alienated from.
2. Two-hour sessions. You can do far more in a single, two-hour session than in many 50 minute sessions scheduled at weekly intervals. I have often said that this is how I always do therapy, and if you have some therapy skills, this model is vastly more effective and cost-effective as well. It puts you under pressure to accomplish something today, right now, and not in the vague or distant future.
3. Uncovering Techniques. You will see how you can use the Man from Mars Technique to uncover more of your patient’s negative thoughts and core beliefs. This is just another way of doing the classical “Individual Downward Arrow Technique” that I developed way back in the 1970s.
4. The Acceptance Paradoxes. There is a great deal of talk these days about Acceptance is being an important key in many schools of psychotherapy. But what is acceptance, and how do we teach it to our patients and colleagues? Today’s session with Zeina, who has a great interest in Buddhist philosophy and practices, illustrates one of more than 20 paths to acceptance, and this one in particular will teach you the steps in accepting others, especially when you are desperately trying to change them and you are insisting that they “shouldn’t” be the way they are!

Self-acceptance is always about grasping a gigantic paradox—and that’s why I’ve always called it the Acceptance Paradox, which states: Accepting yourself as you are, warts and all, is actually the greatest change a human being can make.

Can you see why this is a paradox? It’s because the very moment you accept yourself, everything about you and your world will appear to change. Now here’s another acceptance paradox we will explore today. The very moment when you accept another person exactly as she or he is, that person will suddenly change.

Of course, that is the exact opposite of what we usually do when we desperately keep trying to “change” them, a strategy that actually forces them to be the very monster you are trying so hard to destroy. By the way, do you know what the plural form of paradox is, when you combine Self- and Other-Acceptance? The plural form is called the Acceptance Paradise.

1. T = Testing is crucial! You cannot do truly effective therapy without the T = Testing. You will find out EXACTLY how effective—or ineffective—you are in every session with every patient. When you listen to the podcasts, you can ask yourself questions like these: How effective are Jill and David being? Will they get good empathy and helpfulness ratings from Zeina? Will we see any reductions in Zeina’s powerful negative feelings at the start of the session? Will she make a breakthrough in her relationship with her mother?

At the end of the session, you will see the answers to these questions. And if you’re a therapist, that kind of powerful and precise information will allow you to grow and learn as a therapist, especially if you approach the information with humility and respect for yourself and your patients.

There is almost no limit to the evolution of your therapist skills if you use the T = Testing model I have developed. There is almost no chance for personal growth if you do not use these or similar assessment tools.

However, the price of growth is steep. You have to be willing to see your own failures and errors at every session with every patient, and this will often be painful. But this is the pain that can lead to your own personal transformation along with the blossoming of your own superb therapy skills.

Today, in Part 1 of the Zeina session, you will hear the T = Testing and E = Empathy parts of the session. Next week, in Part 2, you will hear the very brief A = Assessment of Resistance, which really only included the “Miracle Cure Question: ”What, really, are you, Zeina, hoping for in tonight’s session?” You will also hear the amazing M = Methods portion, which will start with Forced Empathy, followed by Externalization of Voices and Five Secrets Practice, along with the final T = Testing and homework assignments for Zeina following the session.

Rhonda, Jill, Zeina and I hope you enjoy the podcasts and learn a great deal from them. And we all want to thank you, Zeina for your courageous and brilliant work, sharing your inner self so openly and generously. I believe that sessions like the one our fans will witness today and next week have the potential to provide hope and healing to people around the world, not only today, but for decades to come. At least, that is my hope!

I also want to thank you, Jill, for your extraordinary teaching and clinical skills, and for your brilliance and warmth.

Thank you for tuning in!

Rhonda, Zeina, and David

Here is a follow-up note from Zeina

Hello David, Jill, and the Tuesday group,

Boy, do I have an update for you all! So, at first, I struggled, and I was very worried to have to potentially send an update to the group that may have been disappointing.

On Saturday, I saw my mom, and I shared with her the insights that I had in our session. She was appreciative, but I didn't feel very connected to her. I had talked with her about this while she and I were on a walk, and I wondered if maybe walking while talking was taking away some of the intimacy or connection that might have happened if we had been looking at each other while talking.

I also noticed that while I was externally behaving somewhat better if my mom criticized me, internally, I still hadn't progressed very far. I would still feel very distant from her; and I still wasn't doing the five secrets.

Today, on Sunday, I saw my mom again. While she did not criticize me, we still got into a little bit of an argument.

I was a bit angry, but as I let myself cool off, I noticed myself feeling incredibly sad inside--like a sadness that had been building and building over the past few weeks. I tried to talk with my mom about it, but she resisted at first.

We had a project that we were working on together today and she thought it would be better if we talked on another day and got back to our project; I insisted, however, and asked that we please talk today. I did not realize it at the time, but I think I had some major hidden emotion stuff happening with my mom (more on this later, perhaps some hidden sadness that was masquerading as anger).

I shared with her that I had felt incredibly sad and genuinely worried about our relationship. I recently moved in order to live closer to her and see her more often, but I had noticed that almost every time she came over to visit me at my new place, we would get into an argument at least once.

I shared that these arguments had really been weighing on me and worrying me. I also told her that I noticed that we would get into arguments when we were at my place, but not as much when I visited her at her place, maybe because I am so particular about how I like things to be at my place.

She, then, said in a very gentle and loving way, "I think ‘particular’ about your space is the operative word here."

I realized that she was totally right, and I was so pleasantly surprised by how gentle and loving she was when she said it.

Feeling encouraged by how the conversation was going, I shared more and said that I had noticed that I had become more sensitive around our arguments lately and that I was feeling very disconnected from her, and I didn't know how to get reconnected with her. I also shared that I had been feeling lonely in my life in general lately and made a guess that maybe my loneliness was making me expect more from our relationship.

Additionally, I also guessed that I might be feeling more drained emotionally because I am doing more hours of therapy per week than I have ever done in my life, and maybe I had yet to find the right balance of how to recreate and regenerate my energy in my off-hours.

I shed many tears all throughout this whole conversation. I checked in with myself and noticed that I was feeling more connected to my mom, but there felt like there was still more, particularly about my loneliness.

This next paragraph might seem like a major tangent, but hang in there!--I promise it is all connected :)

Then, I switched gears a little bit to share with her a different conversation and insight I had had in the past week or so about my recent feelings of loneliness. I had been having a conversation with my very dear friend, James, about how I had been feeling lonely, but was not feeling as drawn to connecting with most of my girlfriends, but only really drawn to my guy friends.

Initially, I thought it was a male-female difference, but then I noticed that I was feeling drawn to my new friend Leigh Harrington, who is female. I realized that maybe the difference had more to do with the fact that almost all my male friends and Leigh were quite funny and playful people, whereas most of my girlfriends were more serious people.

As for myself, I tend to be a more serious person and am not as funny or playful as many people. I realized that I was relying on other people for my laughter, playfulness and fun, rather than learning how to create that myself.

Having just done some flirting training with Matthew May earlier that week, I saw that humor, like flirting, can be a learned skill and might have more to do with a willingness to take risks than an innate quality that people either have or don't have.

I was feeling excited that I could learn to be funnier and flirtier and create more laughter in my life, instead of relying on other funny people for this.

I shared all of this with my mom. She then went on to make a further connection that really blew me away. She said, "I bet if you start to be funnier and create more laughter for yourself and others, you will also start to feel less lonely." It felt so true!

The times I feel most connected to people are when I am laughing with them. THIS is the kind of relationship and connection with my mom that I had been missing lately--when I share deeply with her and, because she knows me so well, she is able to further my insight and understanding of myself and help me to grow.

I feel so connected to her now. I realize now that I think part of my resistance to using the 5 secrets with my mom was maybe a hidden emotion component--I had these deep feelings and worries about our relationship; I was confused if moving closer to her had actually helped our relationship or if it was harming it, and I was genuinely missing these kinds of deep, connecting conversations with her, which we had not had in a while.

My mom has been hanging out at my place all day today and now I notice myself being easily loving and patient with her and my being "particular" about my things and my space has vanished--at least temporarily!

There are a lot of take-aways for me from this whole thing, but one of the biggest ones is that I think I was trying to do five secrets without really fully going into my "I feel" statements as much as I needed to--I feel statements are often the secret that I neglect the most as a person and as a therapist.

So, to connect to what we are doing this week in class, I think I would make a guess that when I ignore the five secret that I need to do the most and struggle with, it can hamper my ability to do the rest of the five secrets effectively and genuinely.

I could write a lot more about all of this, but I think I will stop here for now. I hope this wasn't too confusing as I know I touched on a lot of different things. Thank you all for your time and attention. I'm open to comments or questions.

Warmly,

Zeina

Here is a reply to Zeina from one of the Stanford Tuesday group members

Gosh! Zeina, this is beautiful and so straight from the heart. Takes immense courage to do a deep dive in exploring oneself. I have been marveling at how meticulously you‘ve sifted through and worked towards addressing the different dimensions of the relationship between you and your mum. You are also an amazing raconteur, you’ve brought out the subtle nuances so beautifully!

Your mail took me on an emotional roller coaster ride. It was such a compelling read and had me as a captive co-traveler, holding my breath, and crossing my fingers!

I loved your insights on the “I feel”. Reading that was a personal breakthrough for me, where my relationship with my mum is concerned. That’s exactly what is missing in our relationship too … whoaaaaa! I just don’t share my feelings with her! I love how you were able to do that though, because I can feel this huge wave of resistance engulfing me, despite my insight. I know I’m not yet ready to take the next step! Funny, how tough it can be to be vulnerable before one’s own mom!

More power to you Zeina for ‘daring greatly’ and taking the next step after the Tuesday class. Also, for keeping us posted and for sharing with us in such a detailed manner, and in the process, helping us all learn and grow. Deep regards for your mum as well. She comes across as a tenacious mother of a tenacious daughter … if I may say so.

Warmly,

Nivedita.

Here is a second follow-up from Zeina.

Hello David, Jill and Tuesday group,

I just wanted to send another update as my relationship with my mom has continued to evolve in quite beautiful and magical ways since I sent this last email.  It seems to me that maybe she has stopped criticizing me entirely--I'm not quite sure.  Maybe I need to pay more attention.  Perhaps if she does criticize me, she does it in a gentler way or maybe I am less sensitive to it.  All I know is that she has been wonderfully supportive of me in these past few weeks and we have not gotten into a single argument.  Our relationship suddenly seems easy in a way that I have never experienced before.  I am so profoundly grateful.  I know that we will probably relapse at some point and this may not last forever, but, now I know this is possible.  Now, I know my way back here.  I have always wanted a relationship like this with my mother, and I always thought it wasn't possible because of who she was as a person. Little did I know that to have the mother I always wanted, I needed to do the changing. I knew that the 5 secrets were powerful, but I had thought that their power was more confined to a single interaction or the moment when you use them.  I don't know that I have been especially good at practicing the 5 secrets with my mom lately, yet the effect seems to keep lasting and lasting. I am truly speechless at the profound transformation that has happened.  Thank you. Thank you. Thank you.

I would love any responses!

Zeina

Here is some of the feedback from the training group in the section, “What did you like the best about today’s training session?”

• Jill’s thoughtfulness in selecting the Forced Empathy technique over the Relationship Journal. Jill looked at what had worked in the past for Zeina and saw it as a potential strategy for her current concerns and the result was tremendously positive.
• I loved the training! I loved watching forced empathy and I began to empathize with a close relative simply by watching Zeina empathize with her mom. I was crying throughout. It is hard to describe how touched I was
• Zeina's honesty and her responses to forced empathy was amazing!
• Amazing personal work. Entire session was great learning experience for me. How Forced Empathy brought the shift in Zeina’s way of thinking.
• I really enjoy witnessing the live sessions including this one with Zeina. Seeing how the totality of the model comes together in real time with the clinician's judgment and intuition guiding the specific process is really enlightening and seeing someone's beliefs shift in real time is very inspiring and moving. It was a really nice way to re-join the larger group and I'm glad to hear that went into David's thinking in scheduling it.
• I really like the Forced Empathy. Zeina had a lot of resistance at the beginning. However, She shed tears during doing the Forced Empathy. I also like the role reversal when doing the Externalization voices. I can always learn how to deal with the difficulties of life from David and Jill's wisdom.
• The whole thing was so great. I was really moved by the forced empathy.
• I always LOVE seeing forced empathy modeled to get better at this complex skill, and I am also, like many others, almost always blown away with how powerful it is. I also thought this was a great example of multiple paths (individual mood and relationship work) and multiple methods being all used in one two-hour session so skillful and masterful.
• I loved the open ended approach and the ongoing exploration until the goal was formed/explored/ discovered. For me, it was a demonstration of trust in the process. I especially liked David's "The Man From Mars" that seemed to me an amazing tool with sorting out the mess of relationship work. I also loved Forced Empathy especially here with the work on mother daughter's relationship. I am really intrigued to explore it for myself in regard to my relationship with my parents and my daughter.
• Seeing the whole encounter with Zeina and seeing how Jill and David thought through it together, it was all so organic and incredible to witness
• Very helpful to see the progression of the session.
• Zeina's session has been a gift not only to us, but also to our mothers. Forced empathy felt like a pivot point in treatment and I loved that Z was able to go deep and connect with her mother's feelings. I have plans to travel and visit my mother next month and have been feeling anxious about it. I was reminded of the unconditional love of a mother that is beautiful and spiritual. David and Jill did amazing and transformational work. This is so inspiring!
• I liked everything and how the methods and techniques were woven together very skillfully.
• Personal work is really the best and so gratifying to see. David made a comment at the end about how it would help with motivation to use the skills and work more on them after seeing them in action and I do agree with his comment even if I'm totally not paraphrasing correctly. I LOVE personal work because it bring these skills to life in a way that role plays don't. and of course, it's all the better that someone gets a personal benefit, that's all good too.
• David and Jill did an amazing job again! However, Zeina’s honesty and vulnerability was the greatest gift during this session. I could relate to her struggle as well, so I was extra impressed about her determination to work on this issue.
• It was amazing personal work for me. I feel so grateful for this experience.
• This was another example of the "magic" of TEAM, especially when the therapists are the incredibly skilled Jill and David. What a great, vulnerable and poignant example of relationship issues with a parent. I was very impressed and moved by the power of the Forced Empathy technique. By Zeina's ability to feel into the point of view of her mother, and her insights and connections, especially around how the times of criticism can be seen as opportunities for greater acceptance and love. Moving and really beautiful personal work!!!
• I was moved to tears when Zeina cried her mother's tears during the Forced Empathy exercise and said "I need her to accept me as I am." Wow--that was so powerful! And as for so many others, this experience felt super relevant and helpful to me for one of my own important relationships, and I'm feeling excited to try out Sergio's approach on my own loved one.
• Forced Empathy: I loved all of it! So helpful and informative to witness live work.
• I immediately got why the “what’s my grade?” question was skipped (since the use of the Forced empathy technique had yielded such powerful results). I am eager to try this with a particular client who is having similar issues with their mom. On a more personal level, I felt extremely close to Zeina and seeing how vulnerable and open she was willing to be. This has melted away a lot of my resistance in using the 5 secrets with my own mom. Thank you Zeina!
• I liked seeing the "visitor from Mars" used to uncover Zeina's thoughts when David was having trouble understanding what the issue was. It was great to see David feeling a little "lost" and see how he worked through that.
• Watching the Forced Empathy technique was amazing! I also appreciated when Jill offered several options for which direction to go and explained her rationale. I found it to be a helpful learning moment and also liked the warmth that came across.
• I saw my mom's critical behavior as coming from love-brought tears. Same for my Dad
• Zeina did really powerful and enlightening work! It was also a great learning experience to observe David & Jill.
• I have enjoyed listening to and learning wonderful techniques from Jill and David. I can definitely relate to parent's/child criticism conflict myself, so I have learned some methods of effective communication, empathy skills, especially the opposite empathy (where you step into the shoes of a person you have a conflict with) and learn to empathize strongly vs feeling frustrated and having blame thoughts
• I love every time we do personal work. I always learn and grow so much personally and professionally. Thank you, Zeina for this amazing gift, and thank you, David and Jill for your masterful work. I loved every moment of it!
• Amazing personal work!
• I enjoyed the entire process. I appreciated the partnership between David and Jill. I so appreciated Zeina's work and vulnerability. I like David's creative way of doing the Ind. Downward arrow using "man from Mars" perspective. I liked getting to see, again, the power of Forced Empathy, as it illuminated how we create the very behavior in the other, that we then complain about. I loved how Zeina surrendered to doing the Forced Empathy exercise with such wonderful openness.
• I loved the seamless way Dr Burns and Jill moved between the methods. And Zeina’s courage to be vulnerable. Had an aha moment myself - of course her mother will criticize her because the last thing she wants is for Zeina to have disastrous finances like her own. It shows deep love and caring
• Another Master Class! I loved watching David and Jill working with Zeina. Change the Focus is just an amazing Method. I appreciate Zeina's vulnerable disclosures. Such generosity is much appreciated. This is an amazing group, and I feel privileged to learn from such sophisticated practitioners, who are so generous with their insights and decades’ worth experiences. Some days I just can't believe my luck to be with such heartfelt, dedicated, compassionate and wise folks!
• I very specifically like seeing a long personal work session...the big picture seeing the whole session. Thank you! I learned so very much and how things smooth into each other as session progresses.
• It was great seeing Forced Empathy demonstrated as I've never seen it before and learned so much from the overall training with Zeina, David and Jill. So glad Zeina was willing to be so vulnerable; really appreciated at the end when she said she felt pressure to empathize with her mom if she was vulnerable with her and mom laid it on thick, was wondering the same exact thing in that very moment! Loved how David diffused that for her and put less pressure on how she would handle it! So grateful to be part of this awesome group where I am growing and learning every moment!
• The hi quality demonstration of Five Secrets empathy by David and Jill
• Jill’s patience. David waiting for AHA MOMENTS and pointing them out and best of all ZEINA!
• Personal work is always insightful. I really like the forced empathy technique. I also enjoyed the display of creativity and flexibility of the team model. Amy would regularly explain that it was a model to be used creatively and it's exciting to know there is so much to learn. It can be adapted to each individual. Viewing therapy as a series of skills to learn rather than a step-by-step instructional book is what makes me really love TEAM.
• Loved how Dr Burns used the individual downward arrow so seamlessly during the empathy phase. Dr Burns empathy too was spot on when he said to Zeina that "she could not lean on her Mom." This one line was really powerful for me and resonated deeply.

Loved Jill's internal solution as well as the forced empathy option along with the option of working on the good reasons not to do the 5 secrets. Jill was on a roll with her empathy ... "feels like you're walking on eggshells and don't know what will hurt her." I also liked Jill's disclosure about the times she gets critical with her boys are times when she is most concerned about them. Also liked Jill highlighting how Zeina practicing the Five Secrets was not working at a point because she was not using enough feeling empathy unlike as when doing the Forced Empathy

 

Podcast 295: Forced Empathy: A Master Class--Part 1 of 2

Podcasts 294 (Part 1) and 295 (Part 2)

Forced Empathy: A Master Class

Today Dr. Jill Levitt and I do live work with Zeina Halim who has been experiencing some intense negative feelings because of her mother’s criticisms of her. Zeina is a member of my weekly training group at Stanford and has appeared on the podcast on several previous occasions (Please provide numbers plus link to podcast page on website.)

Zeina is one of our small group leaders in our Tuesday training group.  She works with teens and adults in-person in her office in Menlo Park and also provides tele-health sessions for clients living anywhere in California.

Dr. Jill Levitt is the co-leader of my Tuesday training group at Stanford and will be my co-therapist today. We hope for some more of the “magic” that frequently appears when we do therapy together. Today’s podcast will illustrate a number of teaching points, including these:

1. Forced Empathy: We illustrate exactly how to use this powerful and sophisticated technique. When I first created this technique many years ago, I thought there would be little interest in it, so I rarely taught it in my workshops or training groups. In the past several years, an intense interest in this technique has emerged, so you will get to see exactly how it works.
2. Five Secrets Resistance: There has been great interest in the Five Secrets of Effective Communication that are featured in my book, Feeling Good Together. When used skillfully, they can have a phenomenal effect on any troubled relationship. I am even aware of a case of a woman who was kidnapped at gunpoint by a violent serial rapist who planned to kill her. Out of desperation, she used the Five Secrets I had presented at a workshop he had just attended, and he let her go and turned himself in to the police. The Five Secrets literally saved her life.

And yet, many of us stubbornly refuse to use the Five Secrets with family, friends and loved ones. Why do we fight against the very tools that would rapidly bring us peace, love and joy? And what can we do about our own internal “resistance”?

1. The “inner” and “outer” solutions: Whenever you are involved in a conflict with someone, there are two battles raging at the same time. One is the “inner battle” with your own negative thoughts, telling you that you’re no good, or that the other person is to blame, and the voice that powerfully urges you to do battle.

We approach the “inner battle” with the familiar Daily Mood Log, that helps you pinpoint the distorted messages you are giving yourself. You will see that those messages—the way you talk to yourself when you’re upset—are loaded with distortions; such as All-or-Nothing Thinking, Overgeneralizations, Mental Filtering, Discounting the Positive, Mind-Reading, Labeling, Should Statements and Hidden Should Statements, Emotional Reasoning, Other-Blame, and more.

In today’s session, we do battle with Zeina’s distorted thoughts with the Externalization of Voices, arguably one of the most powerful psychotherapy tools ever created.

1. The EAR Checklist / Relationship Journal. The “outer battle” involves the words you use when you respond to the other person’s criticisms of you. Here we use the Relationship Journal, another super powerful tools that allows you to analyze your own statements with the EAR Checklist and see the shocking reality that you are creating the very conflict that you are complaining about so vigorously. This involves one of the “Great Death” of the self, which can be profoundly painful, but it also leads to liberation from your self-created misery and the chance for renewed love and connection with the person you feel so alienated from.
2. Two-hour sessions. You can do far more in a single, two-hour session than in many 50 minute sessions scheduled at weekly intervals. I have often said that this is how I always do therapy, and if you have some therapy skills, this model is vastly more effective and cost-effective as well. It puts you under pressure to accomplish something today, right now, and not in the vague or distant future.
3. Uncovering Techniques. You will see how you can use the Man from Mars Technique to uncover more of your patient’s negative thoughts and core beliefs. This is just another way of doing the classical “Individual Downward Arrow Technique” that I developed way back in the 1970s.
4. The Acceptance Paradoxes. There is a great deal of talk these days about Acceptance is being an important key in many schools of psychotherapy. But what is acceptance, and how do we teach it to our patients and colleagues? Today’s session with Zeina, who has a great interest in Buddhist philosophy and practices, illustrates one of more than 20 paths to acceptance, and this one in particular will teach you the steps in accepting others, especially when you are desperately trying to change them and you are insisting that they “shouldn’t” be the way they are!

Self-acceptance is always about grasping a gigantic paradox—and that’s why I’ve always called it the Acceptance Paradox, which states: Accepting yourself as you are, warts and all, is actually the greatest change a human being can make.

Can you see why this is a paradox? It’s because the very moment you accept yourself, everything about you and your world will appear to change. Now here’s another acceptance paradox we will explore today. The very moment when you accept another person exactly as she or he is, that person will suddenly change.

Of course, that is the exact opposite of what we usually do when we desperately keep trying to “change” them, a strategy that actually forces them to be the very monster you are trying so hard to destroy. By the way, do you know what the plural form of paradox is, when you combine Self- and Other-Acceptance? The plural form is called the Acceptance Paradise.

1. T = Testing is crucial! You cannot do truly effective therapy without the T = Testing. You will find out EXACTLY how effective—or ineffective—you are in every session with every patient. When you listen to the podcasts, you can ask yourself questions like these: How effective are Jill and David being? Will they get good empathy and helpfulness ratings from Zeina? Will we see any reductions in Zeina’s powerful negative feelings at the start of the session? Will she make a breakthrough in her relationship with her mother?

At the end of the session, you will see the answers to these questions. And if you’re a therapist, that kind of powerful and precise information will allow you to grow and learn as a therapist, especially if you approach the information with humility and respect for yourself and your patients.

There is almost no limit to the evolution of your therapist skills if you use the T = Testing model I have developed. There is almost no chance for personal growth if you do not use these or similar assessment tools.

However, the price of growth is steep. You have to be willing to see your own failures and errors at every session with every patient, and this will often be painful. But this is the pain that can lead to your own personal transformation along with the blossoming of your own superb therapy skills.

Today, in Part 1 of the Zeina session, you will hear the T = Testing and E = Empathy parts of the session. Next week, in Part 2, you will hear the very brief A = Assessment of Resistance, which really only included the “Miracle Cure Question: ”What, really, are you, Zeina, hoping for in tonight’s session?” You will also hear the amazing M = Methods portion, which will start with Forced Empathy, followed by Externalization of Voices and Five Secrets Practice, along with the final T = Testing and homework assignments for Zeina following the session.

Rhonda, Jill, Zeina and I hope you enjoy the podcasts and learn a great deal from them. And we all want to thank you, Zeina for your courageous and brilliant work, sharing your inner self so openly and generously. I believe that sessions like the one our fans will witness today and next week have the potential to provide hope and healing to people around the world, not only today, but for decades to come. At least, that is my hope!

I also want to thank you, Jill, for your extraordinary teaching and clinical skills, and for your brilliance and warmth.

Thank you for tuning in!

Rhonda, Zeina, and David

Contact information for Jill and Zeina: please provide what you want to have included in the show notes.

Here is a follow-up note from Zeina

Hello David, Jill, and the Tuesday group,

Boy, do I have an update for you all! So, at first, I struggled, and I was very worried to have to potentially send an update to the group that may have been disappointing.

On Saturday, I saw my mom, and I shared with her the insights that I had in our session. She was appreciative, but I didn't feel very connected to her. I had talked with her about this while she and I were on a walk, and I wondered if maybe walking while talking was taking away some of the intimacy or connection that might have happened if we had been looking at each other while talking.

I also noticed that while I was externally behaving somewhat better if my mom criticized me, internally, I still hadn't progressed very far. I would still feel very distant from her; and I still wasn't doing the five secrets.

Today, on Sunday, I saw my mom again. While she did not criticize me, we still got into a little bit of an argument.

I was a bit angry, but as I let myself cool off, I noticed myself feeling incredibly sad inside--like a sadness that had been building and building over the past few weeks. I tried to talk with my mom about it, but she resisted at first.

We had a project that we were working on together today and she thought it would be better if we talked on another day and got back to our project; I insisted, however, and asked that we please talk today. I did not realize it at the time, but I think I had some major hidden emotion stuff happening with my mom (more on this later, perhaps some hidden sadness that was masquerading as anger).

I shared with her that I had felt incredibly sad and genuinely worried about our relationship. I recently moved in order to live closer to her and see her more often, but I had noticed that almost every time she came over to visit me at my new place, we would get into an argument at least once.

I shared that these arguments had really been weighing on me and worrying me. I also told her that I noticed that we would get into arguments when we were at my place, but not as much when I visited her at her place, maybe because I am so particular about how I like things to be at my place.

She, then, said in a very gentle and loving way, "I think ‘particular’ about your space is the operative word here."

I realized that she was totally right, and I was so pleasantly surprised by how gentle and loving she was when she said it.

Feeling encouraged by how the conversation was going, I shared more and said that I had noticed that I had become more sensitive around our arguments lately and that I was feeling very disconnected from her, and I didn't know how to get reconnected with her. I also shared that I had been feeling lonely in my life in general lately and made a guess that maybe my loneliness was making me expect more from our relationship.

Additionally, I also guessed that I might be feeling more drained emotionally because I am doing more hours of therapy per week than I have ever done in my life, and maybe I had yet to find the right balance of how to recreate and regenerate my energy in my off-hours.

I shed many tears all throughout this whole conversation. I checked in with myself and noticed that I was feeling more connected to my mom, but there felt like there was still more, particularly about my loneliness.

This next paragraph might seem like a major tangent, but hang in there!--I promise it is all connected :)

Then, I switched gears a little bit to share with her a different conversation and insight I had had in the past week or so about my recent feelings of loneliness. I had been having a conversation with my very dear friend, James, about how I had been feeling lonely, but was not feeling as drawn to connecting with most of my girlfriends, but only really drawn to my guy friends.

Initially, I thought it was a male-female difference, but then I noticed that I was feeling drawn to my new friend Leigh Harrington, who is female. I realized that maybe the difference had more to do with the fact that almost all my male friends and Leigh were quite funny and playful people, whereas most of my girlfriends were more serious people.

As for myself, I tend to be a more serious person and am not as funny or playful as many people. I realized that I was relying on other people for my laughter, playfulness and fun, rather than learning how to create that myself.

Having just done some flirting training with Matthew May earlier that week, I saw that humor, like flirting, can be a learned skill and might have more to do with a willingness to take risks than an innate quality that people either have or don't have.

I was feeling excited that I could learn to be funnier and flirtier and create more laughter in my life, instead of relying on other funny people for this.

I shared all of this with my mom. She then went on to make a further connection that really blew me away. She said, "I bet if you start to be funnier and create more laughter for yourself and others, you will also start to feel less lonely." It felt so true!

The times I feel most connected to people are when I am laughing with them. THIS is the kind of relationship and connection with my mom that I had been missing lately--when I share deeply with her and, because she knows me so well, she is able to further my insight and understanding of myself and help me to grow.

I feel so connected to her now. I realize now that I think part of my resistance to using the 5 secrets with my mom was maybe a hidden emotion component--I had these deep feelings and worries about our relationship; I was confused if moving closer to her had actually helped our relationship or if it was harming it, and I was genuinely missing these kinds of deep, connecting conversations with her, which we had not had in a while.

My mom has been hanging out at my place all day today and now I notice myself being easily loving and patient with her and my being "particular" about my things and my space has vanished--at least temporarily!

There are a lot of take-aways for me from this whole thing, but one of the biggest ones is that I think I was trying to do five secrets without really fully going into my "I feel" statements as much as I needed to--I feel statements are often the secret that I neglect the most as a person and as a therapist.

So, to connect to what we are doing this week in class, I think I would make a guess that when I ignore the five secret that I need to do the most and struggle with, it can hamper my ability to do the rest of the five secrets effectively and genuinely.

I could write a lot more about all of this, but I think I will stop here for now. I hope this wasn't too confusing as I know I touched on a lot of different things. Thank you all for your time and attention. I'm open to comments or questions.

Warmly,

Zeina

Here is a reply to Zeina from one of the Stanford Tuesday group members

Gosh! Zeina, this is beautiful and so straight from the heart. Takes immense courage to do a deep dive in exploring oneself. I have been marveling at how meticulously you‘ve sifted through and worked towards addressing the different dimensions of the relationship between you and your mum. You are also an amazing raconteur, you’ve brought out the subtle nuances so beautifully!

Your mail took me on an emotional roller coaster ride. It was such a compelling read and had me as a captive co-traveler, holding my breath, and crossing my fingers!

I loved your insights on the “I feel”. Reading that was a personal breakthrough for me, where my relationship with my mum is concerned. That’s exactly what is missing in our relationship too … whoaaaaa! I just don’t share my feelings with her! I love how you were able to do that though, because I can feel this huge wave of resistance engulfing me, despite my insight. I know I’m not yet ready to take the next step! Funny, how tough it can be to be vulnerable before one’s own mom!

More power to you Zeina for ‘daring greatly’ and taking the next step after the Tuesday class. Also, for keeping us posted and for sharing with us in such a detailed manner, and in the process, helping us all learn and grow. Deep regards for your mum as well. She comes across as a tenacious mother of a tenacious daughter … if I may say so.

Warmly,

Nivedita.

Here is a second follow-up from Zeina.

Hello David, Jill and Tuesday group,

I just wanted to send another update as my relationship with my mom has continued to evolve in quite beautiful and magical ways since I sent this last email.  It seems to me that maybe she has stopped criticizing me entirely--I'm not quite sure.  Maybe I need to pay more attention.  Perhaps if she does criticize me, she does it in a gentler way or maybe I am less sensitive to it.  All I know is that she has been wonderfully supportive of me in these past few weeks and we have not gotten into a single argument.  Our relationship suddenly seems easy in a way that I have never experienced before.  I am so profoundly grateful.  I know that we will probably relapse at some point and this may not last forever, but, now I know this is possible.  Now, I know my way back here.  I have always wanted a relationship like this with my mother, and I always thought it wasn't possible because of who she was as a person. Little did I know that to have the mother I always wanted, I needed to do the changing. I knew that the 5 secrets were powerful, but I had thought that their power was more confined to a single interaction or the moment when you use them.  I don't know that I have been especially good at practicing the 5 secrets with my mom lately, yet the effect seems to keep lasting and lasting. I am truly speechless at the profound transformation that has happened.  Thank you. Thank you. Thank you.

I would love any responses!

Zeina

Here is some of the feedback from the training group in the section, “What did you like the best about today’s training session?”

• Jill’s thoughtfulness in selecting the Forced Empathy technique over the Relationship Journal. Jill looked at what had worked in the past for Zeina and saw it as a potential strategy for her current concerns and the result was tremendously positive.
• I loved the training! I loved watching forced empathy and I began to empathize with a close relative simply by watching Zeina empathize with her mom. I was crying throughout. It is hard to describe how touched I was
• Zeina's honesty and her responses to forced empathy was amazing!
• Amazing personal work. Entire session was great learning experience for me. How Forced Empathy brought the shift in Zeina’s way of thinking.
• I really enjoy witnessing the live sessions including this one with Zeina. Seeing how the totality of the model comes together in real time with the clinician's judgment and intuition guiding the specific process is really enlightening and seeing someone's beliefs shift in real time is very inspiring and moving. It was a really nice way to re-join the larger group and I'm glad to hear that went into David's thinking in scheduling it.
• I really like the Forced Empathy. Zeina had a lot of resistance at the beginning. However, She shed tears during doing the Forced Empathy. I also like the role reversal when doing the Externalization voices. I can always learn how to deal with the difficulties of life from David and Jill's wisdom.
• The whole thing was so great. I was really moved by the forced empathy.
• I always LOVE seeing forced empathy modeled to get better at this complex skill, and I am also, like many others, almost always blown away with how powerful it is. I also thought this was a great example of multiple paths (individual mood and relationship work) and multiple methods being all used in one two-hour session so skillful and masterful.
• I loved the open ended approach and the ongoing exploration until the goal was formed/explored/ discovered. For me, it was a demonstration of trust in the process. I especially liked David's "The Man From Mars" that seemed to me an amazing tool with sorting out the mess of relationship work. I also loved Forced Empathy especially here with the work on mother daughter's relationship. I am really intrigued to explore it for myself in regard to my relationship with my parents and my daughter.
• Seeing the whole encounter with Zeina and seeing how Jill and David thought through it together, it was all so organic and incredible to witness
• Very helpful to see the progression of the session.
• Zeina's session has been a gift not only to us, but also to our mothers. Forced empathy felt like a pivot point in treatment and I loved that Z was able to go deep and connect with her mother's feelings. I have plans to travel and visit my mother next month and have been feeling anxious about it. I was reminded of the unconditional love of a mother that is beautiful and spiritual. David and Jill did amazing and transformational work. This is so inspiring!
• I liked everything and how the methods and techniques were woven together very skillfully.
• Personal work is really the best and so gratifying to see. David made a comment at the end about how it would help with motivation to use the skills and work more on them after seeing them in action and I do agree with his comment even if I'm totally not paraphrasing correctly. I LOVE personal work because it bring these skills to life in a way that role plays don't. and of course, it's all the better that someone gets a personal benefit, that's all good too.
• David and Jill did an amazing job again! However, Zeina’s honesty and vulnerability was the greatest gift during this session. I could relate to her struggle as well, so I was extra impressed about her determination to work on this issue.
• It was amazing personal work for me. I feel so grateful for this experience.
• This was another example of the "magic" of TEAM, especially when the therapists are the incredibly skilled Jill and David. What a great, vulnerable and poignant example of relationship issues with a parent. I was very impressed and moved by the power of the Forced Empathy technique. By Zeina's ability to feel into the point of view of her mother, and her insights and connections, especially around how the times of criticism can be seen as opportunities for greater acceptance and love. Moving and really beautiful personal work!!!
• I was moved to tears when Zeina cried her mother's tears during the Forced Empathy exercise and said "I need her to accept me as I am." Wow--that was so powerful! And as for so many others, this experience felt super relevant and helpful to me for one of my own important relationships, and I'm feeling excited to try out Sergio's approach on my own loved one.
• Forced Empathy: I loved all of it! So helpful and informative to witness live work.
• I immediately got why the “what’s my grade?” question was skipped (since the use of the Forced empathy technique had yielded such powerful results). I am eager to try this with a particular client who is having similar issues with their mom. On a more personal level, I felt extremely close to Zeina and seeing how vulnerable and open she was willing to be. This has melted away a lot of my resistance in using the 5 secrets with my own mom. Thank you Zeina!
• I liked seeing the "visitor from Mars" used to uncover Zeina's thoughts when David was having trouble understanding what the issue was. It was great to see David feeling a little "lost" and see how he worked through that.
• Watching the Forced Empathy technique was amazing! I also appreciated when Jill offered several options for which direction to go and explained her rationale. I found it to be a helpful learning moment and also liked the warmth that came across.
• I saw my mom's critical behavior as coming from love-brought tears. Same for my Dad
• Zeina did really powerful and enlightening work! It was also a great learning experience to observe David & Jill.
• I have enjoyed listening to and learning wonderful techniques from Jill and David. I can definitely relate to parent's/child criticism conflict myself, so I have learned some methods of effective communication, empathy skills, especially the opposite empathy (where you step into the shoes of a person you have a conflict with) and learn to empathize strongly vs feeling frustrated and having blame thoughts
• I love every time we do personal work. I always learn and grow so much personally and professionally. Thank you, Zeina for this amazing gift, and thank you, David and Jill for your masterful work. I loved every moment of it!
• Amazing personal work!
• I enjoyed the entire process. I appreciated the partnership between David and Jill. I so appreciated Zeina's work and vulnerability. I like David's creative way of doing the Ind. Downward arrow using "man from Mars" perspective. I liked getting to see, again, the power of Forced Empathy, as it illuminated how we create the very behavior in the other, that we then complain about. I loved how Zeina surrendered to doing the Forced Empathy exercise with such wonderful openness.
• I loved the seamless way Dr Burns and Jill moved between the methods. And Zeina’s courage to be vulnerable. Had an aha moment myself - of course her mother will criticize her because the last thing she wants is for Zeina to have disastrous finances like her own. It shows deep love and caring
• Another Master Class! I loved watching David and Jill working with Zeina. Change the Focus is just an amazing Method. I appreciate Zeina's vulnerable disclosures. Such generosity is much appreciated. This is an amazing group, and I feel privileged to learn from such sophisticated practitioners, who are so generous with their insights and decades’ worth experiences. Some days I just can't believe my luck to be with such heartfelt, dedicated, compassionate and wise folks!
• I very specifically like seeing a long personal work session...the big picture seeing the whole session. Thank you! I learned so very much and how things smooth into each other as session progresses.
• It was great seeing Forced Empathy demonstrated as I've never seen it before and learned so much from the overall training with Zeina, David and Jill. So glad Zeina was willing to be so vulnerable; really appreciated at the end when she said she felt pressure to empathize with her mom if she was vulnerable with her and mom laid it on thick, was wondering the same exact thing in that very moment! Loved how David diffused that for her and put less pressure on how she would handle it! So grateful to be part of this awesome group where I am growing and learning every moment!
• The high quality demonstration of Five Secrets empathy by David and Jill
• Jill’s patience. David waiting for AHA MOMENTS and pointing them out and best of all ZEINA!
• Personal work is always insightful. I really like the forced empathy technique. I also enjoyed the display of creativity and flexibility of the team model. Amy would regularly explain that it was a model to be used creatively and it's exciting to know there is so much to learn. It can be adapted to each individual. Viewing therapy as a series of skills to learn rather than a step-by-step instructional book is what makes me really love TEAM.
• Loved how Dr Burns used the individual downward arrow so seamlessly during the empathy phase. Dr Burns empathy too was spot on when he said to Zeina that "she could not lean on her Mom." This one line was really powerful for me and resonated deeply.

Loved Jill's internal solution as well as the forced empathy option along with the option of working on the good reasons not to do the 5 secrets. Jill was on a roll with her empathy ... "feels like you're walking on eggshells and don't know what will hurt her." I also liked Jill's disclosure about the times she gets critical with her boys are times when she is most concerned about them. Also liked Jill highlighting how Zeina practicing the Five Secrets was not working at a point because she was not using enough feeling empathy unlike as when doing the Forced Empathy

 

May 30th, 2022

Our recent Ask David with Dr. Matthew May included a question on the Acceptance Paradox that triggered many enthusiastic email responses, and people were asking for more on this topic. Rhonda read several, including an email from Jeff who finally “got” the Acceptance Paradox and grasped the meaning of the “Great Death” of the Self. So, today, we’re dedicating the entire hour to this topic.

In addition, I’m including a link to a partial draft of a manuscript I’m working on entitled “25 Paths to Self-Acceptance.” It’s fragmentary and far from complete, but does include some potentially useful ideas and techniques, including a vignette with a quiz about a woman from South Los Angeles who experienced what I call “instantaneous enlightenment” during one of my 5-day psychotherapy intensives several years ago at the South San Francisco Conference Center near the San Francisco airport. (LINK TO MS)

First, here’s what a listener named Jeff wrote after the previous podcast.

Ah! I F-I-N-A-L-L-Y get what you're saying. I've pondered this death of "self" for quite a while after reading Feeling Great and it finally sunk in.

Saying "I want to improve myself" or "become a better person" is nonsensical. It's like there's an amorphous ghost "self" that I want to somehow "improve" or make "more worthwhile." But it's all made up. There is no actual "self." Meaning, I can improve skills I have - but my "self" won't be better. My skills might be - but there's no "self" to improve. I can improve my juggling skills but never my "self." Wow.

Even when it comes to flaws, I can see that they're also very specific. I don't have a flawed "self" or a bad "self." I may have certain flaws but there's no "I" or "self" to be flawed or worthless.

It took me a long time to see it - but now that I do, how awesome it is to stop having to IMPROVE myself. Instead, I can just let go of "my self."

Thank you for the response and the additional information. That is so helpful! !

During today's show, a number of vignettes illustrating acceptance were shared, including a man from the CIA who was intensely ashamed because he didn’t have a sense of humor, and all of the men he worked with loved to hang out during breaks at work telling jokes and laughing. He pretended to laugh, but inwardly felt ashamed and inadequate, and was telling himself that he was inferior, or defective because he didn’t have a sense of humor.

His enlightenment came during role-playing with a powerful technique called the Externalization of Voices. David played his Positive Self, and the patient, in the role of his Negative Self said this to David:

Patient, in the role of his Negative Self: You know, you’re really inferior because you don’t have a sense of humor. You’re not a real man!

David in the role of the Positive Self, responded like thi:s.Well, you know, you’re right. And in fact, I have tons of flaws. My lack of a sense of humor is just the tip of the iceberg!

This struck the patient as incredibly funny, and he began laughing uncontrollably for several minutes and almost feel out of his chair.

Then David said, “Not bad for someone with no sense of humor,” and that triggered even more laughter.

That’s why it’s called the Acceptance Paradox. The very moment when you accept yourself, exactly as you are, warts and all, everything—all your perceptions of yourself and the world—are suddenly transformed, and your freed from the prison you’d been in for many years, or possibly for your entire life.

Let me spell out what happened. For many years, my patient had been struggling with his lack of a sense of humor, and the harder he fought, the tighter the trap become. He could not change, and his life had become grim, and he felt inadequate and ashamed, thinking he wasn't a "real man," which seemed awful!

The very moment he "gave up" and accepted the fact that he had no sense of humor, he suddenly found his sense of humor, and laughed uncontrollably for several minutes.

That's what I mean when I say that acceptance is the greatest CHANGE a human being can make--and that's a gigantic paradox. Can you see that now?

One important focus of the show was debunking the many reasons people have for resisting Self-Acceptance, such as:

1. If I accept myself, I’ll just be ordinary, or below average, and I won’t be special.
2. Acceptance is a slippery slope. If I accept something bad about myself, or some awful thing I did, I might end up doing something immoral or wrong.
3. If I did something immoral or wrong, or even if I screwed up and failed to achieve my goals, I deserve to suffer.
4. If people see that I’m flawed or “less than,” they’ll judge me.
5. If I accept myself, I’ll lose my motivation to learn, to grow, and to improve myself.
6. If I accept myself, I’ll have to lower my standards. I may be unhappy, even miserable at times, but at least I have high standards!
7. When I beat up on myself, it shows that I’m honest about my flaws.
8. If I accept myself, I will end up accepting the fact that I might really be inferior!

In addition to addressing these concerns, Matt, Rhonda and David contrasted healthy vs unhealthy acceptance. For example, unhealthy acceptance is associated with feelings of depression, shame, hopelessness, paralysis, loneliness and cynicism. Healthy acceptance, in contrast, is associated with the exact opposite feelings of joy, pride, hope, creativity, intimacy, and laughter.

Matt pointed out that most, and conceivably all people who resist acceptance are not “seeing” something potentially incredible and life-changing.

David pointed out that the “Great Death” of the “self” that the Buddha described more than 2500 years ago is not really the “death” that people fear, but is really the “Great Rebirth.” When you “lose” your “self,” you actually lose nothing, because there was nothing there in the first place. But you gain the world, along with liberation from your suffering.

And that’s every bit as true today as it was at the time of the Buddha!

Thanks for joining us today.

Rhonda, Matt, and David

#400! Yippee!

Today, Rhonda has prepared a special celebration for our 400th podcast, and still going strong! She has invited a number of our favorite people and podcast guests to celebrate with us, starting with our beloved friend and frequent Ask David contributor, Matt May, MD, who officially joined us in early 2000.

Matt’s presence on the show had meant a great deal, personally and professionally, because I supervised Matt when he was a Stanford psychiatric resident, and had been missing our weekly chats! Our reunion via the Feeling Good Podcast has been special for that reason, but also because of Matt’s kindly but scholarly answers to the many questions all of you submit. Keep them coming, and send them directly to Rhonda or David. We love reading and answering them!

Next, we were joined by two more extraordinary psychiatrists and human beings, Drs. Heather Clague and Brandon Vance, who song their rendition (with guitar accompaniment) of “Help Dr. Burns!” (Based on Beetles’ Help, I need somebody!”

With their kind permission, here are the brilliant lyrics!

Help! I need a podcast!

Help! Not just any podcast!

Help! Pushing the Magic Button for ....

Help!

When I was younger, 8 years younger than today

I thought I could help everybody; help them in every way.

I got so grandiose; I was so self-assured.

I’d push my brilliant techniques, but my patients were never cured.

So, Help me not to Help oh Dr. Burns

Will they like me if they have to do the work?

If I set an ultimatum, am I a jerk?!

Won’t you please, please stop me?!

So many times, I tried to help, but then got stuck

I didn’t know but my patients were also thinking what the #?@!

Your podcast said to test at the start and after every session.

And then my eyes they opened wide

Boy, was that a lesson!

Oh Help me not to help, oh Dr. Burns!

Help me unlearn the bad habits I have learned

I’ll do homework when my urge to help returns

Won’t you please, please help me?!

Now I explore my patients’ reasons not to change.

I learned to sit with open hands if they choose to stay the same.

Only when they fight for change and want to do the work,

That’s when I offer tools, and know the changes will endure.

You’ve helped me not to help, oh Dr. Burns

‘Til my patients show me that they really yearn

To do the work and ask me really firmly

Won’t you please, please help me?

Your podcasts helped ME!

Oooooooh!

Much warmth to each of you!

Heather and Brendan

Our next guest was the brilliant and beloved Dr. Jill Levitt who joined my weekly Stanford training group when she and her husband, Brian, and two boys moved to the Bay Area from New York in 2007. Jill has moved up in the ranks and now co-leads the Tuesday group with me, and also joins me as co-therapists in a great many live sessions we have published as two consecutive podcasts.

The idea is to document exactly how TEAM-CBT works, and how we can nearly always get such blow-away results in a single, extended session. That was my dream as a young man, since the methods I was taught as a psychiatric resident almost never got rapid results, or even any noticeable changes in my patients. Now that dream has become a reality, and a great many people in our TEAM-CBT community have contributed to that evolution.

Next we were joined by our beloved Dr. Amy Huberman. Her riveting personal work on perfectionism was published recently on two consecutive Feeling Good Podcasts. Amy was glowing and filled with joy, which gave us great feelings of joy as well!

And then we were graced by a visit from Mina, who has starred in many Feeling Good Podcasts on a number of personal issues. I will be seeing Mina and her beloved husband in a few minutes for our Sunday morning hike and dim sum feast afterwards. It is always a highlight of my week!

Next was another Amy Berner who reported on her recent and wildly successful Intimate Connections Book Club with yet another psychiatrist, Dr. Leigh Harrington. Amy did some personal work with me on dating and sex appeal three years ago, when we discussed the Queen Bee phenomenon.

Apparently, it was successful, because she brought her fantastic husband, Randy Kolin, as proof of the effectiveness of the many dating strategies and tips in that book. Randy is also a mental health professional who works with stressed-out scientists working on nuclear fusion at the Lawrence Livermore Laboratories.

We wish him all the best since the work of those scientists is well on the road to creating commercially viable nuclear fusion, which will transform life as we know it on the surface of the earth by supplying unlimited, clean, low-cost energy.

Their visit was followed by Zane Pierce, whom I hadn’t had the chance to chat with much for a number of years. He led a recent “delight” and “gratitude” hike that we published on podcast # 361entitled “Finding Joy in Everyday Life,” with Dr. Angela Krumm from the Feeling Good Institute in Mountain View, California.

We have done previous podcasts with Zane, and his lovely wife, Daisy, including one of our most popular podcasts ever on “What’s the Secret of a Meaningful Life,” Episode 079.

And then came the magnificent colleague and friend, Indrani Mookerjee.  Indrani joined our community after attending the 2019 intensive, and recently did one of the most explosive and jaw-dropping podcasts, Episodes 359 & 360, “You Wowed Me, A Mother-Daughter Conflict,” featuring her personal work on her relationship with her daughter.

Indrani had struggled, unsuccessfully, to get close to her daughter, whom she loved greatly. She made a mind-blowing discovery of why during her personal work, and instantly achieved what I call “interpersonal enlightenment.) She now provides the joyous follow up on how her relationship with her daughter has blossomed and evolved since that momentous moment.

Next, we were joined by Mike Christensen, who is our top TEAM therapist in Canada. Mike became familiar with my work when he read Feeling Good in 2006 and then heard a keynote speech I gave at a conference in 2009. Since that time, he attended many of my two-day workshops in Canada, and now is a leading TEAM-CBT therapist and teacher. He’s been a featured guest on seven Feeling Good Podcasts or episodes of Facebook Live, when I was doing televised work on Facebook every Sunday afternoon.

Mike describes himself as “joyously average,” a idea that really resonates with me. It is a form of “invisible enlightenment” which nearly everyone fears, but you cannot understand the incredible liberation of this “Great Death” of the “self” until you’ve experienced. We recollected a Feared Fantasy exercise we once did together while hiking one evening following a workshop in Canada.

We also got updated on his beautiful and brilliant daughter, Katlin, who is now studying psychology in college and hopefully heading for her own career doing TEAM-CBT.

And finally, one my most favorite people in the, our brilliant, wonderful, and funny Sara Shane, whose life-changing enlightenment has been a fantastic source of joy and inspiration to me and to many. Sara came from humble roots, as a Mexican immigrant picking fruit with her parents for survival in the US, and is now living in the Central Valley and attending not one, but two weekly TEAM-CBT training groups.

She specializes in brief intensive treatments for the patients she treats. You may recall her from podcast #162, High Speed Cure for OCD, where she described her single-session treatment for 20 years of OCD / contamination phobia. She also did a lot of personal work to achieve liberation from her fairly severe social phobia and feelings of inferiority that were embedded from early childhood.

We love you and so much appreciate you, Sara!

That’s about it for today, but than you all for listening. Next week, we will likely have two consecutive Ask David podcasts with Dr. Matt May, followed by two consecutive podcasts called “Raw Emotion: Personal work with Chris,” featuring the work that Jill and I did with a young man with social fears and an almost unbelievably traumatic childhood, growing up in Palo Alto. The sound quality is not always top-notch, sadly, but the unbelievable quality and impact of this session easily makes up for that, so we have decided to publish it anyway, and hope you find it as amazing as we did.

David, Rhonda, and the whole gang!

Special Announcement 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 long 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.

Hey, another special announcement! The long-awaited Feeling Great App is finally available in the Apple and Google stores. Check it out! You can try it for free!

 

   

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

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.

1. 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?

1. 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?

1. 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.

1. 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.

1. 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.

David Meets the British TEAM Group, Part 1: Treating adolescents, Intrusive thoughts, TEAM-CBT homework, Surprises from the beta tests, and more.

1. Greg – What were the Surprising Results of the Feeling Good Beta Test?

What were the surprising results you referred to in the beta testing the new TEAMCBT App? Were there some things that weren’t effective or didn’t work in the way you expected?

1. Rima – Is Psychotherapy “Homework” required in TEAM-CBT?

I have a question about rapid recovery with TEAM CBT. Traditional CBT usually takes quite a lot of sessions and requires homework between sessions. How does this fit with a recovery in a single (two-hour) session? Do the patients still have to do homework?

1. Paul – Treating PTSD with Intrusive Thoughts

How can TEAM help an individual who has intrusive thoughts about a traumatic event in their past?

1. Jessica – Treating Adolescents with TEAM-CBT

Do you need to vary the therapy techniques when working with adolescents, as opposed to adults? And if so, how?

1. 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?

The following questions will be answered next week in Part 2 of David's encounter with the British group.

1. 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?

1. 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.

1. 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.

1. 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 British 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.

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

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!

 

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

287: Ask David, Featuring Matt May, MD: Acceptance. Irritating Questions. And More!

Today, Rhonda, Matt and David answer several challenging questions submitted by fans like you.

1. William asks: How would the TEAM-CBT model look with an addiction or a habit like procrastination?
2. Robin asks: What’s the difference between a habit and an addiction?
3. Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness!
4. Matt asks: What’s the full list of questions that David finds irritating?
5. Matt also asks: How do we help patients who don’t “get” the Acceptance Paradox?
6. Phil asks: Hey David, Rhonda and Mark, Can’t thank you enough for all your hard work and effort! Where do you guys get all your energy?!

Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways.

1: William asks: “How would the T.E.A.M. model look with addiction and procrastination?”

I have a question about your recent podcast on weight loss with Dr. Angela Krumm. She is doing a great job … but did not need any help from others.

About the T = Testing part of TEAM, you could say that Angela had lost her kilo’s. But I am not recognizing the testing in the form of a depression / anxiety test or something alike.

With the E = Empathy part, it is even more strange. Where is the Empathy section?

How would the T.E.A.M. model look with addiction and procrastination? Anyway, I assume you can’t expect that addiction and procrastination issues will be solved in a single therapy session?

I realize that Dr. Burns empathized in the podcast, but then the ‘work’ already was done.

Thanks a lot,

William

David’s reply

Thanks, William, for your thoughtful questions. I will probably make this an Ask David, but here's the short answer.

Yes, empathy must always come first. As you point out, Angela was simply discussing the methods she used for weight loss. This was not a live therapy session.

And yes, in therapy sessions I always start with T = Testing, but often add the Temptations Scale as well.

And yes, procrastination can usually be cured in a single (two-hour for me) session, and sometimes addictions too, but severe addictions might need ongoing support, as with AA for example.

Rhonda and I did a free two-hour workshop on Habits and Addictions on January 26th, 2022, sponsored by PESI. To view it, you can click on the link and download the entire video. Then you can watch it locally on your devise.

On the bottom of my homepage on www.feelinggood.com, you’ll find an offer for two free unpublished chapters on habits and addictions.

D

2: Robin asks: What’s the difference between a habit and an addiction?

No email, just the question.

David’s reply

You could check with a dictionary. I think Shakespeare said that a rose by any other name is still a rose!

Technically, an addiction is associated with physiologic dependence and withdrawal symptoms during discontinuation. But once again, if “yearning” is a withdrawal symptoms, then habits, too, could be seen as addictions of sorts. You might also think of habits and addictions as two points on a continuum, with addictions being on the more severe side of the bell-shaped normal distribution curve.

But all these definitions are, to some extent, arbitrary. Does “alcoholism” exist? Or just people who are drinking excessively?

3: Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness!

Dr. Burns, I am a huge fan of your books and podcast, and I enjoyed your talk today on Habits and Addictions as well as your “Feeling Great” bonus chapter on the same. I struggle with a habit of internet surfing (news, social media, etc.) when I’m avoiding boring or unpleasant tasks at work.

Do you feel that motivational and cognitive techniques are sufficient for addressing this habit when it often feels like my actions operate below the level of consciousness? For example, I often start surfing the internet before I even consciously realize what I’m doing! Additionally, I’ve found stimulus control to be difficult for this habit given that I work on the computer all day.

Any advice on addressing this particular habit, or similar ones, would be much appreciated. Thank you for all of your work helping people! Edwin

David’s reply

Check out the free chapter(s) offer at bottom of my homepage. Read, do then exercises, then you can ask your question.

Also, it depends on how far “below consciousness” your habit is. If it is only a couple inches below, you should be fine!

D

4: Matt asks: What is the full list of questions that David finds irritating?

David’s reply

Good question. Most of the time, I really appreciate the comments and questions from our many fans around the world, but there are, in fact, some questions that I find irritating.

This may not be the “full list,” but these are some questions that could use, perhaps, a bit of fine tuning!

Some people ask vague, “help me” questions, and like “I’ve always struggled with anxiety. What should I do?”

There are two problems with this question. First, I spent most of my life answering this question with inexpensive paperback books, free podcasts, free anxiety and depression classes on my website, and more.

So, I don’t want to have to repeat all of that for this or any person who writes to me. Perhaps you can tell me which resources you’ve already tried, and where you’re stuck, specifically.

Sometimes, I list the resources, like the “Search” function on every page of my website, www.feelinggood.com, or the list of books there, or the list of podcasts, with links, or the free classes, and more.

In addition, those of you who are familiar with my work understand that I never try to help anyone on a “general” level. I can only help you at a specific moment in time. When was it? Where you when you felt anxious, or whatever? What was going on? What were you thinking and feeling at the moment? Record it on a Daily Mood Log, and highlight the Negative Thought you can’t successfully challenge. What are the distortions in that thought?

Then I can give you all kinds of help!

Perhaps in a future Ask David I can list some more types of problematic questions.

Thanks!

But while we’re at it, here’s another. Sometimes, people will ask a question that was answered 40 years ago, and ever since, as if they’ve come up with something new. In addition, if they ask questions with a kind of “gotcha” arrogance, I sometimes feel annoyed.

Here’s an example. People sometimes say,

“Oh, I can see that my negative thought is irrational, but it still upsets me. That shows that cognitive therapy doesn’t actually work!”

Here’s what I’m thinking when I hear that:

“Aren’t you special! My goodness, no one ever thought of that before!”

In fact, you may be able to identify some of the distortions in your negative thought, but you DON’T see that it’s “irrational.” You STILL BELIEVE IT!

I’ll say it again. Let’s say you’re trying to challenge a Negative Thought on your Daily Mood Log, like, “I’m a failure” or “I’m defective,” and you believe that thought 100%. Obviously, you’ll feel pretty bad.

There are two requirements for an effective Positive thought:

1. 1. It must be 100% true.
   2. It must drastically reduce your belief in the Negative Thought, perhaps all the way to 0%.

The very moment you stop believing the Negative Thought, your feelings will instantly change.

This is not “easy,” like so many people seem to think. That’s why I’ve developed more than 100 methods for challenging distorted thoughts. You won’t need them all, and perhaps you’ll only need a few, but it’s great to have so much firepower available to relieve people of the suffering they experience from feelings of depression, panic, guilt, shame, inadequacy, loneliness, hopelessness, anger, and more.

I have wondered if it would be helpful to have a place on my website where I could give the instructions for asking really good Ask David questions. Then I could require people to read it prior to submitting questions.

5: Matt also asks: How do we help patients who don’t “get” the Acceptance Paradox?

I have a question about one moment in time, the actual moment of recovery. I'd like to better understand what's happening, in that moment, and why some folks, especially those with hopelessness and a strong desire to 'be better' get stuck at the brink, during 'externalization of resistance', for example, and respond in ways like, 'I'd love to accept myself, I just don't know how' and 'it's too hard to accept myself.' I have felt frustrated with clients when they say this and find it challenging to disarm. I feel tempted to disagree and argue that it's far 'harder' to criticize ourselves than to simply *not* do that. I will think, 'it's hard to put down the whip? It's hard to lower the bar? wouldn't it be harder to continue to carry the whip and keep the bar raised?'. I can see how disagreeing and arguing, here, risk empathy and agenda-setting errors. I suspect my resistance has to do with not wanting to collude with the patient's hopelessness/avoidance. I then wonder, perhaps getting hypnotized, whether there is some real difficulty, other than resistance, that I'm not understanding.

I am entering these conversations with a set of assumptions, which may be incorrect, regarding what is happening in the moment of recovery:

My assumptions are that the cognitive and motivational models are correct and that self-criticism, and the desire to criticize oneself (high-standards) are what result in low self-esteem and feelings of worthlessness. Hence, to make the transition from depressed to recovered, the process would start with approving of our depressed self. Putting this another way, we can't recover, before we recover ... so in the actual moment of recovery, we will be accepting our self-critical, depressed 'self', flaws-and-all, including the 'flaw' of being self-critical. Positive Reframing and successfully 'talking back' to our resistance catalyzes this change and allows us to use methods like, 'Acceptance Paradox' successfully, leading to elimination of worthless feelings, in that moment.

Anything either of you would disagree with, there?

If so, when a patient says, 'I want to accept myself, I just don't know how' or 'it's just too hard to accept myself', especially coupled with, 'I don't have resistance, I just can't do it', what is the best response?

Thanks,

Matt

David’s reply

The word “acceptance” has no set meaning, so I would want to start by asking the patient what they think “acceptance” is—what is it that they think they can’t or don’t want to do?

Also, what time of day did you want to accept yourself, and what were you doing at that moment. What were you thinking and feeling, and who were you interacting with? What did they say and what did you say next?

Interpersonal acceptance means accepting your role in a conflict, using the Relationship Journal, instead of blaming the other person.

I am thinking of making a list on the various “types” of acceptance, and what methods we can use to enable each type. Acceptance might be different for depression vs anxiety vs a relationship problem vs habits and addictions, and recovery from each is associated with one of the four Great Deaths of the “self.”

For example, emotional acceptance has to do with seeing the positives in all of your negative emotions, fairly easily accomplished via Positive Reframing.

Specific Acceptance has to do with moving from Overgeneralizations and Labels (e.g. “I’m a failure”) to the specific: what, exactly, did I fail at? Then you can accept that specific failure and make a plan for change if you want.

Then you can have Existential Acceptance, where you accept that you are a “failure” or a “worthless human being” on a general level, and this can be accomplished with Let’s Define Terms as well a sense of humor.

You can also do two CBAs on the Adv and DiSalvo of Self-Acceptance vs Self-Condemnation.

You can also use the Double Standard / Paradoxical Double Standard. What would you recommend to someone else with self-critical or self-condemning thoughts? And what does their Double Standard say about them that’s positive and awesome?

Just some rambling thoughts!

Another solution has to do with recognizing the nonsensical nature of the notion of the “self.: Fabrice says the magic mushroom therapy helps with this, as you finally “see” that the idea of the “self” is just a kind of illusion.

I’m just babbling. This can be a vexing problem for sure. The buddha had little luck on it 2500 years ago, as his followers couldn’t “get it” either.

Let’s add this to our Q and A list?

Finally, role reversal in Ext of Voices can often help, and also “seeing” someone else discover self-acceptance in a group setting can help, too.

I learned it from my cat Obie. Neither of us weas “special,” but we sure had fun hanging out! The six months I spent taking 20 hrs a week of table tennis lessons helped too. I improved but remained sucky compared to the pros, but it was tremendous fun trying!

Does any of this make sense or help?

David

6: Philoma asks: Hey David, Rhonda and Mark, Can’t thank you enough for all your hard work and effort! Where do you guys get all your energy?!

David’s reply

For me, I get excited about what I'm doing. Also, when I do my "slogging" (= slow jogging), which I hate, I have learned just to try to go about 20 feet at a time, like seeing if I can make it to that tree. This helps a lot. Also, I am very lucky to be doing mainly things I totally love and find exciting. That helps enormously. Finally, I am surrounded by people who are very positive and supportive, which makes things non-burdensome. Conflict can be fatiguing! Good relationships can be energizing. And oh, I forgot the main key to energy. One big cup of coffee in the morning! Warmly, david

Phil’s reply to David:

Words of wisdom, for sure! Happy slogging and all the best for a great 2022!

Thanks for listening and reading today!

Rhonda, Matt, and 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

 

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

284: Ask David, Featuring Matt May, MD Defeating your Self-Defeating Beliefs. Help with fear. Dealing with people who gossip.

Today, Rhonda, Matt and David answer three challenging questions submitted by fans like you.

1. 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?
2. Al asks: Can you help me with fear?
3. Khoi asks: How do you deal with colleagues who gossip about your boss?

Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways.

1: 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?

Hi David

I finally got all the CBAs from my Self-Defeating Beliefs done. I have a ton of them. I also did a CBA on Self-acceptance and a CBA on Self-Criticism. I found out, that the disadvantages of my Self-Defeating Beliefs are massively higher than the advantages. Only with Self-Acceptance the Advantages were much higher than the Disadvantages.

Now that I have got all these CBAs done, what do I do with my findings? Do I rewrite my Self-Defeating Belief into something more realistic or lets say, into something with acceptance?

Thanks for your help!

Many greetings

Caroline

David’s reply

Great work. Yes, you can, as a first step, or next step, rewrite each belief so the disadvantages disappear, and you get to keep the advantages. This will be different for each person, and it is called the Semantic Technique, but here is an example:

SDB: Achievement Addiction: My worthwhileness depends on my productivity and achievements.

Revised version: I can enjoy working hard and being productive, but my “worthwhileness” as a human being does not depend on my successes, failures, or hard work. There are many things in life I can love and enjoy. It isn’t just all about achievement and productivity. I can learn from failures and mistakes. They make me more “human,” and not “worthless” or even “less worthwhile.” In fact, I have no desire or need to be “worthwhile.” It’s a nonsensical, meaningless concept. People don’t much care about how “worthwhile” I am. They care about how I treat them!

That’s just an example of how I deal with this particular belief. Giving up the “Achievement Addiction” actually helps me achieve more, because the pressure and the anxiety is gone. But I still enjoy working and creating stuff!

Another dimension has to do with giving up the habit of beating up on yourself.

We are talking about depression and inadequacy here. It touches also on anxiety, but anxiety can have other SDBs as well.

d

2: Al asks: Can you help me with fear?

Dr Burns, I need help with fear. Can you send me podcasts dealing with that subject? Thank you very much.

David’s reply

Tell me which of the many already published, and available via search function on my website, you have already listened to? And how much of my book, When Panic Attacks, have you read?

May make this an Ask David, since it seems lots of folks are not using the massive free resources I’ve already developed.

Have you take the free anxiety test and course on my website, feelinggood.com? The free anxiety course is, in fact, a compilation of some of the best podcasts on fear.

david

3: Khoi asks: How do you deal with people who gossip about your boss?

Hello Dr Burns,

Thanks for your time to write so many great books and creating this podcast.

I am from Vietnam and know about you and your book thanks to the publisher to translate into Vietnamese. When I read your book, it is very simple fact but very true at the same time.

I wonder how can I not know about your book earlier? Actually, I read a lot of self-help books but I find most would say about what should I become or be, but don’t really show me how to do it.

As you said, the idea I feel because I thought is not new, but I don’t know how to change my thought and beliefs after reading these books. Your books show me simple techniques but very useful and effective.

And I really like your 5 Secrets of Effective Communication, especially these podcasts, because it helps me understand more clearly. One difficult situation that I don’t know how to apply, is when somebody attacks somebody else, not me.

For example, my colleague criticizes my boss (behind his back) via email message or face to face with me. I am afraid if I agree with her, my boss might think I talked behind his back too. So, should I just keep silent for this case because she does not attack me?

Another situation is when 2 people attack each other, like 2 of my staff argue with each other, and I cannot agree with one side because it will make the others get mad with me.

Do you have any advice on this?

Thanks Dr Burns.

David’s reply

Good question, and I will include in an Ask David, if that is okay. My short answer is that in most situations, and especially in a business environment, I do not try to "help" other people who are arguing or not getting along. That is simply asking for trouble and push back. When someone is bad mouthing another person, you can possibly use Feeling Empathy and say "it sounds like you're pretty unhappy with person X, and I know that can be uncomfortable when you're not getting along with someone," or some such general comment. Then you could distract the person with some Stroking, like "I really admired your report at the company meeting," or some such thing.

We can check with Rhonda and Matt and see what they think on the live podcast. In a personal situation, you could use an "I Feel" situation, like "I actually get along with person X, but of course we all have our flaws, or some such thing. But in a work environment, I think you are right that it is important to play it safe and to be thoughtful about interactions with colleagues!

So, I commend you on your excellent questions, even though I might not yet have the best answer for you!

David

 Rhonda, Matt, and David

 FROZEN: Part 2 of 2 Featuring Personal Work with Cody

Today, you will hear the exciting conclusion of the work that Jill and David did with Cody, a young man who sometimes freezes in social situations due to feelings of anxiety. He actually froze up when Jill and David were working with him in part 1 last week. What will they do?

Tune in today and you'll find out!

Before I describe Cody’s session, I want to remind you that I am bringing back my annual, four-day summer intensive at the South San Francisco Conference Center this year, for the first time in five years. We had to abandon it due to the pandemic, and this year we are bringing it back to life on August 8 to 11. It will cover TEAM-CBT for depression and anxiety, but with a few changes, hopefully innovations and further improvements.

For one thing, you can attend in person or online this year, and Dr. Levitt will be teaching with me. This will make the experience even better, since Jill is a brilliant psychotherapy teacher, certainly among the top in the world! The in-person seating will be strictly limited to 100, so register early if you are interested, at

Intensive Information / Registration

The online version will be identical, with many skilled experts to guide you in the many interactive exercises, making both the in person and online versions identical. However, the online will be roughly half the cost, so that could be an appealing option if you are cost-conscious or if you live far away. No travel needed this year!

But perhaps most important, this annual intensive always proves to be the best training experience of the year, with chances to learn sophisticated and magnificent TEAM techniques to use with your patients. But you will also have the chance to do your own personal work. Many, many people have said that the intensives are absolutely magical, and I totally agree!

In fact, the summer intensive might be the training you always dreamed about, but never really received, in graduate school!. 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.

Beginning of Part 2 with Cody

You will hear some of the tools that seemed especially helpful, including

• Self-Disclosure
• Positive Reframing, not only for his negative feelings but also for his freezing
• Identify and Explain the Distortions
• Externalization of Voices with Acceptance Paradox
• the Feared Fantasy
• the Experimental Technique
• And more.

Whether you are a shrink or general citizen, I think there might be a lot for you to learn from Cody, not only about techniques to treat social anxiety and feelings of inadequacy, but also about enlightenment as well. ‘

That’s because the goals of a TEAM-CBT session are not just the reduction of negative feelings, but the complete obliteration of negative feelings, along with jumping on a psychic trampoline that catapults you into a state of profound self-acceptance and enlightenment.

At least, that’s my take on it!

Did it really happen?

Here's how Cody was feeling at the start of the session, along with his goals for each feeling at the end of Positive Reframing, and his feelings at the end of the session. As you can see, all of his negative feelings went to zero.

Emotions

% Before

% Goal % After Sad, blue, depressed, down, unhappy

40

10 0 Anxious, worried, panicky, nervous, frightened 95 15 0 Guilty, remorseful, bad, ashamed 20 5 0 Inferior, worthless, inadequate, defective, incompetent 40 10 0 Lonely, unloved, unwanted, rejected, alone, abandoned 50 10 0 Embarrassed, foolish, humiliated, self-conscious 100 30 0 Hopeless, discouraged, pessimistic, despairing 50 15 0 Frustrated, stuck, thwarted, defeated 50 15 0

Angry, mad, resentful, annoyed, irritated, upset, furious

30

5 0

Confused

60 10

0

 

What explains these seemingly impossible changes in a single therapy session? And are they real, or is this all just a bunch of hype?

Stay tuned and let us know what you think at the end!

Early, I had a challenging exercise to do on Cody’s SDBa. Here’s the solution.

To my way of thinking, Cody’s Downward Arrow chain of thoughts suggest a number of related Self-Defeating Beliefs, including:

1. Perfectionism: I should always try to be perfect.
2. Perceived Perfectionism: Others will not love and accept me if they see that I’m flawed or if I screw up. I must earn the respect of others.
3. Approval Addiction: I need everyone’s approval to be worthwhile.
4. Achievement Addiction: My worthwhileness and capacity for happiness are based on my intelligence, achievements, and productivity.
5. Fear of Rejection. Being rejected and alone would be devastating.
6. Worthlessness Schema (possibly): I’m not inherently lovable, likeable, or worthwhile.
7. Mistrust Schema (possibly): Other people are unsafe or predatory, and powerful, and eager to judge or hurt me. (David: this is a new one similar to Perceived Perfectionism, but this belief puts more of a negative twist on the perception of inherent malevolence in others.)

You always have to be the patient’s point of view about the SDBs, so these are just my guesses.

End of Session

Thanks so much for listening, and a big hug for Cody for sharing his inner self with all of us! To me, this is the best teaching because it is real, and you can see what the shrinks REALLY do behind closed doors.

You also get to see shrinks as struggling, vulnerable, and imperfect human beings, just like yourself!

Cody, Rhonda, Jill, and David

Podcast 283: The O of OCD: Featuring Thai-An Truong, LPC, LADC

Overview: The "O" of OCD (obsessions) is treated differently from the "C" (compulsions.) Thai-An Truong teaches us what really works! Compulsions can be treated with Response Prevention. The techniques for treating the Obsessions include Flooding, Cognitive Techniques, Motivational Techniques for Outcome and Process Resistance, the Hidden Emotion Technique, and more.

OCD (Obsessive Compulsive Disorder) consists of frightening thoughts, or obsessions, plus rituals people do in an attempt to prevent or undo the danger. So, for example, if you go to bed and have the thought, “what if I left the burners on the stove turned on,” you might get up and check the burners. Doing this once could be considered normal. But if you do this repeatedly, you definitely have the symptoms of OCD.

Rhonda wanted me to share how I treat the obsessions in OCD (Obsessive Compulsive Disorder), also known as "pure O."

I often say I wasn’t looking to treat OCD, but OCD found me, since I do a lot of work with postpartum women struggling with feelings of depression and anxiety, they are actually about 2.5 times more likely than the general population to develop OCD. We're not sure why, but my theory is OCD attaches to the things we value the most (e.g., health, children’s well-being), and not much is valued more greatly than our baby.

“Pure O” is actually a misnomer. We think that some people with OCD only have obsessions, without the rituals, because they have lots of mental rituals that people can’t see. So therapists wrongly conclude that they just have a “pure O” variety of OCD.

We usually think of compulsions in OCD as mainly behavioral (e.g., handwashing too prevent contamination or checking the mail box repeatedly when you put your letter in to make sure it didn’t get “stuck”), but mental compulsions (rituals) are also very common. Obsessions are the thoughts or images that cause distress; compulsions, in contrast, are the behavioral or mental acts people engage in to try to decrease the distress.

Mental acts, compulsions, and rituals can include:

• Praying
• Counting
• Repeating words silently
• Recalling events in detail
• Repeating a mental list to ensure safety
• Mentally reviewing the past like a video
• Self-assurance: “I’m okay, nothing bad will happen.”
• Saying the number 4 to reduce the distress of seeing 6, associated with the devil
• Thinking of a positive image to replace the disturbing obsession/thought

Those are just common examples, but there are many more.

Dr. Edna Foa, who has done a lot of research on OCD and the effectiveness of Exposure and Response Prevention (ERP) for the treatment of OCD states that patients who have ONLY obsessions or ONLY compulsions are unlikely to have OCD.

• Over 90% of people with OCD reported having both obsessions and behavioral compulsions/rituals.
• When mental rituals were included, just 2% reported “pure O”.
  • Foa, E., et al (2012). Treatment That Works: Exposure and Response Prevention for OCD, Second Edition, p. 12

She states we need to assess patients carefully to weed out other disorders:

• Only O may be depression or GAD.
• Only C may be trichotillomania, Tourette’s syndrome, autism, schizophrenia – all can display repetitive and ritualistic actions.
• Trauma can look like OCD. For example, a woman who was raped obsessed about harm coming her way and compulsively checked the doors and windows in her apartment. She may need trauma treatment instead of OCD treatment.
• Specific Phobias: fear of animals (dogs, snakes, etc), heights, needles, storms, flying, driving, etc.
• Paraphilia: pedophilia, voyeurism, exhibitionism, etc.

Dr. Burns’ EASY Diagnostic System can be a great tool for pinpointing these and many other diagnoses.

How I’ve helped clients: A step-by-step approach:

Disclaimer: This is not meant to be a substitute for therapy. It is frequently most helpful to have a therapist work with you through this process.

1. Initial Assessment:
   1. Dr. Burns EASY Diagnostic System
   2. Y-BOCs – Yale-Brown Obsessive Compulsive Scale - not diagnosti. This tool is great for identifying types of obsessions, compulsions, and avoidance behaviors.
   3. T = Testing – Brief Mood Survey
   4. E = Empathy
   5. Psychoeducation about OCD and nature of obsessions
      1. The more we engage with them, try to suppress them/control them, the stickier they become
      2. Share with them about exposure and response prevention and TEAM-CBT approach to treatment
      3. Ultimate goal is to eliminate all compulsions – since they the OCD and are the food that feeds the OCD monster
      4. Normal for obsessions content to shift from one subtype to another
      5. Let them know I will not provide reassurance. Anything expressed/done once is educational, more than once becomes reassurance
      6. Include the family in this process
   6. A = Assessment of Resistance
      1. DML of most disturbing obsession
      2. Identify the feelings and thoughts to increase your understanding of the content and level of disturbance
      3. Can use the What-If Technique to identify the patient's root fear
      4. Do positive reframing ONLY ONCE – otherwise can become a big reassurance (e.g., you are a good person, etc.)

Here is a driving analogy for how we don’t lose our core values or safety just because anxiety has decreased. For example, think of when you first started learning how to drive. Where was your anxiety 0-100? Mine was probably about 90%. This was tied to the values of wanting to stay safe, keep other’s safe, valuing people’s lives and my own life.

Think of where your anxiety with driving is now, 0-100, after you’ve driven almost every day for months or years. Mine is mostly around 0-5%, unless I’m next to a semi, then it's maybe at 10%.

Did you find that your morals and values changed once your anxiety decreased? Did you suddenly start to drive recklessly without caring about others’ well-being?

Most likely not. This will be the same with our work with OCD. Through exposure, your anxiety around your obsessions will also be dialed way down, but your moral compass and values will still stay intact.

5. Use Burns' Triple Paradox for compulsions

1. 1. 1. 1. Goes beyond moment in time: make a list of all compulsions – want to stop all of them (response prevention).
         2. Go back to moment in time, list benefits of compulsions, values, and cost of change
         3. She described Voicing the Resistance (also known as Externalization of Resistance): The therapist might say:

“Let’s look at this list of powerful benefits of your compulsions, the important values it shows about you, and all the costs of change. Given all those powerful reasons to keep your compulsions,  why would you want to do this work to let go of them? “After all, your compulsion give you  immediate relief from your anxiety.”

"Then the therapist can review the entire list of benefits and costs of change, and ask, ”Why in the world would they want to change considering x benefit and y cost?”

4. Motivation script: I rate the patient’s motivation to get rid of compulsions (0-100) before and after the Triple Paradox, and after Voicing the Resistance. If Voicing the Resistance boosted their motivation to change, I have clients write out or record their responses when we went through Voicing the Resistance. Their homework is to read this motivation script or listen to the audio recording of it it every day and as needed, knowing that there will be moments when the temptation to engage in the compulsion is 100%.

7. M = Methods: Thai-An, do not used any traditional cognitive tools (e.g., id distortions, double standard, examine the evidence), but David does and finds them to be helpful, just not the whole ball of wax! Thai-An points out that John Hershfield, MFT,  a major author in the OCD field also talks about using identify the distortions to build awareness. Of course, David sees a missive contribution of TEAM-CBT methods that goes way beyond building "awareness."

1. 1. 1. Address self-doubt in their ability to change with TEAM structure and cognitive tools
      2. Always explore hidden emotion first (case example of OCD cured by hidden emotion)
      3. Here and now exposure as obsessions come up
      4. Fear hierarchy
      5. In Vivo Exposure (case examples) – exposures in real life
      6. Imaginal exposure – exposures in your mind
         1. Anything that can’t be done in vivo
         2. Only with the most disturbing obsession (flooding
         3. Uncover core fear with What If Technique
      7. You can use David's Devil’s Advocate for the compulsions
         1. Rate how tempting it is to engage in compulsion (0-100)
         2. E.g., OCD: You really should replay that memory one more time to make sure you didn’t molest your baby; Client: That’s OCD talking and I’m choosing to move forward with my life.
         3. Record this and then process the experience after exposure:
            1. What happened during the exposure? Did your fear come true? Were you able to tolerate the distress?
            2. How was the outcome different from what you expected? What surprised you about the outcome?
            3. What did you learn from this exercises?
            4. What could you do to vary this exposure?
      8. Relapse Prevention Training should always be done following the initial recovery..

Thanks for tuning in today!

Rhonda, Thia-An, and David

Thai-An practices in Oklahoma City, but teaches online for everyone. For more information about her clinical work, visit www.lastingchangetherapy.com. For information about r her TEAM-CBT training, visit www.teamcbttraining.com. Through her training website, you can sign up for her free TEAM-CBT webinars, which are held every other month. Her upcoming TEAM-CBT Conference in Oklahoma will be from March 30-April 1, 2022.

Here's the info about the conference:

• TEAM-CBT Conference: Practical Tools for Overcoming Anxiety, Depression & Addictions
• Get more info, register, and pay here: www.teamcbttraining.com/conference
• Dates: Wed, March 30th - Fri, April 1st
• Times: Wed: 9:00-5:30 CDT, Thurs & Fri 9:00-5:00.
• CEUs: 20 CEUs approved for Oklahoman psychologists, LPCs, LMFTs, LADCs, & LCSWs, including 3 of ethics and 10 specific alcohol and drug hours. 20 TEAM-CBT Certification Units approved.
  •  
  • Any therapist can attend, but CEUs only for Oklahomans at this time.
  • Must attend the conference in full to get your CEUs/certification units. Not late arrivals or early departures.
• Perks:
  • 25% off coupon for Dr. Burns's tools
  • 50% off Level 1 TEAM-CBT Certification through FGI
  • Lots of interactive, practical learning through didactics, live demos, and a live session to show the TEAM treatment process from beginning to end.
  • You'll also see a recording of my habits & addictions process with a woman working on decreasing alcohol use.
• Dipti  Joshi, PhD will be joining us all the way from India and will help to teach uncovering techniques on Thursday morning.

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.

1. 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.

1. 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.
2. 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!
3. 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.

1. 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.
2. 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 Unexpected Results of the Latest (and Largest) Beta Test

Feeling Good Podcast Special Edition #1: February 28, 2022

Today’s special podcast features Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the most recent beta test which included 140 participants with depression ranging from no depression at all to the most severe depression that one can possibly experience.

David explains that in the middle- to-late 1970’s he first conceptualized the possibility of creating an electronic version of himself that could treat people without any assistance from an actual shrink. He explains that

My first fantasy was a small booth you could go into, like the ones for taking photos, where you would be presented with a hologram of a shrink who would talk with you in just the same way that a human therapist does. I also imagined creating kiosks that could be placed in groceries stores or places like Epcot Center in Disney World. where people could insert 25 cents and have their emotional or marital problems analyzed, or their depression treated, and so forth. I imagined that the kiosk would be loaded with powerful statistical software that could analyze data on the fly, and create huge data bases, and do research on the causes and cures for emotional and relationship problems.

Once the internet evolved, my fantasy change slightly, and I imagined creating an electronic version of myself that would be available to anyone in the world as an app. In addition, because of some promising published research on the antidepressant effects of my first book, Feeling Good, I had a hunch that I could create an app that might be as effective, or even more effective, than human therapists.

Two years ago, Jeremy and David teamed up to see if this dream was possible. Today, they present the incredible results of the latest beta test of the Feeling Good App. They measured changes in seven negative feelings as well as happiness in 140 individuals who had access to one portion of the app—the Basic Training—for one day only. The seven negative feelings were depression, anxiety, guilt and shame, inadequacy, loneliness, hopelessness, and anger. All feelings were measured on the same scale from 0 (for not at all) to 100 (for completely). The reliabilities of the negative feelings scale were .91 at the initial evaluation and .93 at the end of the day.

David divided the participants into two 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 results indicated, unexpectedly, that they may have already achieved their goal. Here’s what they found:

1. The reductions in depression in both groups, as well as the additional six negative feelings, were substantially greater than the reductions reported in large numbers of published outcome studies with cognitive therapy, other schools of therapy, and antidepressants.
2. All seven types of feelings were dramatically reduced in both groups. For example, the depression reduction was 62%and 51% in the severe and mild groups, respectively, and the anger reduction was 70% and 81%, respectively. (Click here for the complete report).
3. Individuals in both groups also reported boosts in happiness, with a 33% increase in the mild group and a mind-boggling 80% increase in the severe group. The lower (but significant) boost in happiness in the mild group was because many of these individuals were already pretty happy at the start of the app, so there wasn’t a lot of room for improvement.

CLICK HERE FOR THE FULL REPORT

One of the most exciting features of the Feeling Good App is that it does research on itself in real time and shows us which parts are the most and least effective. In fact, one part of the app in this beta test was not helpful, and actually made depression somewhat worse, on average. In spite of that, the changes in all the negative feelings were spectacular by the end of the day.

We have already modified the parts that were not effective, and anticipate the app will become more and more powerful over time. This is just the beginning, and the sky’s the limit!

The feedback we received on the app has been largely totally unexpected. Some things that we thought were blow-away were criticized, and some parts that we thought were weak were strongly celebrated. This experience has been much like using David’s feedback scales in therapy. Therapists learn that their perceptions of how their patient feel are often not off-base, and that many of your favorite techniques and strategies are not effective. This information, if processed with respect and humility, can transform your clinical practice.

And of course, similar information is rapidly and radically transforming our app! Once again, our “patients,” or more accurately “app users,” have become our best teachers.

In the next podcast a week from today, we will discuss the basic science we are doing with the help of the Feeling Good App. We are asking questions like these:

1. How does the Feeling Good App really work? What are the ingredients of therapeutic success? What are the variables that can trigger such rapid and dramatic changes in negative feelings as well as happiness?
2. What is the cause of depression? Is there any support for the theory that depression (and all other negative feelings) are caused by distorted negative thoughts?
3. Is there any support for the theory that changes in negative feelings are actually mediated by reductions in our distorted negative thoughts?
4. Is there any support for David’s prediction, first made in the Journal of Consulting and Clinical Psychology in 1998, that an unknown “Common Cause” simultaneously triggers depression and other negative feelings, like anxiety, and accounts for the strong correlations among these feelings? Here's the reference:

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.

1. Are some groups easier to treat and more responsive? For example, the beta group included therapists and non-therapists, as well as individuals with no or very little familiarity with David’s work, plus individuals very familiar with his work. Which groups responded better to the app? This is important because most of the world is NOT familiar with David’s work. Will they be at a disadvantage when using the app?
2. Are the causes of negative feelings, like depression, anxiety, and anger, the same as the causes of happiness? Or does happiness have its own, totally independent causes?

Stay tuned for the answers to these questions. But in the meantime, make your own predictions, and then you will find out what the data told us!

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, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques. So, hopefully, the new study will be pretty cool, too!

David and Jeremy

Rhonda, Jeremy, and David

Podcast #282: Mike Christensen on Deliberate Practice: Was David Right All Along?

Rhonda and I are thrilled to welcome Mike Christiansen, head of TEAM-CBT in Canada. Mike is a fantastic clinician and teacher, and an old beloved friend. Today he talks about the impact of David’s work that is finally being felt and appreciated by innovators in the field of psychiatry and psychology.

Rhonda begins the broadcast by reading a really touching endorsement from a young man in Turkey whose life was changed by David’s work after he came close to suicide.

One of the key’s was David’s statement that we are disturbed, not by events, but by our thoughts about them.” Of course, that incredible idea goes back all the way to the Greek philosopher, Epictetus, nearly 2,000 years ago. It is so basic that most people don’t “get it,” but once you do, it can be mind-blowing. The young man ended his note to David by saying that, “Life is beautiful now. Thank you!”

Mike described a similar enlightenment experience when he was doing counseling, and first attended one of David’s intensive workshops in Canada. He knew that his training did not provide him with the tools to make much of an impact on his patients. He was excited by what he learned, and subsequently attended many of David’s workshops, and became certified in TEAM-CBT.

Mike now teaches from around the world at the Feeling Good institute in Mt. View, California. He teaches a highly acclaimed 12 week introductory course in TEAM. If you are looking for some in depth training, Rhonda and I would STRONGLY recommend this class.

Mike described a vitally important new direction in psychotherapy called “Deliberate Practice,” and is co-authoring a book on this topic with Maor Katz, MD, head of the Feeling Good Institute, and two pioneers in deliberate practice, Tony Rousmaniere & Alex Vaz.

Essentially, Deliberate Practice refers to two things. First, therapists must use rating scales, like the ones David has created, to assess patients progress in multiple dimensions, as well as their perceptions of therapist empathy and helpfulness, at every single session. This keep therapists on their toes, and gives them a crystal clear picture of their effectiveness or lack of effectiveness with every patient at every session. Although this can often be painful for the therapist, it can transform the therapist’s clinical skills and turn every patient into the finest teacher the clinician has ever had!

Second, deliberate practice refers to refined training tools for therapists to practice on an ongoing basis, not only when learning therapy for the first time, but throughout your entire career. The key is doing short, role plan exercises that focus on specific tools, like the Five Secrets of Effective Communication during the E = Empathy step of TEAAM, or the “Invitation Step” at the start of A = Assessment of Resistance, or the Externalization of Voices during M = Methods.

And here’s the most important part. After the role play, the student is given a letter grade plus specific feedback on what she or he did right and what needs improvement. Then you do repeat role reversals until the student gets an A.

David compares this to the type of training a professional athlete might receive to improve his or her skills at basketball or any sport. However, this also requires great motivation and courage on the part of those who are learning and teaching, because every error is highlighted—there’s no hiding! That’s why the philosophy of learning in the spirit of “joyous failure” is crucial to survival and success!

Rhonda, Mike, and David demonstrated this strategy several times, focusing on the Invitation Step of the Assessment of Resistance with an “easy” as well as a more “challenging patient. Sure enough, grades below an A WERE received, and errors WERE pointed out.

And, in addition, grades of A were fairly readily achieved, showing that this type of “deliberate practice” definitely DOES work.

During the podcast I took the opportunity to vent some of my frustrations with the field, and Mike and Rhonda kindly didn’t point out that I probably sounded like a half-demented loony. But I do feel strongly about this topic, and extremely proud of the amazing work that Mike is doing on so many levels.

Most therapists resist rating scales. One of my students did a survey for his PhD research, and it seemed like only a small percent (less than 5%) of the psychologists he polled who advertise in the Psychology Today website are using ratings scales to track patient progress. To me, this is both unethical, anti-scientific, and totally unacceptable.

Therapists have endless excuses for resisting, and all of the excuses are spurious. For example, they think patients won’t be honest, but the big problem is that the overwhelming majority of patients ARE honest, and therapists don’t want to hear the truth bout their errors and ineptitude.

I do not support, but rather condemn, therapists who refuse to use rating instruments. To me, this is the “unforgivable sin” in our profession. I also believe that the use of valid and highly reliable rating instruments will eventually be required for licensure, and the “science resisters” will soon be a thing of the past.

The field of psychotherapy definitely needs to move into the data-driven scientific era, and leave the current “schools of therapy,” which compete like religions, or even cults, behind, just as physics and astronomy broke away from the Catholic Church during the Copernican Revolution hundreds of years ago.

So, Mike is definitely working on the cutting edge, and he’s just awesome! If you get the chance to take one of his TEAM-CBT classes, jump on it! He will connect with you intellectually, emotionally, and, if I can use a politically incorrect word, spiritually!

Warmly, David, Rhonda & Mike

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

1. William asks: How would the T.E.A.M. model look with addiction and procrastination?
2. 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?
3. Al asks: Can you help me with fear?
4. Khoi asks: How do you deal with colleagues who gossip about your boss?
5. Matt asks: How do we help patients who don’t “get” the Acceptance Paradox?
6. Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness!
7. Al asks: Can you help me with worrying and fear of symptoms?
8. 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!”

1. 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.

 

1. 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

Podcast #280: A Beloved and Brilliant Voice from the Past: Dr. Stirling Moorey!

Rhonda and I are thrilled to welcome Dr. Stirling Moorey, from London, England, to today’s podcast. Stirling was one of my first students, and he sat in with me my on all my sessions as a co-therapist for a month for two summers in the late 1970s. I wrote about Stirling in my first book, Feeling Good: The New Mood Therapy, which was published in 1980.

One of the miracles of the internet, and zoom, is the chance to reunite with friends and colleagues from the past. Needless to say, Rhonda and I were SO EXCITED when Stirling accepted the invitation to join us!

Rhonda starts the podcast by saying that

“Dr. Stirling Moorey had the good fortune to be trained and supervised by two pioneers in the field of cognitive therapy, Drs. Aaron Beck and David Burns. In 1979, when Stirling was still in medical school in London, he did an elective with Dr. Aaron Beck at the Centre for Cognitive Therapy in Philadelphia.“

I (David) might put it a bit differently. I would say that during the early days of cognitive therapy, I had the fantastic opportunity to do co-therapy together with Stirling with many patients. I learned a tremendous amount from Stirling, even though I was, in theory, the “expert” and he, in theory, was a totally untrained and green novice. But he was phenomenal right out of the gates, and those months were among the happiest of my life.

What I learned by observing Stirling’s superb interactions with my patients eventually morphed into my Five Secrets of Effective Communication and my first book, Feeling Good Together!

Rhonda continues:

"Stirling was one of the first British therapists to study CBT when that discipline was in its infancy. David described their fantastic collaborative work with Stirling in Feeling Good, and has described Stirling’s brilliant empathy skills in dozens of workshops.

Stirling is currently a Consultant Psychiatrist in Cognitive Behaviour Therapy, and was the Professional Head of Psychotherapy for the South London and Maudsley Trust from 2005-2013. He has been a Visiting Senior Lecturer at the Institute of Psychiatry, Psychology & Neuroscience in London."

Stirling is a highly regarded therapist, trainer / supervisor / teacher and workshop leader. His main research interest is in the application of CBT to life threatening illness and adversity. He was one of the first therapists to develop CBT for people with cancer and has contributed to five randomized controlled trials in both early and late stage cancer.

Stirling is also co-author with Steven Greer of The Oxford Guide to CBT for People with Cancer, and has co-edited a book entitled The Therapeutic Relationship in Cognitive Behavioural Therapy, published by SAGE (Moorey & Lavender, eds.)

During today’s podcast, Stirling reminds us that one of the aims of cognitive therapy is encouraging patients to examine their distorted negative thoughts and self-defeating beliefs in a way that is not threatening. If patients don’t feel validated, they may feel attacked and become defensive, which, of course, can undermine the therapist’s effectiveness.

He also reminded us that the grandfather of cognitive therapy, the late Dr. Albert Ellis from New York, often attacked the beliefs of his patients in a somewhat aggressive manner, and that this can frequently trigger therapeutic resistance. In fact, an overly aggressive therapeutic style can split patients and colleagues into two camps: those who love you, and those who may stubbornly resist and oppose you.

During the podcast, we reminisced a bit on shared memories, and Stirling said that

“David took me under his wing with such willingness to share his knowledge and experience . . . and I was just an ordinary medical student. We had many great moments!”

Although Stirling was tempted to relocate to America, he decided to remain in England, and has never regretted that decision. For one thing, he met and married his beloved Magda.

My own wife, Melanie, and I were honored to take our two kids to England to attend their marriage. We all loved England and had a ball!

Magda, Stirling's wife

We discussed some of Stirling’s amazing work with the patients we saw together in Philadelphia, as well as his visit one summer when we were in California visiting with Melanie’s parents in Los Altos, where we now live. Stirling recalled that when we were out shopping one day, my wife and I tried to persuade him to purchase a large Stetson hat, but he resisted!

Stirling described the three ways in which he encourages people to change their negative thoughts using the Socratic Technique of gentle questioning: he  asks if the negative thoughts are realistic, if they are helpful, and if an alternative perspective can be taken.

The reality testing approach focuses on the important differences between healthy negative feelings, like healthy sadness or grief, which don’t usually need any treatment, and unhealthy negative feelings like depression, or a panic attack.

One key difference is that healthy negative feelings always result from valid, undistorted thoughts. For example, if a loved one dies, you may tell yourself, “I still love him with all my heart, and I’ll miss the many wonderful times we spent together.” In contrast, unhealthy negative feelings result from negative thoughts about the person who died that are distorted. For example, a young woman who’s brother committed suicide told herself,

“It’s my fault he was depressed because our parents love me more when we were growing up. I should have know that he was considering suicide the day he died, so I, too, deserve to die.”

Of course, the distorted thoughts don’t have to result from a traumatic event. For example, a chronically depressed patient may tell himself, “I’m a loser, and I’ll be depressed forever.”

A more pragmatic treatment approach focuses less on whether thoughts are distorted or not, but rather on their effects. It’s possible for a thought to be realistic but unhelpful. If a tightrope walker in the circus thinks during their act, ”If I fall I will die,” this may be realistic but not very helpful!

Stirling talked about how the third way to look at changing thoughts is based on the fact that our lives always have a narrative—a story we tell ourselves about what has happened, or what is happening right now in our lives. These stories can have a powerful impact on how we all think, feel, and behave, and may often function as self-fulfilling prophecies.

We can change these stories to make them more adaptive for us. For instance, rather than seeing the glass as half empty, we can see it as both half empty and half full; or we may choose to focus on what you can control vs. what you can’t.

What I’ve written so far are just some general ideas, summaries of things that we talked about on the podcast. But when you listen to the podcast, you will perhaps notice the warmth, richness, and depth in the way Stirling thinks and communicates. Then you will “see” and experience his true genius and his immense compassion!

We hope that we can entice Stirling to present to one of our free weekly training groups, and perhaps even see if he might agree to do another co-therapy sessions with me that we can publish on a podcast, so you can actually see and experience this master therapist in action!

Rhonda, Stirling 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.

1. 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.

1. 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.
2. 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!
3. 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.

1. 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.
2. 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

Podcast 279: Dr. Leigh Harrington on Goal Setting for Habits and Addictions or Using Habits to Feel Better

Today, we are joined by a very special member of the TEAM-CBT family, psychiatrist Leigh Harrington, MD, who will teach us how to set goals that work when battling habits and addictions.

Leigh Harrington, MD, MPH, MHSA, is a psychiatrist, TEAM-CBT Therapist and Trainer.  Originally from Michigan, where she completed medical school and graduate school, she had the good fortune to meet Dr. David Burns in 2004 during her psychiatry residency at Stanford University when she joined his original group of Tuesday night students.  She specializes is helping therapists and individuals reach their goals especially in the areas of Interpersonal Exposure, Relationships, and Habits.  She lives in Davis, California with her two beloved daughters.

Leigh begins by saying that there are many parts of the TEAM-CBT model than help when battling unwanted habits and addictions. Our habits definitely result from how we think, and the stories we tell ourselves, and treatment can sometimes be more than just treatment, but a transformational experience.

She explains that

“I gained 20 pounds following my last pregnancy, so I began to set three kinds of goals:

• Mental goals
• Physical goals
• Relationship goals”

Mental goals

She continues:

“I focused on reducing the many Should Statements I was battering myself with, like “I should have done this or that,” or “I should do this or that.” These kinds of statements sounded demanding and triggered feelings of guilt and frustration that actually made it harder to achieve my goals.

“So, I decided, instead, to notice my thoughts, and focus instead on appreciating things. This was just one of many approaches to rewiring my brain.

“For example, I realized I had been letting my brain run itself each morning. When I woke up my mind would start to tell me all the things I needed to (should) do that day. . . Sometimes I would wake up feeling “okay,” but I was definitely not in a state of bliss, gratitude or joy.

“Sometimes it seemed as if my mind would look to find reasons I might not be feeling top-of-the-world: ‘Well there is this issue… or this… and also this…’

“Which told me a story of my unhappiness, or simply a lack of joy. Of course, my mind was well-intentioned, trying to help me out, but it didn’t end in greater joy, but in the weight of ‘shoulds’ and reasons to feel crummy. It had become a habit--a thinking habit.

“I was struck by the idea that I didn’t have to let my mind think whatever it wanted and wondered if I could break this thinking habit. In habit work, we determine the new habit we want, check our motivation, plan solutions to any problems, and commit to the new habit.

“I thought I would keep my new habit simple, believable, and incorporate gratitude, as that can sometimes be helpful, too.

“My new habit was to catch myself while I was still in bed, as soon as I recognized I was having thoughts, and say to myself something I believed that, was non-controversial. When I caught myself thinking any shoulds or telling myself any unhappy stories, I said to myself, ‘I love my bed. I love my house. I love my lamp.’

“This might seem simple, trivial, or silly. But the point of the new habit was not to be profound and brilliant. The point was to change my thinking in the smallest of ways and to prove to myself I could create a new thinking habit.

“This simple thought habit has allowed me to start my day on a better note and has allowed me to prove to myself I can change my thinking habits.”

Physical goals

Leigh explains:

“Here’s how I lost the 20 pounds I had gained. Instead of focusing on one strategy – like, “I will only eat vegetables,” or “I will exercise 2 hours per day,” I focused on achieving the goal by any means. I used the experimental technique and went through a series of habit experiments.

“First I tried just thinking I’d like to lose the weight. I. This may seem crazy, but there have been times in my life when I’ve seemed to effortlessly loose weigh, so that seemed like an easy first go.

“As you might imagine, it didn’t work as well in my 40’s as it did in my 20’s. As long as I kept giving in to my urges to have a sugary treat in the afternoon as a pick-me-up, and refusing to be in deprivation, nothing at all happened with my weight.

“I also allowed myself to eat as much as I wanted to, just as I had when I was pregnant and nursing my daughter.

“Since that didn’t work,. I experimented with some green juice in place of sugary snacks. I felt healthier, but there was no change in my weight.

“Then I decided on a multi-pronged approach. I would keep drinking my fruit-smoothies in the morning, along with a protein shake mid-morning, and a normal lunch, plus a normal dinner – just one serving at lunch and dinner, and no more than one dessert per week, Whenever else I was hungry I would drink a protein drink and lots of water. I also committed to walking every day for 30-60 minutes and going to the gym at least once per week.

“And, I committed to doing this until I saw the results I was looking for. I weighed and measured myself. But in two weeks, I had lost only one pound and zero inches.

“I was discouraged.

“But I was committed to stick with it, no matter what, for as long as it took.

“Three weeks in thee was still not much change.

“But at 4 weeks I started noticing a difference and by 12 weeks the scale read 20 pounds lighter – the same as I weighed in college. Most importantly I felt great and I experienced a sense of accomplishment!

Relationship goals

Leigh continued:

“I also decided to focus on developing better personal relationships with six people, including my mother. I had always felt that she was critical of me, this thought caused me to distance myself from her. I had a better relationship with my dad. So I decided to focus, instead, on what I loved and appreciated about her. For example, she was amazing with my kids.

“This is a little funny, but I was in the middle of a difficult time in life and hired a coach specific to this situation.  I felt sad about the loss of a friend and I found her wisdom really helpful. She suggested, ‘you only need six people, your pall bearers.’

“Since I have a tendency to enjoy and like many people, it made a lot of sense to me to focus my energy on a treasured few.

“I had always prided myself on being a loyal and committed friend and didn’t’ want to give any up.  Even though the suggestion of only 6 didn’t ring true for me, it helped me drop the strongly held belief, ‘I must keep all friends forever.’ I found releasing some relationships allowed room for some really awesome new ones to grow.

“I’m loving those now. And low and behold, I started enjoying hanging out with my mom, and began to realize I had a kick ass mother!”

Leigh summarized some of the keys to successful goal-setting, including the importance of setting small, measurable, and specific goals. She described her upcoming “Boot Camp” on overcoming habits and addictions. For more information, contact Leigh at www.TeamTherapyTraining.com.

Following today’s podcast, we received this lovely note from Leigh:

Hi David and Rhonda,

I so loved being with you both today!! Thank you for being so gracious and welcoming about these ideas on how to modify habits and addictions! I love growing together.

 David, it really struck me how you were breaking things down into steps and making so clear for your listeners - it felt like your intellectual mind and your heart were going at the same time.

Rhonda, I love how you brought up ideas and framed things in such a clear way. You guys rock!!

When we finished up, I thought of a more thorough response to David’s question about slogging today. I was reminded of perfectionism and how I’m trying not to be so perfectionistic. I still remember David’s article on perfectionism from Psychology Today Magazine way back in 1980, when Feeling Good was first released. It was entitled, “The Perfectionist’s Script for Self-Defeat.”

I’ve been working on doing “B” work, and I’ve gotten so much more done and - when I don’t fall into perfectionism again - having so much more fun.

So, I like the idea of holding ourselves accountable, being committed to ourselves and our goals, and to letting ourselves do B work, instead of aiming for perfection. It seems kind of counter-intuitive, but that combo leads to getting more done and being a lot happier!

Maybe you have some insights, David or Rhonda? Much love to you both, Leigh

David wrote back:

Hi Leigh,

Thanks for the beautiful note. I have also struggled with perfectionism, especially when I was younger, and I agree with your conclusions 200%.

But perfectionism has many tentacles, and is always lurking in the shadows, waiting to jump out and grab us again!!

David

Rhonda wrote back:

Hi Leigh,

I also struggle with perfectionism, and when I am feeling overwhelmed I tell myself, “I have an abundance of time to accomplish all I want to do today, calmly, peacefully, and with unhurried grace.'”

That’s not an empty affirmation, but a positive statement created after writing out a Daily Mood Log, seeing the positives in my perfectionism, and looking at the distortions in my thoughts.

Rhonda

We hope you enjoyed this podcast, Rhonda, Leigh and David

 

#278: Buddhist Strategies for Financial Abundance, Featuring Zeina Halim

Jan 24, 2022

Today, we feature the work of Zeina Halim, a beloved member and small group leader in our Tuesday training group at Stanford, who specializes in the treatment of anxiety. 

This is Zeina’s third appearance on our podcast. Previously she helped us with a fabulous program on family conflicts at the start of the pandemic (Corona Cast 3, 4-06-2020) and later did live some personal work on one of the Self-Defeating Beliefs, the Achievement Addiction (Podcasts 211, 10-12-2020, and 212, 10-19-2020). 

Today Zeina brings us something radically different: Buddhist Strategies for Financial Abundance. What in the world does that mean, and why should you care? 

She starts by describing her study of Buddhist practices, and cites some books that have inspired her, including The Diamond Cutter:  The Buddha on Managing Your Business and Your Life, by Geshe Michael Roach.  

Zeina explains the quasi-mystical concept of “Karma,” which is the idea that you get what you give. In other words, the energy and spirit you convey to others, and to the universe, will come back to you. For example, when clients who are not a good fit for her practice contact her, Zeina goes out of her way to help those clients find a great fit with another therapist.  

This “Karmic practice,” she explains, has paradoxically caused many patients to suddenly seem to show up, asking for treatment. In other words, when she meets the needs of others, the universe meets her needs. 

She says that she doesn’t need to do very much at all of the kinds of traditional marketing that most other therapists do in an attempt to build their practices. This “karmic practice” has been mostly sufficient and far more effective than traditional marketing methods.

This is a theme that I (David) resonated with, since I also give away almost everything for free, and have received an abundance of positive and loving gifts from the universe in return.

Zeina cautions that this, and all Buddhist practices, must be done with balance and thoughtfulness: “When I started, I gave too much, and this can actually cause self-harm.” 

She said that some people have raised the question: “But isn’t this an inherently selfish practice, since you are hoping for abundance for yourself?” 

Her response to this is that when you receive financial abundance, you can give even more to others for free. 

She also described another book of Geshe Michael Roach’s, The Karma of Love, where you try to give to the other person and meet their needs instead of worrying about whether they’re loving you enough or meeting your needs. 

In a previous relationship, this led to inner peace and, paradoxically, she felt much more loved, although nothing observable had changed in the way her partner treated her. The change in her feeling loved all came from changes SHE made, not her partner. This aligns very closely with the TEAM-CBT approach to relationships, as well as the teachings of most religions.

We also discussed group TEAM-CBT vs. individual therapy.  I described my phenomenal experiences in Philadelphia creating a large intensive group therapy program at my hospital, which was in a rough, inner city neighborhood. Most of our patients had few resources, and many could not read or write. Some were homeless. The program was more or less free to all of them, and our patients and their families gave us so much in return. 

I was absolutely thrilled that Zeina also loves doing therapy in groups. Many patients and therapists alike think of group therapy as a kind of inferior approach, but my experience has been the opposite. If given the choice, I’d treat everyone in groups.

Zeina will be starting a TEAM-CBT anxiety group within a week of this podcast. The group will focus on all the anxiety disorders, such as chronic worrying, shyness, phobias, OCD, PTSD, and more. There will be one group for adults and one for young adults, aged 18-24.

If you’re interested, feel free to text Zeina at 1-408-412-5678, email her at ZeinaHalimTherapy@gmail.com or visit her website at ZeinaHalimTherapy.com 

As an aside, we’ll find out if Zeina’s Buddhist Karmic Marketing works. She did not ask me to promote her group. I just decided to promote it a little bit because I’m so excited about what she’s doing, and I hope her practice grows and prospers to the max! 

Thanks for joining us today! If you like what we’re doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing. This year, we’ll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen! 

Rhonda, Zeina and David

Rejection Practice: A Love Story, Featuring Dr. Cai Chen

Jan 17, 2022

Rhonda starts today’s podcast by reading two wonderful recent endorsements from listeners. A therapist from San Jose, Ca was moved and inspired by the two podcasts (Episodes 268 & 269, published 11-15-2021 and 11-22-2021) with Dr. Carly on the tragic loss of her baby via ectopic pregnancy, and another listener described TEAM-CBT as “revolutionary” due to the emphasis on reducing resistance. She compared the approach to the indirect hypnotic approach developed by the late Milton Erikson. 

Dr. Cai Chen recently completed his psychiatric residency in Texas, and then moved to California to join the TEAM-CBT community and unite with the love of his life, who happens to be a member of our Tuesday group. 

Cai attributes much of his dating success to one of the techniques he read about in my book, Intimate Connections, called “Rejection Practice,” because he practiced that technique to successfully defeat his negative thoughts about all the awful things that might happen if he tried to talk or flirt with an attractive woman. 

He would tell himself things like:

1. She’ll think I’m being too forward.
2. She’ll be offended and might call the police.
3. People who see me trying to flirt will be offended.
4. I’ll be rejected. 

He described what happened when he forced himself to get 20 rejections in a mall in order to overcome his fears. His stories about what happened are both funny and inspiring. 

Cai also describes his initial intense resistance to using this technique, giving himself messages like, “I shouldn’t have to learn to flirt because it’s beneath me!” I heard excuses like that all the time when I was in clinical practice, working with shy, lonely men! 

Rejection Practice is a powerful and potentially super-effective technique you might want to try if you’re also struggling with social anxiety or if you treat patients with this problem. 

We also illustrated the hilarious Feared Fantasy Technique on the podcast, where Cai enters an Alice-in-Wonderland Nightmare World, and meets the “woman from hell” who represents all of his worst fears, and verbalizes things like this to him:

1. You’re assaulting me and I’m going to call the police. 
2. You’re the last person I’d ever date! You’re forgettable! you
3. You’re too forward.
4. I can see that you’re very insecure!

In addition, he meets the “observer from hell” who verbalizes things like this to Cai: 

1. I’m terribly offended that you tried to talk to that woman. 
2. It’s highly inappropriate to flirt like that in broad daylight. 
3. You shouldn’t be doing that. 
4. I condemn and reject you!

Cai was surprised to discover that the monster has no teeth and experienced some enlightenment and freedom from his fears. Rhonda, Cai, and I had a lot of fun with these techniques, and hope you enjoy them, too. Again, if you’re a therapist, you might consider including these techniques if you work with shy individuals. 

We also discuss the idea of “Physician, heal thyself,” a quotation from the New Testament (Luke 4:23). We are all convinced that doing your own personal work can vastly increase your skills and depth as a clinician, because you can tell your patients, “I know what you’re going through, because I’ve been there myself. And what a joy it’s going to be to show you how to overcome your shyness and develop greater confidence, and more loving relationships with others.”

And that’s exactly what happened to Cai. He found the love of his life. You’ll hear all about it if you listen to this heart-warming podcast! 

Dr. Cai is just starting his TEAM-CBT practice at the Feeling Good Institute in Mountain View, California. However, since he is a trained physician and psychiatrist, he can also prescribe medications if patients need them in addition to the therapy.

Dr. Cai Chen is a warm and brilliant young psychiatrist. If you would like to contact him, you can contact him at Cai@FeelingGoodInstitute.com, or call him directly at 1-916-877-4749.

Thanks for joining us today! If you like what we’re doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing, since I have refused to monetize the podcasts. So our budget is meager at best. 

Still, this year, we’ll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen! 

Warmly,

Rhonda, Cai and David

FROZEN: Part 1 of 2 Featuring Personal Work with Cody

In today’s, and next week’s, podcasts. we present the next episode of live work with Cody. The first, which featured Rejection Practice for social anxiety, was published as Podcast #326 on January 9, 2023 at this LINK.

My co-therapist for this session was the wonderful Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mt. View, California (LINK.).

Before I describe Cody’s session, I want to remind you that I am bringing back my annual, four-day summer intensive at the South San Francisco Conference Center this year, for the first time in five years. We had to abandon it due to the pandemic, and this year we are bringing it back to life on August 8 to 11. It will cover TEAM-CBT for depression and anxiety, but with a few changes, hopefully innovations and further improvements.

For one thing, you can attend in person or online this year, and Dr. Levitt will be teaching with me. This will make the experience even better, since Jill is a brilliant psychotherapy teacher, certainly among the top in the world! The in-person seating will be strictly limited to 100, so register early if you are interested, at

Intensive Information / Registration

The online version will be identical, with many skilled experts to guide you in the many interactive exercises, making both the in person and online versions identical. However, the online will be roughly half the cost, so that could be an appealing option if you are cost-conscious or if you live far away. No travel needed this year!

But perhaps most important, this annual intensive always proves to be the best training experience of the year, with chances to learn sophisticated and magnificent TEAM techniques to use with your patients. But you will also have the chance to do your own personal work. Many, many people have said that the intensives are absolutely magical, and I totally agree!

In fact, the summer intensive might be the training you always dreamed about, but never really received, in graduate school!. 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.

Now, back to the podcast, in which you’ll hear some additional TEAM-CBT magic. Cody asked for help with a problem that’s been bugging him for some time. He sometimes freezes up when asked to do a role play or answer a question during psychotherapy training sessions. This typically leads to an awkward silence, and feelings of intense anxiety, inadequacy, frustration, embarrassment and more.

Here's how he described it:

Upsetting event: I was doing a suicide screening role-play with our clinical supervisor and other therapists. After working through the first step of the role-play, I froze and did not say a word!

Here's how Cody was feeling.

Emotions

% Before % Goal % After Sad, blue, depressed, down, unhappy 40     Anxious, worried, panicky, nervous, frightened 95     Guilty, remorseful, bad, ashamed 20     Inferior, worthless, inadequate, defective, incompetent 40     Lonely, unloved, unwanted, rejected, alone, abandoned 50     Embarrassed, foolish, humiliated, self-conscious 100     Hopeless, discouraged, pessimistic, despairing 50     Frustrated, stuck, thwarted, defeated 50     Angry, mad, resentful, annoyed, irritated, upset, furious 30     Confused

60

   

 

As you can see and might imagine, the most intense feelings were anxiety and embarrassment, but several other feelings were fairly intense as well: such as feeling alone, discouraged, frustrated, and confused.

These were some of his negative thoughts on the Dailly Mood Log that he brought to the session, and the percent he believed each one. Thought 5a, b, and c are an Individual Downward Arrow series, designed to get at the Self-Defeating Beliefs underneath the Negative Thoughts.

What do you think Cody’s SDBs are? Take a guess, and then you can look up the answers, or at least my own thinking, at the end of the show notes.

Negative Thoughts

% Belief

1. I shouldn’t have screwed up. 80 2. I’m not good enough. 80 3. I don’t belong here/I shouldn’t be here. 50 4. Something is wrong with me (my brain) 100 5a. Everyone thinks I’m an idiot        ↓ 100 5b. I should not be in this ↓profession  ↓ 70 5c. I failed to find something I’m good at. ↓ 70 6. I’m worthless 60

 

Although freezing in social situations is fairly common, it can be incredibly challenging and painful for those who experience it. Cody said:

Sometimes they try to help, or may switch to someone else. It sucks, and everyone feels awkward.

The hangover can last a few hours or a day, and keeps me up at night. Over time, some emotions get worse, especially the feelings of depression and inferiority.

I asked if there was also some hidden anger behind his anxiety when called on to perform in a group setting. He said,

Definitely. I feel irritated if I didn’t sleep that well the night before. My heart may not be into it 100%. I sometimes feel forced into it (performing), and just don’t want to be put on the spot. . . What makes it bad is the belief that everyone is looking at me and the belief that I’m being evaluated.

One of the most challenging and exciting events in the work with our courageous Cody was when he actually froze during the session! This gave us the chance to demonstrate and apply in real time. As you know, TEAM is extremely rich in specific methods to help patients within and between therapy sessions. What would be YOUR approach to helping Cody? Or, if you also struggle at times with social anxiety SDB, what is your prescription for yourself?

As usual, Jill and I went through the T, E, A, M. sequence in our session with Cody, which, of course, is highly and totally individualized for every person we work with. In today’s podcast, you will hear the T = Testing and E - Empathy portions of the session. Next week, you will hear the A = Assessment of Resistance and M = Methods portions of the session.

You might be curious to find out which techniques we used, and what approach was the most effective. So tune inn next week to find out!

End of Part 1

Some of the tools that seemed especially helpful included

• Self-Disclosure
• Positive Reframing, not only for his negative feelings but also for his freezing
• Identify and Explain the Distortions
• Externalization of Voices with Acceptance Paradox
• the Feared Fantasy
• the Experimental Technique
• And more.

Whether you are a shrink or general citizen, I think there might be a lot for you to learn from Cody, not only about techniques to treat social anxiety and feelings of inadequacy, but also about enlightenment as well. ‘

That’s because the goals of a TEAM-CBT session are not just the reduction of negative feelings, but the complete obliteration of negative feelings, along with jumping on a psychic trampoline that catapults you into a state of profound self-acceptance and enlightenment.

At least, that’s my take on it!

Did it really happen?

Here's how Cody was feeling at the start of the session, along with his goals for each feeling at the end of Positive Reframing, and his feelings at the end of the session. As you can see, all of his negative feelings went to zero.

Emotions

% Before

% Goal % After Sad, blue, depressed, down, unhappy

40

10 0 Anxious, worried, panicky, nervous, frightened 95 15 0 Guilty, remorseful, bad, ashamed 20 5 0 Inferior, worthless, inadequate, defective, incompetent 40 10 0 Lonely, unloved, unwanted, rejected, alone, abandoned 50 10 0 Embarrassed, foolish, humiliated, self-conscious 100 30 0 Hopeless, discouraged, pessimistic, despairing 50 15 0 Frustrated, stuck, thwarted, defeated 50 15 0

Angry, mad, resentful, annoyed, irritated, upset, furious

30

5 0

Confused

60 10

0

 

What explains these seemingly impossible changes in a single therapy session? And are they real, or is this all just a bunch of hype?

Stay tuned and let us know what you think at the end!

Early, I had a challenging exercise to do on Cody’s SDBa. Here’s the solution.

To my way of thinking, Cody’s Downward Arrow chain of thoughts suggest a number of related Self-Defeating Beliefs, including:

1. Perfectionism: I should always try to be perfect.
2. Perceived Perfectionism: Others will not love and accept me if they see that I’m flawed or if I screw up. I must earn the respect of others.
3. Approval Addiction: I need everyone’s approval to be worthwhile.
4. Achievement Addiction: My worthwhileness and capacity for happiness are based on my intelligence, achievements, and productivity.
5. Fear of Rejection. Being rejected and alone would be devastating.
6. Worthlessness Schema (possibly): I’m not inherently lovable, likeable, or worthwhile.
7. Mistrust Schema (possibly): Other people are unsafe or predatory, and powerful, and eager to judge or hurt me. (David: this is a new one similar to Perceived Perfectionism, but this belief puts more of a negative twist on the perception of inherent malevolence in others.)

You always have to be the patient’s point of view about the SDBs, so these are just my guesses.

End of Session

Thanks so much for listening, and a big hug for Cody for sharing his inner self with all of us! To me, this is the best teaching because it is real, and you can see what the shrinks REALLY do behind closed doors.

You also get to see shrinks as struggling, vulnerable, and imperfect human beings, just like yourself!

Cody, Rhonda, Jill, and David

Here are the questions for today’s Ask David, featuring special guest, back by popular demand, the extraordinary Dr. Matt May, and of course, our super-special hostess, Dr. Rhonda Barovsky!

1. Why is my dad the way he is? Why are people the way they are?
2. What can you do about positive distortions?
3. More Should Statements!
4. How can you talk to someone who refuses to talk to you?

 

Why is my dad the way he is? Why are people the way they are?

Hi Dr. Burns and Dr. Barovsky!

I love your show. Keep up the good work!

I'd deeply appreciate your time and insight.

My dad is 70, my mom is 67, and I'm 38. Throughout my life my dad has done things like he did earlier tonight.

I was at my parent's house and my mom was telling me how Thanksgiving was going to be at my parent's cabin with the whole family like we have in years past at which my point my dad firmly said "No."

My mom asked "Why?" and he just shook his head and shortly after walked out of the room to go to the bathroom, shut the door, and said "no" angrily three times in the other room to himself but loud enough for she could hear.

He'll seemingly randomly act extremely possessive by angrily forbidding family get togethers, or my mom from doing things, or family to borrow things. He'll just say "No" without further explanation.

Always, always, upon asking "Why?" to his "no."

He'll either say angrily, "Because I said so!", say nothing, or just repeat "No" further.

My mom says sometimes "Can you just gave me a reason?" and it's the same "No", silence, or "because I said so."

I don't jump into the aforementioned back and fourth communication because I know such a person can't be changed and don't want to make an argumentative mess.

He's never displayed any comfort with expressing the slightest vulnerability. He's very, very silent. All of my life he has displayed bullying type tendencies. Whenever I visit my parents he always shows tremendous eagerness to want to scowl and berate people for the tiniest mistakes (even people he doesn't know in public, like cashiers.) I think even the most skilled of five secrets practitioners might be outmatched.

My mom tonight, and all my life, has asked me why is he like this?

I've been haunted to try understand this question all my whole life too.

So, I'm putting the question to you Dr. Burns and Dr. Barovsky:

Why is someone like this?

You must've heard of similar situations and have insight?

I want to feel compassion and understanding for him. I don't want to live with baggage.

And mainly, mainly I just want to relieve myself from anger thinking should, labeling, and overgeneralizing thoughts like "He shouldn't act like this", "He shouldn't be such a bully", "He's being a jerk."

Thank you,

Mark

David’s Reply

Thanks, Mark,

I can certainly understand your sadness, frustration, and anger, as well as your love and concern for your mom.

Scientists don’t yet know why people are the way they are. My focus is on helping people at specific moments of interaction when they want help. You have not asked for help in this email.

I do make this type of statement in practically every Ask David episode, but have not had much luck in getting people to listen, because the general questions that have no answers keep rolling in.

You say that your dad cannot change. To my ear, this statement is both blaming and untrue. People change at every moment of every day.

The real question I always have is this, and it might not interest you. Do YOU want to change the way you interact with him?

You and your mom probably both do things that trigger him, like silence, or asking WHY when it is abundantly clear that this response has a 100% guarantee of triggering him.

I apologize if this is not the answer you were looking for!

David

 

What can you do about positive distortions?

How much information is there in the book (or a particular podcast) on how we address positive distortions most effectively?

It is mentioned briefly that these can be more difficult to overcome, because of the more positively perceived "benefits", which may also be re-enforced externally (such as "yes, he is such a nice person, nobody wants him to express any frustration or anger occasionally - not even he himself want to do this!").

It affects motivation to any change, or, at least, creates ambivalence.

Some more on this would be great, please.

Thanks, Tillerich

David’s Reply

Hi Tillerich,

Good question, and I will schedule it for an Ask David. As you point out, there usually isn’t much motivation for change when it comes to positive distortions. Positive distortions trigger habits and addictions, violence, mania, marital conflicts, and narcissism, to name just a few areas.

Each is handled differently, but dealing with motivation / resistance is key in every area.

David

 

More Should Statements

Johnny asks:

Can you help me disprove my negative thoughts? I manage to disprove them, but they return after a few hours.

• “A loser is someone who lives at home with his parents after he turns 18.”
• “I should be bold, confident, and secure.”
• “I should be better than I am.”

David’s Reply

Hi Johnny,

Sorry you’ve been struggling.

The first thing to do is A = Assessment of Resistance, since resistance is the key to nearly all therapeutic failure. Tools would include the Paradoxical Invitation followed by the “Miracle Cure” question: What are you hoping for? What kinds of changes are you asking for?

This is important. For example, you mentioned a problem with procrastination. If you have a procrastination problem, the strategies would be completely different.

Other tools at the “A” portion of the session would probably include

• • The Magic Button
  • Positive Reframing
  • The Magic Dial
  • The Acid Test.

If you decide that you actually DO want to change the way you think and feel, given the fact that you’re still living at home, a few of the many methods that could be used include:

• • Identify the Distortions
  • Explain the Distortions
  • Individual Downward Arrow Technique
  • Semantic Technique
  • Cost-Benefit Analysis
  • Let’s Define Terms
  • Be Specific
  • Examine the Evidence.
  • Double Standard Technique (DST): For example, would you say these things to someone else? Our son has been living with us for a while, but I don’t think of him as “a loser!” My wife and I are actually happy to provide some support while he is sorting out what he wants to do next.
  • Paradoxical DST
  • Externalization of Voices with three strategies:

1. 1. Self-Defense
   2. Acceptance Paradox
   3. CAT (Counter-Attack Technique)

There are many additional techniques that could be used. But first, the action would focus on resistance and motivation. Tackling the distorted thoughts before completing the “A” step is usually not a very good idea!

David D. Burns, MD

 

How can you talk to someone who refuses to talk to you?

Hi Dr. Burns,

I came across your book and podcasts during a time in which I was having a hard time communicating with my adult son. They have helped me tremendously in acknowledging my part in the problem. While I've done a lot of work on my own self-esteem, anxiety and depression, sadly it has come a little too late as my son does not want to talk to me and we are estranged. Any thoughts or advice on how to reach out to a loved one in this situation? Now that I have been practicing for the 5 secrets I want to better connect with my son and work through our issues?

Thanks,

Shelly

David’s Reply

Thanks, Shelly,

I’m so sorry that you are estranged from your son. Have you done the written exercises in my book, Feeling Good Together? That’s a good place to start, as this very topic is addressed in the chapter on how to talk to someone who refuses to talk to you. The method that can be helpful is called “Multiple Choice Empathy” or “Multiple Choice Disarming.”

We will likely illustrate it on the show.

Rhonda, Matt, and David

 

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 9th 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

The Sara Session—Total Blow Away! (Part 2 of 2)

Last week, you heard the first part of the session with Sara, a woman haunted by feelings of anxiety and inferiority from the time she grew up in a village in Mexico. Because she received a great deal of mean-spirited put-downs, she same to see herself as an "outsider" who wasn't good enough. She has finally decided to challenge this crippling and disturbing mind-set, and in today's podcast you will witness her metamorphosis. She will also join us for the fascinating follow-up to her amazing treatment session.

If you click here, you can see Sara’s Brief Mood Survey at the end of the session, along with her Evaluation of Therapy Session. As you can see, the changes in her mood scores were profound, and her ratings of Jill and David on “Empathy” and “Helpfulness” were excellent.

If you click here, you can see Sara’s Daily Mood Log at the end of the session.

By the end of the session, all of Sara’s negative emotions had gone down dramatically, to zero or near zero levels. However, one negative feeling, jealousy, only went down to 30%, and this feeling was still nagging at her. She said she still felt inadequate and jealous of people who had accomplished more, since she’d been procrastinating for years at promoting and developing her private practice.

I don’t like to leave people with loose ends, if at all possible, and Sara clearly wanted to zap the feelings of jealousy if we could, since we hadn’t focused on this emotion at all during the session.

You may be fascinated by the surprise ending to the session, and the method that allowed Sara not only to blow away her feelings of jealousy, but a discovery of how she could use those feelings to connect more deeply with her childhood friends, including those who had accomplished a lot!

There were quite a few teaching points, including but not limited to these:

1. Rapid, profound, and lasting change is possible, even when people have been struggling for years or decades, or even since childhood, with feelings of depression and inadequacy.
2. The goal of therapy is not just a reduction in depression, but a total elimination of depression along with being catapulted into a state of enlightenment, joy or even ecstasy.
3. Sometimes Positive Reframing can blow away a negative thought, as you'll discover in the surprise ending to her session.
4. Sara totally threw herself, body, heart and mind into this work. That commitment is a vital ingredient of success.

Several days after the session, Sara sent this beautiful note to the Tuesday group.

Hello, Tuesday Group!

I apologize for just now sending this email. I had told David I would email the group this past weekend with an update, but I have been TOO busy dancing away (more about this in a second). 😝

Anyway, I will try to make this email short because I tend to go overboard and write too much, and I know everyone is busy. I will just share a few things that have happened since my personal work two weeks ago. I am also forwarding the email I sent David and Jill Tuesday evening after the magical evening.

First of all, THANK YOU all for your awesome support and empathy during that beautiful evening. At that time, I did not realize how much this is the story of many of us in the group (the learning disability and being bullied, humiliated and teased because of it.) I felt very connected to you and felt your love and deep compassion and understanding. Thank you!

So, I was not kidding when I wrote that I am dancing away. You see, during the last two weeks when I have been at a grocery or department store, I have been dancing away to the music playing in the store. For some reason my body just gets moving and doesn’t want to stop no matter what song is playing.

As you can imaging, this is not typical of me. As a matter of fact, I am not a music person let alone a dancer. I prefer to listen to NPR or a Feeling Good podcast when I’m in the car and don’t play any music at home.

Anyway, when I have been at a store these last few days, I have let loose. It was really funny when a lady at the end of the aisle noticed me dancing, and said to me, ‘You go girl!” We both giggled and I kept dancing even after the song was over.

I am NO longer inhibited and have allowed my body to do what it needs to do, and I really don’t care what anyone thinks or says. What a liberating feeling this is!

My husband also thought it was funny that I have made silly sounds, especially during meals, and we would just burst into laughter.

Needless to say, a lot has gone on since my personal work. I am definitely more relaxed, and therefore, less serious and more playful. Enjoying life!!!

The main shift has been my thought that has been ingrained in me my whole life: “Que van a pensar?” which translates to "What are they going to think?” I used to care and believe this !00% but now I don’t believe it (0%) and it does not matter to me what people think.

My new thought now is more powerful and I believe it 100%: "I don’t care what she (they) think. What matters is what I am telling myself!”

I have noticed myself shifting to this new thought quite a bit and it has been so liberating and empowering. I cannot express enough how freeing this feels.

In case you are wondering, the plans for the trip to Mexico will include a visit to my birthplace and gatherings with extended family members and high school classmates as well as some site seeing.

Oh, my goodness, I said, I would make this short, and here again, I went overboard. Sorry!

Once again, thank you for all the love and support!!!

With immense gratitude,

Sara Shane

I want to thank my brilliant and beloved colleague, Dr. Jill Levitt, for her brilliant work in Sara’s treatment, and I want to thank Sara for this fabulous gift she has given all of us!

When you actually SEE the magic happening, it makes all the difference in the world. And when you see the actual techniques that Jill and I were using, you will hopefully realize that you, too, can learn to use TEAM-CBT in your clinical work if you are therapist, or in your personal life if you are struggling with feelings of depression, insecurity, anxiety or low self-self-esteem.

Remember, too, that we still offer unlimited free TEAM-CBT training for California mental health professionals in our Tuesday group and for therapists from around the world in Rhonda's Wednesday group.

If you’re interested in the Tuesday group, contact Ed Walton edwalton100@gmail.com. If you’re interested in the Wednesday group, contact Dr. Rhonda Barovsky rhonda@feelinggreattherapycenter.com.

Thanks for listening!

Rhonda, Jill, Sara and David