Explore every episode of the podcast Feeling Good Podcast | TEAM-CBT - The New Mood Therapy
| Title | Pub. Date | Duration | |
|---|---|---|---|
| 475: Ask David: Are You Getting Old and Cranky Now? TEAM CBT and Spirituality | 10 Nov 2025 | 00:34:31 | |
Ask David Are You Getting Old and Cranky Now? TEAM CBT and Spirituality The answers to today's questions are brief and were written prior to the show. Listen to the podcast for a more in-depth discussion of each question.
Dear Dr. Burns, Let me start by saying thank you for all of your hard work and diligence in creating a method which is so user friendly. Completing the book, When Panic Attacks, changed my life and helped me reach enlightenment. My Ask David question is inspired by the last few podcasts, the live session with Rhonda and the live session with Madelaine which David just did with Jill. David has clearly worked so hard to create TEAM and has dedicated so much time to perfect it. I was lucky enough to have been introduced to the podcast when it first started. Some of my favorite episodes to listen to are the live therapy sessions. I've gained insight and felt heard through many of these such as when David told Lee how lonely enlightenment can be because I agree with that! Recently I have noticed that David's demeanor has changed and was hoping to ask about it. I can imagine David might feel lonely in his expertise sometimes. I might be on the wrong track here too but I wonder if David might be feeling frustrated with the lack of understanding from people around him. He has been dedicating his life to this and still people do not understand certain aspects of his research and teaching. On recent podcasts, David had mentioned that he gets more irritated with teaching now too and it has seemed like he is irritated with Rhonda at points. He has mentioned that he feels disappointed if he doesn't see change in 2 hour sessions. Recently I watched a live session with Madelaine and some of the techniques (for example, calling her negative self sociopath during counter attack) did not seem to land or resonate with her and that wasn't addressed with David's usual love and tenderness and warmth with empathy. It seemed rushed and not necessarily focused on the patient outcome but the timeline. I did not find it to be David's usual work of patience and warmth. I could be completely off the rails but I am wondering if this is resonating with David and if he could share more about what it's been like for him recently. I also am wondering if it is difficult to navigate being seen as "a great leader" in a field. Do people see you as "David" simply a dedicated expert in your field or do people treat you like a "God" that has all the answers? I can imagine people would want help from you 24/7 and if you could speak to that. I am hoping David can look at some of those thoughts and comments he's made on the podcasts and become the client for us listeners! I would love for David to show us how to experience TEAM from the client's perspective for all to hear. I have used TEAM-CBT for 10 years and recently started the Fast Track Program which I am very excited for! Thank you again for this truly amazing process! Jenn David's reply Thanks, Jenn, You are right, I DO feel quite a bit of irritation with our field and can identify a bit with Martin Luther, who nailed his treatise / ideas on someone's door hundreds of years ago, and also Jesus who angrily threw the money changers out of the temple a couple thousand years ago. I know that sounds narcissistic, but that's how I feel sometimes. My frustration has several dimensions:
Are you or others interested in my thinking? Let me know. If so, more later, maybe on a podcast or two with Jill and Matt, and of course, Rhonda. And here are the answers to some of your other questions. You say, "He has mentioned that he feels disappointed if he doesn't see change in 2 hour sessions." We're not on the same page here. I nearly always see dramatic change in 2 hour sessions, and I'm dramatic that I have created a therapeutic approach that makes this possible. When I was a young man, a psychiatric resident, I use to dream about that, and wondered if it was even possible, since I almost never saw meaningful change, much less recovery and joy, in any of my patients using the methods I was talk (supportive listening and antidepressants.) You also wrote: I also am wondering if it is difficult to navigate being seen as "a great leader" in a field. Do people see you as "David" simply a dedicated expert in your field or do people treat you like a "God" that has all the answers? Cool question. I think many people see me as a dedicated expert, but I think a few, particular from some of the Asian countries, to like to see people as "gurus" or something on that level. Sometimes I may even encourage that, as I am a strong believer that therapy, at its deepest level, does become spiritual. So, questions about spirituality and enlightenment do interest me greatly, and many of the techniques I've created are designed to facilitate rapid improvement, in minutes, vs. years of meditation. The Externalization of Voices would be an example, and it was actually the first CBT technique I created, around or even prior to 1975. You say, Recently I watched a live session with Madelaine and some of the techniques (for example, calling her negative self sociopath during counter attack) did not seem to land or resonate with her and that wasn't addressed with David's usual love and tenderness and warmth with empathy. It seemed rushed and not necessarily focused on the patient outcome but the timeline. You are partially correct and perhaps somewhat "off." Where you are right is that I miscalculated the time for the webinar, and thought we had to stop at 12:30. I later figured out we had until 1 PM, and we could have spent more time on EOV. Where you're perhaps wrong is that sometimes a confrontation can "jar" a patient into enlightenment. Few therapists use confrontation, but I have always used it, ever since my days in psychodrama as a medical student. Madeleine commented in her follow up evaluation on the things most helpful to her during the session, and that was one of them. Research has consistently proven that the observers of therapy cannot accurately assess the quality of the therapeutic alliance, as reported by the patient, or the effectiveness of what's happening during a session. I sometimes wish therapist observers had a bit more humility about the accuracy of their observations, based on research that's been replicated over and over! But there I am, whining again so I will stop! At any rate, Jenn, thanks for the wonderfully informative critical thinking, and great questions! Warmly, david Jenn's response to David Hi Dr. Burns, Thank you so much for your fast response. I am really honored that you took the time to reply to me! Thank you for your honesty too and I can imagine it's super frustrating! I do not think that sounds narcissistic, I think you are right. I find it extremely frustrating too and I am just a user and learner of TEAM. I think I "see it" sometimes since I've done some personal work. I'm still human with many flaws as I am sure you caught on to a few in my email. I completely agree with all of your points. I genuinely do not understand how TEAM-CBT is not the go-to. It is finally a scientific method that is proven to be effective. It truly leaves me speechless and I could ramble about TEAM for hours to be honest! I am a registered nurse and I have a difficult time seeing my patients being "thrown" anti-depressants etc. The biological theory was the go-to in mental health and about 10 years ago as I was finishing my nursing degree I read When Panic Attacks. It was mind blowing to me. At the time I was working on a Stroke Rehab unit and the psychologist would recommend our depressed and anxious patients be put on medication. When I asked if she had heard about your work she scoffed at it and it made me so mad! I wanted to scream at her to read your work but she was resistant to even listening and perhaps that will not surprise you based on your points (and also how I incorrectly tried to sell it to her!). I would see so many of my patients put on antidepressants and left alone afterwards as if that would solve everything. Even recently during my labour and delivery training we had a psychologist speak to us about post partum mood "disorders" and she specifically mentioned her patients "yes-butting" her and made a joke about how resistant they are to change and I just had this thought HELLOOOOO has agenda setting not been around for years????? Do people not search out solutions and try to be better? I could Google "my patient is yes-butting me" and your work would come up and it is not easy but it is spelled-out and so accessible to learn. Anyway, I could rant forever. I'm on the same page with you, Dr. Burns! Thank you for the follow-up email as well. You are right on this one for sure- my therapist observer totally was inaccurate! And I was thinking "I wonder what her EOV is here and if that was effective". I had asked that question in the chat after the webinar but it was at the end and we did not get to it So next time I will ask that as a question in my email instead. I had not seen confrontation used like that and it did seem off-putting and that just shows how well-versed you are in its use and how I am a learner. Thank you for the feedback. This is making me laugh because I am in the Fast-Track course and I really strive on feedback, and I like getting errors over with. In my nursing career I always had "med error" as the thing I never wanted to do and it felt so good when I finally made one (and it also helps the patient was fine haha). So, I had this thought about learning TEAM and how I know that the therapists are never accurate and how I never want to be the therapist that assumes their thinking. So, I am very happy to have done it already and I have not even started the course really. I want to comment and ask about the spiritual aspect of TEAM. Did you find the spirituality came after personal work or did you see the spiritual aspect before or just as you were developing the whole process? Externalization of voices and a daily mood log is what got me to enlightenment, but it is hard to put into words. I had blips of the euphoria enlightenment over the years but about 5 years ago I had this "big one" and it was not euphoric. It was nothing (but everything) and it was like I became an observer and absolutely none of my thoughts had emotional attachments. It was instant relief of human suffering for sure. Sorry if this is bizarre and I am not sure if this resonates or if I sound like a crazy person. In your podcast with Lee you mentioned that enlightenment is lonely and so I thought maybe you have been here. When it first happened it was an overwhelm of being just matter and being everything and nothing all at once. I could see humanity from an outside perspective almost. I was raised catholic and everything that I learned made sense but in a very different way than I was taught - it was like I understood what Buddha and you and the bible talks about but the deeper meaning if that makes sense. And I sat in the observer role for a couple of days and it was fine because I had no emotional attachment. Actually, as a test I looked at my husband when he got home from work the day it happened and I recognized him of course but I just felt the baseline contentment or a peace overall. The nothingness and the everythingness all at once. When I looked at him I had no emotions or gut reactions or anything and when I thought "that is my husband" I had no emotional ties but I could recognize that my human self loves him but even that love was all created from nothing and everything. This sounds so bizarre! Day 3 or 4 I went to a house party and again I was just an observer and recognized that my human ego is very tied to wanting others to like me, when I attempted humor it would be to serve my ego, before I'd try to make people laugh for me rather for them and a lot of our actions are tied to our egos. After this party, maybe the next day or something I also saw that as I was observing that although I had no emotional ties that also means…I had no emotional ties! It came to me that to live a human life I cannot be in this enlightenment stage. It was lonely even though that did not bother me at the time and seeing humans from this outside perspective is incredibly hard to describe and was overwhelming. So in my enlightenment it was almost like I had to decide to step back into trying to be human so I could carry on with life and try and find these emotional ties and what to do with this awareness of my flaws and what even my personality is. It has rocked me a bit! I have decided to just follow things that I find fun or challenging or have become an interest and the flaws quickly followed! Have you heard of anyone having a bit of fear in reaching enlightenment again? Although the initial hit was so awesome and a huge relief of suffering, I experienced truly what it is like to not have flaws and not have any emotional ties to thoughts. I do have some interesting anxious thoughts about going "back there" and this was the perfect example of "everything in moderation". I must love my flaws haha. Thanks for your time, Dr. Burns! I thought I had heard you mention during a podcast that you feel disappointed if you don't see change in a 2 hour session maybe while you were empathizing with another therapist so I apologize that I was wrong there. I am most likely remembering it incorrectly or I presented the context incorrectly -it's a common flaw of mine haha usually I need to write things down. Looking forward to hearing back, Jenn David's response to Jenn Thanks, Jenn. Awesome email. In the context of my empathizing with another therapist, I could well have said something like that for sure! You are dipping into enlightenment. Way to go. Very exciting, and now YOU will be the expert. When I lived in Philadelphia, I was lucky to audit a class by James Arbukcle at Temple University on structural equation modeling. It was unbelievably exciting for me, and even though I was in private practice, I went once a week for the three hour seminar and did 20 hours of homework every week. I could not believe my good fortune, as he made everything super simple and clear. It was a wow experience every week. For quite a while, I would ask him question when I got stuck or puzzled analyzing my data with his AMOS program, and he seemed to know everything. Which was also cool. Then, one day, he started answer my questions by saying, "Actually, I don't know the answer to that." Like, the first time this happened I asked him the cause of Heywood cases. That where you get a seemingly impossible result, like a correlation greater than one. But then, an odd thing happened. I found that if I worked at it, I could figure these things out for myself. And often, the answers would come to me in a dream, in the middle of the night. So, like James, I probably can't answer all your questions anymore, although hopefully I can still answer a few of them! By the way, James Arbuckle was one of the most amazing teachers I've ever had, and I will forever be grateful for his generosity in letting me audit his class--I was not even a student at Temple--two years in a row for free. And what I learned forever changed my career and my life, especially my way of thinking about research and statistical analyses. Warmly, david Thanks for listening today! Rhonda, Matt, and David | |||
| Awesome November 5 Social Anxiety Webinar for YOU! | 03 Nov 2025 | 00:02:49 | |
Dr. David Burns and Jill Levitt will teach you seven jaw-dropping techniques to end feelings of shyness and social anxiety. For shrinks AND for the general public. If you're hurting, or you have patients who are hurting, we want you to join us! It's 100% free. Therapists even get two FREE CE credits if you attend the live event. Sign up now at CBTforSocialAnxiety.com. This event could change your life. It's Wednesday, November 5th, 2025, from 11 AM to 1 PM Pacific Coast Time. Be THERE! | |||
| 467: Ask David: How can I help grandma and my mom? | 15 Sep 2025 | 00:53:25 | |
#467 Ask David-- How can I help my elderly, demanding grandma? How can I empathize with hostile political figures? The answers to today's questions are brief and were written prior to the show. Listen to the podcast for a more in-depth discussion of each question. Today's questions.
Hi Dr. Burns, A few months ago my grandma fell down her stairs and broke some ribs. She was in a nursing home for a short while since she needed physical therapy and assistance doing daily tasks. Before the accident, she lived alone and was completely independent. During her recovery, she pretty much had round the clock visitors. More than any other person in the nursing home. My grandma complained constantly and anytime someone would say "you look good" or "you seem to be doing better" she would very quickly respond with how terrible she feels etc. Having listened to your podcast on how to deal with complainers, I could see it was because nobody was acknowledging her feelings. They just wanted to say things to cheer her up. She is now recovered and back home, but she refuses to do things on her own again that she is capable of and the doctor cleared her to do. She has a terrible attitude and is constantly calling up family members and her friends to run errands for her. Example: my mom picked up some lettuce she asked for her. Then my grandma called her friend to go get her one afterwards, saying the one my mom bought was too small. She acts completely ungrateful. She texted me that she has been so lonely with no visitors but then my mom tells me that is not true. That she has had people coming over every day and taking her places. My mom is at her wits end dealing with her demanding attitude and ungratefulness. I know Jill had an example before where her mom was saying how hard things are and nobody is there for her and Jill used the five secrets. This situation feels a little different. How can my mom get her life back and get my grandma to do things on her own again? -Brittany David's reply Hi Brittany, How about including this as another Ask David? One problem, as I see it, is that your mom is not asking David for help. So I could only help you with your response to your mom, acknowledging how difficult things are for her. In other words, use the Five Secrets of Effective Communication. Of course, this assumes you want help with your interaction with your mom. It can be hard not to "HELP" when a loved one, like grandma, AND your mom, are suffering and struggling. Sadly, I have learned that trying to help third parties is not satisfying or effective most of the time. But modifying the way I interact with people is almost always helpful. Don't know if this make sense. Certainly we can see what Matt and Rhonda have to add / suggest. Warmly, david Brittany's response to David: Sure, I think it would be a great ask David. I would be interested in your approach if it were my mom asking you for help. What would you tell her and what your five secrets approach might be. -Brittany David's response: I always prefer have a specific example to a hypothetical question. I can only help you with YOUR responses to your mom, or to anyone. Can you give an example of something she has said to you that you want help responding to effectively? Warmly, david
Dear David and Rhonda, Your session on dealing with cancer was incredibly heart-warming and so compassionate. I will be sharing that with my sister who is in a similar situation and now completely healed from her cancer! My question deals with anger. Many of us are dealing with anger and frustration at our country, president, and White House, who are taking rights away from us that we have earned over the past 80+ years. I find applying your positive ideas about anger to be very helpful: to view anger as having a high moral sense of justice and fairness, and to view frustration as keeping vigilant and to not get discouraged. But I want to investigate further how these anger/frustration ideas can be applied to White Supremacists and Steven Miller. Because when you hear these people talk they are so incredibly angry, and are directing their anger at other people in destructive ways. How could we, if given the opportunity, talk to them and feel empathy with them? Thanks so much, Jenny David's response: If you like, we can include your excellent and highly relevant question in an upcoming Ask David podcast. Thanks for listening today! Matt, Rhonda, and David | |||
| Special Episode #1: The GRIP Program | 04 Jan 2024 | 01:10:16 | |
Rhonda Describes the GRIP Program and Interviews GRIP Graduate, Shakur Ross The Guiding Rage Into Power (GRIP) Training Institute serves incarcerated men and women in California. Their mission is to create personal and systemic change to turn violence and suffering into opportunities for learning and healing. I (Rhonda) was introduced to the GRIP program when two of my dearest friends, Steve Zimmerman and Vicki Peet, invited me to a yearly celebration of the GRIP Training institute. I was blown away by who I met and what I learned that I wanted to share it with the Feeling Good Podcast listeners. Thank you, David, for letting me deviate from our typical subjects. The GRIP program is a different subject for the Feeling Good Podcast, because it is not about TEAM-CBT. What the GRIP Program and TEAM-CBT have in common is that they are both evidence-based programs that incorporate CBT theory and methods into their treatment methodology. But the main thing they have in common is that people who engage in these two therapies experience profound, enlightening changes in their lives. From their program: "The GRIP program is an evidence-based methodology developed over 25 years of work with 1000's of incarcerated people and many victim/survivors. Rooted in Restorative Justice principles, the program's trauma informed model integrates cutting-edge neuroscience research. Students engage in a yearlong, in-depth journey to comprehend the origins of their violence and develop skills to track and manage strong impulses rather than acting out in harmful ways. They transform destructive beliefs and behaviors into an attitude of emotional intelligence that prevents revictimization." The GRIP Training Institute was started in 2011. As of October 2020, nine years after running its first group, 915 students have graduated. Of the 915 graduates, 369 were released from prison. Only 1 graduate in nine years returned to prison, which is a recidivism rate of 0.3%, which is very impressive considering the recidivism rate for California is between 44-46%. Many, if not all of the graduates, say that GRIP saved their lives. Something many people who have benefitted from TEAM-CBT echo. At the GRIP celebration, I was standing in line waiting for the buffet. A man got in line behind me. It was confusing where the line ended, which was not directly behind me. In another circumstance I might have mentioned to him that the line ended somewhere else, but he was kind of scary looking, big, buff with obvious prison tattoos on his neck so I didn't say anything. But the line moved slowly and I was curious so I asked him what his connection to GRIP was. He told me he was a graduate of the program and then politely asked me the same question. It has been my experience that often people love to talk about themselves more than they are interested in other people so I was immediately impressed that he was as interested in me as I was in him. When I told him I was a therapist, he asked me what kind of therapy I practiced. I explained TEAM-CBT, and he was super interested! He told me he loved CBT, and had learned a lot about himself through that kind of therapy because GRIP incorporated it in their program. I asked him about his experience in GRIP and his tough exterior transformed right in front of me as he talked about how GRIP saved his life. I talked to several other men (so far only men have graduated from the GRIP program because the services have only recently been brought to a women's prison), and had the same experience. I met our guest on this podcast, Shakur Ross, who kindly agreed to share his journey of transformation with us. GRIP graduates continue to do the work and live as Peacemakers. Shakur works for GRIP and returns to San Quentin and other prisons to provide the same lessons that he received. The podcast starts with an interview with Kim Moore, the Executive Director of the GRIP Training Institute, who explains some of the key concepts of the program. Thanks for listening today! Rhonda | |||
| 377: Living with Regrets, Part 2 of 2 | 01 Jan 2024 | 01:03:09 | |
Jessica Malvicino Live Work With Jessica-- Living with Regrets Rhonda and I recently did live work at a TEAM-CBT intensive in Mexico City. Our "patient" was a 40 year old mental health professional named Jessica with many years of unhappiness because of a decision she made when she was just 17. Perhaps you've also looked back on your life and thought, "If only I would have . . . " done something I didn't do," as well as, "I wish I hadn't done X, when I was young." Last week you heard the initial Testing and Empathy portions of the session with Jessica. Today you'll hear the Assessment of Resistance, Methods, and final Testing.. Part 2 of the Jessica Session A = Assessment of Resistance Jessica said her goal for the session was learning to accept life and move on, and not have such constant feelings of emptiness, with so many "I should have" thoughts running through her brain. Although Jessica, like most people, said she'd press the Magic Button to make all of her negative thoughts and feelings disappear, we decided to do some Positive Reframing first, to see if there were some positives hiding in her negative feelings. We asked the following questions about a number of her negative feelings and thoughts:
As you probably know, the goal of there are two goals for this paradoxical exercise: First, we want to bring the patient's subconscious resistance to conscious awareness. Second, we want her to see that her struggling and suffering is NOT the result of what's WRONG with her, but rather, what's RIGHT with her. The moment that people really "see" and "get" this, there's often a sharp and sudden reduction in feelings of shame, and a strong burst of motivation to crush the negative thoughts at the heart of her misery. Here are some of the Positives we listed: SADNESSMy sadness shows my passion and love of dancing. It shows my dedication to the idea of having a fulfilling career. It shows that I'm a very loving person. ANXIETY, WORRY, NERVOUSNESS These feelings
After listing these and other positives, Jessica decided to use the Magic Dial to reduce her negative feelings to lower levels, but not necessarily all the way to zero, as you can see in the goal column on her emotions table: Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, unhappy 90 20 Foolish 100 0 Anxious, worried, nervous 90 10 Discouraged 97 5 Bad, ashamed 95 0 Frustrated, stuck, defeated 100 5 Inadequate 90 0 Angry, mad, resentful, annoyed 95 10 Lonely 92 5 Other
Then we went on to M = MethodsThese were some of the negative thoughts that Jessica wanted to challenge, along with the percent she initially believed each of them:
She had many others ad well. We used a variety of techniques to challenge and crush these thoughts, including the Externalization of Voices with Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique), and used frequent role reversals to help Jessica get to "huge" wins when she was in the role of her positive thoughts. Here you can see Jessica's scores in the "% After" column. As you can see, her scores were extraordinarily low, which is terrific. Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, unhappy 90 20 0 Foolish 100 0 3 Anxious, worried, nervous 90 10 0 Discouraged 97 5 0 Bad, ashamed 95 0 0 Frustrated, stuck, defeated 100 5 10 Inadequate 90 0 0 Angry, mad, resentful, annoyed 95 10 5 Lonely 92 5 0 Other
Typically, such drastic and sudden reductions in negative feelings not only indicate "recovery," but the experience of feelings of joy and enlightenment. At the end we asked Jessica two questions:
As you listen to the end of the live session, you'll find out what she said! Rhonda and I hope you enjoyed the session with Jessica. We believe that live work with real people, and not role players who are pretending to be in therapy, is invaluable, and one of the best—and only—ways to learn many of the subtleties of rapid and effective treatment. And if you are a general citizen, and not a therapist, I hope your found our work with the brave and wonderful Jessica to be inspirational and educational, especially if you have also sometimes felt depressed, anxious, or ashamed, and if you have found that regrets about the past can put a real damper on your capacity to live and enjoy your precious present moments! Our best teaching is usually through live work, and so we give you, Jessica, a warm thanks and salute for the great teaching YOU have done today! Thanks for listening, everybody! Jessica, Rhonda and David
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| 376: Living with Regrets, Part 1 of 2 | 25 Dec 2023 | 01:11:55 | |
Live Work With Jessica-- Living with Regrets Rhonda and I recently did live work at a TEAM-CBT intensive in Mexico City. Our "patient" was a 40 year old mental health professional named Jessica with many years of unhappiness because of a decision she made when she was just 17. Perhaps you've also looked back on your life and thought, "If only I would have . . . " done something I didn't do," as well as, "I wish I hadn't done X, when I was young." Today you'll hear the initial Testing and Empathy portions of the session, and next week you'll hear the Assessment of Resistance, Methods, and final Testing.. Part 1 T = Initial TestingDAVID WILL SUMMARIZE SCORES ON BMS AND DML You can also see her scores on the emotions table of her Daily Mood Log here. Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, unhappy 90 Foolish 100 Anxious, worried, nervous 90 Discouraged 97 Bad, ashamed 95 Frustrated, stuck, defeated 100 Inadequate 90 Angry, mad, resentful, annoyed 95 Lonely 92 Other
As you can see, these negative feelings were all incredibly intense. E = EmpathyJessica, who grew up in Florida, explained that she started ballet dancing at the age of 3, and when she was 17, she won a prestigious full scholarship to study and have the chance to join a world renowned ballet company. Jessica was incredibly excited, but her mom did not see ballet as a "true career." In addition, her mother was quite protective, which was not uncommon in the Cuban community, and told Jessica she could only accept the scholarship if she agreed to live with her grandparents in New York. Jessica angrily rebelled and turned down the offer. Although she continued to dance professionally until her first daughter was born 14 years ago, she battled with feelings of anger and regret the entire time, while also blaming her mother for her. unhappiness. She eventually got a bachelor's degree in journalism, and worked in television for a period of time. Then she got a master's degree in counseling, and found that she loves clinical work and helping people. However, she continued to live with feelings of regret and anger directed at her mom from age 17 to her current age of 40, for a total of 23 years, and explained that she frequently "takes it out" on her mom during periods of irritability. She also has feelings of grief about what she's lost when she see her young niece dancing ballet beautifully now. This statement brought tears to her eyes. Jessica described all the sacrifices she'd made when growing up in order to become a top dancer, including periods of bulimia to maintain the thinness that her teachers always stressed. She explained that "everyone did it—they weighted us frequently and would grill us if we were even a little bit overweight. . ." and this was all in order to fulfill her ultimate dream of becoming a world class ballerina, a dream that vanished. Jessica gave Rhonda and David an A on Empathy, and said that the self-disclosure felt uncomfortable, but helpful. Next week, you'll hear the inspiring conclusion of the work with Jessica! | |||
| 375: Ask David Live: I'm Struggling! | 18 Dec 2023 | 01:40:23 | |
Today's special guest, Brittany. Podcast 375. I'm Struggling! Ask David Live: a New Podcast Twist We start today's podcast with a visit from Dr. Jacob Towery. You might recall that one year ago he offered an amazing and (almost) totally free two-day workshop for shrinks and the general public on overcoming social anxiety. Roughly 90 people attended, and it was a huge success. The only "cost" was a $20 contribution to a charity of your choice, including Doctors Without Borders and several others. Dr. Jacob ToweryThis year, Dr. Towery will be repeating this incredible program on March 16 and 17, 2024, which will be on a Saturday and Sunday, in Palo Alto. Once again, the title will be "Finding Humans Less Scary." Jacob and Michael Luo will lead the program and will be assisted by 10 - 20 expert therapists who will lead the break-out groups. Last year, people described the program as "transformative" and "life-changing." Social anxiety can have a significant impact on your life, so you owe it to yourself to attend if you or a loved one has struggled with any of the five common forms of social anxiety:Shy Bladder Syndrome
You'll learn and practice tons of awesome anxiety-busting techniques, including Smile and Hello Practice, Flirting Training, Rejection Practice, Talk Show Host, Shame-Attacking Exercises, and much more. Social anxiety rarely exists alone, but is nearly always associated with other mood problems, such as loneliness, shame, depression, and substance misuse with alcohol and benzodiazepine pills to try to combat the symptoms, to name just a few. How do you sign up? It's easy! Just go to If you attend, let us know how it worked out for you, what you learned, and how you grew. Thanks so much, Jacob, for making this kind of world-class experience available to everyone who's looking for some help, and some wild, life-changing and zany fun in March! Brittany, an enthusiastic podcast fan, asked for help with a conflict with her husband. She wrote: Hi Dr. Burns, I'm struggling a bit. My husband reads a ton of articles and feels that the media has been portraying a lot of the current events incorrectly, especially the horrifying Israel/Palestine conflict. He is extremely frustrated by this and has become depressed because none of his friends or family seems to want to talk about it. He says he feels alone & isolated. I have never been much into politics, abd I don't know enough to have a real opinion on things to say who is right. I try to be a good listener to whatever he says. For example, I may say "yeah, that sounds really frustrating," and then I agree with what he says. But I'm obviously doing a bad job at the empathy because he says the support he gets from me is not satisfactory at all. Sometimes I feel like a parrot, just repeating back what he says. I think you had an example before on an Ask David where you showed how to empathize with someone who says how awful everyone is and how awful all the liberals are. Something like that. But I can't find it. When I empathize my husband says I just don't get it and nobody is doing anything to help these innocent people who are being attacked, and he says that I am not doing anything either. I'm at a loss on how to reply? Maybe you could do an example on an Ask David. Sorry for the long message. - Brittany Hi Brittany, Sorry you're struggling, this is a common but important problem. Yes, we can and will do that. Can you give me an example of something he says to you, and exactly what you say next? You can use the attached Relationship Journal I you like. Try to complete steps 1 and 2 at least, and mail back to me ASAP. Lots of people with this problem these days, so could be great ASK D question. Weren't you on the show live once a few years back? I know you've sent us some great questions. I'm thinking MAYBE you could join and practice with us, using your example. Do you have / have you read my book, Feeling Good Together? Best, david It turned out that Brittany was eager and willing to join us live on today's podcast . This is kind of an experimental podcast where we not only respond to a great question by one of our fans, but actually invite that person to get our "expert" help in real time and live on a podcast. You can let us know if you like this format. To get us started, Brittany sent us an example of a Relationship Journal she had prepared. I thought this was really well done, and gave her revised version a grade of A-, which is way better than most people can do. I sent her an email saying that she could probably add more acknowledgement of his feelings and her feelings, like feeling alone and hurt and a bit lonely, and also a bit more Stroking, like "I want you to know how much I love you, and how special you are to me. And that's why it's so had for me to realize that I've really been letting you down." We practiced with Brittany using my Intimacy Drill, which you'll hear on the podcast. Essentially, one of us would play the role of Brittany's husband, and we would say something she wanted help responding to, and she used the Five Secrets to respond. Then Rhonda, Matt and David gave her an overall grade (from A to F), along with fine tuning suggestions, emphasizing what she did that was especially effective and if there were any changes that might make her excellent responses even better. Then we did role reversals so we could demonstrate ow we might respond, followed by additional role plays until she was satisfied with her response. Five Secrets of Effective Communication This approach is called "Deliberate Practice" and it is by FAR the best way to master the Five Secrets so you can use them successfully in real time. We also discussed her concern that at home she'd been feeling like "a parrot" when she tried the Five Secrets. That is always caused by the absence of "I Feel" Statements in your statements, and we modelled how to correct this error. One of the biggest problems in the way people communicate during a conflict or argument is defensiveness, and given in the urge to argue and defend your territory, so to speak. Matt explained that this nearly always results from thinking you have a "self" that you have to defend. Another common Five Secrets error is the failure to acknowledge the other person's anger. Therapists and the general public nearly always make this error, because of a mindset I call "anger phobia" or "conflict phobia." However, Brittany did really beautiful work during the podcast exercises, as you'll see when you listen. We (the so-called "experts") also practiced what we preached and took turns responding to criticisms, which is always fun and challenging, and often humbling when we goof up! Let us know what you think about this new format of having someone who asks a question actually appear live on the podcast so you can actually learn through practice while we answer your question. Thanks for listening today, and thank you Brittany for blazing new trails on our podcasting adventure! Brittany, Rhonda, Matt, and David | |||
| 374: Anger, Part 2: You Have Always Hated Me! | 11 Dec 2023 | 01:26:41 | |
Featured photo is Mina as a child (more pics below!) 374 Anger, Part 2 You Have Always Hated Me! In the Anger Part 1 podcast (371 on November 20), Rhonda, Matt and David discussed the fact that when you're feeling angry, there's always an inner dialogue—this is what you're saying to yourself, the way you're thinking about the situation—and an outer dialogue—this is what you're saying to the other person. In Part 1, we focused on the inner dialogue and described the cognitive distortions that nearly always fill your mind with anger-provoking inner chatter about the 'awfulness" of the person you're mad at. Those distortions include All-or-Nothing Thinking, Overgeneralization, Labeling, Mental Filtering, Discounting the Positive, Mind-Reading, Fortune Telling, Emotional Reasoning, Other-Directed Should Statements, and Other-Blame. That's a lot—in fact, all but Self-Blame. And sometimes, when you're ticked off, you might also be blaming yourself, and feel mad at yourself at the same time. Matt suggested I add these comments on Self-Blame or it's absence:: Another possible addition would be when you identify the absence of Self Blame when we're angry. For me, it's been easier to think of that as a positive distortion, because you are blind to, or ignoring, your own role in the problem. In other words, when I'm blaming someone else, it's me thinking my poop smells great and tit's all the other person's fault.. I've wondered if we fool ourselves like this because of the desire to have a special and perfect "self," which we then defend. Because nobody's perfect, our "ideal self," as opposed to our "real self," is just a pleasant, but potentially destructive, fantasy. Still, we try to preserve and project the fantasy that we are free of blame and the innocent victim of the other person's "badness," , and we imagine there we have a perfect "self" to defend. Or, as you've said, at times, David, "anger is often just a protective shell to hide and protect our more tender and genuine feelings." We also discussed the addictive aspect of anger, since you probably feel morally superior to the "bad" person you're ticked off at when you're mad, and this makes it fairly unappealing to change the way you're thinking and feeling. Your anger also protects you from the risk of being vulnerable and open and genuine. Today we discuss the Outer Dialogue, and how to express angry feelings to another person, as well as how to respond to their expressions of anger. The main concept is that you can express anger in a healthy way, by sharing your anger respectfully, or you can act out your anger aggressively, by attacking the other person. That's a critically important decision! Toward the start of today's podcast, Rhonda, Matt and David listed some of the distinctions between healthy and unhealthy anger. The following is just a partial list of some of the differences: Healthy Anger Unhealthy Anger You treat the other person with respect, even if you're angry. You want to put the other person down. Your goal is to get closer to the other person. You want to get revenge or hurt or humiliate the other person. You hope to improve the relationship. You want to reject or distance yourself from the other person. You want to understand the other person's mindset and find the truth in what they're saying, even if it sounds 'off' or 'disturbing' or offensive. You want to prove that the other person is 'wrong' and persuade them that you are 'right'. You want to understand and accept the other person. You insist on trying to change the other person. You express yourself thoughtfully. You express yourself impulsively. You come from a mindset of humility, curiosity, and flexibility. You come from a position of moral superiority, judgement, and rigidity. You are patient. You are pushy and demanding. Optimism that things can improve and that there's a great potential for a more meaningful and loving connection. Hopelessness and feelings of certainty that things cannot improve. Open to what I've done wrong and how I've hurt you. Focus on what you've done wrong and how you've hurt me. I-Thou mindset. I-It mindset. You're vulnerable and open to your hurt feelings. You put up a wall of toughness and try to hide your vulnerable true feelings.. You look for positive motives, if possible, and don't assume that you actually understand how the other person is thinking and feeling.. You attribute malignant motives to the other person and imagine that you can read their mind and know exactly why they feel the way they do. You accept and comprehend the idea that you can feel intensely angry with someone and love them at the same time.. You may believe that anger and love are dichotomies, and that conflict and anger, in some way, are the 'opposite' of love or respect.. To bring some dynamics and personality to today's podcast, Mina, who's made a number of noteworthy appearances on the podcast, agreed to describe what she learned on a recent Sunday hike. (I've started up my Sunday hikes again, but in a small way now that the pandemic has subsided, at least for the time being. I'm struggling with low back pain when walking and that severely limits how far I can go.) Mina began by explaining that when she was talking to her mom on the phone. Her mom described a conflict with woman friend who seemed angry with Mina's mom. Mina said, "I can see why that woman got angry with you." Mina explained that her mother, who is "conflict phobic," paradoxically ends up with conflicts with a lot of people. However, Mina's mother sounded hurt by Mina's comment, and said, "You've always hated me since you were a little girl! You always looked at me hatefully!" Here are some of Mina's "angry" childhood photos:
Mina explained how she felt when her mom said, "You've always hated me." My jaw dropped when she said that! It was such a shock. I've always felt like she was my best friend! . . . I hate feeling angry. It makes me every bit as uncomfortable as anxiety. If I express my anger, it goes away, and I feel better. But I don't usually express it, and then it comes back disguised as weird neurologic symptoms. And that, of course, is the Hidden Emotion phenomenon that is so common in people who struggle with anxiety. When you try to squash or hide negative feelings your think you're not "supposed' to have, they often resurface in disguised form, as phobias, panic, OCD symptoms, chronic worrying, or any type of anxiety, including, as in Mina's case Health Anxiety—that's where you become convinced you have some serious neurologic or medical problem, like Multiple Sclerosis. Matt suggested that I might remind folks of my concept that "anger allays get expressed, one way or the other." He's found this idea to be both true and incredibly helpful for "us nice folks who think we can get away without expressing our anger, thinking we can avoid conflicts, entirely. This always backfires, in my experience!" On the recent Sunday hike, Mina practiced how to talk with her mom, using the Five Secrets of Effective Communication. After that, she used what she'd practiced on the hike to talk to her mom about their relationship, and then got an "I love you" message from her mom the next morning. This made Mina very happy, but because she had a full day of back to back appointments, Mina decided to spend time crafting a thoughtful reply at the end of the day, when she had a little free time. But when she went back to her computer at the end of the day to send a message to her mom, she discovered that her mother had deleted the loving message she sent early in the day, and Mina felt hurt. When Mina asked her mom about it, her mom said that deleting the message was just an error due to 'old age." However, Mina did not really buy this, and thought her mom probably felt hurt and angry because Mina had not responded sooner. In the podcast, we practiced responding to mom using the role-play exercise I developed years ago. Essentially, one person plays the role of Mina's mom, and says something challenging or critical. Mina plays herself and responds as skillfully as possible with the Five Secrets, acknowledging the other person's anger and expressing her own feelings as well. We practiced responding to mom's statement, "You've always hated me." Matt played the role of mom and Mina gave a beautiful Five Secrets response. You'll enjoy hearing her response, and Matt's and Rhonda's helpful feedback, when you listen to the podcast. Then Mina asked for help responding to another statement from her mom, who had also said: All of the kids your age are angry, because you were neglected a lot of the time because of the war in Iran, and your dad and I were busy doing what we had to do to survive and avoid being arrested. All of my Iranian friends with children your age are experiencing the same thing. Matt and Rhonda did more role plays with Mina, followed by excellent feedback on Mina's Five Secrets response. Again, I think you'll enjoy the role-playing and fine tuning when you listen to the podcast. One of the obvious take-home messages from today's podcast is to use the Five Secrets of Effective Communication when you're feeling angry and talking to someone who's angry with you as week, As a reminder, these are the Five Secrets. And to make it simple, you can think of talking with your EAR: E = Empathy (listening with the Disarming Technique, Thought and Feeling Empathy, and Inquiry) A = Assertiveness (sharing your feelings openly with "I Feel" Statements) R = Respect (showing warmth and caring with Stroking) However, here's the rub: People who are angry will usually NOT want to do this! When you're ticked of, you will almost always have a huge preference for expressing yourself with the Unhealthy Anger described above. Matt urged me to publish my list of 36 reasons why this intense resistance to healthy communication. LINK HERE for the LIST
So, as you can see, there's a lot more to skillful communication of anger than just learning the Five Secrets of Effective Communication, although that definitely requires tremendous dedication and practice. But motivation is the most important key to success or failure. When you're upset with someone, you can ask yourself, "Do I want to communicate in a loving, or in a hostile way?" The reward of love are enormous, but the seduction of hostility and lashing out is at least as powerful! This battle between the light and the dark is not new, but has been blazing for tens of thousands of years. And, of course, the decision will be yours. Thanks for listening today, Mina, Rhonda, Matt, and David | |||
| 373: Why Therapy Fails | 04 Dec 2023 | 00:56:59 | |
Why Therapy Fails One of the most common reasons patients contact me is to find out why the therapy isn't working. They may be TEAM-CBT patients or patients of therapists using other approaches. Therapists also ask for consultations on the same problem--why am I stuck with this or that patient who isn't making progress? In the Feeling Good App, my colleagues and I have been looking into this as well. Most app users report excellent and often rapid results, but some get stuck, in just the same way they might get stuck in treatment with a therapist. I have tried to organize my thinking on this topic, because if you can diagnose the cause of therapeutic failure, you can nearly always find a solution. Of course, the app is not a treatment device, but a wellness device, but the same principles apply. So today, Rhonda, Matt and I discuss a couple reasons why therapists and patients alike sometimes get stuck. Matt described a patient who was misdiagnosed with a psychotic disorder who turned out to have sleep apnea. When the proposer diagnosis was made and treated, the patent suddenly recovered. Rhonda described a patient who jumped from topic to topic and always brought up a new problem before completing work on the previous problem. This problem was solved when Rhonda explained the importance of sticking to one problem for several sessions, until the problem was resolved. The patient then began to make progress. David described a depressed woman from Florida who was stuck in treatment, and not making progress, and then the therapist said "I just can't help you," This hurt and confused the patient who wrote to me. There were essentially two problems--the patients depression what brought her to therapy in the first place, and her unresolved hurt feelings when the therapist "gave up" on her. This problem reflected many failed relationships is the patient's life. This was resolved when the patient took the initiative to schedule a session to talk about the conflict more openly with excellent results. In addition, the patient had heard that she "should" accept herself, but didn't know how to accept her constant self-critical troughs and intensely negative feelings. I suggested she make a list of the benefits of her negative thoughts and feelings, as well as the many positive things they showed about her and her core values as a human being. She came up with an extremely impressive and long list! For example, her criticisms showed her high standards, her humility, her dedication to her work, her accountability, and much more. In addition, she'd achieved a great deal because of her relentless self-criticisms. I asked her why in the world she'd want to accept herself, given all those positive characteristics She decided NOT to accept herself, and was delighted with her decision. She said she felt profound relief! An unusual, but awesome, path to acceptance! In other words, she ACCEPTED her "non-acceptance." I hope you find today's podcast interesting and helpful. Of course, ultimately therapy is part science and part human relationship art. That's why Rhonda and I offer free weekly training groups for therapists who wish to develop their therapeutic skills. The groups are on zoom so therapists from around the world are welcome. Matt offers a consultation group (free to Stanford psychiatric residents) every other Tuesday for therapists who want help with difficult, challenging cases. To learn more, you'll find details and contact information at the end of the show notes. When Therapy Doesn't Work-- And How to Get Unstuck (for Therapists and Patients) By David Burns, MDHere's are some of the most common reasons why therapy might fail or appear to be stuck / without progress. Some of them will be of interest primarily to clinicians, while others will be of interest to clinicians and patients alike. And many of these reasons will also apply to individuals using the Feeling Good App who are stuck in their attempts to change the way they think and feel. But what does "stuck" actually mean? The definition, of course, is subjective. I believe that a substantial or complete elimination of depression and anxiety can typically be achieved in five sessions with a skilled TEAM therapist. I use two-hour sessions, and can usually see dramatic change in a single session, although follow-ups may be needed for Relapse Prevention Training or other problems the patients might want help with. In my experience, the treatment of relationship problems and habits and addictions usually takes much longer than the treatment of anxiety or depression. The techniques to treat relationship problems and habits and addictions actually work just as fast as the techniques to treat depression and anxiety, but the resistance can be far more intense. For example, someone may be ambivalent about leaving a troubled relationship or giving up a favored habit for many months or years before making a decision to move in a new direction. And, of course, the treatment of biological problems like schizophrenia and bipolar I disorder will nearly always require a long term therapeutic relationship, often requiring medications in addition to therapy. The problems and errors I've listed below are mostly correctable. And although there are many traps that therapists and patients fall into, the vast majority of therapeutic failure the patient's hidden 'resistance' to change and the therapist's lack of skill addressing it. This is true in clinical practice and in psychotherapy outcome studies, as well. On the one hand, a great many patients will feel ambivalent about change. For example, a patient with low self-esteem may not want to stop being self-critical and accept themselves, as-is, but to have a better version of themselves, first. Or they may want to overcome their fears without facing them. Or they might want a better relationship but would want the other person to do the changing. Unfortunately, most therapists lack the skills to address resistance and, in fact, often make it worse by trying to motivate the patient to change, rather than understand their hesitation to change and discuss it with them. This is one area where TEAM training has a great deal to offer, including over 30 skills therapists can learn to address motivation and resistance. The following list of 37 reasons why therapy fails follows the structure of T, E, A, M. Errors at or before the initial evaluation
T = Testing
E = Empathy
A = Assessment of Resistance (also called Paradoxical Agenda Setting)
M = Methods--errors using the Daily Mood Log
Other therapist errors
Thanks for listening! Matt, Rhonda, and David | |||
| 372: At Last! An Outcome Study! | 27 Nov 2023 | 00:57:28 | |
At Last! An Outcome Study! One of the wonderful things about TEAM-CBT is the dramatic and rapid changes we see in so many of our patients. But we've had a huge problem-no published outcome studies. And that has definitely limited the general acceptance and recognition of TEAM-CBT. Today, that era has come to an end, thanks to Dr. Elise Munoz, who joins our beloved Feeling Good Podcast to discuss a remarkable outcome study conducted at her Feeling Good Psychotherapy clinic in New York City. She wanted to evaluate the effectiveness of TEAM-CBT with teens and young adults. Dr. Munoz is the Founder and Lead Therapist at Feeling Good Psychotherapy and Adjunct Assistant Professor at New York University. She is also a Level 4 Certified TEAM-CBT Therapist & Trainer, and specializes in the treatment of anxiety, depression and life transitions. Elise conducted a "naturalistic" study of data from 116 teenagers and young adults aged 13 -24 years of age who were treated by 15 therapists between 2017 and 2022. In a "naturalistic" study, you simply analyze all the data from your patients to evaluate the effectiveness of the treatment. This is in contrast to a "controlled outcome study" where patients are randomly assigned to two treatments to see which treatment delivers the best results. Elise conducted the research study as part of her work for a Doctorate in Clinical Social Work at the University of Pennsylvania in Philadelphia. "The results," she says, "were encouraging." That's perhaps a humble description of her findings. David and Rhonda might say that the results were pretty awesome! Elise told us that although the average number of treatment sessions was 27, most of the patients made maximal gains after just 10 weeks (2.5 months) of treatment, and many achieved maximal improvement by the 5th session. Specifically, by the tenth session. 80% of the patients scored in the "subclinical" range on the depression scale of my Brief Mood Survey (with scores of 0 to 4) and 87% scored in the subclinical range on the anxiety scale (scores from 0 to 4) . These scales range from 0 (no symptoms) to 20 (extremely severe.) Prior to the study, only 30% were in the subclinical range. According to Elise, the rapid improvement suggested that most patients will not need long-term treatment, although some will need more time to incorporate their gains following their initial improvement, and many will want to remain in treatment to deal with other problems, such as relationship issues that are so important in this (or any) age range. Prior to the study, Elise trained the therapists in a weekend TEAM-CBT "boot camp," along with two hours per week of group training and 1 hour per week of individual consultation/supervision. My own view (David) is that learning TEAM-CBT is very challenging, requiring a minimum of one to two years of intensive training. However, the fact that therapists can get excellent results with a relatively small amount of training is encouraging. One of the key components of TEAM is T = Testing. We test every patient at the start and end of every therapy session, asking, "How are you feeling right now?" This provides the therapist with a kind of emotional X-ray machine that allows you to see the precise degree of improvement, or lack of improvement, at every session in multiple dimensions. Therapists can use the information to fine-tune the treatment on an ongoing basis. Many other research studies have demonstrated that session by session monitoring of symptoms, consisting of measurement and feedback, significantly improves outcomes in mental health treatment. (please contact Elise for a list of research studies you can look up online). Research indicates that roughly half of adolescents and young adults will suffer from some mental health problem. Therefore, it is essential to provide accessible, effective treatments to prevent the development of long-term mental health problems. We salute Elise for going the extra mile to evaluate the effectiveness of the treatment and to identify the therapists who get the best results. This requires courage and also allows our field to move forward based on real data rather than subjective impressions. Dr. Munoz's fascinating work adds to the body of evidence supporting the effectiveness of TEAM-CBT. and also sets a commendable example of dedication to improving mental health outcomes through research and ongoing professional development in a private practice environment. The famous and idealistic "Boulder Model" of the "scientist / practitioner" is highly touted in graduate school graining programs for mental health practitioners, but is rarely practiced in real life. Dr. Munoz shows that the integration of science with clinical treatment in community settings is not only possible, but extremely important. Dr. Munoz's research also indicates that the TEAM model offers an exciting path to improved mental health for teens and young adults! | |||
| 371: Anger, Part 1: You SUCK! | 20 Nov 2023 | 00:55:29 | |
Anger, Part 1 You suck! Screw you! Jay asks: Are you EVER going to do a podcast on anger? Dr. Burns, Also are you EVER going to do a podcast on Anger with Rhonda and Matt? You have done many podcasts on depression, anxiety, interpersonal relationships YET there is not one podcast addressing anger. Given the world we live in right now maybe it's time to address Anger from a TEAM-CBT perspective and give it the attention you have given anxiety and depression. All the Best, Jay In today's podcast, Rhonda and David address this important but neglected topic that is perhaps more important than ever in today's angry and violent world. David began by pointing out that in the feeling Good App, anger improved as much as six other negative feeling clusters, with fairly dramatic reductions in just a few days. This was completely unexpected and exciting, and has been replicated in numerous beta tests. Maybe there IS a small glimmer of hope in this troubled, angry world! David pointed out that anger is addictive
Any group that is at war tends to feel morally superior and sees the "other" as scum, the enemy, and these distortions give you justification for hurting and killing them and feeling good about what you are doing. What makes the treatment of anger fairly challenging is that most angry people are not looking for help.
How do you treat a patient who is angry? You always start with T = Testing. David's research on therapist accuracy indicates that therapist accuracy is recognizing anger in their patients is incredibly poor. If you want to assess and deal with patient anger, the Brief Mood Survey at the start and end of every session can be invaluable, and the Evaluation of Therapy session at the end can also help. E = Empathy comes next. However, empathizing with someone who is angry can be challenging because they are often provocative, or want the therapist to align with them in their belief that the person they are angry with is to blame. We want the client to feel accepted, and have a warm relationship with their therapist so the therapist can easily get sucked into the patient's blaming mind-set. David calls this "reverse hypnosis," and this can sabotage the chance for effective treatment. Empathy can be challenging if the anger is directed at the therapist, or if the client is saying they are so angry they want to hurt someone. That can be ethically challenging because of the Tarasoff duties to warn the victim and notify the police. That is tough because the client can get upset with the therapist. A = Assessment of Resistance comes next, starting with the Straightforward or Paradoxical Invitation. With someone who is angry, we nearly always use the Paradoxical Invitation. Here's an example: You have been talking about person X, and I can see you are pretty fed up with her. You said, you've tried everything and nothing works, and she won't change. I have a lot of tools that could be very helpful if you want to do work on the relationship and turn it around. But I did not hear you saying that, and I am assuming that is NOT what you want. Don't get me wrong, if you want to work on this relationship, I'd love to do that so you can develop a closer relationship, but at the same time, there's no law that says you have to get along or like everyone. I'm assuming you DON'T want to work on your relationship with X, but want to make sure I'm understanding you. Am I reading your right? M = Methods Two invaluable tools are the Straightforward or Paradoxical Cost-Benefit Analysis for anger, blame, or for the relationship.
What are the Advantages and Disadvantages of feeling intense anger at the other person.
What are the Advantages and Disadvantages of blaming the other person for the problem.
What are the advantages and disadvantages of having a relationship with this person? David provided this example of a Paradoxical Anger CBA. A man was hospitalized involuntarily in Philadelphia who was brought in by the police. He was working at Savings and Loan company with disgruntled customers. A customer came in who was whining and complaining. The patient was a large and powerful man, and he got so angry at the whining customer that he picked him up and threw him against the wall. They called the police who arrested the man, but he seemed psychotic, or in a manic state, so they brought him, instead, to the hospital. He was sent to Dr. Burns' cognitive therapy group shortly after he was admitted to the locked unit, and defiantly stated at the start of the group that he was sent here for "anger management!" Dr. Burns said he never tried to "manage" anger, and instead suggested that they could list some of the advantages and benefits of his anger with the help of the group, and also list what his outburst showed about him that was positive and awesome. Together, the man and the group listed more than a dozen positives on the white board, including:
At the end of the group, Dr. Burns reviewed all the really good reasons for his angry outburst, and said he did not see any reason for him to change or to give up his anger. The patient said he totally agreed. At the start of the group, the man's anger had been 100 on a scale from 0 to 100. Dr. Burns asked him how angry he was now, and the patient said zero! The dramatic change came about because of the Paradoxical Cost-Benefit Analysis. That strategy can be tremendously helpful when you are working with an angry patient. You won't get any buy-in by trying to convince the patient to manage their anger. David was actually siding with the patient's resistance, and the patient could sense that David actually liked and admired him. This can form the basis of a trusting and productive therapeutic relationship. But many therapists are afraid of this type of paradoxical strategy and reluctant to let go of their addictions to "helping," in spite of the high failure rate with that approach. You and your patient have to be on the same team if you want to use tools for effective change. If the patient is motivated and wants help, you can work on the inner dialogue or the outer dialogue, or both. The inner dialogue is the way you are thinking about the situation, and the outer dialogue is the way you are communicating with the other person. Anger always results from your inner dialogue—your thoughts about the other person, and those thoughts will nearly always be distorted. The Daily Mood Log can be very helpful at eliciting and challenging those distortions. The focus with the DML is on the inner dialogue, which will nearly always include a rich mix of positive and negative distortions including
Once you've identified the distortions in a thought, you can use any of the more than 100 M = Methods I've developed to challenge it, such as
If our listeners (meaning you) want a Part 2 podcast on anger, we can describe helping the patient with the Outer dialogue, which is how you actually communicate with the person you're feeling angry with. This was not discussed in great detail on today's podcast, but we just touched on a couple points. The first topic is the difference between Attacking with your anger vs Sharing your anger. It's not bad to be angry, but it is how you share and express your anger that's most important. There's a huge difference between healthy and unhealthy anger. If your goal is to hurt and demean the other person, it's unhealthy, destructive anger. You may want to get back at the other person, hurt them, or put them down. Healthy anger is very different. Martin Buber, a 20th Century Jewish theologian, distinguished an "I-It" vis and "I-thou" relationship. Buddhist philosophy is similar. They say that the cause of all evil is the belief that you are separate from an external reality, so you see other person or group you're angry with as the "enemy" or the "it," that is separate from you, and "different," as opposed to the "thou." Then you can rationalizing using, hurting, or even killing them in order to advance your own interests, or so you think! Sharing your anger involves letting the person know directly and openly and respectfully that you are angry with them because of something they DID, and not because of something they ARE. The goal of healthy anger is to develop a deeper and more loving (or satisfying) relationship with the other person. Healthy anger is the decision you make to share your anger, rather than to attack with your anger out of vengeance, frustration or rage. Healthy anger is not the choice that most people seem to make, since unhealthy anger gives feelings of vengeance and moral superiority. A Part 2 podcast on anger might include Forced Empathy Relationship Journal (RJ
The RJ Requires insight, communication skill, and the painful death of the "self" Examples:
Thanks for listening! Rhonda, and David | |||
| 370: Ask David--the fear of ghosts, do nutritional supplements work? and more! | 13 Nov 2023 | 00:57:36 | |
Ask David The fear of ghosts; the truth about nutritional supplements; the fear of fear; how does anxiety treatment work? And more. Today, David and Rhonda answer six cool questions submitted by podcast listeners like you!
In the following, David's reply was David's email response to the person prior to the podcast, just suggesting some directions we might take on the podcast. The Rhonda comments were based on notes she took during the live podcast. For the full answers, make sure you listen to the podcast! Joseph asks: How would you use exposure to confront your fear of ghosts? Hi David and Rhonda, Thank you again for your wonderful replies and the amazing podcast. If you would humor me, I have another question -- I know David talked about exposure therapy in overcoming fears, but I wonder how this could apply to some fears like the fear of ghosts where it is caused by an over-active imagination (in which case, what should one be exposed to?) Regards Joseph David's reply Cognitive flooding would be one approach. Will give details on podcast. Thanks! David Rhonda's notes Find out what is happening in the person's life, and treat that specific problem. Maybe someone developed a fear of ghosts after the death of a loved one, so the idea of being around death or dead things may also cause intense anxiety. Going to a cemetery may be part of their exposure. Other examples of exposure for overcoming the fear of ghosts could be:
Fear of darkness may accompany fear of ghosts so staying in the dark may be part of your exposure. Fear of sleeping alone may also accompany fear of ghosts so sleeping alone in your home may be part of your exposure. Salim asks: What herbs and supplements will help me become more zen and relaxed? Hello Mr. David D Burns, I want to tell you that i loved "Feeling Good", your book helped me a lot in improving my life, I have a question, can you recommend herbs or supplements that help me be more Zen and more relaxed? I would be eternally grateful. 🙏. Thank you so much. Salim David's reply. Hi Salim, I don't believe in the efficacy of herbs etc. except for their placebo effect. However, the written exercises in the book, like writing down your negative thoughts, can help a lot. You'll find lots of free resources on my website. At the same time, the use of herbs and supplements is kind of a "cult" thing, and as you know, cult followers don't like to have their views challenged! And our field of mental health is, to my way of thinking, a mine field of cults! Thanks! David Burns, MD Peter asks: How do you stop fearing the fear and discomfort of anxiety? David's Reply Exposure! However, I don't "throw" methods at symptoms, but rather work systematically with the TEAM approach, and always incorporate four models in my work with every anxious patient: The cognitive, motivational, exposure, and hidden emotion models. You can learn more about this in the free anxiety class on my website! You'll find it right on the homepage for www.feelinggood.com. Thanks, David Rhonda added You don't stop fearing the fear and discomfort of anxiety before doing an exposure. You do all of the work necessary using the three other models of treating anxiety (see the anxiety question directly below this one) and then you dive into the exposure, embracing the discomfort until it's reduced or gone. Jillian asks: How does cognitive therapy work to help reduce anxiety? Hi David, I have questions about how using your methods helps people. I'm someone that uses an acceptance method for my anxiety with success and throughout this journey I've really been able to catch my mind trying to focus on the negative and trying to spiral into ruminating. With negative thoughts, how do your methods actually help, does it start to change the way you think or make you automatically think in more of a positive way (eventually without having to "challenge" each thought?) Do you have to believe the challenges to your negative thoughts in order for it to work? What if you believe the original negative thoughts more? Do you actually start viewing things in a more positive light? Kinds regards, Jillian David's Reply Hi Jillian, I can make this an Ask David question for my weekly podcast if you like. You can find the answers, too, in the free anxiety class on my website and in my book, When Panic Attacks. Thanks1 Essentially, and I've covered this in detail in a podcast, cognitive techniques can be very helpful in reducing anxiety, but they are only one strategy among many. I actually use four models in treating anxiety: the Motivational Model, the Cognitive Model, the Behavioral (Exposure) Model, and the Hidden Emotion Model. You can learn more about them in Podcasts #22-28. You can find links here: https://feelinggood.com/list-of-feeling-good-podcasts/ I use all four models with every anxious individual I treat. The Acceptance Paradox is a small but important part of the Cognitive Model. Positive Thoughts have to be 100% true to be effective, but that does not mean they will be effective. They also have to radically reduce your belief in the negative thoughts triggering your anxiety. If you still believe your negative thoughts, you need to try a different method to challenge them. I have developed 125 or more methods for challenging negative thoughts, since each person is a bit different! Thanks! D Rhonda's comments We do not treat a diagnosis with a formulaic process. We treat a human being, one specific event at a time. Empathy is absolutely necessary for the treatment. Here are David's Four Models for treating anxiety:
Exposure. No one wants to do exposure. You may also have to feel feelings that you do not want to feel. Feel intense emotions instead of binging, for example.
Sanjay asks: How do you give up wants, needs, and desires? Hello David, Rhonda, and Fabrice, It was really nice to meet Fabrice after a long gap. The topic Fabrice has started is very special of Should , Want and Need. I have heard about this topic in bits and pieces by you in many podcasts and also in your set of 4 podcast of self-deaths. I kept thinking a lot about this beautiful concept of Want versus Need. And if we are able to learn technique to balance between Want & Need ,our lives will become happier and more stress-free. Buddhist teachings say that Desire is the cause of suffering, so they want us to achieve a state with zero desires, which is Nirvana. Also, the Holy book of Hinduism Geeta says further that if the purpose of our desires are to fulfill a duty or to help someone, only in these two cases will desires be good and bring happiness to the person. So, desire to eat a Mango will not fall in any of the two😄 But the penultimate question is that if we don't have desires, life will be very dull and boring. As you had mentioned in podcast number 348 with Dr. Tom Gedman that unless one is in a very very positive state (which is rare like Buddha himself was) then only you can remain in a state of zero feeling otherwise you are bound to fall down and will lead to a very fast relapse . As you have mentioned a number of times that FEELING GOOD APP is a very high priority for you but you try to keep it as your "want" and try not to enter this desire in the NEED zone. Balancing desires on the border between Need and Want is quite challenging I request that please do a podcast for discussing as how to keep desires in check till want and if possible please develop a self-assessment questionnaire in a podcast with Matt May and Rhonda ,sounds i feel this is a valuable topic for exploration. It can provide listeners with tools and insights to strike a balance between fulfilling their desires for happiness and well-being without becoming enslaved by them. I hope my message is clear and I am eagerly looking forward to the discussions amongst yourself. Warm regards, Sanjay New Delhi , India David's Reply. We can discuss this on a podcast, and I can tell you the story of a woman who attended a workshop I gave in San Antonio. She was raised as a Buddhist, but her family gave up Buddhism because her mother felt she'd "failed" at giving up wants and needs and desires. Rhonda added these definitions:
Dana asks for help with the Disarming Technique. Dear David, I would like to request that you, Rhonda, and Matt show your listeners how disarming practice would sound with the following statements.
I feel like when my flight response is in mode I cannot think of how to respond to targeted questions especially. I feel so inferior. Please think of any others you can and add to these to help. Thank you so much!!!! Dana David's reply. Thanks, Dana, We might include these on an Ask David. It might help, too, if you could provide a brief context for these statements, and what, exactly, you typically say next. That way, we might be able to point out your errors as well, if you are interested in learning how you might trigger these statements. Of course, most folks don't want that, preferring to blame. But it can be empowering, at least for the brave! David Rhonda described one of the responses we modeled on the podcast.
David's A+++ reply (according to Rhonda) Ouch, I'm feeling zapped right now, and you're right. I am starting up on something that's been very annoying to you. I think it was aggressive on my part. I have to plead guilty as accused. I love you to death. When we go round and round it is painful for me, too. Clearly, I am to blame for that right now. I am ready to listen. Maybe you can tell me what it is like for you when I start preaching again and we go round and round. It is clearly disrespectful. I want to listen. You may be angry, frustrated, and pissed off. Can you tell me what this has been like for you and how you're feeling right now? At the end of our answer on the podcast, David added: Dana, will you please take one of the examples you sent us, give us a context or a few details, and we will illustrate better disarming responses on a future podcast. Will you also please use the Relationship Journal, and make your own attempt at a 5-Secrets response that we could evaluate and make suggestions on a future podcast? Thanks for listening! Rhonda, and David | |||
| 369 The Invisible Racism | 06 Nov 2023 | 01:16:33 | |
369 The Invisible Racism We All Deny, Featuring Drs. Manuel Sierra and Matthew May Today we're joined by Drs. Manuel Sierra and Matthew May on the sensitive topic of racism. Manuel Sierra MD is a child and adolescent psychiatrist practicing in Idaho, one of the places where he grew up (he also spent time in Oregon). He was a classmate of Matt May during his residency training days at Stanford, and they remain close friends today. Rhonda begins today's podcast with this mail we received from Guillermo, one of our favorite podcast fans: Guillermo asks: How do you respond to family or friends who make racist comments? Hello, Dr Burns Not sure if you have addressed this in any of the podcasts (I don't recall it being a topic) but: I was recently in a group chat with some cousins, and I read some really disappointing racist comments about a particular group. Many people ignored it (as I did) and a couple AGREED with the comments. How can we balance not judging not just any people but our longtime friends and family about overtly racist actions/comments and the thinking that it is not the event but our thoughts that create our emotions? I don't care about "judging them" (in the sense that I don't think it is my place to "change" their views) but just hearing/reading comments like this bothers me when they come from people close to me. When I see it on tv or the internet, I don't get affected because I feel it is beyond my control. I don't believe they will change their views so do I just remove them from my life? I apologize, the topic is too wide, but I've been thinking about this. Sincerely grateful for all you do, Guillermo Manuel kicked off our answer to Guillermo by saying that he has been personally familiar with racism within families and communities, and says that he and Matt have talked about this topic "a lot." He explained that: Although I am proud of my Mexican-American heritage, I was born and grew up in Oregon and Idaho, where I'm currently practicing. I encountered considerable racial bias when I was a kid, and later in life as well. I clearly cannot speak for all Mexican-American people, I can only speak for myself and what I've personally experienced, and I am extremely aware of how difficult the current times are. My grandparents didn't teach my mom Spanish. She was a single mom, and we lived in a small town in Idaho. I also have family through marriage who live on Native American lands. In grade school I began hearing jokes about Mexican Americans, and this was very awkward, painful, for me. I also got ridiculed for not speaking Spanish. Even my grandfather asked me, "why aren't you speaking Spanish?" There were also gangs where the racial bias got worse and frequently turned violent. After learning more about Manuel's experiences, we modeled various ways of talking to a friend or family member who has made hurtful racist comments. Manuel cautioned that it might be best to do provide the feedback individually, and not in public, so as not to shame the person. In addition, this can reduce the chance for social posturing and responding in an adversarial way. Matt agreed and emphasized the importance of combining your "I Feel" Statement with Stroking. For example, you might say something like this, assuming the racial slur comment came from a relative or person you like, Jim, as you know, you're one of my favorite people, but I want you to know that when you said X, Y and Z, it really upset me, because it sounded like a put down to people who are (Mexican, Jewish, Moslem, gay, or whatever). I (David) like this approach because it sounds respectful and direct, but not judgmental or condemning. Rhonda modeled an excellent alternative response which included this type of add-on: "And I'm going to request that you not say that again in my presence. " I (David) would prefer not to add the directive statement at the end, which could, in theory, rankle some individuals with coercion sensitivity, because it might sound scolding. However, that's just my take on it, and it's not some kind of gospel truth. If you want to push your assertiveness and stick up for yourself, it might be effective, and was effective recently for Rhonda because the relative she said this to stopped making similar racial comments in her presence. I would suggest ending any kind of response to the person who made a racial slur with Inquiry, asking them about their racial feelings as well as the fact that you are criticizing them. Do they feel hurt, angry, anxious, or put down? You might also ask something along these lines--Have they always had negative feelings about this or that racial or religious group? Manuel described an experience in medical school when an attending doctor was supervising a group of medical students in how to do a particular medical procedure quickly, and said this to him, "You can be like a Mexican jumping bean!" Then Manuel asked himself, "Should I say something?" Which of course incurs the risk of retaliation from an authority figure in a position of power. Manuel mentioned that just because you're working in a prestigious medical setting, this does not protect you from racial slurs. He described hearing people comment on how he and several Mexican-American classmates probably got into medical school because of their ethnicity, implying they weren't sufficiently intelligent or on par with their classmates. He also mentioned an incident during his internship when he checked in on a patient wearing his white lab coat with stethoscope around his neck, and the patient asked him if he was there to pick up the trash and could he please get the doctor. Manuel humbly replied that he could pick up the trash, and he was the doctor. I asked Manuel how he felt when hearing these types of belittling and patronizing racist comments. He said that he felt annoyed, embarrassed, angry, put down, anxious, and alone. He described one of his best friends growing up who was white. However, this fellow grew up poor as well, so they easily formed bond because they'd had similar class-based experiences. His friend sometimes lived in all-black neighborhoods and had also felt out of place at times, not accepted, and targeted. I asked Manuel how he felt describing these intensely personal experiences on the podcast today, knowing so many people would be listening. He said, "It's anxiety-provoking. My mouth is dry, my heart is racing, and I'm afraid I'll sound like an idiot!" We discussed the differences between being unintentionally or intentionally offensive with racist comments, and also mentioned the related topic of bullying which, of course, is intentionally hurtful. Manuel said that an example might be calling me names or saying terrible things about my mother, or making threats to hurt your family, or your mom. Often the bully is trying to get you to fight, so you'd be beaten up. The bully's goal is to humiliate you in front of others and make you feel bad about yourself. Manuel introduced us to some of the approaches he uses when working with kids who are bullied. I'd like to hear more on this topic but we were running out of time. We could address bullying on a future podcast with the same crew, since Manuel and Matt both have a lot to offer on that sensitive and exceptionally challenging topic. Let us know if you're interested in hearing more. The response to bullying has to have two dimensions. First, your thoughts, and not the bully's statements, create all of your moods. So, you can use the Daily Mood Log to record and modify your inner dialogue. The goal would be to support yourself and not buy into the notion that you are somehow "less than" or a loser or coward just because someone is trying to bully and exploit you in a sadistic fashion. The cognitive work is based on the idea that ultimately, only you can bully yourself. The words of the bully cannot affect you unless you buy into them. But then it's your own beliefs that are the source of your emotional misery. Second, your verbal response to the bully can also be helpful to you, or it can serve to make the situation worse. But these techniques, based in part of the Five Secrets of Effective Communication, can be challenging to learn, especially during the heat of battle, so considerable practice is vitally important. The goal of changing your thoughts as well as the way you respond is not to blame you for the problem, but to give you some reasonably effective coping skills, perhaps similar to the verbal karate I mentioned in my first book, Feeling Good. At the end of the podcast, we did a survey among the four of us on whether meanness and aggression and exploitation is one of the inherent and genetically based drives in human nature, along with our more loving impulses and drives, or whether humans are basically good and all the hostility and killing is the result of adverse influences along the way. There was a sharp difference of opinion, and you can listen to the podcast to find out what everyone thought! We were, of course, just speculating, as this question is partly scientific and partly philosophical. I asked Manuel how he felt at the end of the podcast, and he said he was feeling a lot better. He was powerful and informative, and I was grateful he could appear with our team and teach us from the heart today! I hope you enjoyed today's program as well. Thanks for listening! Manuel, Matt, Rhonda, and David | |||
| 466: Ask David: Is friendship a need? Help! I'm lost and alone! | 08 Sep 2025 | 00:58:17 | |
Ask David: Is friendship a basic human need? Lost and alone--What should I do? #466 Ask David: Is friendship a basic human need? Lost and alone—what should I do? The answers to today's questions are brief and were written prior to the show. Listen to the podcast for a more in-depth discussion of each question. Today's questions.
Hello Dr. Burns, I have a question that has been pestering me for years. I know you said you don't need romantic love to be happy, but I find it hard to believe that you can be happy alone without any friends. Humans are social creatures and there have been studies that said being alone is equivalent to smoking cigarettes - that's how detrimental it is to your health. Being alone can be very dangerous - that is why solitary confinement is one of the worst punishments given in prisons. Best regards, Zainab David's reply However, the question, as I see it, would be whether adult, or romantic love as you call it, is a want or a need? Do we "need" it to feel happy? What were your happiest moments, between 0 and 100? I have had several incredibly happy moments that did not have anything to do with being loved or not being loved. What, in your opinion, is the maximum happiness possible if you are alone or unloved? What, exactly, is the claim that you are making? Have you ever intentionally spent time alone to check it out? And if, just if, you did not "need" romantic love to feel happy, would you want to know that? Or would you prefer to insist that we "need" love for happiness, even if it isn't true? In my experience working with many patients, the "need" for romantic love can actually be one of the greatest causes of unhappiness, and one of the greatest barriers to love as well! Best, david PS Here's another way to answer the question. What's your definition of "need?" Or, to put it slightly differently, what is it that you think you "need" friendship for? It wouldn't be a cup of coffee at Starbucks, for example, because anyone can walk in and purchase coffee. And you don't need friendship to breathe. Air is free. And also, what, in your opinion, would be the difference between "wanting" friendship and "needing friendship?" Also, what is your definition of "love." Love has many meanings, and is not some precise "thing." It's just a word we use in a great variety of ways. I love blueberry pie, but these days I avoid it because it is quite sweet, and I'm trying to avoid calories. I don't "need" blueberry pie. It's just a "nice to have" every now and then. I promised to include the Pleasure Predicting Sheet in the show notes so you can do the experiment suggested on the podcast. So here it is! Pleasure Predicting SheetSlash says: I'm lost and alone. I really don't know what direction to take in my life! What should I do? Subject: Feeling Lost Hi Dr. Burns, I wanted to share some mixed feelings with you. Your podcasts and techniques have been very helpful, and I'm truly grateful for the comfort and hope they bring me. I've been a shy, lonely person for most of my life, and only recently have I started to feel a little bit of confidence. Still, I worry a lot—just like my father. It's 4 a.m. as I write this, and I keep asking myself, What should I do with my life? Sometimes I dream about learning music, sometimes I think about getting a job, but whenever I try, my anxiety takes over and I step back. I often see myself as someone carrying many kinds of anxiety—social anxiety, constant worrying, nervousness about driving, blood phobia, and even anxiety that comes out of nowhere. I've also learned from you that hidden emotions can be powerful, and I'm beginning to notice that in myself. Sometimes I go out with my friends, enjoy the moment, and feel lighter. But when I come back and look at my father, my uncle, and my grandfather, I feel a wave of sadness again. My father struggles with anxiety, my uncle (who once lived bold and fearless) now has schizophrenia and cannot work, and my grandfather, at 88 years old, still travels in crowded buses to support the family. Their struggles weigh on my heart, and I often feel I'm not doing anything meaningful in comparison. Sometimes I even find myself seeing you as a grandfather figure, because your words carry so much wisdom and kindness. It feels strange to say, but I really don't know what direction to take in my life. If you could share even a little guidance, I would be deeply grateful. Warmly, Slash David's response We can include this in an Ask David podcast if you like! Please advise. Warmly, david We can use your first name or a fake name, whatever you prefer. Matt, Rhonda, and David | |||
| 368: A Strange Paradox | 30 Oct 2023 | 00:57:16 | |
A Strange Paradox-- The Incredible Impact of Compassion + Accountability Featuring Adam Holman, LCSW We want to remind our listeners about the upcoming Mexico City TEAM intensive from November 6 – 9, 2023, organized by Level 5 TEAM therapist, Victoria Chicural, and Level 4 TEAM therapist Silvina Bucci. The Intensive will be held in a beautiful part of Mexico City (Sante Fe) at the Hotel Camino Real. There will be lots of opportunities to practice every aspect of TEAM-CBT along with many excellent, internationally renown TEAM-CBT trainers. I (David) will do a keynote address on Day 1, On Day 2 Rhonda and I will do a live TEAM demonstration with a volunteer attending the conference. On Day 3 everyone will have the opportunity to practice the TEAM model from start to finish. And on Day 4 Leigh Harrington and I will answer questions about the TEAM treatment model. This promises to be an Intensive not to be missed! To learn more and register, please visit their website: https://teamcbt.mx, Today we are joined by Adam Holman, LCSW, whose podcast 288 on April 22, 2022 was a big hit. He shared his strategies for working with kids with video game addictions, and his no-nonsense, patient-focused approach made good sense and resonated with many of our podcast fans. Today, he talks about what he calls a "Strange Paradox," which is: If you treat people like they're fragile, they act and behave like someone who's fragile. If, in contrast, you hold them accountable, with compassion, they will discover their strengths. He began by commenting on hearing David talk about how therapists often get hypnotized by our clients without realizing it. When that happens, we buy into the clients' beliefs that they're helpless and hopeless. And, I (David) might add, worthless. When that happens, we start to treat them as if the beliefs are true, further proving to them that they're helpless, hopeless, and worthless. This became incredibly evident after Adam had a unusual encounter with a child while on a hike with his partner near Prescott, Arizona. The child was shrieking in terror at the top of his lungs. As they got approached the child, they saw that he was paralyzed by fear of a swarm of flies near his head. They also realized that his family had already walked past, and were about 45-seconds down the trail, hoping that he would become brave and walk through the flies and catch up with them. But that clearly wasn't happening. Adam walked past the flies and stood next to him before saying, "I know you're scared, that's okay. I just walked past the flies and it's safe. You can walk through." Then, the boy immediately stopped crying and walked past the flies on his own. The boy willingly chose to walk past them the moment that his suffering was acknowledged. He heard the message that there was nothing wrong with him or the fear that he was feeling. In other words, the acknowledgement of his fear send the message: "It IS scary, and you can do it. You're capable of doing scary things." And he immediately found his courage and became capable. Adam continued: My partner and I began thinking about the suffering that the boy had experienced in that moment, and how little he needed in order to become strong and courageous. We felt close to the boy, and talked about our own suffering, and our parents' suffering that was passed on to us. We cried for three hours that day and began to think about all the suffering in the world. It felt incredibly relieving, I felt so connected to all of the people in my life, and naturally began thinking more about the suffering experienced by my clients. I realized that with many of them, I've just given in to listening without holding them accountable. I had been standing next to them, but I was treating them as if they could not walk past the flies. . . . I loved your podcast on stories from the 60's, especially your experience when you were crying for hours when driving through the Nevada desert. All the same kinds of feelings bubbled up in me. I saw that his parents were just doing what they'd learned to do; to try to discourage the uncomfortable feelings by walking away from them. Unknowingly, this was sending the message that he isn't strong enough and that he is weak for feeling so fearful. Like many of us, they had learned that it's not okay to suffer, that experiencing feelings like fear is not acceptable. This, ironically triggers more suffering because you learn to avoid and fear your negative feelings, and you don't gain the courage to sit with your painful feelings and the feelings of others You can say (to the little boy), it's okay that you're suffering and afraid, and that's not a problem. I related to that boy. My dad was very critical, and would berate me for feeling anything other than happiness. Feelings like fear or sadness were signs of weakness, and eventually I stopped realizing that I was even feeling them. Then my feelings came out in the form of a lot of anxiety that I was avoiding, and the avoidance of that anxiety didn't allow me the opportunity to see that I had strengths. Rhonda, Adam and David discussed the role of tears in healing. Rhonda mentioned the immense value of exposure in recovery from anxiety, as opposed to avoidance, and the importance of making her patients accountable. David mentioned that our field is based on the idea that your negative feelings, like depression, or fear, show that there's something "wrong" with you, like a "mental disorder," so you need to be fixed, by some pill, or some new school of psychotherapy. But if you're trying to "fix" someone, you're giving them the message that they're "broken." TEAM, in contrast, is based on the opposite idea, that our negative thoughts and feelings will always be the expression of what's right with us, and not what's wrong with us. "Getting this," which may not be easy at first, can paradoxically open the door to rapid change, just as we saw with the frightened boy that Adam encountered on the hike. Finally, Adam discussed how he ended up applying what he realized to a client he had been working with. The client was diagnosed with "Treatment-Resistant OCD," and had years of therapy and medication that had not brought him to much relief. Adam had been working with him for a few months and they were able to recognize some outcome resistance. Outcome resistance is when the client has one or many good reasons not to give up their symptoms. Specifically, this client had an intense fear of rejection, and was making sure that his appearance was absolutely perfect in order to prevent rejection. Adam discusses sadness and frustration over the term "Treatment Resistant", noting that it often keeps people feeling more stuck. Once the client saw this, he decided that they wanted to go forward and let go of his compulsions and agreed to include exposure in his treatment. This would mean that he would have to let his appearance be imperfect, and allow himself to feel anxious. Thinking back on the treatment, Adam realized that he had been providing listening and support without making the patient accountable and insisting on exposure. The next session, Adam recognized that just like the boy, he needed to treat his client with compassion and accountability. Adam re-invited the client to address the OCD and offered the gentle ultimatum, reminding the client that in order to go forward, we're going to have to do exposure. The client agreed, then started to hesitate as a result of his fear when he realized that the exposure would be taking place right at that moment. Adam messed up his own hair and invited the client to do it along with him. Adam reiterated that getting over it requires the use of exposure. The client then messed up his hair, and expressed feeling anxious for a few minutes before erupting into laughter. Then the client proceeded with his day without fixing his hair. He also decided to do more exposure on his own after session without giving into the anxiety. When he returned for the next session, he explained that his compulsions were gone for the first time in his life. The moment he was treated with compassion and accountability, he also found the strength to recover. So, what's the bottom line? When working with your own fears, or the fears of your clients or friends, two things are required. First, respect and compassion can help you accept your fear without feeling broken, or ashamed, or less than. And second accountability can give you the courage to confront your fears for the first time, and make the magical discovery that the monster really had no teeth! This is one form of enlightenment, going back 2500 years to the teachings of the Buddha on the "Great Death" of the "Self." Thanks for listening today! Adam, Rhonda, and David | |||
| 367: Treating Troubled Couples, with Thai-An Truong | 23 Oct 2023 | 01:07:37 | |
TEAM for Troubled Couples A New Twist! Today we are joined by a favorite guest, the brilliant Thai-An Truong. Thai-An is a Licensed Professional Counselor (LPC) and Alcohol and Drug Counselor (LADC). She is the first Certified TEAM-CBT Therapist and Trainer in Oklahoma. She has found TEAM-CBT to be life-changing professionally and personally and is passionate about training other therapists in this "awesome approach." In her private practice, Thai-An specializes in the treatment of trauma and OCD. To learn more about her TEAM-CBT Trainings, visit www.teamcbttraining.com Thai-An has been featured on many Feeling Good Podcasts focusing on
Now Thai-An adds an important dimension to the TEAM Interpersonal Model—working with trouble couples, as opposed to working with individuals with troubled relationships. She also describes a new way to use Positive Reframing to reduce patient resistance to giving up David's famous list of "Common Communication Errors," and she adds five new errors to the list. At the start of the podcast, Thai-An described a woman who complained that her husband often "shuts down" when they are communicating about a sensitive topic, and she wondered why. Thai-An decided to invite him to join the session so his wife could find out why. This really opened things up, and the wife discovered that her husband shut down because he was feeling inadequate when she pointed out all the things that were wrong with the house, and he was taking her comments as criticism. However, the more he shut down, the more she complained, and this pushed him away even further since her criticisms intensified his feelings of inadequacy. Thai-An then used Positive Reframing to help her see why he shut down. One of Thai-An's new ideas was to use Positive Reframing to cast our list of "errors" on the "Bad Communication Checklist" in a positive light, just as we do with the negative thoughts and feelings of people who are using the Daily Mood Log. By siding with the patient's resistance and listing all the good reasons NOT to change, nearly all patients paradoxically let down their guard and powerful urges to oppose change. Instead, they open up and become receptive to the many methods for challenging distorted thoughts. Thai-An has observed the same phenomena with troubled couples. When they see the GOOD reasons to why they or their partners use dysfunctional ways of communicating, they paradoxically let down their guard and become more willing to use the Five Secrets of Effective Communication. She says: Positive reframing started to open them up to each other, and helped them see each other in a more positive light. At the same time, they discovered that they shared the same values. Voicing the good reasons to maintain the communication errors as well as the cost of change (e.g., it'll be hard work, I'll have to focus on changing myself, it'll be vulnerable) allowed each partner to melt away their resistance to change. David comment: This is an excellent example of a "double paradox." Once again, instead of trying to "help," which often triggers intense resistance, the therapist sides with the resistance, and this paradoxically triggers strong motivation to change! Thai-An reminded us that it's important to go through the TEAM structure before moving forward with tools to help the couple change. For testing, she asks both partners to complete the version of David's Brief Mood Survey that includes the Relationship Satisfaction Scale, and asks both to complete the Evaluation of Therapy Session at the end. She makes sure both partners rate her empathy toward them at 20/20 (perfect scores) before proceeding to the next steps. During the Assessment of Resistance, she begins to work with David's Relationship Journal to get a specific moment in time of conflict. Then when they do Steps 3 and 4, where they identify their own communication errors and their impact on their partners, she does positive reframing of the bad communication errors, which you can see here, along with five new errors that Thai-An has listed below.
The Bad Communication Checklist* Instructions. Review what you wrote down in Step 2 of the Relationship Journal. How many of the following communication errors can you spot? Communication Error (ü) Communication Error (ü) 1. Truth – You insist you're "right" and the other person is "wrong." 10. Diversion – You change the subject or list past grievances. 2. Blame – You imply the problem is the other person's fault. 11. Self-Blame – You act as if you're awful and terrible. 3. Defensiveness – You argue and refuse to admit any imperfection. 12. Hopelessness – You claim you've tried everything and nothing works. 4. Martyrdom – You imply that you're an innocent victim. 13. Demandingness – You complain when people aren't as you expect. 5. Put-Down – You imply that the other person is a loser. 14. Denial – You imply that you don't feel angry, sad or upset when you do. 6. Labeling – You call the other person "a jerk," "a loser," or worse. 15. Helping – Instead of listening, you give advice or "help." 7. Sarcasm – Your tone of voice is belittling or patronizing. 16. Problem Solving – You try to solve the problem and ignore feelings. 8. Counterattack – You respond to criticism with criticism. 17. Mind-Reading – You expect others to know how you feel without telling them. 9. Scapegoating – You imply the other person is defective or has a problem. 18. Passive-Aggression – You say nothing, pout or slam doors.
* Copyright ã 1991 by David D. Burns, MD. Revised 2001.
Thai-An Truong's 5 Additional Communication Errors:
Here's how Thai-An did the Positive Reframing with this couple. First she asked the wife, "Why might your partner suddenly want to "shut down" and stop communicating during a conflicted exchange?" She also asked, "What does this do for the person who is shutting down?" This is the list of positives they came up with. Shutting down . . .
Once she saw why he shut down, she realized the negative impact of her complaints, and began to provide more genuine words of appreciation to him. He said that this meant so much to him and made all the hard work worth it. Her common communication errors included "truth" and "making complaints." He realized, again through positive reframing, that she also wanted validation, that raising children can be hard, and that she ALSO wanted appreciation for how well she was keeping up with the home and the care of their children. So, when she wasn't getting validation and appreciation from him, she was even more likely to complain to try to voice her perspective. Once he was able to stop shutting down, and instead began to make more disarming statements, use feeling empathy, and stroking, she was much less likely to complain. They also realized they had the same values of wanting healthier communication and to provide a safe and happy home for their children. Was this effective? Both went from 10/30 and 11/30 on the relationship satisfaction scale (shockingly poor scores) to 26/30 by the end of the relationship work together (extremely high scores indicating outstanding scores on my Relationship Satisfaction Scale.) Thai-An provided us with a cool Positive Reframing document for all of the communication errors. You can check it out if you CLICK HERE. I (David) pointed out that Positive Reframing can also be used in conjunction with the Relationship Journal in another way. In step one of the RJ, you write down one thing the other person said, and you circle all the many feelings they were probably having, like hurt, alone, anxious, angry, sad, unloved, and many more. In step two you write down exactly what you said next, and circle all the feelings you were having. This would be an ideal time to do Positive Reframing of your partner's negative feelings, so as to shift you perception that the other person is "bad" or "to blame" or some negative interpretations that you may be making. This reframing might be helpful in the same sense that my technique, Forced Empathy, can sometimes cause a radical shift in how you see the person you're at odds with. Announcements On January 4, 2024, Thai-An Truong will be offering a 14-week training program in TEAM couples therapy for mental health professionals. The class will meet weekly from 11:30 to 1:30 East Coast time. To learn more, please go to Courses.teamcbttraining.com/relationships There will be a 4-day TEAM-CBT Intensive November 6-9, 2023, in Mexico City, at the Hotel Camino Real. To learn more, please go to: https://teamcbt.mx/welcome Thanks for listening today! Let us know what you thought about our show! Thai-An, Rhonda, and David | |||
| 366: AI and Psychotherapy: Doomsday or Revolution? | 16 Oct 2023 | 01:38:12 | |
AI and Psychotherapy— Doomsday or Revolution? Featuring Drs. Jason Pyle and Matthew May Today we feature Jason Pyle, MD, PhD and our beloved Matthew May, MD on a controversial, exciting and possibly anxiety-provoking podcast on the future of AI in psychotherapy and mental health. Will AI shrinks replace humans in a doomsday scenario for shrinks? Or will AI serve shrinks and patients in a revolutionary way that sees the dawning of a new age of psychotherapy? You are all familiar with Matt, due to his frequent and highly praised appearances on our Ask David segments, but Jason Pyle, MD, PhD, will probably be new to you. Jason joined the Evolve Foundation as Managing Director in 2022 to focus his work on the mass mental health crisis and the rampant diseases of despair, which afflict tens of millions of Americans. The Evolve Foundation is a private foundation dedicated to the advancement of human consciousness. Evolve is active in philanthropy and venture investments in the mental health fields. Jason is an accomplished biotechnology executive with over twenty years of executive management and technology development experience. He is committed to developing healthcare technologies and bringing science-backed healing to the most important problems of our generation. Jason is a veteran who served as a US Ranger, and earned an Engineering degree from the University of Arizona. He received both his MD and PhD in Neurosciences from the Stanford University School of Medicine, where he met Matt May and they became close friends. At the start of today's podcast, Matt and Jason reflected on their long friendship, starting as classmates at the Stanford Medical School 20 years ago. The following questions were submitted by Jason, Matt, and David prior to the start of today's podcast. Jason's Questions:
Matt's Questions about AI:
David's question about AI:
Jason kicked off the discussion with a brief description of AI and machine learning, and outlined four potential roles for AI in psychiatry and psychology:
The ensuing dialogue was illuminating and exciting. In fact, I got so engrossed that I stopped taking notes, so you'll have to give it a listen to find out. However, one thing that was interesting and unexpected was highlighting the strengths and weaknesses of AI. For example, a patient with social anxiety might benefit greatly from armchair work, focusing on ways to combat distorted negative thoughts, but will still have to interact strangers in social situations to conquer this type of fear. David and Matt nearly always go with the patient out into the world for interpersonal exposure exercises, and find that the presence and trust and "push" from the human therapist can be invaluable and necessary. It is not at all clear that an AI therapist working via a smart phone could have the same effect, but that might require an experiment to find out. Jumping to conclusions without data is rarely safe or accurate! Maybe an AI "helper" could be very helpful to individuals with social anxiety! Jason raised the question of whether AI could replicate the trust and warmth and rapport of a human therapist, and whether the warmth and rapport of the therapeutic relationship was necessary to a good therapeutic outcome. I (David) summarized some of the findings with our Feeling Good App showing that app users actually rated the "Digital David" in the app substantially higher on warmth and understanding that the people in their lives. And now that we are incorporating AI into the Feeling Good App, the quality of the empathy / rapport from our app may be even higher than in our prior beta tests. We have not done a direct comparison between the rapport of human therapists and the rapport experienced by our Feeling Good App users. Many people might jump to the conclusion that human shrinks have better rapport than would be possible from a cell phone app, but this might be the opposite of the truth! In my research (David), I've seen that most human shrinks believe their empathy and rapport skills are high, when in fact their patients do not agree! In my research on the causal effects of empathy on recovery from depression in hundreds of patients at my clinical in Philadelphia, and also in more than 1300 patients treated at the Feeling Good Institute in Mountain View, California, it did not appear that therapist empathy had substantial causal effects on changes in depression. The late and famous Karl Rogers believed that therapist empathy is the "necessary and sufficient" condition for personality change, but most subsequent research has failed to support this popular belief. I (David) believe that AI therapists are likely to outperform human shrinks in rapport, warmth, trust, and understanding, but it remains to be seen whether this will be sufficient to make much of a dent in the patient's symptoms of depression, anxiety, marital conflict, or habits and addictions. Other techniques are likely to be required. However, we may have new data on this question shortly, as we will be directly studying the effectiveness of AI empathy on the reduction in negative feelings. We might be surprised, as our research nearly always gives us some unexpected results! Rhonda gave a strong and appreciated pitch for the idea that there is something about a person to person interaction, like a hug, that will never be duplicated by an app. If this is true, or even believed to be true, then there will likely never be a complete replacement of human shrinks by AI apps. But once again, you can believe this on a religious, or a priori, basis, or you can take it as a hypothesis that can easily be tested in an experiment. We do have very sensitive and accurate tests of therapists' warmth and empathy, so "rapport" can now be measured with short, reliable scales, making head to head comparisons of apps and humans possible for the first time. At one time, it was thought that AI would never be able to beat human chess champions, but that belief turned out to be false. The podcast group also discussed some of the potential shortcomings of an AI shrink. For example, the AI does not yet have the insight of how to "see through" what patients are saying, and takes the patient's words at face value. But a human therapist might often be thinking on multiple levels, asking what's "really" going on with the patient, including things that the patient might be intentionally or unintentionally hiding, like feelings of anger, or antisocial behaviors. At the end, all four participants gave their vision, or dream, for what a positive impact of AI might have on the world of mental illness / mental health. Rhonda had tears in her eyes, I think, over the suggestion that an effective and totally automated AI therapist would be scalable and might have the potential to bring ultra low-cost relief of suffering to millions or even hundreds of millions of people around the world who do not currently have access to effective mental health care. And I would add the individuals who now have access to mental health care, often cannot find effective treatment due to severe limitations in therapists as well as all current schools of therapy. Jason described his vision for an AI shrink as the helper of human therapists, extending their impact and enhancing their effectiveness. Jason is super-smart and wise, and I found his vision very inspiring! I have trained over 50,000 therapists who have attended my training programs over the past 35 years, and one thing I have learned is that most shrinks, including David, have tons of room for improvement. And if a brilliant and compassionate AI helper can enhance our impact? Hey, I'm all for that! Thanks for listening today! Let us know what you thought about our show! Jason, Matt, Rhonda, and David | |||
| 365: Ask David: Do Thoughts REALLY Cause Feelings? And More! | 09 Oct 2023 | 01:03:21 | |
Where Do Feelings Come From? Getting Unstuck from Apathy Ancient Stoic Philosophers--and More! Ask David Questions for Today Bystad: Why is it so helpful to write down your negative thoughts when you're upset? Anyinio: Do we have to have a thought every time we have an emotion? What if I see a car coming fast and about to hit me? Would I have to have a fast automatic thought? Raghav: How can I get unstuck from apathy? Anita: What are the necessary and sufficient conditions for emotional distress as well as escape from emotional distress? Louisa: Can you tell us some more about the ancient and modern Stoic philosophers who influenced the development of CBT and TEM-CBT? Answers to today's questions. The following answers were written before the podcast. The information on the podcast may be quite different in some cases, and will typically provide much more information than the brief answers below. David
Bystad asks: Why is it so helpful to write down your negative thoughts when you're upset? Dear David! I have practiced the paradoxical approach where I just write down my thougts / worries without challenging them. I think I learned that approach from your great book «When Panic Attacks». This is something that really works for me, especially for worries. It is almost like I «get the worries out of my head». Can you talk about this approach in your lovely podcast, why is it so effective for some people?? Best regards from Martin David's reply Great question. Will address it the next time we record an Ask David podcast!
Anyinio asks: Do you ALWAYS have a thought before you can experience an emotion / feeling? David's response The word "thought" is just a form of shorthand for perception. Perception can take many forms. When you see a car about to hit you, you already HAVE a negative and alarming thought! If you like, you can check out the railroad track story in my Feeling Good Handbook. It is a story about a man who became euphoric after his car was hit by a train going 60 MPH because of his thoughts about it! When a deer spots a pack of howling wolves, it runs in terror. It does not have a "thought" in English, but it DOES have the perception of being in imminent danger, and it DOES experience intense, sudden fear. However, the deer did NOT feel fear / anxiety until s/he SAW and correctly interpreted the pack of wolves. Thanks, best, david
Raghav asks: How can I get unstuck from apathy? Hi Dr. Burns, I hope you're doing well and thank you so much for all of your incredible work! It has really helped me pull myself out of some of the deepest depressions and anxieties I've had. I wanted to ask for your help with a problem I've been facing recently: I seem to get stuck in depressive cycles at times where I don't want to do a DML even though I know it will make me feel better. When I start doing the positive reframing, it helps melt away this resistance, but I still mope around for a while before I start the positive reframing. My thoughts during this time are generally "There's no point to getting better," "Doing a DML is like forcing myself to cheer up," "I should care about getting better more than I do right now," and "There's no meaning to life." How would you recommend I go about dealing with this apathetic state? I would greatly appreciate any help in this matter! Thanks, Raghav David's reply: You could perhaps list:
Something along those lines. I might make this an Ask David question if that's okay with you. Could use your first name only, or a fake name if you prefer. Thanks! Good question, as so many can relate to it! Best, david Raghav's response to David Here's the answers I came up with: Good Reasons NOT to do a DML
Core Values it shows about me
How the Avoidance Helps Me
Raghav David's reply Great work, thanks! So now my question is this: Given all these positives, it is not clear to me why you'd want to do a DML. What's your thinking about this? Best, david
Anita asks about the necessary and sufficient conditions for emotional distress as well as escape from emotional distress? Dear David While revisiting Feeling Great I was thinking further about the interplay of necessary and sufficient conditions that are correlated to emotional distress. Necessary condition: You must have a negative thought Sufficient condition: You must believe in the negative thought I was thinking of another sufficient condition that may account for the behavioural component of emotional distress: Sufficient condition: You must act in way that reinforces your negative thought. For me this additional sufficient condition unlocks another philosophical underpinning why exposure is a key to overcoming anxiety. For example, if I have a negative thought I'm going to screw up in a presentation and then I believe it 100%. I can still summon up the courage to go ahead and do the presentation. Thus, I'm behaving in a way that doesn't fulfil the second sufficient condition, and therefore another way to reduce emotional distress. More often than not, the presentation is not as calamitous as I anticipated anyways. Thanks for reading. Warm Regards Anita David's reply Hi Anita, Great question, thanks. I greatly appreciate folks who think more deeply about these things. Exposure is a desirable tool in the treatment of anxiety, for sure, but if you point is "necessary and sufficient" for emotional distress, then the action thing is an unnecessary and erroneous, to my way of thinking, add-on. For example, many people who are severely depressed and believe themselves to be worthless do very little, and others do a great deal, but both feel the same severity of distress. Could we use this for an Ask David, with or without your first name? If so, we could also discuss the "necessary and sufficient" for emotional change. Here the sufficient condition is that you no longer believe the negative thought, or your belief has gone down significantly. You can respond, too, if you like to my comments. Warmly, david Anita's Response to David Thanks David, sure I'd be pleased if you find any of what I wrote useful for your listeners. Feel free to use my first name. I'm also curious to know more about the depth of belief in a negative thought as a sufficient condition for emotional distress. Is there a particular intensity or tipping point that might lead to the emotional distress? David's Response: The greater you belief in a negative thought, the greater the emotional impact. There's no "tipping point." I loved the premise of your book: "When you change the way you think, you can change the way you feel" It got me pondering about the possibility other things such as some behaviours in addition to thoughts that could be associated with emotional distress. David's Response: Your own or someone else's behaviour won't have any effect on you until you have a thought, or interpretation, of what's happening. This is the basic premise of CBT, going back 3500 years or more. An example I'm thinking of is workplace procrastination. Let's say I have been given two weeks to tackle a laborious project. I might initially have thoughts there is plenty of time and I can procrastinate for the first week doing things I find more satisfying at work. Towards the end of the second week, panic sets in as I rush through the project so I can still meet the deadline. After the event, I start ruminating and believing self-critical thoughts such as "I shouldn't have been so lazy" and "I'm never able to handle projects well." Is it to say, the behaviours before the event has little to no bearing on the negative thoughts or belief after the event? And if so why is it really the case that the negative thinking comes into play after the event happens? David's Response: Negative thinking can happen before, during, or after an event. I really have gained much from many of your books. I'm inquiring to deepen and refine my own thought processes. Thankyou Warm Regards Anita David's Response Thanks so much for you kind and thoughtful comments.
Louisa asks: I'd like learn more about the ancient and modern Stoic philosophers who influenced the development of CBT and TEM-CBT. Hello Rhonda and David, I am a Belgium based listener thoroughly enjoying the podcast and sharing it far and wide! I love the TEAM CBT structured approach. I find in particular that many of the methods are (relatively) easy to remember and administering self-help feels much easier than I ever imagined. Well-done, David! I wonder if David could talk one time about the different influences various figures in the development of CBT right from its inception with (it seems to me) the Roman Stoics until this century. Some names that come to mind are Seneca, Epictetus, Marcus Aurelius, to Albert Ellis, Aaron Beck & William Glasser (these last three all since passed away.) Are they any particular names that stick out as having been particularly useful in the development of TEAM CBT and why or how? Do the Roman Stoics still have anything to offer us? Thanks for the great show! Louisa David's Response Hi Louisa, Thanks, will include in the list of questions for the next Ask David, depending on time constraints. Best, david PS Albert Ellis documents much of the history in his book, Reason and Emotion in Psychotherapy. I believe that Karen Horney, the feminist psychiatrist of the first part of the 20 th century, discuss lots of the current ideas as well, especial the "need" for love, success, etc. and the idea that we have an "ideal" self and a "real" self. We get upset when we realize that the two don't match! David and Rhonda are grateful that Matt can join us often on the podcast. | |||
| 364: Ask David: Self-Esteem vs Self-Confidence vs Self-Acceptance | 02 Oct 2023 | 00:52:29 | |
Self-Esteem, Self-Confidence, and Self-Acceptance What's the Difference? What's More Important? Questions for today's Ask David podcast David asks: What's the difference between self-confidence, self-esteem, and self-acceptance? Guillermo asks: How do you help people who are not asking for help or don't even know they need help with depression? The answers to today's questions in these show notes were written before the podcast. The information on the podcast may be quite different and will typically provide much more information than the brief answers below. David David asks: What's the difference between self-confidence, self-esteem, and self-acceptance? Hello David, The mental health world seems to like or argue about the meaning of terms like self-confidence, self-esteem, and self-acceptance? What's the difference between them, and which one is the best thing to have? David's response: Great question, David. I think of self-confidence as the conviction that you're probably going to win because you're very good at something. Self-esteem, in contrast, is the decision to love yourself whether you win or lose. Between those two, I'd say that self-confidence is more fun, but self-esteem is more important. But where does self-acceptance fit in? That's the big buzz word these days, although the concept has been around for ages. We'll have to ask the experts today to find out where it fits in! I'm a bit confused at the moment! Guillermo asks: How do you help people who don't know that they need help with depression? Hello, Dr Burns I was curious as to how you would help someone who isn't aware (or capable to know--but not in a medical sense) that they need help. You've said before that the worst thing you can do is try to help (especially when no one asked for help), but how have you handled in the past cases when someone isn't aware that they need help for depression? Seems like it would be very tough without the person being motivated. As always, thank you for all you do, Guillermo Campos Rhonda, Matt, and David will reply on the podcast. David and Rhonda are grateful that Matt can join us often on the podcast. | |||
| 363: This Podcast is a MUST, starring Dr. Fabrice Nye | 25 Sep 2023 | 00:56:22 | |
Shoulds and More with our Beloved Fabrice! Three little words that will make your life miserable are "shoulds," "wants," and "needs," says Dr. Fabrice Nye, the father / creator of the Feeling Good Podcast several years ago. But for the purpose of this episode, we'll add a fourth word, "Musts," which was popularized by Dr. Albert Ellis, who referred to it as "Musterbation." Fabrice says that, "Shoulds are a trap. . . . There's no such thing as a should, except for the laws of nature. For example, if I drop my pen, it "should" fall to the floor because of the effects of gravity. And sure enough, it does! "But when I say, 'I should get an A on my upcoming exam,' i may just be setting myself up for frustration. That's because there's no laws of the universe saying that people will always get As on their exams. "Similarly, if I say it SHOULDN'T be raining today, I'm involved in fiction, not reality. The clouds don't obey our whims, they are just obeying the laws that govern the weather." Fabrice explained that when you apply shoulds to some past event, telling yourself that your shouldn't have made some mistake, you just make yourself guilty because it sounds like you're scolding yourself. Again, you're living in some fictitious reality where things are always the way you want them to be, because it's impossible to change the past Fabrice reminded us that the Anglo-Saxon origin of the word, "should," is "scolde." So when you "should" on yourself, you're actually scolding yourself. Fabrice also explained that the concept of "needs" can also get us into emotional hot water, since we sometimes tell us that we "need" things that we may want but don't really "need." So, if you tell yourself that someone "needs" to do something for you, you are simply applying pressure to the situation. For example, you might want or prefer for the person to be on time for appointments or planned activities, but you don't "need" them to be on time. Similarly, you might want to find someone to love, or someone to love you, but you don't "need" love, according to Fabrice. . . . and David agrees! It has been shown in research studies that infants and young children need love to grow and develop in a healthy way, but love is not an adult human need. According to the Buddhists, "needs" are not real. They're just cravings, or intense desires that we've elevated to some godly state. Of course, there ARE things that we really do "need." For example, we "need" to breathe to stay alive, and we "need" to have gas in the car if we want to drive to San Francisco. Those things are needed to fulfill a particular goal. So the key to an actual need is adding the phrase, "...in order to..." Fabrice also described some "want" traps. For example, you may sit at your computer cruising the internet or playing digital games, all the while telling yourself "I really want to get to work on my paper," or taxes, or whatever. But in point of fact, you DON'T want to get to work on the thing you're putting off. You WANT to be doing exactly what you are doing. Fabrice explains that we "trick ourselves into thinking we want something (like doing our taxes) when we really want to be doing something else (watching TV, playing computer games.) So, once again, we are telling ourselves stories that don't map onto reality." Our real "wants" are the result of an unconscious cost-benefit analysis we make in our head, where the choice that comes out on top is our real want. It's only when I really start doing my taxes that I'll know this is what I want to be doing (probably because the urgency of the matter made the cost-benefit analysis tip in that direction). David was trying to see if this concept of "wants" can be helpful in therapy but had trouble seeing how this might help someone who's procrastinating. Fabrice explained it like this: First, we need to realize that we are doing what we want in the moment; so, it's a choice. Next, we can make our cost-benefit analysis conscious and see that we're only considering short-term factors (e.g., it's a lot more comfortable right now to be watching TV than doing taxes). Finally, we can develop some empathy for our future self (the one who will be pulling an all-nighter three weeks from now, or who will have to pay late fees) to reevaluate our cost-benefit analysis with more complete data. Fabrice also explained that procrastination can sometimes be difficult to treat because it's an addiction. Rhonda also commented on the use of these concepts in therapy. Fabrice concluded the podcast by saying that he watches out for those three little words in his own thinking: "should, need, or want." Thanks for listening today. Fabrice, Rhonda, and David | |||
| 362: Menopause. The End? . . . or the Beginning? | 18 Sep 2023 | 01:39:48 | |
Menopause-- The End? . . . or the Beginning? Rhonda starts today's podcast, as usual, with a warm endorsement from Sally, a podcast fan who really liked Podcast 355 on the topic of "Relationship Problems: Be Gone!" She said the role-play demonstrations were "incredible" and especially helpful. We'll keep that in mind and see if we can do some more role-playing demonstrations in future podcasts, along with instructions so you can practice at home, as well. This can be extremely helpful if you want to master the techniques we describe. They may sound simple, but they're not! In our recent podcast on free practice groups (put LINK), you can find many virtual practice groups you can join from home to practice many of the techniques in TEAM-CBT with like-minded colleagues and become part of the growing TEAM-CBT community. We now have many excellent and free practice groups for the general public as well as and training groups for shrinks. Today, Mina returns to the show with a new problem—pre-menopausal symptoms that are scaring her and casting a shadow on her future as well as her marriage with her husband, Maurice. Menopause is a topic that freaks many people out, due to feelings of anxiety and shame which can sometimes be intense. Today, menopause will be out in the open and front and center. However, Meina is confused because so many problems and feelings are swirling around in her head, and she doesn't quite know where to start. At the start of the session, Mina's Brief Mood Survey indicated mild depression, severe anxiety, moderate to severe anger, and greatly diminished feelings of happiness and relationship satisfaction, thinking of her husband, Maurice.f If you review Mina's Daily Mood Log. you can see that the Upsetting Event is irregular periods due to menopause. You can also see that Mina is struggling with fairly feelings of depression, anxiety, shame, inadequacy, loneliness, embarrassment, hopelessness, frustration and anger, and she's giving herself some intensely negative messages, like "My body is falling apart," and "My husband will leave me," and "I'll get osteoporosis and die in pain like my grandmother," and more. During the initial Empathy phase of the session, Mina described quite a lot of personal and professional concerns, as well as somatic complaints of various kinds. Sometimes, in the past, Mina has developed numerous somatic complaints that terrify her, because she has interpreted them as possible serious diseases, like multiple sclerosis. However, excellent physical evaluations rarely or never provide any medical evidence or explanation for her symptoms. This pattern of obsessing about somatic symptoms is actually quite common. Many general practice doctors report that as many as a third of their patients complaining of pain, dizziness, and so forth do not have any medical disease that could possibly explain the symptoms. In fact, in his classic book, Caring for Patients, the late Dr. Allen Barbour from Stanford reported that about half of these types of patients experience a disappearance of their somatic symptoms when they identify some conflict or problem that they've been avoiding, and then take steps to express their feelings or solve the repressed problem. Pretty much every time, this has been true of Mina, too. It often turns out that she is upset about something she is sweeping under the rug, and the Hidden Emotion Technique has proved extremely helpful in pinpointing the hidden feeling or conflict. Then, as soon as she acts on this information, and expresses her feelings, the somatic problems immediately disappear. So, our first task in today's session was to see if the same thing was happening. It turned out that she was quite upset with her husband, Maurice, so we did a Relationship Journal to see if we could get a better understanding of what was going on. Her complaint was that Maurice did not want to talk about "difficult feelings." Instead, he suggests they go for a nature walk or watch a movie. So, she felt sad, anxious, rejected, hurt, frustrated, and alone. But, as is the case nearly 100% of the time, when we examined a brief interaction between them—what did he say and what did she say next—it became clear that she was actually pushing him away and putting him down. This was understandably painful for Mina to see, and a bit embarrassing, but she was super brave, and saw how she could use the Five Secrets to respond to Maurice in a radically different and more inviting manner. As an aside, the person who seeks treatment for a relationship problem will nearly always discover that they have actually be causing the very problem they're complaining about. If Mina's husband had come to us for help, he would have made the exact same shocking discovery—that HE was causing the problem he was complaining about. I call this strange but fascinating phenomenon the "theory of interpersonal relativity." Mina feared abandonment, but discovered that her real problem was that she was rejecting her husband, and forcing him to reject her! Although this type of sudden insight can be tremendously painful, it is also liberating at the same time. That's because people discover that they have far more power than they thought. Mina felt helpless, but was actually pulling the strings. Once you "see" this, you have the option of moving in a radically new and more rewarding direction. Mina promised to send a follow up once she's had the chance to try a new approach during her interactions with Maurice. We have our fingers crossed! In addition, we worked with Mina's negative thoughts and feelings on her Daily Mood Log, starting with Positive Reframing, which she found helpful. What did her negative thoughts and feelings show about her that was positive and awesome, and how were they helping her? Then we did several rounds of Externalization of Voices and she was quickly able to knock her negative thoughts out of the park, with incredible results that you can see if you examine the emotions goal and outcome columns on her emotions table HERE. As you can see, there was an immediate and dramatic reduction in all of her negative feelings. We publish these TEAM-CBT sessions because we believe that the vast majority of mental health professionals do not know how to trigger rapid and extreme changes in how people think, feel, and interact with others. It is our hope that these podcast live therapy sessions, in conjunction with our weekly training groups, will make mental health professionals aware of what's now possible, and how TEAM-CBT actually works. We try to make it look simple, but it requires tremendous training, practice, and commitment. Rhonda and I have strong, tender feelings toward our dear colleague, Mina, and we are deeply indebted to her for making herself vulnerable in a public forum so that we can all learn and feel much closer to one another. Personal work is one of our finest teaching tools. In addition, feelings of respect, love, and connection are so often missing in our embattled and hostile political and world environment these days. We cannot change the world, but we can definitely make our own small ripples in the pond, and work on changing ourselves. If you'd like, you can take a look at Mina's Brief Mood Survey and Evaluation of Therapy Session at the end of the session. Thanks so much for listening today! Rhonda, Mina, and David | |||
| 361: A DELIGHT-full Adventure! | 11 Sep 2023 | 01:01:21 | |
361: Cultivating Delight Today we feature Dr. Angela Krumm, Clinical Director at the Feeling Good Institute (FGI) in Mountain View, Ca, and Zane Pierce, LMFT, a Level 3 TEAM therapist at FGI, on a novel and arguably controversial tool which is not aimed at reducing negative feelings, but rather boosting positive feelings. Zane Pierce Rhonda, as usual, starts the podcast with a wonderful email from Andrew who really enjoyed Podcast 357, on what David learned on the streets of Palo Alto in the wild and wonderful latter half of the 1960s. Then Angela described her Journey to Delight, which may be silly and goofy, or wonderful, or perhaps a little of each. She was inspired by a podcast interview she heard with Ross Gay, who wrote the popular Book of Delight, a book of ultra short essays he wrote every day for a year, starting on his 42nd birthday, describing "common place" things he noticed that were amazing, inspiring, or delightful. An example was noticing a weed with a beautiful flower growing out of a crack in an ugly piece of concrete. Then Angela noticed that she felt "neutral" during and after a pleasant family hike on a pleasant and beautiful day, with the people she loved. She asked herself, "Why did I only feel neutral? And can something be done to cultivate greater delight and joy in our daily lives? She asked herself, "I want to be more open to delight in my life—is it possible to cultivate delight? And if so, how?" She reasoned that since we have more than 100 TEAM-CBT to reduce and eliminate negative feelings, like depression, anxiety, shame, inadequacy, and even anger, couldn't we create some methods for boosting positive feelings? Could we focus, for example, not just on how to challenge and crush our negative internal dialogues, but also on how to cultivate more positive self-talk? Can we "elevate" our more neutral moments. In order to set the agenda, she did a Cost-Benefit Analysis during one of her Thursday morning training groups with the therapist at FGI. She asked David, Rhonda and Zane to list some really GOOD reasons NOT to try to cultivate greater delight in our lives, including:
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| 360: "You wowed me!" A Mother-Daughter Conflict: Part 2 of 2 | 04 Sep 2023 | 01:23:23 | |
360: The Story of Indrani "Why can't I get close to my daughter who I love so much?" Today, we present Part 2 of the awe-inspiring work that David and Jill did with Indrani in the Tuesday group at Stanford. Indrani was a mother with a heart-breaking but all-too-common story of a conflict with her daughter. Sometimes, we love someone tremendously, but every time we try to get close, they seem to push us away. The story should ring true and be helpful to so many people, as nearly everyone runs into conflicts at times with our family members, including our parents, siblings and children. And, as usual, the solution often involves attending to your "inner" dialogue, which is the conversation you're having with yourself about the conflict, and the "outer" dialogue, which is what happens when you try to get close to the person you love. And today's session illustrates not one, but two forms of enlightenment. The changes in the inner dialogue involves challenging and crushing the negative messages you've been giving yourself about h problem with the person you love so much. You can see Indrani's Daily Mood Log if you click HERE. As you can see, she's been telling herself that her daughter has shut her out of her life, and that she'll die alone/ That's incredibly sad! And she's also telling herself that all of her friends have wonderful relationships with their daughters "and I don't" and she's blaming herself for the problem: "I deserve this treatment," and "nothing I do pleases her." You can also see the intensity of Indrani's negative feelings, including sadness, anxiety, inadequacy, loneliness, embarrassment, discouragement, irritation, and more. You can also see a typical exchange with her daughter if you look at her Relationship Journal (RJ). As you may know, the whole theme of my interpersonal model in TEAM-CBT is that we create our own interpersonal reality at every moment of every day. In other words, we unknowingly create and cause the exact relationship problems that we complain about, but just don't realize this, so we think there's something wrong with the other person. But how can this be? If you look at Step 2 of Indrani's RJ, her response to her daughter seems innocent enough! But stayed tuned, because Indrani makes a shocking and mind-blowing discovery during the session, and that discovery requires the exceedingly painful "death" of the "self." But this "Great Death" is instantly followed by a "Great Rebirth.!" At the end of the session, a Tuesday group members named Keren, said this to Indrani: "You wowed me!" One of the men, Ed, could barely speak because he was sobbing. You may also be sobbing for joy when you listen to this heart-warming story. In part 1, today's podcast, you'll hear the initial T = Testing and E = Empathy. In part 2, in next week's podcast, you'll hear the M = Methods, including Jill and David's incredible work with Indrani on her R and her rather sudden discovery, in Step 4, of exactly how and why she'd been driving her daughter away—and how to stop doing that and begin to communicate in a way with a far greater chance of enhancing closeness and love. The Jill and David turn to Imani's Daily Mood Log so she can smash her distorted negative thoughts with the Externalization of Voices, and several role reversals illustrating the integration of Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique.) You can see Imani's initial and final Brief Mood Surveys plus her Evaluation of Therapy Session, We are extremely grateful to Indrani for giving us this very intimate glimpse into her inner life in a way that will illuminate and inspire every person with the good fortune to listen to Indrani's amazing Journey this evening! PS I emailed Indrani this morning to see how she's doing, and recevied this wonderful reply: I'm still feeling great…very light and hopeful. I've listened to the audio. I sound goofy at times but loved re-living the moment when the truth dawned on me and how I felt immediately afterwards. My daughter Soni ( like the Japanese electronic company :) is coming on Thursday. I would've been filled with intense anticipatory anxiety but now I can't wait to give her a big hug and use what I've learnt to connect with her. I'm looking forward to watching the video with Soni. Thank you so much Dr. Burns and Jill! Thanks for listening! Rhonda, Jill, and David | |||
| 359: "You Wowed Me!" A Mother-Daughter Conflict, part 1 of 2 | 28 Aug 2023 | 01:03:53 | |
359: The Story of Indrani "Why can't I get close to my daughter who I love so much?" Today, we present the awe-inspiring work that David and Jill did with Indrani in the Tuesday group at Stanford. Indrani was a mother with a heart-breaking but all-too-common story of a conflict with her daughter. Sometimes, we love someone tremendously, but every time we try to get close, they seem to push us away. The story should ring true and be helpful to so many people, as nearly everyone runs into conflicts at times with our family members, including our parents, siblings and children. And, as usual, the solution often involves attending to your "inner" dialogue, which is the conversation you're having with yourself about the conflict, and the "outer" dialogue, which is what happens when you try to get close to the person you love. And today's session illustrates not one, but two forms of enlightenment. The changes in the inner dialogue involves challenging and crushing the negative messages you've been giving yourself about h problem with the person you love so much. You can see Indrani's Daily Mood Log if you click HERE. As you can see, she's been telling herself that her daughter has shut her out of her life, and that she'll die alone/ That's incredibly sad! And she's also telling herself that all of her friends have wonderful relationships with their daughters "and I don't" and she's blaming herself for the problem: "I deserve this treatment," and "nothing I do pleases her." You can also see the intensity of Indrani's negative feelings, including sadness, anxiety, inadequacy, loneliness, embarrassment, discouragement, irritation, and more. You can also see a typical exchange with her daughter if you look at her Relationship Journal (RJ). As you may know, the whole theme of my interpersonal model in TEAM-CBT is that we create our own interpersonal reality at every moment of every day. In other words, we unknowingly create and cause the exact relationship problems that we complain about, but just don't realize this, so we think there's something wrong with the other person. But how can this be? If you look at Step 2 of Indrani's RJ, her response to her daughter seems innocent enough! But stayed tuned, because Indrani makes a shocking and mind-blowing discovery during the session, and that discovery requires the exceedingly painful "death" of the "self." But this "Great Death" is instantly followed by a "Great Rebirth.!" At the end of the session, a Tuesday group members named Keren, said this to Indrani: "You wowed me!" One of the men, Ed, could barely speak because he was sobbing. You may also be sobbing for joy when you listen to this heart-warming story. In part 1, today's podcast, you'll hear the initial T = Testing and E = Empathy. In part 2, in next week's podcast, you'll hear the M = Methods, including Jill and David's incredible work with Indrani on her R and her rather sudden discovery, in Step 4, of exactly how and why she'd been driving her daughter away—and how to stop doing that and begin to communicate in a way with a far greater chance of enhancing closeness and love. The Jill and David turn to Imani's Daily Mood Log so she can smash her distorted negative thoughts with the Externalization of Voices, and several role reversals illustrating the integration of Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique.) You can see Imani's initial and final Brief Mood Surveys plus her Evaluation of Therapy Session, We are extremely grateful to Indrani for giving us this very intimate glimpse into her inner life in a way that will illuminate and inspire every person with the good fortune to listen to Indrani's amazing Journey this evening! Thanks for listening! Rhonda, Jill, and David | |||
| 465: The Music of TEAM | 05 Sep 2025 | 00:55:59 | |
The Music of TEAM-- A Little Different from the Music of REBT! There are many paradoxes in TEAM! That's part of what makes TEAM challenging, but also exciting. Do you know what the plural of paradox is? Paradise! Sometimes, music allows us to "see" or "get" something that pure thinking struggles with. Years ago, followers of the renowned but controversial Dr. Albert Ellis loved singing the famous and outrageous songs written by Dr. Ellis and featuring key ideas in the Rational Emotive Behavior Therapy (REBT) he created. They were popular because they captured his core messages, involving low frustration tolerance, whining and complaining, and more. Dr. Ellis wrote the words, and the music came from popular songs familiar to anyone, like Battle Hymn of the Republic, and many others. If you like, you can hear a brief interview with Dr. Ellis, and listen as he discusses the dire "need" for love and sings one of his songs about the need (demand) for love AT THIS LINKAlthough none of the REBT songs made the top list on the top ten charts, they brought tons of glee to his many fans, especially when the participants at his psychotherapy conferences would sing them together. His humorous music made it a little easier for some of us to recognize the absurdity in the intense "shoulds" we direct against ourselves when we fall short and a world that isn't the way it "should" be, according to our narcissistic rules! Today, we hear some of the music of TEAM CBT which seems to be increasing in popularity recently. However, the themes are quite different from the cutting and sarcastic music of the Albert Ellis era. Instead, they tend to focus on some of the more tender and inspiring messages of TEAM CBT. For example, I've often described a key idea that I learned from my beloved cat, teacher, and friend, Obie: "When you no longer need to be special, the world becomes special." The message focuses on the perfectionism and self-criticism that so many patients and therapists alike indulge in, criticizing themselves mercilessly for every error, failure, and shortcoming, thinking that if they work hard enough, they will achieve something tremendous and attain a lofty status of true "specialness." You will hear the song, "Am I Special?" on today's podcast. The lyrics of "Am I Special?" were written by Angela Poch, the music was written by Shalynn Burton. Angela Poch put together the virtual choir featuring Rachael, Shalynn, Brandon Vance, Eric Burns and Heather Clague. The Acceptance Paradox is at the core of that song and many TEAM CBT techniques—finding joy and enlightenment when you accept your shitty, below average self. And here's the essence of the Acceptance Paradox: When you accept yourself exactly as you are, warts and all, everything suddenly changes. You perceive yourself and your world through new eyes, and you see that everything is actually quite different from the way you thought, and you experience a sense of freedom, liberation, and joy. David Burns, MD This is a paradox because total acceptance and total change appear to be exact opposites! But in fact, their the exact same thing! Along the same lines, the so-called "Great Death" of the "self" is actually the "Great Rebirth," or a great "waking up" from a trance. Much of today's music revolves around those kinds of themes. And some of it focuses on the Five Secrets of Effective Communication and the Disarming Technique, which highlights another key paradox that I call the Law of Opposites: When someone criticizes you with an unfair and untrue criticism, you will the overwhelming urge to argue and defend yourself. If you give in to this urge—and nearly everybody does—you will actually PROVE that the criticism was actually 100% valid, and the critic will continue to attack and criticize you. That's a Paradox! And here's the other side of that paradox: If you immediately, humbly, and genuinely agree with a criticism that sounds unfair and untrue, you will instantly put the lie to it, and the criticism will suddenly realize that the criticism simply isn't true. That's also a Paradox. So much for the background, and some of the philosophy behind the music you'll hear today. First, here are the performers you'll hear in today's podcast, with brief bio sketches: Mark Noble, PhD is a famed neuroscientist and recently certified TEAM CBT coach. Today, he sings three songs with guitar: Placebo, Mind Warp, and Song of My Self. You can contact him at mark_noble@urmc.rochester.edu Heather Clague, MD is a psychiatrist and Level 5 Advanced Master TEAM therapist practicing in Oakland, California. Heather and her colleague, Brandon Vance, MD, are the originators of the immensely popular Feeling Great and Feeling Great app book clubs. For more information, got to https://www.heatherclaguemd.com. Brandon Vance, MD is also a psychiatrist and Level 4 Master TEAM therapist and song writer practicing in Oakland. For more information, go to https://www.feelinggreattherapycenter.com/brandonvance. He works with Heather on a variety of immensely popular Feeling Great book and app clubs. Heather and Brandon sang the song Heather wrote, "TEAM Is Paradoxical." In addition to singing, Heather plays the ukulele. Erik Burns is the son of David Burns, MD. He lives with his wife and son in Santa Cruz, California, and practices hypnosomatic therapy for individuals struggling with anxiety as well as those with gastrointestinal complaints. He was recently featured on the Feeling Good Podcast (#435, February 10th, 2025: https://feelinggood.com/2025/02/10/435-meet-erik-burns/). You can learn more about Erik's life and practice at https://www.instagram.com/erikburns.bloom/. Shalynn Burton, ACSW is TEAM therapist who practices virtually throughout California at the Feeling Good Institute. She specializes in anxiety, dating/ relationship, race/ethnic challenges, social skills, self-esteem, and more. To learn more, you can check her out at https://feelinggoodinstitute.com/find-cbt-therapist/shalynn-burton. Rachel Dillman is a singer / songwriter who creates music to help people build greater resilience. To learn more, check her out at www.linkedin.com/in/rachmd www.resilwave.com. She asked me to emphasize that that her songs help her memorize and put into practice important concepts, like the Five Secrets of Effective Communication. In addition, she is a strong believer that songs can influence our thoughts and emotions. You can hear her songs such as Change How You Feel, Five Secrets, and more at the link above! Angel Poch is an immensely popular and talented TEAM CBT coach and teacher. She practices in Canada, and offers TEAM CBT training internationally through her many outstanding virtual classes and certification program for coaches. For more information, see https://angelapoch.com// Angela also wrote the songs: "Feeling Great," and "Tell Me the Truth." Thanks for listening today! Rhonda, Angela, Rachel, Shalynn, Erik, Heather, Brandon, Mark, and David | |||
| 358: Ask David - Depression, schizophrenia, and more! | 21 Aug 2023 | 01:00:14 | |
Are the "physical" symptoms of depression specific or non-specific? How do you treat schizophrenia with TEAM? Why don't more shrinks help themselves? Healthy vs unhealthy negative feelings-- what's the difference? Questions answered in this podcast: 1. Laura asks: Why don't you include the physical symptoms of depression in your assessment tests? 2. Fred asks: How would you use TEAM-CBT to treat individuals with schizophrenia? 3. Author not known: Why don't the therapists you treat with TEAM treat themselves using self-help techniques? 4. Zach: How does David understand the difference between healthy and unhealthy emotions? Is there any overlap between EFT (Emotionally Focused Therapy) and David's TEAM-CBT? The following are David's written responses to these questions. However, in the podcast, Rhonda and David discuss them, and their answers together may differ or enlarge on the material below. Also, in some cases, the written answers contain additional information not included in the live podcast. 1. Laura asks: Why don't you include the physical symptoms of depression in your assessment tests? Author: Laura asks a question about post #248: "David and Rhonda Answer Your Questions about Exercise, Empathy, Euphoria, Exposure, Psychodynamic Therapy, and more!" Comment: Fabulous, David. Bless you. Have you done a show on assessments? I'll be honest about my confusion. Some of the measures that you have developed almost seem too simple to be accurate. For example, the depression test isn't sensitive to any of the physical manifestations of the illness. Anyway, I was just curious about that. David's Reply Thanks, Laura! Good questions! First, the so-called physical symptoms of depression are non-specific and not uniquely associated with depression. Only the core emotional symptoms are good indicators of depression: feeling down, hopeless, worthless, unmotivated, and not enjoying life. If you want to measure physical symptoms, they won't give you much information about depression, but at least they need to be worded correctly, which they aren't in most assessment tols. For example, you can measure weight gain, OR weight loss, in single and separate items, but not in the same item. But if you go to a mall and ask how many people have had weight gain, you'll probably find that more than 50% report weight gain, but this is rarely due to depression, rather it is due to overeating! Similarly, a significant fraction will say yes to a question about weight loss, and in the vast majority of cases this will be due to dieting, not depression. Similarly with the other poorly thought out physical symptoms, like trouble sleeping. The reliability of my depression measures has typically been .95 or better, as compared with measures like the Beck or PHQ9 that have only .78 to .80 reliability coefficients (called "coefficient alpha.") I have observed a phenomenal lack of critical thinking behind most current psychological tests for depression, anxiety, and other variables of interest to clinicians and researchers. You also asked about apps for anxiety, like OCD, as opposed to depression. The Feeling Good App causes rapid and significant reductions in, not one, but seven categories of negative feelings, including feelings of depression, anxiety, guilty/shame, inadequacy, loneliness, hopelessness and anger. Thanks so much! Finally, I have to confess my bias toward trying hard to make things simple, so we can all understand what we're talking about! When things are overly complicated or hard to "get," I usually feel fairly suspicious about the person who is trying to "teach." In college I always had the policy that if I can't understand what the teacher is trying to say, the teacher has a problem! My thinking today is pretty similar! I've always appreciated teachers who keep things simple for us mere mortals who appreciate having things explained clearly and in everyday words. Best, david 2. Fred asks: How would you use TEAM-CBT to treat individuals with schizophrenia? Hi David, Do you have any schizophrenia thought experiments? Most of my clients struggle with voices. I tell them there is always a good voice, which I believe is the Holy Spirit woven into every person at birth. I also tell them to welcome the voices and listen for what they need, because the voices need to be welcomed back into the body - the "family" - of the person, according to Internal Family Systems. I welcome your thoughts. I am not a therapist so anything I say or do needs to fit my role as a recovery coach. Fred South Bend, Indiana David's Reply. Thanks, Fred, great question. I have treated many individuals with schizophrenia, but they have rarely or never asked for help with the voices they hear. I like to set the agenda for each patient, finding out what they specifically want help with. And individuals with schizophrenia respond very well to TEM-CBT, both the individual treatment model for depression and anxiety, as well as the interpersonal model for relationship problems. An experience early in my career highlighted the folly of trying to challenge the delusions of individuals with schizophrenia. A young man, a new patient, seemed uncomfortable and when I inquired, he explained that the receptionist, Lucretia, was listening in because she could "hear" our thoughts and our conversation. I explained that Lucretia did not have much money, and that if he wanted we could do an experiment to test his belief. I put a $20 bill on the desk and said that if Lucretia knocked and came into the office, she could have the money. So I did that and Lucretia did not knock on the door or appear in the office. I asked the young man what he concluded from our "experiment." He said that she "knew" it was an experiment since she could "hear" our thoughts, and didn't come in because she didn't want us to know she was "listening in" on our dialogue! That's an excellent example of what happens when the shrink tries to set the agenda, as opposed to helping patients with what THEY want help with! In my experience, you can help individuals with schizophrenia with self-esteem, anxiety, and relationship problems with psychotherapy, and they do feel and function somewhat better, but they still, sadly, have schizophrenia. This is my thinking only, and others may differ. I know that Aaron Beck and many of his followers have done research studies claiming they can help schizophrenia with traditional CBT. I am skeptical, but have not read those studies or evaluated the data with a critical eye! So who knows? Maybe they have some decent results. Best, david 3. Author not known asks: Why don't the therapists you treat with TEAM treat themselves using self-help techniques? Why can't the TEAM-CBT therapists who have done personal work with you on the podcasts do that work themselves in self-help mode?" They know all the techniques and have all the tools. With no qualifications, I have my own theory on that, which is actually based on TEAM. I don't know how to give myself the level of E=empathy required to move on to the next stage. So I guess my question could be reworded as "Is it possible to give yourself sufficient empathy in self-help mode?" or "Are there techniques or tools you can use to give yourself empathy in self-help mode?" David's Response Thanks, cool question!
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| 357: Stories from the 60s, Part 1 | 14 Aug 2023 | 01:39:53 | |
Podcast 357: Stories from the 60s, Part 1 Today's podcast will be a little different. I had the good fortune to be alive in Palo Alto, California during the late 1960s. For me, it was a magical era of happenings, the Haight-Ashbury District in San Francisco, psychedelics, war protests, civil rights activity, cool music, learning about life, and cutting an awful lot of medical school classes! But what I learned on the streets was far more valuable in my later career as a psychiatrist, working with real people with real problems, than anything I learned in medical school. It was an era of magic, to be honest. In fact, to me, California has always had the feel of magic. And that magic is still alive and well, happening every day, at least in my life. Let me know if you like these stories. I shared them at my weekly Stanford training group, and publish the recording of that evening's training session here, with trepidation. Some of the stories are pretty far out. If you like them, and want more, I have a lot more, which I've listed below. Just let me know, and I'll gladly start babbling again. . . IF I haven't been arrested! If you'd like to see one of the R-rated but gorgeous Larry Keenan photos taken at my "Uptightness" happening, you can see it at this link: Look for the photo called "The Kiss." https://www.larrykeenan.com/prints Larry Keenan, a brilliant young commercial photographer at the time, attended my "uptightness" happening and took many fantastic photos that day. Larry became a famed photographer of many of the greats of the "Hippy Era," like Bob Dylan, Neil Cassady, Lawrence Ferlinghetti, and a host of others. Sadly, Larry passed away several years ago, but I will always be grateful to him for the gorgeous and now-famous photos he created that day in the infamous but glorious 60's! Warmly, david Part 1 (in this podcast) Psychodrama / encounter
Here's the Stanford group feedback from group after telling stories 1 – 5 Positive Feelings about the Training Not at all true Somewhat true Moderately true Very true Completely true N/A 1. I felt I could trust my trainer. 0 0 0 0 17 1 My trainer paid careful attention to what I said 0 0 0 0 7 11 My trainer critiqued my work in a sensitive manner. 0 0 0 0 7 11 I felt good about the training I received. 0 0 0 0 17 1 Overall, I was satisfied with my most recent training session. 0 0 0 0 17 1 Negative Feelings during Training Not at all true Somewhat true Moderately true Very true Completely true Sometimes I felt uncomfortable during the training. 18 0 0 0 0 Sometimes I felt defensive during the training. 18 0 0 0 0 Sometimes I felt frustrated during the training. 18 0 0 0 0 Sometimes I felt anxious during the training. 18 0 0 0 0 Sometimes I felt insecure during the training. 16 2 0 0 0 Helpfulness of the Training Not at all true Somewhat true Moderately true Very true Completely true N/A I expect to use these ideas with patients I am now treating 0 0 2 1 11 4 What I am learning seems useful in my clinical training. 0 0 1 2 13 2 My trainer and I are working together effectively. 0 0 0 2 10 6 The training was helpful to me. 0 0 0 1 16 1 I felt I was learning and growing during the training session. 0 0 0 1 16 1 Respectfulness and Safety of the Training Not at all True Somewhat true Moderately true Very true Completely true N/A My trainer was sensitive to potentially relevant cultural, racial, religious, age, gender, or sexual identity issues that might impact the therapy. 1 0 2 0 13 2 My trainer created a safe and warm space for all identities. 1 0 1 0 14 2 Difficulties with the Questionnaire Not at all true Somewhat true Moderately true Very true Completely true It was hard to be completely honest answering some questions. 16 1 0 0 1 My answers weren't always completely honest. 16 1 0 0 1 Sometimes I did not answer the way I really felt inside. 16 1 0 0 1 Please describe what you specifically disliked about the training? What could have been improved? Were there some things you disagreed with or did not understand?
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| 356: Ask David - Burn Out; When Challenging Thoughts Doesn't Work; and more! | 07 Aug 2023 | 00:55:56 | |
Ask David: Burn Out; When Challenging Thoughts Doesn't Work; and more! Featuring Dr. Matthew May In today's podcast, Matt, Rhonda and David discuss four challenging questions from podcast fans like you: 1. Joseph asks if it's okay to take a break when you get "burned out." Below, David expands on this and describes the difference between "healthy" and "unhealthy burnout." 2. Joseph also asks why your feelings might not change when you challenge your negative thought with a positive thought that's 100% true. 3. Dan asks about Step 4 of the Relationship Journal, which is the most difficult and important step in the TEAM interpersonal model—see exactly how you're forcefully causing and reinforcing the very relationship problem you're complaining about. For example, if the person doesn't "listen," you'll see that you're forcing them not to listen. If she or he doesn't open up and express feelings, you'll see that you prevent them from opening up. And if you think your partner doesn't treat you in a loving and respectful way, you'll suddenly see exactly why this is happening—if you have the courage to take look and see: But if fact, this is one of the "Great Deaths" of the "self" in TEAM-CBT, and very few folks are willing to "die" in this way. 4. Finally, Clay asks about EMDR. He's been treated with it without success. David and Matt weigh in with their thoughts about EMDR. This question was not addressed on the podcast, since some practitioners of EMDR might be offended by David and Matt's thinking, but they did describe their thoughts in the show notes below. If you are an EMDR enthusiast, you might prefer NOT to read our comments. Joseph writes: Thanks, David, for sharing so much on the podcasts! I have a couple questions. Personally, I find that when I'm burnt out, I get a lot more anxious automatic thoughts. While it's definitely good to combat these distorted thoughts by replacing them with realistic ones, my takeaway is that it's also sometimes wise to change our lives / circumstances (e.g. to take a break). By the way, I also wanted to ask if you've ever faced a situation where you are convinced that a thought is distorted and irrational (and you know what the realistic thought is), but you still can't shake it off? I sometimes get stuck when I already know the "right answer" (ie. what the realistic thoughts are based on the methods you've taught), but I just can't seem to get my brain to fully believe it. For example, I was recently on vacation and a small blip made me think "my vacation is ruined!". I immediately identified it as all-or-nothing thinking, and replaced it with "my vacation is still going very well even if it's not perfect" (and I'm convinced this thought is true), but somehow my mind kept going back to the automatic thought again and again. Curious if you've ever experienced this. Thanks again so much for your time and your teaching; just wanted to say I really appreciate it! :) Regards Joseph David's Reply to Joseph. Thanks for the great questions. We address both of them on an upcoming podcast. Here's the quick response. Yes, it is okay to take a break when you feel "burned out." However, you can get "burned out" in a healthy or unhealthy way. For example, after I edit for two or three hours, which I love, my brain gets "burned out." So I take a break and come back later, maybe even a day later, and I feel refreshed and filled with enthusiasm about writing and editing some more, because I love these activities. When I was in private practice in Philadelphia, I saw 17 patients back to back on Wednesdays. That way, I could have a three day weekend. Actually, I loved it and as the day went on, I got higher and higher. At the end I was exhausted, but exhilarated. I was never "burned out" because I loved what I was doing, and the clinical work was SO rewarding! However, sometimes I made a mistake and a patient would get very upset, sometimes angry with me, or felt hurt. THAT was when I got suddenly burned out and exhausted. But it wasn't because of my work, or the conflict, but rather my thoughts about it, which generally involved a combination of self criticism and frustration with the patient, both the result of distorted thoughts, generally Self-Directed and Other-Directed Should Statements. And THAT kind of "burned out" won't improve with a break. The answer is challenging and changing your own inner dialogue, as well as your dialogue with the other person, using the "failure" in the relationship as an opportunity to listen and support and create a deeper and more meaningful relationship. With regard to your second excellent question, we explored that in depth in the podcast, and also made it a problem for our listeners to think about. So tune in for the answers! This is a popular question I've been answering for more than 40 years, and the answers tell us a great deal about how cognitive therapy actually works. Thanks so much, Joseph! Subject: Relationship Journal Gem I Found Dan (a former participant in David and Jill's Tuesday training group at Stanford) writes: Hello to the Dynamic Duo (David and Jill), I came across this doc for Step 4 of the Relationship Journal, but I don't really understand it and I don't remember the context. I know it was from the Tuesday Group years ago. It says it's about conceptualizing the problem, just not sure how to utilize this in step 4. Thanks. (You will find this document in the show notes below.) ~Dan (Daniel C. Linehan, MSW, LCSW) David's Reply Hi Dan, Great question. In this document, I am trying to make it a bit easier for folks to see how they are triggering the very problem they are complaining about. So, I have listed three categories of common complaints. For example, an Empathy complaint would be that "My partner doesn't listen," or "always has to be right." Then you ask, "If I wanted to force my partner to behave like this, how could I so?" Well, one good way would be to interrupt when your partner is trying to talk, or argue and insist your partner is wrong when they're trying to make a point, and so forth. This would force your partner to argue and insist that they are right! It is pretty basic and obvious. But most human beings don't "get it," and in part that's because a great many don't want to. Blaming the other person seems way more popular than looking at your own role in the problem these days. Good to hear from you on this important topic! People can usually "see" how step 3 of the Relationship Journal works—you simply examine what you wrote down in Step 2, and you can almost always see no E (Empathy), no A (assertively sharing your feelings with "I Feel" Statements, and no R (conveying respect or liking to the other person, even when you're angry.) But most people don't seem to have the natural mental aptitude or the stomach for Step 4, where you go beyond Step 3 and explain EXACTLY how you FORCE the other person to behave in the exact way you're complaining about. The document in the link is an attempt to help people with Step 4—IF you are willing to examine your own role in the problem. In Step 4, you ask yourself what category you see the other person in, and there are three choices to make it fairly simple. You might feel that they don't listen or try to see your point of view. This would be an E = no Empathy complaint. Or you might feel like they can't, or won't, share their feelings. Instead, they might just keep arguing, or they might refuse to open up. This would be an A = no Assertiveness complaint. Or, you might complaint that they don't treat you with warmth, love, or respect. That would be an R = no Respect complaint. This makes it much easier to "see" how your response to the other person in Step 2 actually causes and reinforces the exact behavior you're complaining about. Lots of people get defensive or annoyed at this step of the RJ, and refuse to continue! That's because Step 4 is all about the third "Great Death" of the "self," or "ego," in TEAM-CBT. Most of us don't want to "die" in this way. It can feel humiliating, or shameful, to pinpoint your own role in the problem. But, there's usually a big reward—you're suddenly "reborn" into a far more loving and satisfying relationship. In the podcast, brave and wonderful Rhonda provided David and Matt with an example when she was visiting her son and daughter in law in Germany last month to help out with their twin baby girls. This example really brings this "Great Death" to life, and we are grateful to Rhonda for helping us in this very vulnerable and real way! Feel free to ask again if I have not made it clear. To me, this phenomenon of causing the very problems we are complaining about in our relationships with others is incredibly fascinating. However, change involves the "death of the self," which is painful, because you have to see, usually for the first time, your own role in the problem you're complaining about. It is based on the Buddhist idea that we create our own interpersonal reality at every moment of every day. In other words, we CREATE our enemies, and then whine and complaint about it! Most people don't want to see this! They want the therapist (or friend they're confiding to) to agree that the other person REALLY IS a jerk, or to blame, or whatever. They just want to complain and blame and feel superior! In my book, Feeling Good Together, I think I said something to the effect that we "want to do our dirty work in the dark." In other words, we don't want to turn the lights on so we can "see" how we're actually causing the conflict. The person asking for help can nearly always be shown to be the 100% cause of the conflict. This technique is one I recommend when working with an individual, and not a couple. Other less confrontational techniques are probably more effective when you are working with both partners at the same time. Warmly, david (David D. Burns, MD) Here's the document: Conceptualizing the Patient's Complaint in Step 4 of the Relationship Journal (RJ) By David D. Burns, MD* Problem Area Specific Complaint—S/he Complaints about the other person's lack of E = Empathy
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| 355: Relationship Problems - Be Gone! Featuring Dr. Matthew May | 31 Jul 2023 | 00:58:25 | |
355: Relationship Problems: Be Gone! Featuring Dr. Matthew May In today's podcast, Matt, Rhonda and David discuss relationship problems, and how to overcome them. We also give instructions on the Paradoxical Invitation, one of the most important and difficult techniques for TEAM-CBT therapists to learn. We started today's podcast interviewing Tania Ahern and Andy Persson who give a plug for the upcoming TEAM-CBT intensive from August 14 to 17, 2023 in Bristol, and incredible British city with an outstanding TEAM-CBT training program in store for you. Many notable TEAM experts will be presenting, including Drs. Leigh Harrington, Heather Clague, Marius Wirga, Stirling Moorey, Mike Christensen and many other notable teachers. Special thanks to Peter Spurrier for being a fantastic TEAM therapist and organizer! I will also be there virtually doing a keynote address, a Q and A session, and a live TEAM-CBT demo with a workshop volunteer. The amazing Mike Christensen will be my co-therapist. Hope to see you there! Go to TEAMCBT.UK for registration and more information. Today we focus on relationship problems, starting with a real example, which often makes for the best teaching. Rhonda recently spent time with her son and daughter-in-law to help with their new twin babies. Rhonda's daughter-in-law had a very difficult delivery, and was in the hospital for several weeks following the birth of the babies. Rhonda worked relentlessly cooking and cleaning for them, feeding the babies, changing their diapers, and comforting them, and providing help for the new mom, who was overwhelmed and fearful of bathing the babies, thinking she might hurt them when attempting to bathe them. As so often happens in real life, Rhonda ran into a severe conflict with her daughter-in-law and responded with anger, and we all so often do. She reveals how terrible she and her daughter-in-law felt, and how she saved the day after deciding to have a "redo" of the interaction, using the Five Secrets of Effective Communication. Rhonda, Matt and David described one of the most difficult therapy tools in TEAM-CBT, the Paradoxical Invitation Step, and contrasted it with the Straightforward Invitation. Rhonda also mentioned some podcasts for further information on the Relationship Journal and the Interpersonal Model in TEAM-CBT. There are even more, but here are some that might interest you. My book, Feeling Good Together, is also a must-read for anyone wanting to make profound changes in the way you connect with the people you love, as well as your patients if you're a shrink! # Podcast Title Min 054 Interpersonal Model (Part 1) — "And It's All Your Fault!" Healing Troubled Relationships 54 055 Interpersonal Model (Part 2) — "And It's All Your Fault!" Three Basic Assumptions 27 056 Interpersonal Model (Part 3) — "And It's All Your Fault!" Interpersonal Decision-Making and Blame Cost-Benefit Analysis 46 057 Interpersonal Model (Part 4) — "And It's All Your Fault!" The Relationship Journal 44 226 The "Great Death" in a Corporate / Institutional Setting 56 227 Echoes of Enlightenment 43 We finished today's podcast with some entertaining role-playing exercises, using the Five Secrets of Effective Communication in interactions with extremely difficult individuals. This gave me the chance to role-play some incredibly obnoxious and practically impossible to please. My favorite role! Enjoy! Warmly, Rhonda, Matt, and David | |||
| 354: The Explosion of FREE Help! | 24 Jul 2023 | 01:02:10 | |
Grass Roots TEAM-CBT Completely FREE Practice / Training Groups Today we interview four courageous pioneers of free and low-cost TEAM-CBT for the masses, featuring Brandon Vance, MD, Patricia O'Neil, Ana Teresa Silva, DVM and Nicholas Santascoy, PhD. Many of you are already familiar with Brandon Vance and Heather Clague's awesome online Feeling Great Book Clubs which will start again, running from September 13, 2023, through December 6, 2023. The book clubs are popular and have gotten wonderful reviews. They are a fun and engaging way to structure your reading, discuss the book, see demonstrations, practice tools, ask experts questions and connect with others around the world who are working on Feeling Great – and no one is turned away for lack of funds. Sound interesting? You can learn more and join here. But you may not be aware of a growing number of fantastic totally free self-help groups springing up for people around the world. These groups offer training in different aspects of TEAM-CBT. For example, Patricia offers DAILY (!) practice sessions that focus on the use of the Daily Mood Journal. You can also join
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| 353: The Inner Scoop on "No" Practice! | 17 Jul 2023 | 02:22:09 | |
353: The Inner Scoop on "No" Practice! The "Inner" and "Outer" Dialogues— The "Inner" and "Outer" Solutions As you know, I have created many powerful communication techniques, including the Five Secrets of Effective Communication and more. One of the additional techniques is called "No" Practice, and it's designed for people who have trouble saying "no," or setting limits with other people. Essentially, you do a role-play with a colleague or therapist who keeps pestering you with pushy demands, and you have to practice saying "No" in a polite but firm and assertive way. Sounds simple, right? But it's not! People have many reasons for not wanting to say "No." For example, you may be afraid of hurting the other person's feelings, or letting them down, or running the risk that they may get mad at you if you don't say, "Yes." In addition, you may feel like you'll miss out on some special activity if you say no, so you end up way over-committed. In this session, you will meet an exceptionally compassionate and highly trained young psychiatrist named Lee, who asked for help with a problem relating to some of his patients. My co-therapist is Dr. Jill Levitt, who is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California. Lee explained how he struggles with saying "no" when patients make inappropriate requests, like pushing for a medication they're addicted to, and wanting premature discharge from the inpatient unit when they have unrecognized safety issues. Instead, he seems to get drawn into long explanations of his thinking and why he's declining the other person's requests, sometimes for half an hour, and ends up frustrated when the other person still doesn't "get it" and with himself for spending the time. People often think that therapy is easy, and that people just need encouragement, advice, or behavioral practice to change the way we interact with others. But as you will vividly see in this session, that is often not the case, and things that may seem simple or obvious can seem almost impossibly difficult to learn. Why does this happen? Why is it so difficult for people to learn new and seemingly simple verbal skills? Well, to find the answer, we have to go back to the teachings of the Buddha and Epictetus, who taught us that our negative feelings do NOT result from what's happening, but from our thoughts. What does this mean? Well, Lee is an incredibly intelligent and compassionate young psychiatrist, and he's clearly highly motivated, and yet he seems very slow in learning how to say "no." Can his thoughts illuminate his apparent resistance to learning a new approach? During the session, Dr. Levitt reminded us of the fact that whenever you are involved in a conflict with someone, or any interaction for that matter, there are always two dialogues going on: the Inner and Outer Dialogues, and if you ignore either one of them, you may have difficulties triggering change. The Outer Dialogue involves what you say to the other person, and what they say next, and how you respond. For example, Patient says: "Doctor, I want to get discharged from the hospital." Lee says: "No, I can't do that because you'd be in danger and without a place to live. You'd be living on the streets, and it wouldn't be safe for you." Patient (who is in a state of psychosis) responds: "No doctor, I'll be okay, because I'm living with Michael Jackson." Then Lee tries to explain his thinking again, and then the patient asks to be discharged from the hospital again. And this cycle repeats itself many times, over and over, for as much as an hour. And they both end up frustrated and a bit miffed. Why is it so hard for Lee to say no in a kindly way and then move on to some other activity? That's where the Inner Dialogue can be so important. It appears that Lee has two types of distortions that interfere with his ability / willingness to say "no."
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| 352: Ask David: Marijuana, Anger, Ultra-Short Sessions, and more | 10 Jul 2023 | 01:05:00 | |
Featuring Dr. Matthew May In today's podcast, Matt, Rhonda and David discuss four challenging questions from podcast fans like you: 1. what do you do with patients who use marijuana excessively but have no interest in changing or reducing their use? 2. How do you help clients control their anger? 3. How can you use TEAM if you are only allowed to see clients for 15 to 20 minutes? 4. If David never went into the medical / mental health field, what career path do you think you would have chosen? The answers on the show are live and will differ considerably from the information below, which is primarily to document the full questions that the fans submitted. 1. When a client expresses concerns in multiple areas of their life, such as mood, relationships, and habits, is there a particular hierarchy that you follow? In particular, what do you do with patients who use marijuana excessively but have no interest in changing or reducing their use? I'm particularly interested in your perspective on the hesitancy within the therapeutic community to treat individuals with co-occurring depression and anxiety, alongside marijuana habits or addictions that they do not wish to address. How do you approach and navigate this complex situation, and what are your thoughts on effectively addressing the client's mental health concerns while considering the impact of their substance use on the therapeutic process? With the increasing acceptance and use of medical and recreational marijuana, do you believe it is still morally or ethically justifiable to turn away clients who use marijuana and express no desire to quit? It appears to be a prevalent practice, and I would appreciate your insights on this matter. Casey Zeigler Matt: Great Question, Casey! For me it depends on the pattern of usage and reasons for using Marijuana. For example, if someone gets anxious and then uses marijuana to reduce their anxiety, then I'd be unable to help them treat their anxiety if they weren't willing to set marijuana aside, for a while, to practice some new methods. I might ask, 'imagine you could feel calm and relaxed, but didn't need marijuana to accomplish this. What would it be worth to you, to have that ability? For example, would you be willing to go through an uncomfortable period of deprivation and awkwardly failing at methods to reduce your anxiety, in order to get there?" David: in a Harvard study years ago, individuals with benzo addictions were randomly assigned to two withdrawal groups: Klonopin-only slow withdrawal, and Klonopin slow withdrawal plus group (I think) CBT. The success in terms of numbers of patients who successfully withdrew was far greater in the CBT group. Or, if they used Marijuana to avoid feeling depressed, I'd wonder if they would be willing to set that aside temporarily, in order to prove that they could feel great without Marijuana. My approach is to identify what the patient wants and to be realistic about the approach to achieve those results. There's also long-term data showing that daily use of marijuana is associated with worse mental health, in the long-term. David: I think these decisions have to be individualized, and consultation with a colleague when in doubt can be very helpful.2. I have a question about anger. How do you help clients control their anger? 2. How do you help clients control their anger? I was going to mention it to you as a good topic to cover anyway in a podcast, because it is the one emotion that has not particularly been dealt with in the podcast. This is ironic, since anger is apparently the one emotion we don't acknowledge!). I did a search and there were only two that touched on it and neither covered how someone can learn to control their anger. I have had several clients who talk of how they snap at their children or partners and want to learn to deal with it. Does it work to use a daily mood log in these cases, as the emotions are more like explosive reactions, and maybe less easy to defeat with distortion-free positive thoughts? Thanks Andy Perrson Matt: Thanks, Andy! I can help people overcome anger, but they probably don't want the type of help I can offer! David: individuals beta testing the Feeling Good app have shown dramatic and rapid anger reductions. In a group or individual therapy context, I would use TEAM systematically. I do not typically "throw methods" at feelings, problems, diagnoses, etc. I treat humans, finding out what's going on in their lives, conceptualizing the problem, melting away resistance, and choosing methods based on all of that. All that being said, the CBA or Paradoxical CBA are almost always the first techniques with anyone who is angry: vignette about the angry doctor and the angry banker. 3. Do you have any tips to use TEAM skills for very short time session(about 15 to 20 minutes). I am not yet running my private practice. I am employed in other person's private clinic as a psychiatrist and usually prescribe pills and the time per patient is at most 20 minutes. Luci Eunkyoung Yang Matt and Rhonda; This would require a focus on 'homework' outside of session. Happy to discuss. David: Can empathize and refer to groups, app, books for those who want more help. 4. If David never went into the medical / mental health field, what career path do you think you would have chosen? A few guesses, a magician (I believe he referenced in a podcast an affinity for magicians), theatre (Brigadoon story - fear of heights), politician (David sometimes has an opinion on a variety of topics), lawyer (David knows all about black/white thinking, as well as being able to see things in shades of grey), scientist (creator of TEAM-CBT), writer (best selling author) or entrepreneur (what couldn't he create/sell?) Whatever the path, he would have been a leader in that field too for sure and I'm so grateful that he chose ours. Best, Todd | |||
| 351: Free Master Class on Perfectionism, Part 2 of 2 | 03 Jul 2023 | 01:38:34 | |
A Second Visit to David and Jill's Tuesday TEAM Training Group at Stanford Last week, you "sat in" on our Tuesday training group at Stanford and learned about two of the four most important techniques in the treatment of perfectionism, or any other Self-Defeating Belief. (For a list of 23 common Self-Defeating Beliefs, click here.)
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| 350: Free Master Class on Perfectionism, Part 1 of 2 | 26 Jun 2023 | 01:01:33 | |
Tuesday TEAM Training Group at Stanford In 1980 I published an article entitled "The Perfectionist's Script for Self-Defeat" in Psychology Today Magazine, in an attempt to get some publicity for my (then) new book, Feeling Good. At the time, it was the cover feature and became the most popular article in the history of that magazine. Perfectionism is definitely one of the most common themes I have confronted in my clinical work and teaching over the past many decades. If you would like to take a look, you can check it out at this link. They had fantastic colorful illustrations, including a bleeding dart board wtih a dart in the bullseye, and sadly you'll only get the text in black an white at the link. It seems that almost everyone succumbs to this mindset from time to time, and it can cause many negative moods. But at the same time, the attempt to be perfect brings many benefits at the same time. This can be a dilemma. The next several podcasts will be based on a two-week perfectionism class I developed for the weekly Stanford TEAM-CBT training group that I direct along with my esteemed colleague, Dr. Jill Levitt. This podcast class is suitable for therapists and non-therapists alike. These podcasts will give you the opportunity to "attend" the group and witness the procedures we use to train therapists. You will have the opportunity to practice the same techniques the students will practice when we break into small groups. I would encourage you to turn off your podcast temporarily so you can practice the exact same techniques on your own when we break into small groups for practice. For example, in the first class you are about to hear, we will spend 20 minutes doing a Cost-Benefit Analysis for perfectionism. You will find a blank CBA if you click HERE. I would encourage you to practice the same thing for 20 minutes during each practice group. During the first breakout group, you can spend 20 minutes listing the advantages and disadvantages or perfectionism. Ask yourself, "how might this mindset help me? And how might it hurt me?" You can use this blank CBA. After listing the advantages and disadvantages, weigh them against each other on a 100-point scale, and put two numbers adding up to 100 in the two circles at the bottom. For example, if the advantages are greater, you might put 75 and 25 in the two circles. If they are about equal, you can put 50 and 50. And if the disadvantages are somewhat stronger, you might put 40 and 60 in the circles. Remember, it's not the number of items in the columns, but how you feel about them overall. Sometimes, one powerful advantage might feel much more important than the five disadvantages, and sometimes one powerful disadvantage might feel more important than numerous advantages. Part of the fun (hopefully) of this podcast is that you'll get to hear the questions and suggestions of many of the 45 or so students in the class that night. As you will hear, we have a multi-cultural rainbow group with therapists from around the world. We started Part 1 of the Perfectionism Master Class with these important two questions:
If you want to join David and Jill's Tuesday group, that meets from 5:00-7:00 pm PST, please contact Ed Walton: edwalton100@gmail.com If you want to join Rhonda and Richard Lam's Wednesday group, that meets from 9:00-11:00 am PST, please contact Ana Teresa Sliva: ateresasilva6@gmail.com Thank you for listening, David, Jill and Rhonda | |||
| 349: Borderline Personality Disorder; Traumatic Events; and More! | 19 Jun 2023 | 00:54:38 | |
Six Cool Ask David Questions from Carlos and Greg Carlos asks: 1. Are your tools available in Spanish? 2. Is there any evidence that TEAM can help patients with Borderline Personality Disorder (BPD)? 3. How do you get patients with BDP to stop jumping from problem to problem? 4. How do you get them to stop endless venting during therapy sessions? Greg asks: 5. What comes first, thoughts or feelings? 6. Can't a genuinely negative or tragic event directly cause negative feelings, without having to have negative thoughts? Dear Dr. Burns: 1. I would like to use your BMS but I mostly work with patients in Mexico. Has there been any standardization of your tests in any Spanish speaking country? David and Rhonda address this. You can email Victoria Chicural, who is one of the TEAM-CBT leaders in Mexico (along with Silvina Carla Bucci), at victoriachl@yahoo.com and ask her about access to TEAM-CBT forms that have been translated into Spanish. 2. I am wondering if TEAM has proven to be effective in the treatment of BPD (Borderline Personality Disorder). I use it a lot, but I have found quite a few challenging elements. David describes his published work, indicating an excellent response to TEAM-CBT in patients with BPD. 3. People suffering from BPD usually have trouble prioritizing tasks and activities. The same happens when it comes to setting objectives. Because of their emotion dysregulation, they usually decide to work on one objective, and later on, they sometimes say: "Well, this objective is not THAT important anymore. Let's do another." For them, doing the specificity part can be really challenging because their perspective changes very quickly and they usually go back to the former objective when they're being challenged by a similar situation!!! How do you get them to prioritize objectives and not to switch from one to another so quickly? Or, do you think I could be making a mistake when setting objectives? David describes the strategies he has developed for coping with this type of clinical problem, including the development of his Concept of Self-Help Memo that he required every new patient to fill out prior to their first therapy session. 4. BPD usually come up with a lot of material to the session. They may be facing complex PTSD but also dysfunctionality at work, at school, etc. They want to say everything in a single session even if we have agreed to follow one single objective. Many sessions turn into endless talking without getting anywhere - some of them argue they need to vent out what they feel - but as time goes by, they complain that therapy is not working! How do you deal with a patient who is overwhelmed with numerous factors in a session where you have a previously set objective? David describes the strategies he has developed for coping with this type of clinical problem, Carlos S Bouchanm, Clinical Psychologist David's Response Hi Carlos, I think these would make for excellent Ask David podcast questions. If so, can we use your name and read your questions? I reported on the effectiveness of the forerunner of TEAM in the treatment of BPD is the Journal of Clinical and Consulting Psychology in the 1990s. TEAM was specifically developed for this population, since 28% of my patients in Philadelphia had BPD. In the live podcast, I will address the excellent questions you asked about treating individuals with BPD. Thanks! David From: Greg Hi David, Thanks for everything you do and for the great podcast! I have another couple questions possibly for the "Ask David" segment of the podcast. 5. Can you say some more about automatic thoughts? CBT is based on the idea that we're thinking things that produce feelings, but with an automatic thought it just kind of pops up and is there. It's not like actively, intentionally thinking it. Other schools of thought (for example Somatic Experiencing) posit that feelings from the nervous system occur first and that the thoughts are actually the product of that, which seems to run counter to the CBT view. This has been a little challenging and confusing. David and Rhonda discuss this, including new research on the causal links between emotions and thoughts. 6. How do you apply TEAM CBT to worries about real and true things, like a real diagnosis or a tragic event? It would seem that it's not just one's thoughts about it, but an actual threat or upsetting event causing feelings because that is simply how one would feel about. Maybe the thinking is accurate? This, too, has been particularly challenging and confusing, so I'd love to hear more on this. David and Rhonda discuss how thoughts trigger all of your feelings, even after a genuinely tragic event. Thank You, Greg L. David's Response Thanks, Gary. These are great questions, and perhaps we can address them om an Ask David podcast! There are strong, clear answers that might be interesting or helpful, as nearly everyone has these questions! Best, david Thanks for joining us today! Rhonda, and David | |||
| 464: Hopelessness: A New Approach | 01 Sep 2025 | 00:54:54 | |
Hopelessness: A New Approach Featuring Mike Christensen Often, therapists are drawn to become specialists in the very area where they once suffered and felt most vulnerable. In Mike's case, he describes his own feelings of failure, betrayal, bitterness and hopelessness in his early career, and how he found his way to become a star in the TEAM therapy firmament. Today, he describes a breakthrough approach in the treatment of hopelessness as well, based on the A = Assessment of Resistance portion of TEAM. Mike began by saying that treating hopelessness is always a challenge. . . in fact, I can vividly remember when I felt hopeless! And of course, part of the challenge is the fear that hopeless patients may try to take their own lives. This is the "dark side" of clinical practice, and it is not often talked about because of the terror it strikes in the hearts of mental health professionals. Mike started out with a bit of his traumatic personal history. He explained that he once owned and ran a bicycle shop in Canada when he was in his mid- to late-twenties. "There was a fellow businessman in my town who was a bit older than me and somebody I really looked up to. He was successful, had a beautiful family, was well respected in the community and had some wonderful friends. One day I got a phone call from my wife and she said to me: 'Did you hear what happened to John? She went on to tell me that it was shocking and terrible because he was somebody who enjoyed hunting. One day he went out to the family cabin and took his shotgun and took his own life. Mike said that at his funeral, "I can remember it like it was yesterday hearing his daughter's voice when she spoke and those words that she said. "Daddy, why were you so sad?" "A number of years later we had moved on, sold the business and our home and moved to another town to work in an organization supporting people. I had done my degree in theology with focus on youth and counseling and was working with young families. Unfortunately there were some real difficulties in the situation and it did not turn out very well after a little over a year. He felt betrayed, and ended up with no job. He was now in his mid to late-30s, and got a job in a hardware store. "I was really struggling with the sense of confusion, frustration, depression and hopelessness. Even though I had a supportive family, and had been successful in many areas of my life. He recounts, "One day I looked in the mirror and as I was having those thoughts of hopelessness I was reminded of John, my business colleague who had taken his own life 10 years earlier and I thought about my 2 young daughters. I could hear John's daughter's voice: "Daddy why were you so sad" in my head and I thought I have to get some help" "My wife is a nurse and has a very wise family physician, Dr Mariette deBruin, who is incredibly skilled at empathy. Fortunately, she had been at a mental health conference earlier that year and heard this brilliant psychiatrist share a powerful approach to treating depression without medication. That psychiatrist was Dr David Burns. She suggested I get a hold of the book, Feeling Good, and that was the start of my recovery in 2006. I went back to grad school to do my Masters in Counseling Psychology and then attended my first workshop with Dr. Burns in 2009." Looking back, I realized that hopelessness was actually my best friend. I was in a tremendous amount of pain. Here were some of the positives I discovered in my feelings of hopelessness:
When I'm working with practicum students or interns that are early in their counseling or therapy career, one of the greatest fears that they have is that one of their clients or patients will take their own life. Sadly, when you go into this line of work the reality is that at some point, someone we work with in some capacity will experience that level of hopelessness and so I have to inform them that "suicide is not if, but when." This is why it's so critical for us to know how to work with it. He explained that "Hopelessness validated how I felt. People were all trying to cheer me up. That's the WORST thing you can do. "My TEAM training was pointing me in the opposite direction. Validating it and acknowledging it took the pressure off of it and began the process of bringing about tremendous relief." We discussed the power and value of Positive Reframing, even with the hopeless patient, as well as the value of empathy. He said the Positive Reframing shows that "you totally get what this is like for me." The positive reframe serves as our most profound empathy tool. By enabling us to perceive the world through the eyes of our clients or patients, it eliminates their sense of isolation. The hopelessness shows something beautiful and awesome about you. He recalls his early training in TEAM, and the immense value of the Externalization of Voices and Feared Fantasy work he did with David to challenge his negative thoughts, including:
We illustrated the Externalization of Voices and Feared Fantasy live on the podcast, including the blow-away Acceptance Paradox. Because of that training, "I am no longer afraid of failure!" Thanks so much for joining us today! Mike, David and Rhonda | |||
| 348: Dr. Tom Gedman: A British Family Doctor | 12 Jun 2023 | 00:55:29 | |
A British Family Doctor on Burnout, Recovery and T.E.A.M in 10 Minute Consultations! Today, Rhonda and David interview Dr. Tom Gedman, a family doctor in England and one of the founders of TEAM-UK, along with Dr. Peter Spurrier who has also been a guest on a Feeling Good Podcast. Rhonda started the podcast with a kind email from an enthusiastic podcast fan who loved our podcasts with Dr. Mark Noble (#167 and #265) on the "Brainology" of TEAM-CBT. He said these podcasts were "pure gold" and appreciated a look behind the curtains to see how TEAM actually worked at the level of the brain. Tom described his burn out episodes, which started during his third year of medical school, resulting from a familiar theme—the belief that he was inferior and just not "good enough." His inferiority complex was a severe, total body experience, with "horrible thoughts" for six months. After he recovered, he worried about going into that state again. And the stress returned again during his medical internship. He explained that as a General Practitioner (GP) in the British medical system, you only have ten minutes for each patient, and felt like all the pressure was on him to get it right, and stated that "the pressure broke me." In Britain, you can get free therapy as a GP, and went to Dr. Peter Spurrier for help. Peter was using the TEAM-CBT he'd learned when he came to California the previous summer for one of David's four-day intensives, and Tom described him as "a natural. We made a deep connection right away and the Positive Reframing really clicked!" Tom's negative thoughts included: 1. I'm not good enough. 2. I'll fail my patients. 3. I'll do them harm. 4. I'm not smart enough. 5. I'll never be normal. He explained that the last thought triggered feelings of hopelessness, which really was the worst emotion of all. He discovered the Feeling Good Podcasts and listened to about 200 of them in just two weeks! And after two or three hour-long sessions with Peter, he recovered and actually felt like he was on a "high" for about six months. He says, "I had almost limitless confidence!" Then he had an as-predicted relapse which disappeared after a 30-minute tune-up with Peter. Tom said that the he'd always admired Carl Rogers, who emphasized empathy, and began using the Five Secrets of Effective Communication in his medical practice. This helped him clinically, and he discovered that "you don't always have to 'help;' skillful listening is often enough. For example, patients often have to wait for months to be seen medically, and they're angry and frustrated at first. I acknowledge their frustration and let them know that I feel sad as well. This calms them down immediately." He also gave an example of how trying to "help" a man with agoraphobia simply put the man into a state of rage. "I tried to convince him that exposure would be good for him, but we just got into an argument, and he threatened to report me to the authorities to have my medical license revoked! That experience taught me something really important about 'helping.' Many people have intense resistance and just want to be heard and understood." For example, one of his patients was in tears because of her father's Parkinson's Disease. The patients was helped greatly by learning He that her emotional distress was actually her love for her father, and she suddenly felt proud of her "symptoms." Another patient with a massive opiate addiction opened up about a severely disturbing childhood incident he'd never before talked about, and then was able to cut his opiate use "way down." We also discussed Tom's new plans for his medical practice, working with indigent individuals, and explored the possibility of testing my Feeling Good App with this population for free to see how they would take to it. He discovered that a group in England has "stolen" my names, and also have a "Feeling Good App" and a "Feeling Good Podcast," which causes me considerable distress. We may have to rename our app the "Real Feeling Good App," or some such name! Dr. Tom can be reached at BlueprintMedical.co.UK or at DrTomGedman.com. Tom, Rhonda, and I would also like to urge any listeners in or near England to attend the upcoming four day TEAM-CBT intensive in England from August 14 – 17th. This four day training conference will be awesome and only costs 440 pounds. Participants will receive 38 CPD points as well as credits in the TEAM-CBT certification program. For more information about the conference, go to www.TEAMCBT.UK. Thanks for listening! Rhonda, Tom, and David | |||
| 347: "What if my family rejects me?" Part 3 of 3 | 05 Jun 2023 | 00:46:24 | |
Live Therapy with Veena: Part 3 of 3 Relapse Prevention Training In the last two weeks, you heard Parts 1 and 2 of our live work with Veena, a young woman who felt devastated for fear she would be unable to conceive. One week after the work with Veena, I received a request from colleagues to have a Tuesday evening session at Stanford on Relapse Prevention Training (RPT). Jill and I decided to demonstrate the RPT techniques with Veena so we could demonstrate this technique in real time with a real situation. Prior to the role play demonstrations that you will hear, I presented the highlights of RPT with four PowerPoint slides. Here are the guidelines when working with a patient who is depressed: 1. Do RPT immediately when the patient has recovered, and before you discharge the patient. This means that the patient's scores on the Brief Mood Survey will be low and the patient is feeling terrific. If the patient's scores are still elevated, they have still not recovered completely, and need more therapy work. 2, Inform the patient that the likelihood of relapse is 100%. Relapse is defined as one minute or more of feeling upset. By that definition, most of us relapse frequently, perhaps every day. However, these relapses do not have to be a problem if you anticipate them and know how to deal with them. 3. When they relapse, they will typically experience two kinds of negative thoughts. First, the negative thoughts that had previously will return. So, in Veena's case, she will again be probably telling herself that "I cannot be happy without a kid," "my in-laws will judge me and sideline me," and so forth. Veena imagined having a relapse and prepared a Daily Mood Log prior to the training group. If you would like, you can review it here. 4. In addition, nearly everyone who relapses will have thoughts like these:
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| 346: "What if my family rejects me?" Part 2 of 3 | 29 May 2023 | 01:21:09 | |
Live Therapy with Veena: Part 2 of 3 Last week you heard the first half of the session with Veena, a young woman who was devastated by a medical problem that may make it difficult or impossible to conceive the child she is dreaming of. Today, you will hear the inspiring and dramatic conclusion of her story, along with the feedback comments from the individuals in David and Jill's Tuesday training group who witnessed the live work. A = Assessment of Resistance Jill asked if she felt ready to roll up her sleeves and get to work on some aspect of what she'd been telling us, and she was. Jill then asked what she was hoping to get from tonight's session. If we could offer a "Miracle Cure," what would that look like? She said, "I'd feel a lot less guilty and responsible, so I would no longer feel like the problem was my fault. I'd know that I did my best and that I can be okay even if people don't like me or judge me. Jill asked the Magic Button question, and she said that she love to see her guilt go all the way to zero, but not her many other negative feelings, like depression, anxiety, inadequacy, self-consciousness, hopelessness, upset, insecurity and self-doubt. With Positive Reframing in mind, we listed many of the positives in these negative feelings, including:
Veena with her in-laws M = Methods During the methods phase of the session, we used a variety of techniques, especially Externalization of Voices with the Acceptance Paradox, Self-Defense, and the CAT (Counterattack Technique.) We did quite a few role-reversals, which is typical, before Veena got to wins that were "huge." There were lots of tears and laughter, and eventually Veena blew all of her negative thoughts out of the water. It was inspiring to observe this process, and to be a part of it. You can see her final Daily Mood Log if you click HERE. I think it is fair to say the Veena experienced a kind of enlightenment which was profound. Final T = Testing You can see Veena's end-of-session Brief Mood Survey and Evaluation of Therapy Session if you click HERE. You can also see her final Daily Mood LOG if you click here. Our work with Veena was some of the most inspiring work that I can recall. It was tremendously mood-uplifting, and took on a spiritual quality. You will have to listen to the session to get a feel for how majestic it was. But in my opinion, Veena did not just recover, but she achieved enlightenment, which including discovering how to love herself and her extended family as well! The following is an email I sent Veena the next morning: Hi Veena, Thanks. You were totally awesome last night, thanks so much for your contribution. I am sure the podcast will reach huge numbers of people and make a big impact on peoples' lives. I cannot remember a more exciting and loving session. We will see what the groups thinks in the feedback. I did not copy or read the chats during the session, but perhaps you or Jill did. . . We will invite you to join us on a podcast recording to get some follow-up information from you, as folks will be very interested, for the two-part podcast. Yes, I think we really were walking on holy ground last night! Thanks so much for making that happen! I am trying to recall (and will do more of this) the teaching points from last night, and a few seem important to me. They seem awfully basic and simple, but still of towering importance and have to be "seen" to be understood at a deep level. 1. In TEAM, even when a problem is "real," it is still our thoughts that create our emotions. Our thoughts really DO create all of our feelings. 2. Those thoughts can be subtly distorted in all kinds of ways and seem determined to trick us into believing things that are not true. And even super smart people, like Veena, can be fooled. 3. We are not aiming for improvement, although that is obviously desirable, but a dramatic transformation of the human spirit and outlook. 4. Warmth, tenderness, and compassion—for others and for yourself--are important and powerful. 5. There is a strong mind-body connection, and healing your soul can often help to heal your body. 6. Good therapy can sometimes be much more than just "therapy." Something almost magical can sometimes happen, and the change can sometimes happen rapidly. However, many people do not like hearing this, and some are even angered by this idea! This is especially true of people who have suffered and struggled for many years without success in changing the way they think and feel. 7. Recovery sometimes requires courage and trust. Just more babbling from the old guy! Apologies if it sounds ridiculous or "off." If other teaching points come to mind, please let us know so I can add them to the list! I am betting that Jill and Veena can maybe add to this list! (and edit it as well) Warmly, david Below, you will find some excepts from the feedback that the participants provided after the session. Please describe what you specifically disliked about the training? What could have been improved? Were there some things you disagreed with or did not understand? Nothing. It was beautiful. I wouldn't want to change anything about tonight's experience. It was so moving! Please describe what you specifically liked about the training? What was the most helpful? Were there some things you learned? I loved Veena's personal work and besides my admiration and pride of her and the gratefulness to David and Jill for sharing this wonderful work . . . I enjoy the empathy and validation as well as the trust in the process that was so beautifully demonstrated. Beautiful job by all concerned. Very impressed with Veena and how clearly she "got it" when she used the CAT (Counterattack Technique). I was very moved by Veena's story and her courage in sharing it with us. I felt as if we were witnessing a kind of history because, in the past, wives who couldn't bear children were often devalued and even rejected. Veena pushed back against that kind of thinking and instead chose to love herself. By working toward dispelling the distorted thoughts, she affirmed not only herself, but women with similar experiences now and throughout history. When she affirmed that her mother, mother-in-law, and husband would be empathetic and wouldn't actually reject her, I felt elated, thinking that the world is making progress and becoming a more compassionate place. I was also touched by the following ideas: feeling genuine sadness without distortions; locating the source of pain in distorted self-critical thoughts; painful experiences bringing loved ones closer together. The safe space that was created, the sensitivity with which the topic was handled and the respect accorded to the client. It's incredible how the trainers (Dr. Burns & Jill), set aside their ailments, and were with Veena through her journey of anticipatory loss, and her fears and apprehensions, along with her inner battle of dealing with deeply entrenched social conditionings, that are hard to face and ward off. I loved the session. Enjoyed watching the whole team model unfold. I'm so grateful to Veena for sharing this previous part of her life with all of us. It was a huge honor. I am constantly surprised by Dr Burns' and Jill's mastery of TEAM and their deep empathy skills. This was moving and exhilarating…all at once. Observing two great therapists in action. I liked how Jill and David would make notes to the class about what step they were going on to next. Veena was so amazing and brave to share her experience. As a 23 year old woman with fears of fertility issues myself due to genetics, I found the experience extremely profound and impactful on a personal level. It was awesome to go from the NEWBIE group to this session whereby a lot of the skills we were learning individually were incorporated sequentially into the session. Thank you to everyone!! I liked seeing david and jill go through the entire team model. I liked the pointing out of the Emotional Reasoning distortion and even using the straight forward technique. Excellent! I really liked seeing an entire session completed in one sitting. A very beautiful night. I really felt for Veena and what she is going through, and it was great to see her recovery. David and Jill were empathic and so knowledgeable. The humor in dark moments. the tears from time to time It was exciting to see how as Veena shed the self-blame, simultaneously she was able to see the people in her life as the caring, kind people she knows them to be--and no longer to feel afraid that they would reject her. Accepting herself allowed her to see others as accepting, and not critical. What training could be better than watching David and Jill tag TEAM thru the model! Thanks to Veena's willingness to be vulnerable and her bravery doing this personal work and inviting us all into her world and her pain. It felt like we were all a web of love and support surrounding her and a privilege to get to know her. It was extraordinarily rich and illuminating. I loved everything: the incredible empathy Jill and David demonstrated and how things were turned around for Veena. I was amazed that this was accomplished in such a short period of time; I always am when it comes to live work! I also loved knowing Veena more and seeing how wonderful of a person she is; I have so much admiration for her!!! Incredible empathy and 5 secrets from both Jill & David! So much warmth and love from the group. Seamless incorporation of the steps & methods. Please describe what you learned in today's group15 responses DML at it's best!!!! TEAM-CBT, done by skillful therapists, with open and vulnerable client, can be such a gift! I learned again how to go through the entire team-CBT process of crushing negative thoughts and helping clients to feel better. There were so many moments of subtle shifts by Jill. Each one of them were penny drop moments for me. . . Thank you both. That people have a lot of beautiful qualities. I felt I learnt anew the power of empathy and the importance of asking our clients specifically what caused the change. Thank you so much Veena. I got some therapy by proxy tonight. I felt myself take a kind of journey with you from fearful for you, and judgmental (of your aunties!) to warm and open and loving - by witnessing your transformation. A better understanding and appreciation of the entire team model and using that for a real life situation. More of the artfulness and symphony of the steps being followed with empathy being woven again and again throughout and bringing out the birth of what is really true about the self, mother, mother-in-law, and husband rather than the assumptions and self-deprecation. On how to get from T to M with E and A in the middle! I loved David's insight that this is what it means to be in a loving relationship--to hurt at times. So wonderful to get to watch Jill move through TEAM in her warm, empathic, brilliantly thoughtful way, with David interweaving his work of genius!!! So grateful to be part of this incredible community! Thanks so much! The importance of Thought Empathy and flexibility with using different techniques, as I tend to be quite rigid. For example, I love how David went right into EOV which I believe would work wonderfully with someone who knows TEAM well. It definitely did work for Veena. So very helpful to see TEAM in action in its entirety by the masters of TEAM CBT! Thank you for listening today! Veena, Rhonda, Jill, and David | |||
| 345: "What if my family rejects me?" Part 1 of 3 | 22 May 2023 | 00:44:20 | |
Live Therapy with Veena "It's all my fault!" The star of today's 2-part podcast is Veena Mulchandani, a 28-year old certified Indian TEAM therapist who has just learned that her difficulties becoming pregnant result from an infection in one of her fallopian tubes. Veen feels devastated and fears that she might never be able to have a child. She also fears that her husband and extended family will judge and reject her, since there is so much pressure in Indian culture for women to have babies. And although she has many medical options, including IVF, she is intensely fearful that they might not be successful. My beloved colleague, Dr. Jill Levitt, will be my co-therapist for today's session. Jill is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California (www.feelinggoodinstittute.com). Today you will hear part 1 (T = Testing and E = Empathy), and next week you will hear the exciting conclusion (A = Assessment of Resistance and M = Methods), along with some follow-up. Part 3 will be the Relapse Prevention Training we did one week after treating Veena. Jill and I treated Veena in our Tuesday evening training group at Stanford. We feel that personal work is an essential part of the training of any therapist. Veena with her two very beloved nephews who she considers being a mother to T = Testing and E = Empathy At the start of the session, we reviewed Veena's Brief Mood Survey just prior to the start of the session. You can review it if you click on it here. Veena was tearful and said that to make matters worse, her mother has been recently diagnosed with brain cancer, and although she is doing "okay," she is not doing "great." Veena explained that she has always dreamed of being a mother, and feels like she is lettinhttps://feelinggood.com/wp-content/uploads/2023/04/01-BMS-wt-ETS_veena-1.pdfg down the many people who love her and want to see her have a baby. She and her husband first talked about having children when Veena was 24, but they decided to defer that for a few years because of the intense demands of her graduate schooling. Now Veena is blaming herself, thinking she "should" have gotten pregnant when she was 24. I mentioned to Veena that my parents tried but were unable to create a pregnancy, so they finally adopted 3 children. Then I came along unexpectedly, after they had given up. I also said that I've treated many women who felt like they couldn't become pregnant, who then became pregnant. You can listen to the dramatic podcasts featuring my session with Daisy and her husband, Zane (#79 and #80) as well as podcasts 268 and 269 featuring a session with Carly (Click here for list of podcasts with links). Both women became pregnant shortly after those sessions, and I hope we can do the same for Veena! However, the key is overcoming the tremendous despair, shame, anxiety, and disappointment that the woman feels, so that the body can heal and prepare for the pregnancy. You can see Veenas partially completed Daily Mood Log if you click here. As you can see, her negative feelings are extreme, and she is telling herself that
Veena with parents I asked Veena how she was feeling after opening up in front of so many colleagues in the Tuesday group. She said she felt sensitive and exposed, and was afraid they don't understand and will also judge her for not starting earlier with attempts to become pregnant. Although we were still in the Empathy phase of the session, I suggested she might want to do an experiment to find out how they were feeling. Although this idea made her anxious, she asked quite a number of the Tuesday group members how they felt, and received an outpour of warmth, love, tenderness, and support. We asked Veena how we were doing in terms of Empathy. Did we understand how she was thinking? How she was feeling inside? And did she feel accepted. She gave us an A+, and so we were ready to move on to the A = Assessment of Resistance, which you will hear at the start of next week's podcast. Thank you for listening today! Veena, Rhonda, Jill, and David | |||
| 344: The Grief Method: Featuring Thai-An Truong | 15 May 2023 | 01:13:59 | |
Making Space for Grief Featuring Thai-An Truong, LPC, LADC Today, we feature a popular podcast guest, Thai-An Truong who joins us from Oklahoma. Thai-An is a level 5 Certified TEAM therapist and trainer who specializes in post-partum problems as well as anxiety disorders, with a special focus on OCD. Today Thai-An describes a TEAM-CBT technique to help with grief. She believes that empathy is always crucial, and emphasizes that people who have lost a loved one need to be encouraged to express and accept their feelings and to make space for their grief. However, because empathy alone may not be enough, it is often helpful to go beyond empathy and offer specialized techniques to help the patient deal with feelings of grief and loss. In her work specializing in women struggling with post-partum depression, she has seen many women grieving over a loss—such as the loss of a pregnancy, or the loss of a parent when their child is young, or the loss of an infant at birth, or during the first couple months after delivery. She said that the entire TEAM model can be invaluable, including the initial Testing and Empathy, the Daily Mood Log to detect the grieving patient's (often distorted) negative thoughts, as well as the Assessment of Resistance (the positive reframing step, and the Methods. Healthy grief is often complicated by feelings such as depression, guilt, anger, and more. These feelings can complicate and get in the way of healthy grieving. For example, Rhonda treated a woman who was struggling with guilt over the death of her son, who was in great pain because of advanced, metastatic cancer. At one point, she told him that it was okay to "let go," and her son died shortly after that. But then, she felt guilty and blamed herself for his death, thinking he might have lived several more days if she had not said that. Thai-An said that losing a son or daughter is one of the greatest pains a parent can have. You may beat up on yourself with "I should have done X" or "I shouldn't have said or done Y." But these negative, self-critical thoughts and feelings will nearly always be expressions of your core values as a human being, and your love for the child you lost. This can sometimes be eye-opening, and a relief for the person who is grieving. Thai-An has struggled with grief. She told us about the loss of one of her best friends 16 years ago. He was like a brother, a young man with bipolar manic-depressive illness. At times during manic episodes, he would get high and go out "teaching" on the streets. During one of these episodes something tragic happened—Thai-An was unable to find out what—but her friend was found dead in an alley. Thai-An felt a profound sadness and regret, and to compound the problem, her friend's mother cut ties with Thai-An, who didn't even know if a funeral was held or was able to ask any questions about what happened to him.. Thai-An felt understandably hurt and angry,. She recently found out he was buried near a Buddhist Temple in Houston, Texas. She emphasized the value of maintaining a ritual with the person who has died so as to continue the relationship. For example, a woman had a beautiful baby boy who died of an overwhelming infection shortly after he was born. This woman loves nature, and thinks of her son whenever she gardens. For example, when she sees a little bird, she thinks, "that little bird looks just like him!" Thai-An feels that a wide variety of rituals can nurture the bond with the person who died. You might light a candle, or even bake a cake for the baby or person you have lost. The goal is not to achieve some kind of "closure" that is so often emphasized in the media, but rather to continue a positive and meaningful relationship with the person you have lost. Thai-An illustrated a therapeutic technique she calls the Grief Method that involves doing a role-play with the person who has died. The therapist first gathers messages that the grieving patient would like to share with their deceased loved one. The therapist then takes on the role of the patient as the patient takes on the role of the person who has diedThis gives the patient the chance to have a conversation with the love one they have lost. In the following role play, Rhonda played the role of Sam, the young man who died of overwhelming cancer, and Thai-An played the role of his mother, who was grieving and feeling guilty about her son's tragic death. Thai-An (as Mother): Hi Sam, I really miss you every single day. Rhonda (as Sam): Hi Mom, you're the person I miss the most. Thai-An (as Mother): I'm sorry we had an argument shortly before you died. Rhonda (as Sam): It's no big deal. . . We got into little fights pretty often. . . but we always got over it. Thai-An (as Mother): I regret that I left when the doctor told me to leave the room. I should have stayed, so I could be with you when you died. Rhonda (as Sam): I understood that they pushed you to leave the room, and I know that you would have stayed if they'd let you. . . I was in a lot of pain, and I was ready to leave. You gave me a lot of reassurance. Now I'm with grandma. Thai-An (as Mother): I would have done everything for you. Rhonda and Thai-An processed the experience together, and they both cried, even though it was only a role play. Thai-An emphasized the importance of letting your negative feelings flow, and continuing your bond with the person or beloved pet you have lost. For parents who have suffered the loss of a child, Thai-An recommends the book Shattered: Surviving the Loss of a Child by Gary Roe. To access her free grief training for therapists, you can visit courses.teamcbttraining.com/grief. This summer, Thai-An will be offering a special 14-week training course (2 hours / week) which will focus on treating individuals and couples with relationship problems using TEAM. For more information on this and other TEAM training courses, go to courses.teamcbttraining.com. . Thank you for tuning in today! Rhonda, Thai-An, and David | |||
| 343: A Proud Father and his Wise Daughter | 08 May 2023 | 00:52:53 | |
The Invitation Step in Family Life: "Dad! Don't give me that psychology crap!" Today we are joined by our beloved Mike Christensen and his wonderful daughter, Caelyn, for a discussion of one of the humblest but most important and challenging tools in TEAM-CBT, the Invitation Step. We will focus on how this can be important in family life as well. Caelyn will be entering college in the fall, and plans to major in psychology, but she has already picked up a lot of TEAM-CBT from her dad. We'll tell you more about her at the end of the show notes. The invitation step is the bridge from the E = Empathy phase of TEAM-CBT to the A = Assessment of Resistance, but you don't issue an invitation until you get an "A" in Empathy from your patient. This generally takes about 25 minutes or so with a new patient if you empathize skillfully using the Five Secrets of Effective Communication. There are two types of Invitations: the Straightforward and the Paradoxical. The Straightforward Invitation is for reasonably cooperative and motivated individuals who are struggling with individual mood problems, like depression and anxiety, and it's fairly simple. You simply say something along these lines: Jim (or whatever the patient's name is), you've told me some pretty heartbreaking and painful problems you're confronting, including X, Y, and Z, and I'd love to help you change the way you've been thinking and feeling. I'm wondering if this might be a good time to roll up our sleeves and get to work, or if you need more time to talk and vent, because that's important and I don't want to jump in before you're ready. Typically, the person will say "I'm ready," and you're all set to set the agenda for the session and reduce the patient's resistance to change using the many familiar TEAM-CBT techniques, like Miracle Cure Question, Magic Button, Positive Reframing, Magic Dial, and more. The Paradoxical Invitation is for patients who seem unmotivated or even oppositional, and is intended for patients who are struggling with Relationship Problems or Habits and Addictions. Unlike the Straightforward Invitation, your assumption is that the patient probably is NOT asking for help, but just wants to vent, so you might say something along these lines: Sarah (or whatever the patient's name is), you've told me some pretty upsetting things about your conflict with your sister ever since you were young. You say she constantly criticizes you and says things that aren't really true, and that you've tried everything, but nothing works. For example, she insists that you look down on her because you have a PhD, and she didn't graduate from college, and when you tell her that's not true she just gets enraged. I can understand how frustrating that must be for you. I've got some really cool tools that might help you turn things around and develop a more loving relationship with her, and I think you'd really learn these tools quickly because you're clearly very smart, but I'm not hearing that you're asking for that. I'm thinking that you mainly wanted to let me know how difficult and impossible she is. Am I reading you right? I'd love to work with you on your relationship, but would totally understand if that isn't what you're looking for. So, in the Paradoxical Invitation, you're asking the patient to put their cards on the table and acknowledge that they're NOT looking for help. This prevents a power struggle and you can ask them if there's something they DO want help with. At the start of today's podcast, Mike pointed out that the Invitation Step is not only important in therapy, but in family life as well. For example, a lot of parents ask him, "How do I help my teen?" Well, the first answer is to stop trying to help and use the Five Secrets of Effective Communication to listen and understand where your teen is coming from. This is actually hard to do, because so many parents struggle with the compulsion to throw "help" at their kids, and this usually just creates a lot of tension. At the same time, Mike emphasizes that many parents ask, "Well, what do I do when I'm doing empathizing?" Mike says, "That's the time to issue your invitation. If I don't do that, Caelyn gets irritated and says, "Don't' give me that psychology crap!" If I jump in and try to help or give advice (which is what all parents do almost all of the time) it just ends up in a power struggle. Mike sometimes asks this question: "Did you just want to get that off your chest? What do you want going forward?" Mike and Caelyn did some role-playing to illustrate how this is done, including bad parent technique and excellent parent technique. Caelyn described a disturbing interaction with an angry customer where she works, and Mike first played the "bad dad" and then the "good dad". Caelyn was delightfully wise and skillful and is heading for a great career in counseling or psychology. For more on this topic, you might want to listen to the podcast #164 on "How to help and how NOT to help!" LINK: How to HELP, and how NOT to Help! Rhonda and I love Mike, and Caelyn as well, and were touched by getting to take a look inside of a real and beautiful father-daughter relationship! Caelyn Bio Sketch Caelyn is a keen student of psychology and is starting her university career in the fall of 2023 She loves animals (her Cat Evie and horse Tulio top the list) and has studied positive reinforcement focused training with horses, under Adele Shaw, at The Willing Equine in Texas. She has read a number of Doctor Burns's books and implements his CBT principles into her writing. Currently she works full time in customer service at a beauty salon and part time at a garden center where she gets regular opportunities to practice her 5 secrets skills. She is a big fan of Taylor Swift. Thank you, Mike and Caelyn, for an awesome interview today! Warmly, Rhonda and David | |||
| 342: Defeating the Outer Bully | 01 May 2023 | 01:01:09 | |
The Outer Bully Featuring Matthew May, MD Today we are proud to be joined again by our old pal, Matthew May, MD. This is a special two-part edition of Ask David, focusing on two of the most important problems that trigger emotional and interpersonal suffering. Last week, Matt led our discussion of the Inner Bully that causes the lion's share of internal suffering in the world. Feelings of depression and anxiety always result from the harsh distorted messages we give ourselves, telling ourselves we're "less than," or "defective," or "unlovable," and so forth. However, the world is also filled with Outer Bullies who can be threatening, even violent. Today we describe how you can often deal with the Outer bully with the Five Secrets of Effective Communication (LINK). Today's podcast was inspired by a question submitted by Guillermo, one of our podcast fans: Hello, Dr Burns I've seen some cases of bullying lately in schools. Would the 5 secrets help a kid who is being bullied in school? (Not physical bullying). I have a son who will be going to middle school next year and wonder about this. David's Reply Hi Guillermo, Thanks, I might read question on podcast and address it. Might have two consecutive shows on the "inner bully" and then the "outer bully." I know one thing for sure, although I am not an expert in this area, and haven't worked much with kids. But ultimately, only your thoughts can upset you. The words and criticisms of others will never upset you, unless you buy into them. So, the good old Daily Mood Log is always the first step. Once you no longer find bullying threatening, it becomes much easier to deal with it. The bully relies on getting you all scared and terrified and hurt and so forth. Warmly, david Matt began today's podcast with a real case description working with a violent, involuntarily hospitalized, 6'6" patient weighing 300 pounds snuck into his office while Matt was dictating his notes, locked the door, and announced that he was going to kill Matt because the involuntary hospitalization was "illegal." The man had been brought to the hospital by the police in a psychotic manic state because of bizarre behavior at his home that troubled the neighbors. Matt was terrified and said, "That was just one occasion when the Five Secrets of Effective Communication saved my life!" Link to Five Secrets Here's what Matt said to the man. I will indicate the communication technique(s) in each sentence in parentheses at the end of each sentence: "You're right! (Disarming Technique) You served your country and fought for our freedom (Stroking) and now we're taking away your freedom. (Disarming Technique) I feel the same way you do, (I Feel Statement). Can you tell me more about what you've been going through? (Inquiry)" The man was taken aback and immediately sat down and began to open up. Matt continued to empathize, using the Five Secrets, and after a few minutes the patient fell asleep in his chair. He was then transferred to a higher security hospital ward. Essentially, Matt sided with him, rather than getting defensive or arguing, and saw the truth in what the man was saying, in spite of the fact that he was floridly psychotic, and treated the man with respect. David summarized the case of a colleague of his who was kidnapped by a violent serial rapist. She also used the Five Secrets, which transformed the entire nature of the interaction, and the rapist gave himself up to the police. He also described being bullied by two violent teenagers in a gigantic jeep when he was driving home from the drugstore, where he'd rented an enormous carpet cleaner. David's use of the Five Secrets in response to violent threats prevented violence, but also turned a potentially hostile and abusive interaction into a joyous and warm one. We concluded with Bullying Practice, saying the worst imaginable things to each other, like "David, you're a terrible person," or "Matt, you're a bad therapist," or "Rhonda, you're an insignificant person," and then responding with the Five Secrets. It was an unexpectedly fun exercise, and the Five Secrets triumphed big time every time! The Outer Bully had no chance at all! However, this level of skill requires that you've mastered your own inner Bully, so you're not buying into what the bully says to you. This gives you a sense of peace and confidence that makes the Five Secrets a piece of cake, so to speak! David, Rhonda, and Matt want to emphasize that we make the Five Secrets look really easy and almost magical. Nothing can be further from the truth. We do hope to inspire you with examples of what's possible, but mastering these powerful tools takes an enormous amount of dedication, determination, and practice. If you'd like to learn more, I would strongly recommend reading David's book, Feeling Good Together, and doing the written exercises while reading. This would be an excellent first step! (Include book cover with link to Amazon.) https://www.amazon.com/Feeling-Good-Together-Troubled-Relationships/dp/0767920821/?asin=0767920821&revisionId=&format=4&depth=1 Here, by the way, is an interesting link to a Ted Talk on bullying that you might enjoy. One of our colleagues, Dr. Daniele Leavy, found it and shared the link with our Tuesday group. Link to Ted Talk on Bullying Daniele explains: The speaker does a good job of differentiating what is commonly referred to as bullying from assault or criminal behavior, and demonstrates how to playfully use Disarming and Stroking to deflect the bullying. Thanks for joining us today! Matt, Rhonda, and David | |||
| 341: Defeating Your Inner and Outer Bullies | 24 Apr 2023 | 01:08:25 | |
Featuring Matthew May, MD Today, Part 1. The Inner Bully Next week, Part 2. The Outer Bully There are two types of dialogues that can get us in trouble. The first is your "Inner Dialogue." Your Inner Dialogue sometimes consists of negative thoughts and perceptions of yourself and the world, which are often dominated by the familiar cognitive distortions that trigger internal mood problems, like depression, anxiety, guilt, shame, inadequacy, loneliness, hopelessness, and more. Examples would be "I'm a failure because . . . " or "I should be better than I am," or "I'm really going to blow it when I give my talk, and a myriad of variations on these themes. Your Inner Dialogue often consists of mean-spirited things you say to yourself, much like the schoolyard bully who intimidates younger, weaker children. The only difference is that you are doing this to yourself, often without noticing or realizing what that voice inside your brain is up to. When you challenge and crush these distorted perceptions, you can CHANGE the way you FEEL. Your Outer Dialogue consists of the things you say when you have with interactions with other people, and this can be especially important when you're dealing with others who are critical of you, or even threatening you with violence. The strategies are quite different from the strategies you might use to challenge and defeat your Inner bully. Today, Rhonda, Matt and I will demonstrate various strategies for defeating the Inner Bully. Next week, in Part 2, we will demonstrate strategies for defeating the Outer Bully! Those strategies, in extreme cases, might even save your life one day, as you'll see next week. Rhonda starts the podcast by reading an awesome comment by certified TEAM-CBT therapist Dan Prine, who commented in a kindly way on podcast 334, where we interviewed Michael Yapko on hypnosis. Then we focus on multiple techniques to challenge two negative thoughts with a variety of strategies. The first negative thought is one we've seen on a number of occasions from women who had abortions as teenagers, and then experienced extreme depression and guilt later in life because of their thought, "I'm a bad person because I murdered my baby." Using role-playing, we illustrated E = Empathy, using the Five Secrets of Effective Communication, followed by A = the Assessment of Resistance, using the Magic Button, Positive Reframing, and Magic Dial, followed by M = Methods. Methods included Examine the Evidence, the Double Standard Technique, the Externalization of Voices (with Self-Defense, the Acceptance Paradox, and the CAT, or Counter-/Attack Technique, along with the Socratic Technique, and more. Then we focused on a thought familiar to Rhonda during moments of insecurity and self-doubt: "I don't matter!" This thought has plagued Rhonda since she was a child. She recalled her father often saying, "c"Who are you? You don't matter!" She told herself, "he's saying that because I don't matter." Even the memory causes great pain and agitation. Of course, on some level, her father's comments never had any effect on her. Only your thoughts can cause you to feel one way or another. But this was devastating to Rhonda because she believed what her father said, which is understandable, and those thoughts caused the pain. We again illustrated many approaches to challenging this thought, but one of the techniques that was most helpful was the CAT. During the Externalization of Voices, the Positive Rhonda said this to her Inner Bully: "I'm not going to listen to you anymore! I've had enough of your BS!" Thank you for listening today. Remember to tune in to the Outer Bully next week! Rhonda, Matt, and David | |||
| 340: Sexual Abuse / Emotional Eating, Part 2 of 2 | 17 Apr 2023 | 01:29:03 | |
Sexual Abuse / Emotional Eating Personal Work with Orly, Part 2 of 2 Last week, you heard the first half of our live session on Emotional Eating, featuring Orly. Today, you will hear the second half and exciting conclusion and follow-up on that therapy session. A = Assessment of Resistance (previously called Paradoxical Agenda Setting) Orly did want help, but there were a number of directions / conceptualizations we could have pursued, including:
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| 339: Sexual Abuse / Emotional Eating, Part 1 of 2 | 10 Apr 2023 | 01:06:06 | |
Sexual Abuse / Emotional Eating Personal Work with Orly, Part 1 of 2 In today's podcast, you will hear the first of a two part series on Emotional Eating, featuring Orly, an Israeli psychologist who experienced sexual abuse at age 6 when she was a "skinny little girl." After that, she began devouring her grandmother's delicious cookies, and suddenly gained a great deal of weight. She continued binging for more than 50 years whenever she was excited or upset. This led to a pattern of dramatic swings in weight of 100 pounds or more over and over again. And now, Orly has decided she wants to end this pattern. My dear colleague, Dr. Jill Levitt, will be my co-therapist in this single, 2 hour-session that was conducted in front of my TEAM-CBT Tuesday training group at Stanford. Part of therapist training involves doing your own personal work, although this is not a requirement, it is recommended. That's because the patient experience gives you a much deeper appreciation for how the therapy works. Rhonda, Jill and I want to thank Orly for permission to publish her highly personal work, and hope you find it immensely educational—so you can see exactly how TEAM-CBT works in real time with real people—and inspirational as well. Nearly all of us are pretty flawed in one way or another or many, and learning how to accept our flawed selves and celebrate is one of the deeper goals of the therapy. Today, we will cover the T = Testing and E = Empathy phases of the treatment. Next week, you will hear the exciting conclusion of our work with Orly, as well as the follow-up. Will she really be able to resolve a severe problem that has defied a solution for more than 50 years in a single TEAM therapy session? Let's check it out! Part 1 of the personal work with Orly T = Testing At the start of the session, we reviewed Orly's scores on the Brief Mood Survey that she completed just prior to her session. She scored only 3 out of 20 on the depression test (minimal), zero on suicidal thoughts and urges, 5 out of 20 on anxiety (mild), and 2 out of 20 on anger (minimal.) Her happiness score was 16 out of 20 (very happy with a little room for improvement), and her relationship score with her daughter was 18 out of 30, indicating lots of room for improvement. She indicated she'd done a great deal of homework in preparation for the session. You can also see her scores on nine mood dimensions if you take a look at her molestation Daily Mood Log. As you can see, her scores were quite high, and you can also review many of her negative thoughts when she was growing up. For example, at age 8 she told herself, "I am the fattest kid here. I will never be beautiful or desirable." You can also see her Habit and Addiction Log (HAL) just prior to binging after a backpacking trip if you look HERE. Once again, you can see that all of her negative feelings were intense, and rated in the range of 90 to 100. You can also see her tempting thoughts, like "I can afford it since I spent so many calories during the hike." E = Empathy David and Jill empathized while Orly told her graphic story of sexual abuse from a young man while growing up on a farm in Israel around the time of the "Six Day War" in 1967. She explained that he had been like an "older brother," and she didn't quite understand what had happened, since there was no Hebrew word for sexual abuse, and the subject was never discussed in public or with children. As she grew up, she learned to be independent, and felt like she was "different" and never really fit in. She developed a strong connection with nature and with spiritual values, and served as a park ranger during her military service in Israel. After her military service and an undergraduate degree from the Hebrew University, she set out to backpack in South America for a year and then settled in Los Angeles. She was married, and had a daughter who she considers her most important relationship, However, it was a troubled marriage and Orly and her husband were divorced when her daughter was 6. For quite a while, her daughter "blamed me for the divorce and for many other things." Eventually, she settled down in the United States and decided to become a psychologist after going to therapy, which was "the only diet I had never tried." In 2020 she got some medical help from her doctor and started hiking extreme distances and heights, and lost a tremendous amount of weight. Nonetheless, she still finds herself "eating her feelings" and engaged in binge eating every once in a while. She also joined our Tuesday training group at Stanford, and said that it made an enormous impact on her life and on her clinical practice, and began at times to think, "Maybe there's NOT something wrong with me." She said the group made her an effective therapist and "I got to liking myself just a little bit!" She said the group also helped her tremendously with relationships. I believe she was referring to the five Secrets of Effective Communication that we have demonstrated so often in our podcasts as well as other tools such as the Relationship Journal She shared she was feeling terrified and had a number of negative thoughts during our session, since she was really hopeful that she could finally end her Emotional Eating. Her thoughts included:
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| 463: The Perfectionism Webinar, Part 2 of 2 | 25 Aug 2025 | 01:01:42 | |
Defeat Perfectionism and Discover the Art of Self-Acceptance Part 2 of 2 Last week, we published Part 1 of the two-hour webinar on techniques to defeat perfectionism. This week, in Part 2 you'll learn many powerful methods to crush the distorted thoughts that trigger perfectionism, including
You can take a look at the workshop handout if you CLICK HERE! This live, practical training will equip you with powerful, research-backed techniques to help yourself and your clients transform perfectionism into peace, power, self-acceptance, and emotional freedom, all illustrated with dramatic video clips from an actual TEAM CBT session with a woman struggling mightily from brutal self-criticisms, self-doubt, and sleepless nights, due to the very perfectionism that has catapulted her into an incredible career. Thanks for listening today! And please let us know if you like (or do not care for) these two part-podcasts based on one of my two hour webinars with Dr. Jill Levitt! Jill, David and Rhonda | |||
| 338: Good Grief—Sadness is Not Depression | 03 Apr 2023 | 01:06:36 | |
Good Grief—Featuring Mike Christensen Mikes' beloved friend, Kris Yip, word-ranked bicyclist who suddenly and tragically died. Mikes' beloved dog and best friend, Josie, who died the day before the podcast was recorded In today's podcast we feature one of our favorite people, Mike Christensen. Mike is a Certified Level 5 Master TEAM CBT Therapist and Trainer, and is the Director Feeling Good Institute, Canada. Mike is a Registered Clinical Counsellor with the British Columbia Association of Clinical Counsellors and holds a Master of Arts in Counselling Psychology degree. His diverse background in business, community organizations, and family support roles has provided Mike with a wide array of experience in leadership, administration, parenting training, and team building. He provides advanced level online training with the Feeling Good Institute for therapists around the world and is currently co-authoring a book with Maor Katz on Deliberate Practice of TEAM-CBT. Mike specializes in treating depression and anxiety, with experience and training in addictions, PTSD, and relationship challenges. Today, Mike comes to us today with a personal issue, grief and loss. The day before the recording Mike's beloved dog, Josie, died, and this came on the heels of the death of one his best friends, Kris Yip, a month earlier. Kris had died suddenly and unexpectedly at the age of 47. Kris was 7 or 8 years younger than Mike, and appeared to be the perfect example of health and fitness, so his loss was an unexpected and devastating punch in the gut. Mike explained that Kris was a celebrity in the bicycling community. He was the Canadian national champion and war ranked 59th in the world. However, he was humble and never promoted himself. Instead, he always focused on others, encouraging even those who were just beginners. Mike has also been a competitive bicyclist, and Kris had invited Mike to join an online racing team consisting of four friends who got together daily on stationary bikes linked by videos on the internet so they could talk while biking. In January of 2023, while riding, Kris's heart suddenly stopped. A friend of Kris called Mike to say, "Kris is gone!" This was devastating to Mike, who said: "He was the fittest of our group. The impact was profound." He had trouble sleeping and was in disbelief. He said, "It felt surreal. It felt like something is wrong. He told himself, "I should be able to keep it together without falling apart." Mike also told himself that Kris, was too young to go, and missed him tremendously. Mike thought of Kris's mom, and how much she was suffering, so he spent a week with Kris' family and friends in Prince George. Which was where Mike was born, and his brother and his other biking buddies live. He said, "We cried together and were together." He explained, "Whenever I got on my bike to ride, Kris was always there. He'd always say, 'Let's ride.' I miss his voice." He also said that during his rides, you could see Kris' face on the video feed, and he was always struggling, digging deep, suffering, but loving it! Mike said that all of his losses, including his sister, his son, and Kris, were actually double losses, because "I lost not only what had been, but what was to come in the future, and didn't." Mike said, "Kris was so humble, so I want to brag for him. He always cared and made all of us feel so encourage and inspired!" Mike mentioned some of the positives he saw in the pain of grief:
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| 337: The Queen Bee Phenomenon: A Delightful Love Story! | 27 Mar 2023 | 01:07:00 | |
Amy and her "fab fiancé," Randy Kolin! Secrets of Flirting, Sex Appeal and True Love! Today Rhonda and David interview Amy Berner, who has fallen in love and has quite a story to tell! Today is Valentine's Day (we recorded this on February 14, 2023), so we thought a love story would be a ray of joy for all of you, whether you are in a loving relationship or still looking for one! But first, Rhonda and David briefly interview Jeremy Karmel, the co-CEO of David's Feeling Good App. Jeremy tells his dramatic personal story that led to the creation of the app, and solicits for people who might want to join us for beta testing, which has gotten very busy of late. David also present some amazing data from a small, four-week beta test in December involving around 45 beta testers. The findings appeared to indicate that beta users experience far greater warmth and understanding from the app than from the people in their lives, which is on the sad side, since at the time users applied for the app, they only estimated 55% (on a scale from 0 to 100) warmth and understanding from the people in their lives, and roughly 85% from the digital "David" they interacted with in the app. We'll see if those amazing findings hold up in two larger replication studies now in progress. If you think you might be interested in being a beta tester, please sign up at www.feelinggood.com/app. Rhonda also gave an endorsement for the upcoming second World Congress on TEAM-CBT in Warsaw, Poland this year, March 30-April 2, 2023. It sounds exciting. I will be there is a variety of capacities including conducting a personal session with Jill Levitt, PhD. Please check it out! And, as usual, she read a compelling comment from one of our regulars, Irish Brain, who wrote: "Another amazing podcast for the collection!" Amy Berner is a licensed marriage and family therapist who works with adults and teens online in California. She loves helping her clients heal from heartache, depression, and anxiety. You can find her at the FeelingGreatTherapyCenter.com. Amy's love story started at a women's group that Rhonda was also in more than a year ago. It turns out that Rhonda is quite the match-maker, and has arranged dates for large numbers of her friends and colleagues, including Amy. However, Amy was feeling insecure, as so many of us might, before this date. To help her, Rhonda suggested the Feared Fantasy Exercise, and asked Amy to list some of the things she was afraid her blind date might be thinking, but not saying, when they met. When you do the FF, one person plays the role of the "Date from Hell" who not only thinks these awful things about you, but gets right up in your face and says them. This list of awful things the Date from Hell might say included:
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| 336: Perfectionism, Part 2 of 2 | 20 Mar 2023 | 01:28:36 | |
Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 2 Mariusz and his wondaful family. Last week, you heard Part 1 of the personal work that Rhonda and I did with Dr. Mariusz Wirga, which included initial T = Testing and E = Empathy. Today, you'll hear the conclusion of our work, including the Assessment of Resistance, Methods, final Testing and follow-up. I am repeating this darling photo Mariusz's beloved cat, with his tail strait up, showing pride and love for Mariusz! Orangina at her favorite scratching post, with tail straight in the air to show pride and love for Mariusz! A = Assessment of Resistance Once we empathized, we issued a Straightforward Invitation, asking Mariusz if he needed more time to talk and have us listen, or was ready to focus on the problem and see what we might do to help. Mariusz wanted to get to work, and said his goal for the session was to reduce his perfectionism, but when I asked the Magic Button question, he said he would not press it, even if the Magic Button would bring about a sudden and dramatic elimination of all of his negative thoughts and feelings. So, together, we listed the many positives and advantages of his negative thoughts and feelings, including:
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