This podcast features David D. Burns MD, author of “Feeling Good, The New Mood Therapy,” describing powerful new techniques to overcome depression and anxiety and develop greater joy and self-esteem. For therapists and the general public alike!
Here's the Latest Episode from Feeling Good Podcast | TEAM-CBT – The New Mood Therapy:
Rhonda and David discuss two challenging questions submitted by listeners like you.
Question #1: Cindy asks: My suicidal daughter refuses to talk to me! What can I do?
Comment: Dear David,
I stumbled upon you teaching in another podcast a few months ago. Immediately I was stunned by how much your words echoed in my mind. I have listened to your book three times in Audible and many of your podcasts. You Changed my life!!!
I am much more relaxed now and I can sleep!!! I talked about you with my massage therapist and she bought your book for her daughter (who has anxiety attacks) and her niece. Her daughter is an aspiring artist who said that she would buy your book and give them away to teens when she becomes famous.
I now ask you to change another life, that of my daughter's. She has been depressed for more than 20 years, suicidal (bought a noose, watches suicide movies, talked about ways to kill herself) and no therapists could help. We went to therapy together this past summer and it only ended that she abruptly canceled and is no longer responding to me by any means: phone, text, card, or email. The last time I saw her was late August and she was very down and had very poor personal hygiene. I have since sent her a loving text at least every other day, I offer to drive to her city (an hour away) to have dinner with her, I sincerely apologized for everything I could think of that I have done wrong since she was a child, I sent gifts to her by mail, I invite her to come for holidays, I ask her cousins to call (she did respond to them). No response to me at all. I am wondering how to communicate with a loved one who just totally shut you off.
Always your fan,
Thank you, Cindy. Sorry to hear about your daughter, very concerning. My heart goes out to you. Our own daughter had a rough time as a teenager, too, but now is doing great. I hope things evolve with your daughter, too.
This podcast may help: https://feelinggood.com/2019/10/28/164-how-to-help-and-how-not-to-help/ as well as this one:
The first podcast highlights common errors in trying to “help” someone who is hurting, and emphasizes how to respond more effectively, using the Five Secrets of Effective Communication.
The second podcast illustrates how to get people to open up using one of the advanced secrets called “Multiple Choice Empathy / Multiple Choice Disarming.
My book, Feeling Good Together, explains these techniques in detail, with practice exercises, and includes an entire chapter on how to talk to someone who refuses to talk to you. You can learn more on my book page. (https://feelinggood.com/books/). Some support from a mental health professional might also be helpful to you, as these techniques sound simple, but are actually challenging to master.
Your daughter might also benefit from my book, Feeling Good: The New Mood Therapy (https://feelinggood.com/books/). It is not a substitute for treatment from a mental health professional, but research studies indicate that more than 60% of the people who read it improve significantly in just four weeks. It is inexpensive, and I’ve linked to it if you want to take a look.
All the best,
Question #2: Lorna asks: How can I deal with my jealousy?
Comment: Hi David,
I've recently discovered your books and your podcast and CBT has really been helping me in my personal life. I really want to thank you for all the amazing work you do!!
The issue I'm having however seems to still really get my moods down and I was wondering if perhaps you could offer some general advice via the podcast.
I'm in a great relationship but the ex-girlfriend of my partner has recently moved back to the city where we live and now we are in similar social circles. They were together for a very long time and now I'm really struggling with the prospect of spending time with her.
When we all spend time together, it’s actually fine, but afterwards I really struggle with thinking about them together, getting to know her and thinking about her personality and how we compare.
I think most people would find this uncomfortable, but it really has triggered a downward spiral for me. My partner and I argued about it and I struggle to let things go that were said in arguments.
Do you have any advice on dealing with a situation of an ex-partner being on the scene and perhaps how to not dwell on things that were said during arguments?
Thanks, might work. What does this mean: “Do you have any advice on dealing with a situation of an ex-partner being on the scene and perhaps how to not dwell on things that were said during arguments?”
The rest of the email seems to suggest feelings of jealousy, insecurity, and so forth, as if she is a threat to your current relationship. is this correct?
Thanks so much for getting back to me!
I don't actually think she is a threat to our relationship, and don't feel that they have feelings anymore for each other, but it just makes me super uncomfortable to think about how long they spent together.
I'm always comparing our relationship to what I think their relationship was like in the past. I know I should stop thinking about those things but I really struggle to stop!
I know my partner and I are very much in love but I keep having thoughts like
- “It’s not fair that I have to spend time with her,” or
- “I feel really guilty because he wants to be friends with her but can't due to how I feel about the situation.”
I also feel like he blames me.
I was hoping you could shed some light on what you think in general is a good strategy for dealing with situations where an ex-girlfriend/boyfriend of your partner is on the scene and you all have to spend time together.
I do have feelings of jealousy and insecurity but I struggle to understand why as I don't believe they want to be together anymore at all.
We had a few arguments about it initially where he said things like “you are just angry that I have an ex-girlfriend” or “what's the big deal about it all?”
I was so hurt by the way he made my feelings seem petty and trivial. We have both apologized but I keep remembering what he said and how hurt it made me feel.
Do you have any advice on letting go of past arguments when the 'problematic situation' (ex-girlfriend being around) is still on-going?
Thank you so much!
David and Rhonda discuss this question, and include David’s story in Intimate Connections as a medical student when David had a broken jaw and the ex-boyfriend of Judy, the girl he was living with in Palo Alto, charged into his house with a tough-looking friend and demanded to see Judy. David called the police, and the two fellows left and set, "we're going to get you!" David was terrified, since his jaw was still broken, and got some jaw-dropping advice the advice from his buddy, Sergio. You will be surprised to hear about what happened next!
In addition to learning to "let go" of jealousy, Rhonda and David discuss many additional strategies for dealing with jealousy, including:
- Use of Self-Disclosure
- Positive Reframing: do you really want to give up your jealousy and vigilance?
- Cost-Benefit Analysis: Is it worth the hassle of constantly being suspicious, as opposed to simply deciding to trust and let the chips fall here they may?
- Downward Arrow: What are you the most afraid of?
- Love Addiction
- Fear of Rejection
- Fear of Being Alone
- Overcoming the fear of being alone and the “need” for this man’s love, or any man’s love, is discussed in the first section of Intimate Connections.
- Exposure: You could fantasize the two of them together, making yourself as anxious and jealous as possible, until the feelings diminish and disappear.
- Self-Monitoring: Counting your thoughts about them on a wrist counter or cell phone for four weeks. David describes his work with an intensely jealous law student after his girlfriend broke up with him so she could date another fellow in his class.
- Understand the frequent ineffectiveness of apologizing, and why it doesn’t work! This is really important. David describes a powerful vignette about a troubled couple, where “I’m sorry” was CLEARLY a way of saying “shut up, I don’t want to feel about how hurt and angry you feel.” The Five Secrets of Effective Communication are a vastly more effective way of dealing with negative feelings. David and Rhonda contrast effective vs. dysfunctional “apologizing.”
While it can be important to say "I'm sorry," this formulaic response is usually insufficient because it often ends the conversation but the difficult or hurtful feelings remain. What's important to add is talking about the other person's feelings, thoughts and experiences of the conflict and sharing your own thoughts and feelings.
When you say, "I'm sorry," it's sometimes insufficient because it often ends the conversation, but the difficult or hurtful feelings remain.
What's important to add is talking about the other person's feelings, thoughts and experiences of the conflict and sharing yours.
After David emailed Lorna with the outline for the podcast, Lorna replied:
Thank you sounds great! Can’t wait to listen to the episode. I think I will definitely order your book - I think it’s the only one missing for me to have the complete collection. Thanks again!
Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast.
See below for details and links!
Rhonda and David address a question from Karolina, a therapist in Poland who was failing with a depressed patient who felt totally convinced he was a “useless” human being. I think you will find their discussion of this case fascinating, as it deals with the cause of practically ALL therapeutic failure, and illustrates the solution al well, using TEAM-CBT methods and concepts.
Today’s podcast is intended for therapists and patients alike!
For the show notes, we are including the email David received from Karolina, as well as his initial response.
Dear Dr. Burns,
I've been listening to your podcast for 6 months now and it's been so helpful with my work as a therapist as well as in my personal life. I'm starting to develop a habit of considering every unwanted state with a "what does it say that's awesome about me?" and I'm much happier now :).
I'm wondering if you'd consider helping me some more. I have a client who's been struggling with depression for many years. At the moment he's doing ok and his mood is up. Lately the topic of his uselessness came up again and he's willing to work on that. He said he'll consider the possibility that he's not a useless human being and asked me to not to dismiss the possibility that he is - that's how he'll know that I'm not just trying to cheer him up.
It's been bugging me ever since. Although I've agreed, I really can't find in me any part that is ready to think that. I strongly believe he's not a useless person. I can't imagine labeling anyone in that way and in his case it feels so personal as I like him very much and I care about him.
I'm starting to have dreams about our next session when I fail him by trying to convince him to think as I do. How can I be open about our conclusion when my mind is already fixed? Any thoughts on this would be deeply appreciated.
Best wishes from Poland
Thanks! The term has no meaning. It is just a vague put down, like what a bully might say.
I might ask him what time of day he was feeling useless, and then have him fill out a Daily Mood Log for that moment, step by step. We can only help him at one specific moment.
You can use a large number of techniques but must first get an A on Empathy, and then do effective paradoxical agenda setting, starting with the Paradoxical Invitation Step and then asking “what type of help would you be looking for?” then you can do the Magic Button and Positive Reframing.
All of the negative thoughts and feelings on the Daily Mood Log will be advantageous and will show something about him that is awesome and positive. You should be able to generate a list of at least 25 overwhelming positives. Then you can use the Magic Dial.
When you get to M = Methods, you can put the thought, “I am a useless human being” in the middle of a recovery circle, and then select a minimum of 16 methods to challenge it.
You can start with Identify the Distortions. There are likely at least 9 distortions in the thought, including AON, OG, MF, DP, MAG / MIN; ER; LAB; SH; SB.
You can try, “let’s define terms,” and ask what’s the definition of a “useless human being”? You’ll find that no matter how you try to define it,
- The definition will apply to all human beings.
- The definition will apply to no human beings.
- The definition does not apply to him.
- The definition does not make sense.
- The definition is based on some kind of arbitrary cut-off points.
You can do this as a role-play, being a close friend trying to find out if you’re useless, and asking him for guidance on how to find out.
You can do the Paradoxical Double Standard Techniques, Downward Arrow, Hidden Emotion, Externalization of Voices, Acceptance Paradox / Self-Defense Paradigm, Examine the Evidence, Semantic Method, and on and on.
The problem is NOT that he’s a “useless human being” but rather that he’s obsessing and wasting time on a meaningless construct, and beating up on himself.
The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge, since it may be working for him, and also reflects all those 25 wonderful things about him.
The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge, since it may be working for him, and also reflects all those 25 wonderful things about him. Remember that just about 99.9% of therapeutic failure results from Agenda Setting errors. Is this something you want to help him with, or something he is desperately asking you for help with? I am almost 100% positive that this is your agenda, not his. In fact, your need to “help” him with this may actually keep him stuck.
In fact, here is the proof. You write: “I'm starting to have dreams about our next session when I fail him by trying to convince him to think as I do. How can I be open about our conclusion when my mind is already fixed?”
If you don’t understand this, I recommend some supervision from a TEAM therapists or join one of the online classes, or attend my workshop on resistance, coming up in a month or so, check out my website workshop page for details. You can join online.
David D. Burns, M.D.
Hi Dr. Burns,
Thank you so much for your quick and thorough response!
I kinda felt that my "helping" is the issue here as I've felt my own frustration rising...
Thanks for reminding me that uselessness is just a meaningless concept, I needed that. And I love the idea of role-playing as a friend asking for help with defining his uselessness. I'll pace myself, though, and give us time to walk through all the steps, especially Empathy and Agenda Setting and check how it goes and what my clients wants, not I.
I appreciate information on the resources and supervision I can access online, so good to know there are options!
You can use my real name, can't wait to hear the podcast :).
Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast.
See below for details and links!
People in the featured photo for today's podcast. Back row: Amir, David, Rhonda, and Dave. Front row: Steve and Barb
This will be our first podcast of 2020, so we wanted to make it a really good one!
Rhonda, Dave and I are very proud to welcome Steve Reinhard and his wonderful wife, Barb, on today’s podcast. Steve and Barbara flew in from Colorado to join the Sunday hike and do this podcast in the “Murietta Studios” following the hike. Steve is a former electrical contractor and lay minister, and is the first certified life coach to be admitted into the TEAM-CBT certification program at the Feeling Good Institute in Mt. View, Ca, (link).
The following is a heart-warming email I received from Steve prior to the show.
Subject: Re: looking forward
Woohoo! We are partners in crime! I'm feeling super comfortable now.
Thanks David for your generous invitation! I'm happy to jump on any of the 3 options you suggested for the show. I'd love to hear your stories, especially those of undistorted sadness where you celebrated with tears, aware of the suffering we folks tend to keep hidden.
I cry a lot these days, laugh a lot too. In that regard I'd love to have my own personal Ask David session. David, I love the old, demented, weak human guy, while admiring the pioneering, genius who teaches so clearly & humanly. My questions wouldn't be so much for me to learn or be taught but to connect with you. I'm crying as I write. As a listener I want to connect with the human, David. May or may not be something you want to do. We have loads to interact with.
Yep, I take a "spiritual " approach & would love to interact with you being anti-religious. Listeners might find this helpful & it sounds fun to me. A great opportunity for me to experience a death of the ego & the acceptance paradox which I have found liberating before I knew what it was called.
I'd love to talk about what it's like to be diagnosed with blood cancer and holey bones & some of the nutty things we say to each other when we don't know what to say. Empathy in the Five Secrets way is extremely rare from my distorted perspective. Aging & being willing to challenge the many shoulds & shouldn'ts that accompany things being different than they were last year would be fun to talk about.
I can't keep track of the # of times folks repeat "getting old is hell", same with cancer, vision problems, walking problems, drug side effects. I would love to hear your stories & experience as an old demented guy who can't walk as fast as he did a couple years ago.
Thanks for your generous invitation. I still find it surprising that I get to have this experience with you all. I'm really looking forward to today’s show.
We began the podcast with a discussion of the role of lay therapists in the field of mental health. Coaching is newly emerging field of counseling that does not require graduate work in psychiatry, psychology, social work, or counseling. In the past, coaches have not been permitted to enter the TEAM-CBT certification program. However, Dr. Angela Krumm, who is the head of the FGI certification program changed that policy specifically so that Steve—and now, other certified coaches as well--can be certified in TEAM-CBT, and I applaud this change.
The role of lay therapists has always been highly controversial. I can recall that when I was in college in the 1960s, there was a lively debate about so-called “lay psychoanalysts.” Previously, you had to be an MD to be a psychoanalyst, but over time, non-MDs were permitted to become psychoanalysts. To my way of thinking, this debate has always been more about power and the protection of territory than about skill or the capacity to heal.
Now we are seeing the same questions being raised about certified life coaches. In my experience, graduate training doesn’t always guarantee that someone will be a skillful therapist, and sometimes the opposite is true. In fact, in my experience, the LESS previous training therapists have, the easier they are to train in TEAM-CBT, because they don’t have so much training they have to “unlearn.” The Buddhists say that an empty cup is better than a full cup, because the full cup spills over when you try to pour the wine.
Of course, there’s a downside, too, since therapists can also be sometimes exploitative and can be hurtful to patients. This includes coaches as well as mental health professionals with graduate training.
Next, we asked Steve about the role of spirituality in his TEAM-CBT counseling, since he is a also a lay minister. I am convinced that the spiritual dimension can be important and powerful in therapy, and that at the moment of our deepest change, the change is not only psychological, emotional, and behavioral, but also spiritual, because we may suddenly “see” things from a much deeper perspective. Much in TEAM-CBT is easily integrated with spirituality. For example, the Acceptance Paradox is an inherently spiritual technique that can play an important role in recovery from depression and anxiety.
One of Steve’s motives I doing this podcast was to have his own Ask David session, and one of his questions was, “What is it like to be regarded by many people as a guru?” I described the blessings as well as the occasional curses and problems that come with this moniker!
Then the conversation turns to Steve’s devastating diagnosis of blood cancer—multiple myeloma—just over a year ago, and how hard and frustrating it has been for Steve to get people just to listen and provide support, including his doctors, and how incredibly meaningful it is when people express simple compassion and love.
Steve also talks about how he has decided to accept his cancer, and not to “fight it” or to go to war with his body. And acceptance does not mean refusing treatment—Steve is receiving chemotherapy for his multiple myeloma. The acceptance we are describing is more of a mind-set of peacefulness. We also talked about the fact that the problems of aging are not unique, but are simply the problems of living, problems we can encounter at any age. The whole basis of cognitive therapy is that our feelings result from our thoughts, and not the circumstances of our lives. This is a very optimistic message because we often cannot change the facts of our lives, but we can do a great deal to change the way we think and feel.
I ended the podcast by raising the question of “Sadness as Celebration.” I asked whether tears and feelings of sadness in response to the suffering of others might actually be one of the highest experiences a human being can have, and is perhaps the deepest meaning of spirituality. I described a somewhat bizarre experience I had on the Nevada desert when I was a Stanford medical student in the 1960s—it was an experience I have kept secret for nearly 50 years, and talk about for the first time on this podcast.
After the podcast, I emailed Rhonda to get her “take” on the show. Usually, we focus on specific techniques our podcast fans might want to learn. But this time, we just kind of were “hanging out” together, so I was concerned and feeling a bit self-critical. I was also concerned that I may have sounded like a loony at times on the show, since my personal story was perhaps over the top.
Here’s how Rhonda replied:
As I was listening to the Steve podcast, it struck me that it was really friends talking, getting to know each other, sharing stories and joking around and being serious sometimes. That's why I thought it was really lovely.
I listened to Steve's podcast after dinner. I loved it!
You are so charming, and tell sweet stories that open up your life to the listener. I think everyone will love how endearing you are.
Steve was articulate, vulnerable and open. While it's not an episode where you are teaching anything specific, it is a lovely podcast and I think regular listeners will love the opportunity to get to know you.
So, let us know what you think!
Thank you, Steve and Barbara, for your generous appearance on today’s show.
And we also thank YOU for tuning in today!
Rhonda and David
PS After the show, Rhonda and I got this great email from Steve:
Hi David and Rhonda,
Just getting back to communicating after a full & thrilling trip to California! Arrived home Monday evening, then off to Chemo center most of Tuesday & now regaining energy.
I like your show notes David—mucho.
Really enjoyed the hike, lunch, getting to sit in on Amir's podcast, then to interact with David, Barb, & Rhonda. Loved your stories, David, and the whole experience of tears and celebrating sadness. Oh yea, and the big kiss on the lips!
A lot of other ideas & questions have popped into my thinking since the podcast. One being that us Christians are pretty judgmental. This is supremely true, and is probably one of the best-selling points of religion that's kept hidden behind the smoke and mirrors.
It's so much fun to judge folks, look down on everyone else and have that feeling of moral superiority! Probably better than LSD I'm guessing.
What bugs me about "religion" most is how many folks suffer under the whip of having to improve and become better and jump over impossible standards. Of course, they could move on to the Acceptance Paradox and right into celebrating sadness in a split second if they wish.
What wonderful time it was with you all.
Feeling grateful to share life with each of you.
Second PS: If you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. See below for details and links! David
This will be our last podcast of 2019, so we wanted to make it something special. We also want to thank all of you for your support over the past year, and wish you all the very best in 2020!
Thanks to all of you, we surpassed 1.5 million downloads this year, and will likely hit 2 million in the spring of 2020. If you like the Feeling Good Podcasts, please tell your friends and family members, as word of mouth is our best marketing by far. In addition, if you are a member of any mailing lists, send them this link to the list of all the Feeling Good Podcasts. On any given day, 30% of human beings are feeling depressed and / or anxious, so you'll be doing lots of people a favor, since the podcasts, as you know, are entirely free.
We are joined today by Amir Sabouri, PhD, MD, a highly esteemed neurologist from Iran with extensive medical training in the United States in addition to his PhD research in molecular immunology in Japan. Amir specializes in the treatment of horrific neuromuscular disorders such as ALS (the dreaded Lou Gehrig's Disease) at one of our local Kaiser Hospitals here in the San Francisco Bay Area. In today's riveting and inspiring interview, Amir describes how he discovered that, in spite of his extensive technical training, his strongest and most effective medicine by far is sometimes a healing dose of humility and compassion, delivered with the Five Secrets of Effective Communication.
We are also joined by our wonderful host, Dr. Rhonda Barovsky, as well as my friend and neighbor, Dave Fribush, who has joined many of our podcasts recently, as well as Steve Reinhard, a certified coach and TEAM-CBT therapist who flew in from Colorado for the Sunday hike and podcasts. Steve will be the featured guest on next week podcast, along with his wife, Barbara, on the topic of "Sadness as Celebration."
Back row: Amir, David, Rhonda, and Dave Fribush. Front row: Steve and Barb
Amir and I have had a friendship and professional collaboration that goes back several years, when Amir first joined one my Sunday hikes, along with his wife, Dr. Sepideh Bajestan, PhD, MD, who was one of my students during her psychiatric residency at Stanford. In the past couple years, Amir has attended the Sunday hikes regularly and has worked hard to learn and master TEAM-CBT, especially the Five Secrets of Effective Communication, which have begun to play a huge role in his clinical and professional work.
Amir begins with a description of the first time he did personal work on one of the Sunday hikes. At the time, Amir was struggling with feelings of sadness, guilt and inadequacy about his role as a physician and neurologist. That's because, in spite of his incredible background training and research in molecular immunology and neuromuscular pathology, the bottom line was that he had no cure to offer his many patients he had to diagnose with incurable diseases, such as ALS, and he confessed that he often felt like a failure in his attempts to help these unfortunate patients and their families.
However, by looking at his own negative thoughts, and pinpointing the distortions in them, he was able to challenge and crush those thoughts, and accept the incredible value of the immense caring and compassion he brought to his work with his patients. The change he experienced on that hike was quite pronounced, and was arguably his first "enlightenment." It was a very moving experience for me, too.
Next, Amir tackled the Five Secrets of Effective Communication, and worked extremely hard to practice and master these techniques, which have also been invaluable in his medical work. He describes two recent patient encounters where these skills were invaluable. One involved an angry new patient who aggressively criticized Amir from the very moment he walked in the door. The many also criticized bitterly all the other doctors he'd seen. He complained that he didn't want to be there, that nobody could help, and that nobody cared about him.
Amir responded using the Five Secrets of Communication, empathizing and disarming hat the man was saying, and using "I Feel" Statements, Feeling Empathy, Stroking, and Inquiry as well. The man suddenly began to sob and share his deepest feelings throughout his entire encounter with Amir. At the end, Amir was concerned that he'd given him "nothing" other than his efforts at skillful listening using the Five Secrets, and was afraid the man might issue yet another complaint.
One hour later, Amir received a touching email from the patient, filled with praise and gratitude, and he said he felt hope for the first time! We talked about the paradox of "giving nothing," just listening with compassion, without trying to help or fix. and how this is often the greatest gift of all.
Amir also talked about his interaction with a young woman who suffered horrific complications from a powerful medication that Amir had prescribed for her neurologic problem, and Amir was flooded with guilt and fear, thinking that he had failed her and that he might get sued. But once again, his use of the Five Secrets transformed their interaction into a deeply meaningful connection.
We discussed how training in the Five Secrets should perhaps be mandatory for medical students, and residents as well, since rigorous training in communication with patients is not really a part of medical training, although the doctor patient relationship is, of course, given lip-service. Of course, we also strongly feel that Five Secrets training should be mandatory for all human beings!
I mentioned an experience I had as a medical student working in the medical outpatient clinic at Stanford under the direction of Dr. Allen Barbour, who wrote a beautiful book on the human side of medicine, Caring for Patients. I was assigned to a mailman who had been struggling with intractable angina, which is relentless chest pain due to problems with the blood supply to the heart. He was scheduled for one of the first open heart surgeries at Stanford. The idea was to improve the blood circulation to the heart, and the surgery was brand new and still somewhat experimental, and potentially quite risky.
While I was examining the patient, I had a hunch that something was "off," and asked the man if there were any problems in his life that were bothering him. This led to an unusual and unexpected set of events you can hear about on the podcast. Telling the story so many years later brought tears to my eyes.
After the podcast, Steve Reinhard, who had been in our "live audience" at the "Murietta Studios" today, began to cry and mentioned his own struggles with cancer. He told us how hard it has been for him to find compassionate doctors who seem to care, and how wonderful it would be if he could find a gentle, humble and loving doctor like Amir! We decided to edit Steve's comments into today's podcast as well.
High tech medicine is wonderful, and evolving rapidly, with new healing miracles every day. But the doctor's most powerful medicine, by far, is still the bedside manner, just as it has been for the last two thousand years.
The Five Secrets of Effective Communication can enrich your life, too, and can vastly improve your interactions with loved ones, friends, and colleagues. These tools can also make you more effective in the business world, or in any human interaction. Our world seems very troubled these days, to say the least, and we can all start some healing by changing the way we relate to others and learning to speak with our third "EAR," which stands for Empathy, Assertiveness, and Respect.
I hope that doesn't sound hopelessly corny, elderly, or demented, but if so, I will have to plead guilty as accused.
Thanks so much for tuning in today, and if you like these shows, please tell your friends!
If you would like to learn more about the Five Secrets, a great first step would be to read my book, Feeling Good Together. Make sure you do the written exercises while you read, and make sure you practice as well!
On the right hand panel of every page on my website, www.feelinggood.com, you'll find a Search function. If you type in "Five Secrets" or "Relationships," you'll find many helpful podcasts on this topic as well.
Learning the Five Secrets takes lots of commitment and practice. It's like learning to play the piano or learning to play tennis. You'll have to work at it. Amir is incredibly brilliant, and he had to work at, too. If you're willing to do the same thing, the results can change your life, too!
All the best,
Amir, Rhonda, Dave, Steve, and David
Note: As an Amazon Associate I earn from qualifying book purchases. My books are available from virtually any online or in-person book seller.
Happy Holidays to everyone! Today's podcast is nestled between Hanukkah (on the 22nd) and Christmas Eve (on the 24th.) We send our warmest greetings to all of our listeners of all religious faiths.
Today, Rhonda, Dave and David discuss three questions you have submitted:
- Does emotional trauma cause brain damage?
- Do you have to have a good cry when something traumatic happens?
- Why does avoidance make anxiety worse?
1. Is it true that emotional trauma affects the brain?
Hi again Dr Burns,
I love the 5 secrets, and have had great success in my new job by implementing them! I keep listening to all the 5 secrets podcasts over and over to keep it fresh for me and really loved the podcast on advanced techniques.
My question today is about how trauma affects the brain. ‘Trauma’ is the new buzz word in education, and psychologists are creating presentations geared for teachers and other school professionals that claim the “trauma-affected brain” is altered and cannot learn as easily. They allege imaging technology can prove this.
Do you know if PTSD/trauma actually impacts a person’s ability to learn? I thought that it was the negative thoughts that interfere with attitudes toward learning, not an actual brain impairment.
Another term that is used frequently is “intergenerational trauma”, meaning if my parent experienced trauma, it could be passed down to me and therefore impact my ability to cope with life stressors. Any thoughts? Any credible research you are aware of?
In the Ask David, could you also include your opinion on how Adverse Childhood Experiences impact people's mental health and ability to cope? There are a range of experiences cited in studies from moving around a lot in childhood to witnessing a murder to molestation. After listening to your podcast episode 147 (Garry with PTSD) I was satisfied with the effectiveness of TEAM to treat trauma rapidly. But then I remembered a documentary I had seen about 'feral children' who were extremely neglected as children, and I wondered if there are some cases where the psychology or potential of a person is forever impacted by an adverse childhood experience. Your take?
All the best,
Mountaintop School Division
David finds these buzzwords and buzz-theories somewhat misleading, and sometimes even pseudo-scientific. He has treated large numbers of patients struggling with the effects of severe trauma, and has found that trauma patients are usually the easiest to treat and the quickest to learn. David like to focus on rapid healing, using TEAM-CBT, rather than sending people the message that they are impaired, damaged or defective because of some emotionally traumatic experience.
In fact, nearly all humans have experienced quite a lot of traumatic events, which can range from mild to extreme. And lots of us have some degree of brain damage. My brain (David Burns) was squashed at birth, for example, and there are certain cognitive functions that I’m not very good at. For example, for some reason, I can't often find something that's right in front of me, and I have lots of trouble remembering names and faces.
I just try to accept my many shortcoming and work around them. The problem is rarely our flaws or imperfections, but rather the distorted negative messages we give ourselves; messages that generate anxiety, fear, inadequacy, shame, and so forth.
Of course, animals and humans with traumatic experiences at a young age, or any age, may struggle with fear and may seem, as you say, "feral." My wife and I (David) have adopted many feral cats, and have found that consistent warmth and love can lead to dramatic changes and the development of trust. We all have a history, and every person's story and suffering deserve respect and profound compassion.
2. What’s displacement? Is it true that you have to have a good cry when something traumatic happens?
Hi there again,
I've been practicing TEAM-CBT for a year while at the same time studying Dr. Gordon Neufeld's theories on the need for "tears of futility" for true healing (including adaptation, maturation and development of resilience). He states that if we only work on the cognitive level, we risk to just displace the symptoms in our clients and they would miss out on maturation and adaptation. I'm wondering if you have ever seen a displacement of the symptom in treating your patients with TEAM-CBT?
In most live sessions I've seen with you you seem to have this gift / skill to make it safe for the client to let the tears flow and that this often seem to be the moment when a breakthrough is about to happen. So I wonder if you think the client needs to shed tears or at least feel the feelings of futility or "true sadness" before we should move forward to methods (in addition to getting perfect empathy scores)? And what role you think tears play in the healing process?
Would love to hear your thoughts on this! (See my last e-mail if you want more details to why I'm asking.)
I am really pleased to see that you, Malena, are a certified TEAM-CBT therapist in Sweden! I always love to hear from a fellow Swede!
You are right, Malena, that emotion is very important in therapy, since it shows that the patient trusts the therapist and is willing to be vulnerable. This is a critical part of the E = Empathy in TEAM-CBT. Therapy without emotion, without tears, may be overly technical, dry and almost "empty."
In addition, some patients do intellectualize as a way of avoiding emotions. I call this fear of negative emotions “Emotophobia.” I try to confront patients who do this in a gentle way. I might say, “Gee, Jim, I just asked you how you were feeling, and I notice that you didn’t really answer my question. Did you notice this as well?”
This technique is called Changing the Focus, and it has to be done in a kindly, non-threatening way. We discussed it on a recent podcast that was one of our most popular.
I’ve seen a patient recently who had incredible problems sharing his own feelings in interactions with his wife, and equally intense problems acknowledging her feelings. If a patient is determined to overcome this fear of his or her feelings, using the Five Secrets of Effective Communication, tremendous progress can be made, but the patient’s resistance has to be dealt with first.
Early in my career, I was aware of the idea that if you don’t cry when a traumatic event, like the loss of a loved one happens, that you are setting yourself up for emotional difficulties, so I often pushed my patients to cry. And occasionally this was very helpful.
But in general, I have not found it necessary to think that every patient has to cry, and it is definitely not true that crying during sessions is a panacea. During my residency training, I had many patients who cried constantly during therapy sessions without any improvement at all. They just kept crying and crying every session! You could even argue that this makes patients worse, because you continually activate and strengthen the same negative circuits in your brain.
When I learned cognitive therapy, I had many tools to help patients change their lives, and that's when I became to see far more improvement and recovery. The tears were helpful, but rarely or never curative.
If you are getting perfect empathy scores from your patients on the scales on the Evaluation of Therapy Session, Malena, you are doing great! Way to go!
David (a fellow Swede)
3. Why does avoidance make anxiety worse?
Hi Dr. Burns,
I love your show and work so much. I can't wait to buy "Feeling Great."
There's a question I've had for about three years that I've badly wanted to get my head wrapped around. It's in regard to something I've heard you say on a Feeling Good Podcast: "Most experts in exposure therapy or behavior therapy say that attempts to control your symptoms (of anxiety) is the cause of all anxiety." I have heard others say that too/
Why is this?
I understand if you push-through an anxiety you can learn whether it's warranted or not.
But how is trying to avoid an anxiety actually the cause of all anxiety?
I want to be able to understand it for when I feel myself trying to move away from social anxiety I can understand at a moment's notice why doing so actually is the cause of all my anxiety. To be able to skewer the rationalizations in my mind of why I shouldn't push-through.
Thank you David.
Rhonda, David and Dave discuss why avoidance makes anxiety worse, and why exposure often leads to improvement or even complete recovery. David describes the incredible resurgence of his own fear of heights when he took his children on a camping adventure in Havasupai Canyon in Arizona one spring when he and his wife were living in Philadelphia, and he avoided climbing down a cliff he had climbed down many times when he was younger.
Anxiety is not caused by the thing you fear, but by your distorted thoughts and fantasies. When you pull back instead of confronting the monster, you do not get the chance to discover that the monster has no teeth, so your negative thoughts and fantasies can quickly spiral out of control.
We will see you again next week for our final podcast of 2019. Thanks for so many wonderful questions, and for your support during the past year. We have had more than 1.5 million downloads, thanks to you! We look forward to serving you again in 2020!
If you like the podcasts, please tell your family, friends, and neighbors. You are our marketing team! And if you are a mental health professional, you might be interested in my February workshop on therapeutic resistance with Dr. Jill Levitt. It's going to be a good one, and you can find the details below.
Rhonda, David, and Dave
Today, Rhonda rejoins us as host after a three week hiatus! My neighbor, Dave Fribush, joins us as well, as we answer two thought-provoking questions!
- Is it possible to treat “burnout?”
- Can negative feelings can make physical pain worse?
1. Does "burnout" exist? How do you treat it?
I have been listening to your podcast for a while now and it has helped, and has encouraged me and made me feel less alone. Thank for your work and sharing your podcast with us!
My situation now is very much defined by my burnout syndrome (a medical diagnosis in Sweden, not sure about the US) and/or depression. From what I’ve learnt there is no evidence of CBT as a treatment for burnout - really nothing other than adaptations at your workplace. What triggered me to ”hit the wall” was studying too hard and not giving my body and mind time to recover.
Do you have any thoughts on burnout and effective treatment of it? I feel I have made huge progress in the underlying reasons to my burnout like perfectionism, performance-based self-esteem, figuring out how I want my life to be, who I am etc (although the last one is a big one!). All this with the help of CBT and other sorts of therapy. What remains is mental fatigue, on and off anxiety, not being able to focus and hardly any mental or emotional resilience.
Through healthcare, you are basically treated for depression, the treatment being anti-depressants. I’ve been on sick leave full time for over four years now, am in my late twenties and am constantly frustrated, sad and feeling stuck. I want to get going towards this life I now know that I want but I don’t seem to get any better. I eat and sleep well and exercise. I realize this could be a complete medical question but nobody REALLY seems to know anything about burnout. A long question but hey ho :) Would be grateful for any thoughts you might have, thanks again!
I’m sorry to hear that you’ve been struggling for some time, but I'm glad you've been making progress, and I'm so glad you wrote to me.
To my way of thinking, there is really no such “thing” as burnout. Depression, anxiety, anger, and other negative feelings do exist. Burnout is just a vague buzzword for feeling upset when something upsetting has happened.
When I was in clinical practice, I saw as many as 17 depressed and anxious patients in one day, and as the day went on, I just got higher and higher and more energetic. That's because I loved what I was doing and felt I had something to offer, a lot, actually. I only got "burned out," or unhappy, if I felt I had said something that hurt someone's feelings, or if I had not done a good job for someone. Then I got really upset, but it was my thoughts, and not what I was doing, that caused my feelings. That, of course, is the cognitive model.
I found it helpful to zero in on one moment when I was feeling depressed, anxious, or “burned out,” and to do a Daily Mood Log focusing on that moment. I’ll attach one to this email in case you are interested. I’ve also included a completed one so you can see how it works. This is not a similar case, just something I grabbed by way of illustration.
David (a fellow Swede)
On the show, I describe one of the most stressful experiences of my career, when I appeared on a Philadelphia TV show with Maury Povich, and a patient of mine threatened to commit suicide. Fortunately, the story had a surprise ending that was very positive.
So my message is one of hope. The idea is to focus on some specific thing you are upset about, as opposed to getting overly focused on a concept like "burnout."
I think we all feel pretty exhausted at times, and if you've been studying or working too hard, it definitely makes sense to take a break to take care of yourself. When I transferred from my residency training program at Highland Hospital in Oakland, California, to the residency program at the University of Pennsylvania, in Philadelphia, one of my supervisors gave me this advice--he told me to make sure I set aside at least one half a day a week to stare at walls.
What he meant was that I was working intensely, 24/7, during the first two years of my residency, and he wanted to make sure I gave myself a break to rest from time to time. So every Sunday afternoon I just watched football games on TV, often with a cat on my lap. This was refreshing and helpful, and my supervisor's advice helped me avoid feeling guilty for not working 24/7!
2. More on physical pain. Is it really true that negative feelings can make physical pain worse?
We recently did a podcast with Dr. David Hanscom, a back surgeon who emphasized non-surgical treatments for back pain that can be surprisingly helpful. In that podcast, I described my research indicating that 50% of the pain we experience can the result of negative feelings, such as depression, anxiety, and anger. And if you can reduce or eliminate those negative feelings, your physical pain will often diminish substantially, and may even disappear entirely.
I first discovered this amazing phenomenon when I had a dramatic and traumatic personal experience as a medical student. One night I was drinking beer at a bar in Palo Alto, and hurt a commotion, and turned to look. A fight had broken out, and although I was not involved in the fight, I saw a beer mug flying in slow motion toward my face. It hit my jaw, and glass exploded everywhere, and blood came gushing out of my mouth. I realized that my jaw was broken, and my front teeth were loose as well, so I ran outside to my old VW Beetle and drove at high speed to the emergency room of the Stanford Hospital. I ran inside and announced that I was a medical student and my jaw was broken.
They put me on a gurney, and ordered an x-ray. I was in intense pain, and I was scared and angry, and still intoxicated, and probably wasn't the most cooperative patient.
Eventually, a plastic surgeon was consulted and he talked to me after reviewing the X-ray. He explained that I had a broken jaw, and that he was going to hospital me and do surgery in the morning. He said my jaw would be wired shut for six weeks.
I asked if I was going to lose my front teeth that were loose. He said he didn't think so, but that I would have a dental consult to check things out after they removed the wires on my jaw in six weeks. Then he said that he knew I was in severe pain, and that he'd ordered pain shots for me during the night. He said he wanted me to be comfortable, and explained that he wanted me to request a pain shot any time I was in pain during the night. Then he put his hand on my shoulder and said, "This is very routine, and you're going to be fine."
At that very moment, my pain instantly went from severe to zero, and I did not need a single pain shot all night long.
Dave Fribush emphasizes that while the surgeon's warmth and compassion were helpful, the thing that made my pain suddenly disappear was the sudden disappearance of my negative feelings--intense anxiety about losing my teeth, as well as anger at feeling that I was being neglected. And the very moment my negative feelings changed, my anger disappeared as well.
My later research confirmed that negative emotions can, in fact, magnify the experience of physical pain, and that, on average, 50% of the pain we experience results from our negative emotions. This finding should provide hope for individuals struggling with physical pain, especially since this is a drug-free treatment not involving opiates.
if you want to reduce your negative feelings, one approach would be to read one of my books, like Feeling Good or When Panic Attacks.
They are, of course, not guaranteed to cure you, but research confirms that many people who read them do develop a more positive outlook on life and experience significant reductions in depression and anxiety. And the can be obtain inexpensively at Amazon or other book sellers.
Next week, David, Rhonda and Dave will discuss three more questions you have submitted:
- Does emotional trauma cause brain damage?
- Do you have to have a good cry when something traumatic happens?
- Why does avoidance make anxiety worse?
David & Rhonda
Today, Rhonda could not join us due to the religious holidays, so we have recorded several podcasts with my wonderful neighbor, Dave Fribush, as host. In addition, we are joined by Michael Simpson, a friend and colleague from New York.
Dave, Michael and I answer two thought-provoking questions!
1. Working with Abused Women
Hi David (and Rhonda!),
I want to start out by stating how much I love your podcast. It has helped me understand myself, and, in turn, has made me a much more effective counselor.
I'm a drug and alcohol counselor, working here in Los Angeles. I work primarily with women from 18 - 25 years old who have aged out of the foster care system. They are an endearing group of women, as I know you are aware (I've heard you speak of working with this population), and they just want to feel loved and worthy. However, their deep-seated beliefs of being unworthy of good things happening in their lives prevents them from attaining their goals of getting jobs, getting their children back, and gaining housing.
These deep-seated beliefs are based on mistreatment by their families of origin, and their subsequent experiences in the social services system. Most were sexually abused or physically abused as children, taken out of their homes, then bounced around from one Foster Care family to the next.
Despite my best efforts, the majority of these women go back out to the streets just shy of completing our 6- to 12-month treatment program. Once on the streets they return to drug dealing, prostitution, and crime. After which, if they are lucky, they get picked up and incarcerated. Many die on the streets of drug overdoses or murder.
I'm using all of the tools I can to help them change their core beliefs, but it is challenging to say the least!
My question to you is—is there a book coming out which goes into depth about T.E.A.M. therapy? I need to become the most effective counselor I can in order to help these women recover and lead normal lives.
Thank you so much for your help! Keep up the good work. You are definitely saving lives!!
Thank you so much for your question. I did work with this population at the Presbyterian / University of Pennsylvania Hospital in Philadelphia, and found the patients to be incredibly rewarding and hungry for help, love, and connection, as you have said. I’m sure it is heart-breaking for you to see so many fall short, continue to struggle, and even die on the streets.
I found this population to be particularly easy and rewarding to work with because they seemed so grateful to be getting any kind of help at all. Many of our patients were homeless, and about a quarter of them could not read or write. We gave them more than eight hours of cognitive group therapy every day in a residential treatment setting, so they got 40 to 50 hours of therapy per week. The program was very inexpensive to run, and was more or less free to the participants, paid for by some type of medical assistance insurance, as well as by our hospital. Most patients showed dramatic changes within three or four days. The average length of stay was something like a week or ten days or so.
In today's podcast, I describe a patient in one of our groups, a woman who was severely depressed. She thought of herself as "weak" and "a bad mother." She recovered from her depression in just 20 minutes or so when I used a TEAM-CBT method called "The Paradoxical Double Standard Technique.
My book, Ten Days to Self-Esteem, is the program we used at my hospital in Philadelphia when working with this population. It is a simplified version of CBT, and it is a ten-step program that can be administered individually or in groups (which I prefer.) It is written using simple words for individuals with little education.
We gave a copy to every patient entering our program, and found that really boosted our outcomes. The hospital purchased them in quantities of 50 or more, and got the wholesale price, which made the books cheaper than having to copy the materials for the patients.
There's also a companion Ten Days to Self-Esteem, The Leader's Manual, that you can get as an eBook. It shows the group leaders how to set the groups up and what to do at each of the ten group sessions.
There are many additional resources for you, if you'd like to learn more about CBT, as well as TEAM-CBT. First, my new book, Feeling Great, is now at the publisher, PESI, and should be coming out in 2020. I'll update you as more details become available. But yes, it does have all the new TEAM-CBT stuff in it. It is intended for therapists as well as the general public, and features lots of written exercises while you read, so you can really master the many new methods and concepts.
My psychotherapy eBook, Tools, Not Schools, of Therapy, is for therapists, and we use it in all of our TEAM-CBT training programs. It is an interactive book that shows you how to do TEAM-CBT in a step-by-step way. this book also features many challenging interactive written exercises to complete as you read.
You might enjoy some of my in person workshops, as well as the many weekly online TEAM-CBT training programs at the Feeling Good Institute. My one day workshops with Dr. Jill Levitt are really well received, and you can join online from anywhere in the world. My yearly intensives in the US and Canada are usually pretty awesome as well.
I hope this information is helpful, and Iwish you the very best in the important and compassionate work you are doing with this incredibly deserving group of women who are suffering so greatly!
2. Why don’t you advocate “Wellness” or “Holistic” Approaches?
A therapist named Georgina recently emailed me and was pretty excited about her clinical work which was dedicated to “Wellness” and to “Holistic” treatment methods. I mentioned in an email that I am “intensely anti-wellness and anti-holistic.”
She sounded a bit shocked and added: “I'm one of those clinicians who provide consults to other clinicians on Pilates and yoga in integrative psychiatry.”
Thanks for your thoughtful emails! I know my statement was “politically incorrect” in an era that emphasizes lots of non-specific treatment methods like meditation, healthy dieting, daily exercise, yoga, and so forth.
The quick answer to your question, which you can also hear in the podcast on “fractal psychotherapy,” (https://feelinggood.com/2019/03/04/130-whats-fractal-psychotherapy/) is that I focus narrowly on one specific moment when the patient was upset, and if it is an individual mood problem, like depression or anxiety, I ask the patient to record his or her negative thoughts and feelings at that specific moment on the Daily Mood Log. This activates just a few brain networks, out of the billions or trillions of networks in the brain, and we selectively modify those networks using techniques specifically chosen for this individual patient. There are no no-specific interventions.
The goal is rapid complete recovery followed by highly specific Relapse Prevention Training, so the patient will know exactly what to do the next time s/he falls into the black hole of depression, hopelessness, and despair. Essentially, I give the patient a little ladder that she or he can use the next time the Negative Thoughts return.
No one can feel happy all the time, but nearly all people can learn to limit those bumps in the road that we all encounter from time to time.
It sounds like the work you do for patients with Parkinson’s Disease is terrific, and desperately needed. My father in law died of Parkinson’s Disease several years ago, and we saw and experienced personally what a devastating and tragic disease it is.
Although I do not include any ”wellness” or “holistic” tools or concepts in my treatment plans, I have nothing against aerobic exercise, yoga (my daughter totally loves it!), meditation (my host, Rhonda, is a strong advocate), or a healthy diet, or anything else someone may find fun, exciting or helpful. It’s just that I’m trained in, and have developed, highly specific, super-fast acting treatments.
I believe that “non-specific techniques” have only a placebo effect on mood, although the placebo effect itself can be quite strong and potentially very helpful. In addition, I believe that non-specific techniques can ONLY change mood if you change the way you think.
So, if you jog, or eat a healthy diet, or meditate daily, and tell yourself, “Wow, I’m really living a healthy life,” you will feel good if you believe this thought. The jogging or food you eat will not, itself, cure your depression, or panic attacks, or fix your broken marriage, or help you recover from OCD, or PTSD, and so forth.
These conditions ARE highly treatable, however, using specific, fast-acting techniques that are individualized to you. We call this treatment TEAM-CBT. Again, I’m sure that many people will HATE what I just said, but I guess we will need some pretty refined research—research that’s never been done—to find out! The research that’s out there definitely cannot answer this question.
All I offer is a quick cure for specific problems. I’m not offering “everything” to “everybody.” I am aware, too, that my answer may be cheered by some and may be angrily booed by others. I like to speak from the heart, and from my experience, but I’m often wrong, and sometimes way off the mark, so no problem if you disagree or think I’m nuts!
Today's podcast features Michael Simpson, a friend and colleague of Dr Burns, who describes his personal battle with social anxiety. Dave Fribush will again be our host, since Rhonda is celebrating the important religious holiday of Yom Kippur with her family.
Michael first became acquainted with David when he read David’s book, When Panic Attacks, which he says was SO GOOD! But when he went to David’s website, www.feelinggood.com, he was shocked to see so much terrific free content for people, but the website was not well-presented. In fact, it was pretty sucky!
So, Michael sent David a brief video, pointing out all the problems, and offered to redo the website in exchange for some help with his social anxiety—and the relationship took off from there!
Michael describes his own experiences with social anxiety, which amounts to slight to moderate nervousness, tension and dis-ease during interactions with people. There is no apparent pattern to his triggers: he can become anxious (or not) around friends, strangers, men, women he is attracted to, and women he is not attracted to. He experiences the anxiety physically: butterflies in his stomach, tension around his face and a general tightness in his body. He is usually unaware of his negative thoughts, which involve fears of looking weak, being judged by others because of his anxiety, and being unable to connect with others while he is feeling anxious. He usually tries to hide all of these fears.
In addition, his social anxiety does not appear to inhibit him — he is a tall, handsome, articulate man, and when he confides his social anxiety to others, they are usually extremely surprised that someone who outwardly appears so confident could possibly be struggling with social anxiety.
Michael describes one of his first “homework assignments” from Dr. Burns, who suggested that instead of hiding his anxiety, he should approach attractive women he encounters on the street and simply tell them that sometimes he becomes anxious when speaking to attractive women. The purpose of the exercise was to confront his fear (Exposure) and do a real-world experiment to find out if his fears of being judged are realistic.
Opening up about his anxiety was very challenging for Michael, to say the least, given that he had spent most of his life trying to hide it. He describes walking around Times Square in New York City, procrastinating, and trying to muster up the courage to follow through on his assignment.
So, he finally approached a woman from Brazil whom he found exceptionally attractive. He kind of had to chase after her to stop her to tell her. We can call her Adrianna. Adrianna did not judge or reject Michael, and the two of them seemed hit it off tremendously. And they talked and hung out together every day.
Michael described their relationship as one of the deepest and most fulfilling relationships he’d ever experienced. He was amazed by Adrianna’s warmth, compassion, and openness, and appreciated the respect and love she conveyed to everyone she met. Michael also describes visiting her and spending a week together in Brazil after she returned home.
One of the take-home messages for Michael was that vulnerability, rather than trying to be cool, or trying to impress people that you have it all together, is the real key to intimacy and joy in our relationships with others.
Dave Fribush and David Burns feel very indebted to Michael for his awesome work on today’s podcast. Michael hopes his experiences will be helpful to any of you who have also struggled at times with social anxiety.
My new website makeover will probably be launched by the time you read this, so let us know what you think! It's will be at the same address: www.feelinggood.com.
If you are struggling with social anxiety, you might also enjoy my book, Intimate Connections. It's now a bit dated, but the ideas can still be tremendously helpful. Here's an unsolicited endorsement I recently received from a young professional woman:
"I’d like to share a story about a book I started reading on my trip to Asheville this past weekend. On the plane, both tears and uncontrollable laughter simultaneously streamed from my face while reading the Intimate Connections book. No more peanut butter and jelly sandwiches telling myself what a loser I am!" ZR
Happy Thanksgiving if you live in the United States! This is my favorite holiday, because it means just hanging out with the people you love, eating some wonderful food together, and doing simple things like a family hike, without the commercialism and "push" of some of the other holidays. I wish the very best to you and yours, too!
Today, Rhonda could not join us due to Yom Kippur, the highest Jewish holy day. So we will record three podcasts with my wonderful neighbor, Dave Fribush, as host. In addition, we are joined by Michael Simpson, who flew out from New York to attend my Empathy workshop two days ago. He will also join the Tuesday group at Stanford tonight. Michael is doing a massive upgrade / fast lift of my website, www.feelinggood.com, which will likely be published by the time you read this. Let us know what you think about the new "look."
Dave Fribush, Michael and I answer many thought-provoking questions submitted by listeners like you!
1. How can I overcome my fear of blushing?
Hopefully this reaches you well. I am dealing with Erythrophobia (the fear of blushing) and have been having issues with going out with friends, being in public, in work meetings, etc. The weird part is that I don't even get red, but the visualization in my head is so vivid sometimes (Kool-Aid man) that I believe it.
Sometimes, if I think about it long enough (like an internal panic attack for 20+min), I get kind of red. . . . Currently, I am trying to just break this habit and I have been reading your book When Panic Attacks and it has been pretty good at helping me.
I have been facing my fears and going out into public and hanging out with friends; I'm kind of anxious on the inside of getting red all of sudden, which puts me on edge. I look in the mirror and see that I am not red, but it’s been hard to train my brain to believe it. I started reading your book five days ago and it has helped a lot already. Since then, I have been able to accept
I don't mind being occasionally red or nervous and I'm fairly confident, but I struggle to accept the idea of being perpetually red? Part of me wants to accept the idea that "Eff-it! If I'm red, I'm red! That's who I am,” but another part of me knows that it's not true; occasionally I might blush but it’s not the norm.
Please let me know if you have any advice. I think this might be a great podcast topic because I know a lot of people with Rosacea deal with anxiety and I'm sure that would help a lot of others.
I have a awesome podcast on the fear of blushing! You might find it helpful (Podcast #88, published on May 14, 2018.)
I cannot do therapy through this medium, so this is just general teaching, but exposure / self-disclosure in one method you could use. You could tell 5 to 10 strangers every day something like this:
“Could I speak to you for a moment? I’ve had the fear of blushing almost all of my life, and I’ve been hiding it from everybody out of shame. But today, I’ve decided to stop hiding and being ashamed, so I’ve decided to tell people, and that's why I'm telling you.”
Actually, blushing is NEVER a problem. The only problem is the shame. Without the shame, the blushing, like shyness, can be an asset, making you more human and more appealing.
Also, on my Sunday hike yesterday, we were joined by a young Stanford dermatologist who showed us some photos and videos of a new laser treatment for rosacea, which is similar to blushing. Apparently, the treatment is quite effective.
2. How can you get over a broken heart?
First of all, I would like to thank you from my bottom of my heart for the wonderful jobs you are doing. I have a question regarding aftermath of divorce and searched feelinggood.com for any post but I couldn't find any. My best friend is going through divorce process and he cannot forget the good memories he had with this wife. He still loves her so much and would like to continue their relationship but she's not interested in that. They have been separated for 4 years and he tried his best to bring her back.
How can I help him move forward? Those good memories are haunting him?
Thanks for your terrific question, as most of us were rejected by someone we loved at some point in our lives.
You’re in luck! We just recorded a podcast on how to help a friend or loved one who’s hurting, and by the time you read this, it will have been published. It's Podcast #164 on “How to HELP, and how NOT to Help!” It was published on October 28, 2019. You can find the link on the list of all of the published podcasts on my website. I would definitely listen before trying to "help" your friend!
Resources for your friend might include the book I wrote on this topic, which is called Intimate Connections. One of the themes is that rejection could never upset a human being—only distorted thoughts about being rejected. This book can be helpful to the many people who have been divorced, or who have broken up with someone they loved, and are having trouble getting back into the dating game effectively, as well as the many people who are having trouble getting into the dating game for the first time.
Another great resource for him would be the chapter on the Love Addiction in Feeling Good: The New Mood Therapy. It describes a woman who had just been rejected by her husband, who was having an affair with his secretary, and she was telling herself that she couldn’t be happy without his love. The story had an amazing outcome, and might be very helpful for your friend.
Of course, motivation is incredibly important. Your friend might not want to be “cured,” so to speak, since his depression and thoughts about his Ex keep the relationship alive in his mind, and also give him an excuse to avoid dating and developing new relationships, which can be anxiety-provoking and effortful for just about anybody!
3. How would you treat someone with anorexia nervosa?
This question was submitted by our friend, Professor Mark Noble, on behalf of one of his colleagues at the University of Rochester.
I, David, explain what anorexia is, and describe my experience with an anorexia patient I treated in Philadelphia when she was discharged from the inpatient unit. I emphasize the need for the TEAM-CBT technique called the Gentle Ultimatum, since the patient didn't want o maintain her weight at a safe level, and just wanted to talk talk talk during sessions without doing any psychotherapy homework.
I also describe the “Coercive Therapy” also called Family Therapy for anorexia, developed at the Maudsley in London, and we talk about how the same principle—getting the parents to work together on the same team, with firmness, intense mutual support, and compassionate insistence—works for almost any problem children are having.
However, this requires the parents to support one another, and work together as a strong and loving team, and many parents who are in conflict will find it difficult to do this, since the urge to argue and fight can be so powerful. Then the parents sacrifice the well-being and happiness of their children in the name of ongoing war (blame, fighting, sticking up for “truth,” and so forth).
Dave F. and Michael Simpson ask why this approach of getting parents to work together, can be so incredibly powerful and helpful to children.
Professor Mark Noble was our special guest on the one hundredth Feeling Good Podcast. In that podcast, he described the effects of TEAM-CBT on the human brain. Many listeners were enthralled by Dr. Noble's revolutionary ideas!
Today, Dr. Noble returns to discuss his illuminating ideas, and prevents an overview of his chapter entitled, "TEAM CBT and the Art of Micro-Neurosurgery: A Brain User's Guide to Feeling Great," which will appear in David's new book, Feeling Great, which will be released by PESI in 2020.
Rhonda begins the podcast by asking how Dr. Noble met Dr. Burns. What brought the two of you together?
Dr. Noble explains that he read about David's work on drug-free treatments for depression in the October, 2013 issue of Stanford Magazine entitled Mind Over Misery, This article became the most-read article in the history of the Stanford Magazine. Dr. Noble was particularly interested in drug-free treatments for depression because of some alarming research emerging in his laboratory on the central nervous system impact of some popular antidepressants on lysosomes in the brain.
So, Dr. Noble made a trip to California so he could visit David's Tuesday training group at Stanford and participate in one of David's famous Sunday hikes. This was so much fun, and so intellectually rewarding, that he become an irregular regular at the Tuesday groups and Sunday hikes! Since that time, there have been many Sunday hikes and many Tuesday groups in the emerging friendship and professional collaboration between David and Dr. Noble.
David describes some of the resistance he runs into from mental health professionals who cannot believe that the rapid recoveries David sees in TEAM-CBT can be real. Most therapists were trained to believe that depression develops slowly, over many years, and that effective treatment must also be very slow, often requiring many years, or even more than a decade of weekly sessions. But Dr. Noble argues that the amazingly rapid changes David routinely sees in TEAM-CBT are actually highly consistent with the latest neuroscience understanding of how the human brain works.
David and Dr. Noble on a Sunday hike
In fact, Dr. Noble presents the amazing idea that if you had to invent a form of psychotherapy that was specifically developed to capitalize on how the brain works, you would come up with something very much like TEAM-CBT.
Dr. Noble discusses neuroscience in simple, everyday terms that anyone can understand. Even me (david)! Dr. Noble teaches in a kind of clear, accessible way of communicating that I (david) admire greatly. I have seen this in all of the teachers that I've admired the most in college, medical school and beyond.
Dr. Noble explains that if you want to change the way you think, feel, and behave, you have to change certain specific networks in your brain. That's because networks of nerves are the biological equivalents of thoughts.
But how do you do that? How can you change the networks in your brain that cause you to feel depressed, anxious, and inadequate? It's through two basic concepts of neuroscience called FTWT and WTFT! In Dr. Burns' new book, Dr. Noble writes:
"One of the most famous concepts in the science of learning is called, "What Fires Together Wires Together" (FTWT). Nerve cells that frequently interact with each other become functionally connected, and the more they fire together, the stronger the connections become. This is how new networks are formed and how existing networks become stronger.
"In addition, nerve cells that are Wired Together tend to Fire Together (WTFT). WTFT. This idea explains why once you've learned something it gets easier to repeat it every time you do it."
Dr. Noble also views TEAM-CBT as a kind of micro-neurosurgery, because you replace highly selected negative brain circuits that send distorted signals, such as "I'm not good enough," or "I'll never recover," with new circuits that are far more accurate and positive.
Dr. Noble also explains why Dr. Burns' concept of "Fractal Psychotherapy" is so complimentary to our understanding of the human brain, as are the other components of TEAM-CBT, including T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods.
David and Dr. Noble following a Sunday hike, just before the dim sum feast with the hiking group at the Joy Luck Palace in Cupertino, California, Notice the slightly bulging but happy stomachs from both doctors!
Dr. Noble also explains why conventional therapy--where the patient comes in week after week to vent about his / her problems--may actually make the patient worse. This is because the neurons that Fire Together every week, actually Wire Together. So, in simple neuroscience terms, conventional therapy may actually lead patients in the wrong direction, by strengthening the negative circuits in the brain.
You will love this down-to-earth discussion of TEAM-CBT and the human brain!
David D. Burns, M.D. & Rhonda Barovsky, Psy.D.
In today's podcast, David and Rhonda interview Dr. David Hanscom, a renowned and controversial spine surgeon who gave up a large and lucrative surgical practice in favor of helping and educating people struggling with back pain, directing them on the path to recovery without surgery or drugs.
Dr. Hanscom describes his personal journey and recovery from panic, pain, and other disabling somatic symptoms when he read Dr. Burns' book, Feeling Good: The New Mood Therapy, and began doing the written triple column technique to challenge his own negative thoughts and overcome his own feelings of depression, panic, hopelessness, and anger.
He also began to study alarming research reports indicating that many of the surgical procedures were no more effective than placebos; and even worse, he could see that back surgery often had damaging and even disabling and horrific effects on patients. And he also discovered that most of the patients seeking surgery for back pain could be helped simply through talk therapy and support, by focusing on the problems in their lives, rather than simply focusing on pain and pills.
Dr. Burns supports Dr. Hanscom's premise, that even physical pain can have powerful psychological causes and cures. Dr. Burns briefly summarizes his own research on hospitalized inpatients with significant emotional problems as well as chronic pain. He wanted to answer the question of why physical pain and negative feelings so often go hand-in-hand.
To find out, he studied changes in negative feelings, like depression, anxiety and anger, as well as the intensity of pain, in more than 100 patients attending a 90 minute cognitive therapy group. He saw that there were often massive shifts in negative feelings, like depression, anxiety, and anger, as well as the severity of physical pain, during the groups.
He analyzed the data with sophisticated statistical modeling techniques to evaluate two competing theories about why pain and negative feelings go hand-in-hand.
- Physical pain could cause negative feelings, like depression, anxiety and anger. This seems plausible, since physical pain is so debilitating, and just plain awful.
- Negative feelings could have a causal effect on physical pain.
The analyses indicated that there were causal effects in both directions, but the most powerful effect, by far, was the effect of negative emotions on physical pain. In fact, the analyses indicated that, on average, half of the physical pain these patients were experiencing, on average, was the direct result of their negative emotions.
This means that if you're in pain, and you're emotionally upset, which would be totally understandable, that a great deal of the pain you are feeling is the result of a magnification of the pain by your negative emotions.
There is a positive implication of this finding that supports what Dr. Hansom is saying--namely, that if you are in pain, including chronic pain, and you are willing to overcome your negative feelings and deal with the problems in your life, there is a good chance that your pain will improve substantially. Some people, as David saw in the groups, will experience a total elimination of pain--something he often observed within the group.
It is also possible that you will experience a reduction of your pain, but not a complete elimination. And it is possible that your pain will not improve when your negative feelings disappear--but at least you won't have to struggle with pain and depression!
So he has now devoted his life to making people, as well as his surgical colleagues, aware of the realities vs. the myths of back surgery. To learn more, visit his website, or pick up a copy of his terrific book, Back in Control. The book includes a section on your personal roadmap out of pain.
Rhonda and I are incredibly grateful to Dr. Hanscom for this illuminating, challenging, and profoundly personal interview. We hope you enjoy it! And if you've been struggling with any kind of chronic or debilitating pain, we hope you will find some hope, as well as a drug-free path to recovery!
David D. Burns, M.D. & Rhonda Barovsky, Psy.D.
In today's podcast, David and Rhonda answer two questions about suicide submitted by podcast fans.
Question 1. Why do shrinks kill themselves?
Dear Dr Burns,
Before I get to my question (which I hope you will consider addressing in your 'Ask David' segment of the podcast), I would like to extend my gratitude to you. Your book, Feeling Good, came to me at a time when I was struggling to make sense of my depression and anxiety, and it has been a vital part of my recovery journey. The exercises and the podcast have been such lifelines, and I am grateful to you for the incredible and life-changing work that you do.
I know you have addressed the topic of suicide in a previous episode, but I recently was struck by a piece of news from my alma mater, the University of Pennsylvania, where a senior member of the college's counselling services (CAPS) died by suicide. Here was someone who had spent his life's work on promoting suicide prevention, and had a great deal of knowledge on resilience. How can we process/understand the decisions that someone like this might make to take his life. How can I arrive at the understanding that his decision doesn't necessarily spell doom for the rest of us? What TEAM-CBT exercises can we do to make sense of the world when it might not make much sense at first glance, during situations like these?
Thank you very, very much,
Dr. David's Answer
Thanks, Sindhu, this is a really great question.
I’ll put this in the Ask David folder. Should I use your name?
Here’s the short answer. It’s a lot like saying that an infectious disease expert shouldn’t get pneumonia, or that an orthopedic surgeon shouldn’t have back pain, or a broken leg. I know of at least three mental health professionals who have committed suicide, but my knowledge based is tiny. I’m sure there are thousands of mental health professionals who have committed suicide.
People can commit suicide for many reasons, and I can only mention a few here, as my knowledge, like yours, is limited.
- Hopelessness is one of the most common causes of suicide in depressed individuals. Hopelessness always results from cognitive distortions, and never from a valid appraisal of one’s circumstances. Depressed people often turn to suicide, thinking (wrongly) that it is the only escape from their suffering.
- You may have done something that you are profoundly ashamed of, and fear it is about to be made public. Like the fellow in New York arrested for child abuse who hung himself just a few weeks ago.
- I am convinced that sometimes people commit suicide to get back at someone they are angry with, someone perhaps who rejected them.
- Physician-assisted suicide. I believe that physician assisted suicide is absolutely indicated and compassionate if someone is in excruciating pain from an irreversible terminal illness.
- The Achievement Addiction. Feelings of failure and worthlessness. In our culture, we sometimes (wrongly) base our feelings of self-esteem on our success in life, our income, or our achievements. And so, if your achievements are only “ordinary,” you may feel worthless, like “a failure,” and kill yourself.
- The Love Addiction: Many people (wrongly) tell themselves they must be loved to feel happy and worthwhile, and then kill themselves when they are rejected by someone they thought they loved and “needed.”
- Drug and alcohol abuse: These habit, when severe, can greatly disrupt a person’s life. They can also make someone more impulsive, and more likely to jump or pull the trigger when intoxicated.
There are likely way more causes than just these common ones. For example, a psychotic process like schizophrenia might sometimes play a role as well.
I suspect you may have a hidden “Should Statement,” telling yourself that a mental health professional “should not” get depressed or have the urge to commit suicide. But to me, that would be a nonsensical claim, and it isn’t even clear to me why you might think that way. In fact, most people are drawn to this profession because of their own unresolved suffering. There is, I suspect, MORE depression and anxiety in mental health professionals, but I have not seen data, so I’m not certain of this. But I’ve trained tens of thousands of mental health professionals, and pretty much ALL of the ones I’ve known personally have struggled at times, and sometimes intensely.
People also ask, “Why did so and so commit suicide? S/he was so famous and loved and wealthy!” Well, famous and loved and wealthy people often suffer and commit suicide, too.
Finally, I would say that suicide is both tragic and devastating—for the patient for sure, for the family and friends who typically suffer for years, and for the therapist as well. Fortunately, the family and friends can be helped, if they ask, but it is too late for the person who was depressed. And the tragedy is needless in most cases, since the patient’s intense negative feelings can be treated effectively in nearly all cases.
Question 2. How can you find out if a friend or loved one is suicidal?
Many people are afraid to ask a depressed friend or family member if they are feeling suicidal, fearing this will create conflict or may even cause the person to become suicidal. For the most part, these fears are unfounded, and the biggest mistake could be avoiding the topic.
Most people who are feeling suicidal are willing to discuss their feelings fairly openly. Several types of questions can be useful.
Suicidal thoughts or fantasies. Most people with depression due have suicidal thoughts or fantasies from time to time, and these are not necessarily dangerous.
First, you can ask, “do you sometimes feel hopeless, or have thoughts of death, or wishing you were dead?” If s/he says yes, you can ask him / her to tell you about these thoughts and feelings. You can also ask if s/he thinks of suicide as the only way out of his / her suffering.
Second, you can ask if s/he simply has passive suicidal thoughts, like “Sometimes I feel like I’d be better off if I were dead,” or active suicidal thoughts, like, “Sometimes I have fantasies of killing myself.”
Suicidal urges. You can ask if s/he sometimes has urges to kill himself / herself. Suicidal thoughts or fantasies without suicidal urges are usually not especially dangerous.
Suicidal plans. You can ask if s/he has made any plans to actually commit suicide. If so, what method would s/he use? Jumping? Shooting? Hanging? Cutting?
You can also ask if s/he has been acting on these plans. For example, if shooting is the choice, you can ask if s/he has access to a gun and bullets. If jumping is the choice, you can ask where s/he plans to jump from.
Deterrents. When evaluating suicide, you can also ask if there are any strong deterrents, such as religious beliefs, impact on family and friends, and so forth. If there are no strong deterrents, the situation is more dangerous.
Desire to live, desire to die. You can also ask the person how strong their desire to live is, and how strong is their desire to die?
Past suicide attempts. If the person has made suicide attempts in the past, the risk of a future suicide attempt is greater.
Drugs and alcohol. You can ask if the person drinks or uses drugs, and has ever has a stronger urge to commit suicide when intoxicated. This is a danger sign.
Impulsiveness. Some people make suicide attempts when they’re feeling impulsive, kind of on the spur of the moment. You can ask if they every have these kids of sudden impulses.
Willingness to reach out. You can ask if they’d be willing to reach out and ask for help if they ever have a suicidal urge.
Honesty. You can ask if they were felt reasonably open and honest in asking your questions, or if it was difficult to answer some of the questions.
Once you have explored these types of questions, you can decide whether action is necessary. If the person seems in danger of making a suicide attempt, you can bring him / her to an emergency room for an evaluation.
If s/he refuses, you can dial 911 and ask for help. Generally, the police will come immediately and do a safety check, and bring the person to an emergency room involuntarily if necessary. You can also call his or her therapist and alert that person to the situation.
This may all sound grim and very unpleasant, but these kinds of conversations can sometimes be lifesaving, and can protect you from much greater pain later on.
In a future podcast, we will focus on this question: How do you treat someone who is suicidal using TEAM-CBT?
David D. Burns, M.D. & Rhonda Barovsky, Psy.D.
Lately, I’ve received numerous emails asking, in essence, "how can I help my loved one who has this or that problem?" I would say that I get several emails like that every week.
For example, here's one from a man we’ll call “Karl.”
Love you podcasts. Listen as often as I can. keep reading your books.
Our son is in an unhappy marriage. Last night we talked and he mentioned that there is no love in their marriage. Just coldness. The children "feel" the chasm. There is a lack of trust in the home.
Our son feels he did not protect the children in defense of their mom, even though he disagreed with her. Now the children feel their father does not have their best interests. Our daughter-in-law feels that everything is fine. She uses the passive-aggressive "silent treatment" to punish others.
Our son says she is controlling and manipulative, and that the children have become that way also. There's no truth in the home. Years ago, she wanted them to go to counseling, but our son refused; now the tables are turned.
Sad. We want to help but don't know how to approach it.
What podcasts would be helpful to us? And to our son and daughter-in-law? We visit our grandchildren often, sometimes one-on-one. Communications are open with them and with our son.
Daughter-in-law feels, and tells others, we are conspiring against her
Thank you Karl, for that moving email. It can be really sad and frustrating to see a couple in conflict who are at odds with each, especially when your son and grandchildren are involved. And I can imagine you might also be feeling anxious and a bit helpless, and deeply concerned!
When I wrote Feeling Good forty years ago, I tried to make it clear that the cognitive therapy tools I described in that book are for people to use to help themselves. It is okay to correct your own distorted negative thoughts in order to break out of a bad mood. But it is generally NOT a good idea to try to correct someone else’s distorted thoughts, because they’ll just get ticked off at you!
This is a very understandable error, because you may get really excited by the things I’m teaching, and how helpful they can be when you’re feeling depressed, anxious, or insecure. So it just makes sense that you would want to share these tools with others.
But those are generally NOT the tools to use when you’re talking to your son, daughter, spouse, or friend who’s feeling down in the dumps. There is a way to help someone you love who’s hurting—but you’ll have to use an entirely different set of tools and skills—the Five Secrets of Effective Communication—WITHOUT trying to “help.”
So, the short answer to your question is—skillful listening is all that’s called for. Anything more runs the risk of getting you into trouble. But this may require a radical change in the way you communicate, as well as your personal philosophy.
Let’s talk about what TO do, and what NOT to do when patients, friends or people you care about express angst, or seem troubled, or describe problems in their lives, and they seem to be hurting a lot.
- Give advice
- Try to help
- Try to cheer the person up
- Try to solve the problem s/he is struggling with
- Try to get the other person to think or act more positively
- Try to minimize the problem by saying it’s not that bad, or things will get better.
- Point out ways the other person may be thinking or acting in a self-defeating manner.
Before we tell you what does work, let me focus on just one of these errors, to bring it to life for you. Recently, Rhonda and I recorded a live therapy session with a man named who was upset because his mother had lost the use of her legs to due a rare neurological disorder, and needed much greater care in an assisted living facility. This required selling the house his mother was living so they could afford the assisted living facility, and it was a great loss for everyone, since Kevin was raised in that house, and his parents and grandparents had lived there, too.
After Rhonda and I empathized with him for about thirty minutes, we asked the other therapists to offer empathy as well, as part of their practice and training that evening. We stressed the importance of simply summarizing what Kevin had told us (Thought Empathy) and how he was feeling (Feeling Empathy), without trying to “help.” One of the therapists, who was new to the group, kind of missed the mark, She did what we call “cheerleading,” telling Kevin what a wonderful and heroic person he was without acknowledging what he’d be saying and how painful it was for him.
You’ll hear this brief excerpt from the session in the podcast. When we asked Kevin how he felt about her comment, he had to tell her that he was embarrassed, and not helped, by what she’d said.
Here’s why. When you don’t acknowledge someone’s profound negative feelings of loss, anxiety, sadness, anger, and more, you might unintentionally convey the message that you don’t want to hear about how they really feel inside. And when you cheerlead, it also conveys the message that the person is not very intelligent, and simply has to be cheered up, and then everything will be okay!
We cannot be too hard on this therapist, because her efforts came from the heart, and I'm sure she felt sad for this man. And most of us have made the same mistake at times, or even often. I frequently hear parents trying to cheer their children up, or trying to tell their children what to do, or how to change, without really listening.
But, most of the time, it just doesn’t work like that!
Now that you know what NOT to do, what can you do that WILL help?
Use the Five Secrets of Effective Communication, with an emphasis on the listening skills. One of the most important skills is called Feeling Empathy—simply acknowledging how the other person is feeling, and asking them to tell you more, and if you got it right.
For example, let’s say a friend or family member is procrastinating on something important, like a research report or college application, and is feeling pretty upset and self-critical. You could say something like this: “It sounds like you’re beating up on yourself for procrastinating, I’m wondering if you’re feeling
- down, sad or depressed?
- anxious, worried, pressured, or nervous?
- guilty or ashamed?
- inadequate, worthless, defective, or inferior?
- alone or lonely?
- humiliated or self-conscious?
- discouraged or hopeless?
- stuck or defeated?
- angry, annoyed, hurt, or upset?”
I find that people really like it when I ask these questions, and I let them answer each one. Then I ask them about their negative thoughts. What are they telling themselves? What are the upsetting messages?
When you use this approach, you are literally doing nothing to “help” the other person, but if you listen skillfully, she or he will probably really appreciate your listening, and you may end up feeling really close. In fact, I (David), had this exact experience just a couple days ago with a student who was struggling and feeling down.
Often, the person who’s depressed will be someone you love, like a family member, so your concerns for him or her, and your desire to “help,” are an expression of your love. But listening skillfully will likely be a whole lot more effective. And you can express your own feelings, too, with "I Feel" Statements, like "I feel sad to hear how down you've been feeling, because I love you a lot."
A woman named Clarissa was concerned because her son, Billy, who is in his early 20s, had been severely depressed for several years, and had not responded to treatment with antidepressants and even lithium. Clarissa had read my book, Feeling Good, and listened to almost all of the Feeling Good Podcasts. She described herself as a true “TEAM-CBT convert because she’d worked with a therapist trained in TEAM-CBT and no longer suffered from the depression and anxiety she’d struggled with most of her adult life. She agreed with a lot of what I’d said on the podcasts about the chemical imbalance theory (there’s no convincing evidence for it) and antidepressants (recent research suggests they do not outperform placebos to a clinically significant degree).
But Billy was saying things like this:
“Mom, I KNOW I have a chemical imbalance because this cloud will suddenly come over me, and I feel TERRIBLE. It’s not about negative thoughts—I don’t have any negative thoughts. My depression is clearly the result of a chemical imbalance, and I feel doomed by my genes.”
Then Clarissa would try to cheer him up, which always failed, or would try to convince him that it’s not about a chemical imbalance and that if he really tried TEAM-CBT, he could overcome his depression, just as she had done. These are such common errors!
How could Clarissa respond more effectively? If she focuses on good listening skills, instead of trying to win an argument, she might say something like this:
“Billy, I really love you, and feel so sad to hear about your depression. You’re absolutely right, too. Sometimes a bad mood seems to come from out of the blue, with no rhyme or reason. And genes can be important. I've struggled with depression in the past, and maybe you've inherited some of my genes. Tell me more about how you’ve been feeling. Have you been feeling down, anxious, ashamed, hopeless, or angry? What you’re saying is so important, and I really want to her what's it's been like for you.”
Can you see that Billy would be more likely to open up and might even share some things that he’s been hiding, out of a sense of frustration, anger, or shame? And can you also see that providing some love and support—pure listening, with compassion—might be a lot more helpful than getting into an argument about the causes of depression? He might open up about all sorts of things that have been eating away at him—problems with girls, sex, sports, or his studies, or concerns about his looks, or even feelings of shame about his depression.
The next question is—when DO you help someone? And HOW do you help them.
The approach I use as a therapist might be the same approach you’d want to use. At the beginning of every therapy session, I empathize without trying to help, exactly as I’ve been teaching you in this podcast, and in this document, and I give the other person some time—typically about 30 minutes or so—just to vent while I use the Five Secrets of Effective Communication—listening skillfully—without trying to “help.”
Then I ask the patient to grade me on empathy. I say, “How am I doing so far in terms of understanding how you’re thinking and feeling? Would you give me an A, a B, a C, or perhaps even a D?”
Most of the time, the other person WILL give you a grade. If they give you an A, you’re in good shape. But if they give you an A-, or a B+, or worse, ask them to explain the part you’re missing, or not getting right.
When they tell you, you can use the Five Secrets again, summarizing the part you missed, and then ask what your grade is, to see if you’ve improved. Usually, your grade will improve a lot.
Do NOT try to “help” until you received an A!
So, let’s assume you’ve gotten an A. What then?
Then I do what’s called the Invitation Step in TEAM therapy—I ask if the other person wants help with any of the problems s/he has been discussing. You can ask the same question.
If the other person does NOT want help, but just wanted to talk and get support, your job is done. You can also ask if they want to talk some more. Most of the time, all people want is a little listening and support, and they’re not looking for help or advice.
But if the other person DOES want help, you can ask what kind of help they’re looking for. Then you can decide if you’re in a position to provide that type of help. Sometimes, the help they're looking for might not be something you can provide. For example, they may be angry at someone they're not getting along with, and may want you to tell the other person to change. I explain that this is not something I would know how to do, but I could possibly help them change the way they interact with that person.
This may sound really simple, but it takes a lot of practice and determination! It can be a lot harder than it looks.
Many people will NOT want to go down this road, and will insist on jumping in to help or cheerlead. You can do that if you want, but in my experience, pushing help on people who are hurting is rarely helpful. The “need” to help or rescue can result from your love and compassion, but it can also result from narcissism, codependency, or the desire to control or dominate another person. I see it as a kind of an addiction, too.
If you want to learn more about this, here are some things you can do:
- You can read my book, Feeling Good Together, and do the written exercises while reading, so you can master the Five Secrets of Effective Communication. This is a BIG assignment, but the reward, in terms of more loving and satisfying relationships with the people you love, will be equally great.
- You can try using "I Feel" Statements and Feeling Empathy with at least one person every day this week.
David D. Burns, M.D. & Rhonda Barovsky, Psy.D.
163: Ask David: Anxiety, Dreams, Cyclical Negative Thoughts, Secrets of Selling, Exposure, and more Can you treat anxiety without meds? How do you interpret dreams? Are negative thoughts cyclical? How can I get over anxiety when selling? How does exposure work? Will you teach on the East Coast again?
Hi! We’ve had tons of great questions from listeners like you. Here’s the first:
Question #1. TREATING ANXIETY WITHOUT MEDICATIONS
Hi Dr. Burns,
I would love to talk to you!!!
I have been going to a wonderful counselor for several years, and he is the one who recommended your book. My question is how can you overcome anxiety without taking medicine?
I have been on a very low dose medicine for years and would love to discontinue but when I try the anxiety seems to come back.
Thank you for your email! This is one of my favorite topics, since I’ve personally had at least 17 different anxiety disorders that I’ve had to overcome. That’s why I love treating anxiety. Whatever you’ve had, I can say, “I’ve had that too, and I know how it sucks! And I can put you on the road to recovery, too!”
Did you read When Panic Attacks, or one of the earlier books? The written exercises would be the way to go, I think.
You will find more than 40 methods in that book. Write back if you have questions after reading it. Focus on one specific moment when you are anxious, and do a Daily Mood Log, as illustrated in Chapter 3.
You can also listen to the free Feeling Good Podcasts on anxiety. Go to my website, FeelingGood.com, and click on the Podcast tab. There, you’ll find a list of all the podcasts, with links. In the right hand panel of every page, you’ll find the search function. You can type in “anxiety,” or “social anxiety,” and so forth, and all the relevant podcasts and blogs will pop right up. You can also sign up in that same right-hand panel of every page so you’ll receive all the new podcasts, along with the show notes.
In addition, withdrawal effects are pretty much inevitable when going off of benzodiazepines, if that is the type of medication you are taking. These are the drugs most often prescribed for anxiety, like Valium, Librium, Ativan, Xanax, and so forth. Typically, the withdrawal, which typically involves insomnia and increased anxiety, take several weeks to wear off.
Your medical doctor can guide you in this. I cannot advise you about medications in this forum, so make sure you check with your doctor!
Question #2. How can you interpret dreams?
Hello, Dr. Burns.
I am terrified that this may be the most boring question you have ever received, but, I’ll press on none the less.
I often experience very vivid dreams after listening to your podcasts. In fact, I recently dozed off after listening to one of your podcasts on procrastination (#75) and forgot to turn off my phone. In my dream I was in my childhood house and could hear you talking away in some far corner of the house and I was really getting quite annoyed and angry.
I really wanted to find you to tell you to shut up, but I couldn’t get the words out.
When I awoke, podcast #77 was playing, which seems to explain some of my unconscious hostility. I struggle with most of my relationships and don’t really want to deal with all the hard work I have to do to improve them.
So, there you have it!
Thanks for listening to me and all your Herculean efforts on behalf of all those in the struggle to grow.
I explain how dreams function, and give an example with my dream that I had a broken jaw!
Question #3. Are Negative Thoughts cyclical?
David, I have a question about our strong attraction or inclination to negative thoughts.
Are our psychological processes cyclical? People seem to recycle the same negative thoughts for years. Even if we produce a strong alternative thought or reattribution it may not be a default choice the next time. How can we make the alternative/ positive thoughts a conscious choice?
Negative Thoughts are not cyclical for the most part, but are an inherent part of our human nature. The podcast on fractal psychotherapy might be useful, since the same Negative Thoughts will tend to come back over and over throughout your life. And once you have learned how to combat those thoughts, you can use the same techniques to smash the thoughts whenever they pop back into your mind.
The written exercises I describe in my books, like the Daily Mood Log, are extremely helpful, even mandatory, in building new brain networks and strengthening them through repeated practice.
Bipolar manic-depressive illness is a little different, and it can be quick cyclical. (David will briefly explain this.)
Thanks Rajesh for yet another great question!
Question #4. I’m in sales. How do I combat my Negative Thoughts about each person I approach?
I have been struggling with anxiety for the last 18 months and recently faced up to the fact I have also been suffering from depression. And then I discovered your podcasts.
I have been spending a lot of time on the episodes I believe I can benefit from the most. I have found your solutions to be the most beneficial I have come across. Thank you for sharing your ideas and techniques with all of us!
A couple of questions—How would you advise constructing a work day to reduce anxiety? I work in sales and feel anxious before every phone call or visit I encounter, and the anxiety can be for reasons that seem to be related solely to each sales encounter on individual basis! And my anxiety will grow as the day goes on.
My second point would be, would there be a benefit in monitoring positive thoughts and feelings throughout the day, like happiness and hopefulness, rather than negative feelings?
I’ve done a lot of sales work, including door-to-door sales when I was young. When I was 8 years old, I sold show tickets door to door. When I was a teenager, I sold Fiesta Chips, Cosmo’s Cock Roach Power, tick powder for dogs, and For Econoline Vans door to door in Phoenix. So, I feel a soft spot in my heart for everyone involved in sales! In fact, I’m still involved in sales! But these days I’m selling happiness, self-esteem, and intimacy.
I think it could be useful to do a written Daily Mood Log on the anxiety you feel before one of your calls. I think you will find there are certain themes that are common to each call, such as fears of rejection, disapproval, or failure. Once you’ve dealt with these fears successfully, I think they will help in all of your sales encounters. If you send me a partially filled out Daily Mood Log, perhaps Rhonda and I could provide more specific tips on how to crush your Negative Thoughts. If you listen to Rhonda’s work on performance anxiety, you may find it extremely helpful.
In addition, the Five Secrets of Effective Communication are the keys to successful sales. I used to think that you had to sell yourself, or your product, which is rarely true. I learned that the key is to form a warm relationship with your customers. David will explain what he learned from his mother, who sold women’s clothing part-time at a department store in Phoenix.
Thanks, Rudi, I hope to hear more.
Question #4. Why and how does exposure for anxiety work?
Hi Dr. Burns,
I am a big fan and believe that you are the greatest living psychologist of our time. I have seen you in person and hear your recent PESI presentation (link).
Quick question, when exposure is used to get rid of anxiety, what do you think is the mechanism in the brain? It works paradoxically, instead of strengthening a neuro-network it extinguishes it. Any ideas how.
Thanks for your time, and again I have learned so much from you in my over 30-year career, thank you for that also.
Sincerely, Dr. Mark
Hi Dr. Mark,
With your permission, will include this on an upcoming Ask David on my Feeling Good Podcast, but I think you discover a couple things during exposure:
- When you stop running away and confront the monster, you discover that the monster has no teeth, so you go into enlightenment. This is the basis of Buddhism and the teachings in the Tibetan book of the dead.
- During exposure, you also discover that after a while the anxiety just kind of wears out, dwindles, and disappears. The brain simply cannot continue creating anxiety for prolonged periods of time, especially when you are doing everything you can to make it as intense as possible.
- You discover that you can, in fact, endure the anxiety and survive, and that you do not have to “escape” from the feeling of anxiety via avoidance.
One other thing that is important is that I treat anxiety with four models, not one: 1. The Motivational Model; 2. The Hidden Emotion model; 3. The Exposure Model; and 4. The Cognitive Model. All play vitally important and unique roles in the treatment of anxiety. Exposure alone is NOT a treatment for anxiety, just one tool among many that can be helpful, and often incredibly helpful, as you’ll see in the upcoming podcast on the treatment of Sara, a woman struggling with severe OCD for more than 20 years.
Great question! Hope to catch you in one of my upcoming in-person / online workshops!
Mark’s reply and a brief final question
Hi Dr. Burns,
Yes, of course you have my permission to use my question! Also, I do understand your impressive approach to treatment (not just exposure), and again it is genius. I also love that you see the connection between Buddhism and cognitive restructuring, where as Dr. Beck only went as far back as Socrates and the Greek Stoic philosophers. I don’t know if you ever read the Dhammapada (best translation I found is Eknath Easwaran) as it clearly states that our life is shaped by our mind, and that our feelings follow our thoughts just like a cart follows the ox that pulls it.
Thanks again! Will you be coming to the East coast again soon?
Hi again, Mark,
David D. Burns, M.D. & Rhonda Barovsky, Psy.D.
“Yikes! I might get contaminated!” The Treatment of Sara
Today we are joined by a woman named Sara, who will be featured in one of the chapters from my new book, Feeling Great.
Rhonda begins today’s podcast by reading two heart-warming endorsements from podcast fans. Then we did a brief overview of OCD. OCD consists of two components, obsessions and compulsions. The obsessions are intrusive, anxiety provoking thoughts, like “what if I forgot to turn off the burners on the stove.” Compulsions are rituals that temporarily relieve the anxiety, such as going back into the kitchen repeatedly to make sure that the burners really are turned off. This problem can become more and more severe until the obsessive thoughts and compulsive rituals consume massive amounts of the patient’s time and become crippling.
You are probably aware that OCD plagued the life of the billionaire playboy, Howard Hughes, featured in the recent film, “The Aviator.” During the last years of his life, he became totally consumed by concerns about germs, and ended up isolated in the penthouse suite at the top of a hotel in Las Vegas. According to a “psychological autopsy” (https://www.apa.org/monitor/julaug05/hughes) published by the American Psychological Association, Hughes lay naked in bed in darkened hotel rooms in what he considered a germ-free zone. He even wore tissue boxes on his feet to protect them, and burned his clothing if someone near him became ill.
Sara, today’s guest, was a victim of the same type of OCD. She describes how her intense fears of germs and contamination came on more than 20 years ago, and the devastating impact of the OCD on her as well as her relationships with friends and family. She also describes her shame about her rituals of constantly washing her hands and desperately trying to avoid contamination.
Sara also describes, in vivid detail, her remarkable and inspiring five minute “cure” one evening at David’s Tuesday evening training group at Stanford earlier this year. She had courageously volunteered to be the patient so David could to demonstrate TEAM-CBT with a problem generally thought to be exceptionally challenging and refractory. And although Sara’s dramatic and mind-blowing recovery only took about five minutes, the treatment required a lifetime of courage!
Fortunately, one of my students had his cell phone in hand, and made a brief video of the last phase of her treatment at the Tuesday group, which involved putting her hands into a slimy, dirty garbage can right outside the front door of our Behavioral Sciences Building at Stanford and then rubbing her fingers on her face. Check it out! (link)
And yes, the effects DID last! Her treatment was many months ago, and she’s been a totally changed person!
Following the podcast, Rhonda and I got two beautiful emails from Sara:
Wow! What a beautiful day! Thank you, Rhonda and David for the amazing opportunity to share my story! I feel very selfish but I enjoyed every minute of it. You both made me feel so comfortable and welcome. You two are so incredibly AWESOME! You make a superb team! :)
And here is the second wonderful email:
David, I hope you are feeling better and that you recover from your cold soon, very soon.
I wanted to share an afterthought I had a couple of days after we recorded the podcast. I wish I had thought about it before the podcast because this was so much part of my OCD.
Anyway, for years (many years) I bought sanitized hand wipes and carried them in my purse, car, briefcase, you name it—I had hand wipes everywhere. I was known for having wipes with me all the time.
Not long after the magical treatment of my OCD, I was at the grocery store and proceeded to add three packets of sanitized hand wipes to my basket and I burst into laughter, even though I was by myself! I, then, put them back on the shelf, as I told myself, “I don’t need these anymore!”
Since then, I no longer carry them NOR NEED THEM!
Funny enough, I have been approached on different occasions by family members and friends saying something like, “You always have wipes, can we have one, please?” I have to say, “Sorry, I don’t carry wipes anymore since I’ve been cured!”
What a wonderful feeling that is—not to feel dependent nor a slave to the sink and hand wipes. Not to mention, all the money I am saving by not buying wipes!!!
Anyway, I thought I should share that with you and I’m sad I didn’t remember it until after the recording of the podcast.
Once again, thank you both for the amazing recording, all your support, and all you do for our Tuesday training group and humanity in general!
With Immense Gratitude,
Sara Shane is a certified TEAM-CBT therapist practicing in the central valley of California (Stockton). She is multi-lingual and offers intensives—extended, single-session treatment of depression and all of the anxiety disorders. And, here’s something fantastic—although Sara is a superb therapist, her fees are modest, thus bucking the current trend of charging outrageous fees for psychotherapy in California. This is something I really admire and appreciate!
If you would like to contact Sara, you can reach her at: 209-476-8867.
David and Rhonda
Hearing the Music Behind the Words
This podcast again features the music of two beloved colleagues we introduced last week, Brandon Vance, MD and Heather Clague MD. We will be listening to music again this week, but it will be, for the most part, a different kind of music—it’s the music behind the words when someone criticizes you. We will be focusing on the most challenging and important of the Five Secrets of Effective Communication, the Disarming Technique. This week, Brandon and Heather will help Rhonda and David illustrate how to use this technique when you’re under the fire of criticism. But in addition, Brandon and Heather will also sing one more of their extremely beautiful and fun songs, appropriately entitled, “The Five Secrets!”
When you use the Disarming Technique, you find the truth in a criticism, even if the criticism seems untrue, unfair, or exaggerated. This technique is based on the Law of Opposites. The essence of the Law of Opposites is that if you genuinely and immediately agree with the criticism that seems untrue, you will put the lie to it, and the critic will stop believing the criticism. This is a remarkable phenomenon that can be enormously helpful in conflicts with patients (if you're a therapist) as well as friends, colleagues, and loved ones. However, it is challenging, because you have to be able to really listen and "hear" the music behind the other person's words.
If you use the Disarming Technique, or any of the Five Secrets, in a mechanical way, it will backfire. And I (David) have noticed that even trained mental health professionals can have a tremendous difficulties learning to use the Disarming Technique.
Here's an example of POOR technique. Although this is a therapy example, it is equally valid for conflicts between friends and loved ones.
Let's say that you're a therapist, and your patient confronts you by saying, "This is the second week in a row that you've been late for my session."
I've seen therapists respond like this: "You're right. I have had emergencies which made me late for your sessions last week and today."
Is this a good example of the Disarming Technique?
NO! Can you see why?
It's because this therapist is agreeing with the criticism in a literal way, and not hearing the "music" behind the words. What is this patient really saying? He's probably saying that he feels a lack of caring from his therapist, and this may be one of his core conflicts, thinking that the people he cares about never care about him. So the therapist's "mechanical" answer misses the boat.
Here's an improved response that addresses what the patient really said. After each sentence, I'll put the name(s) of the technique(s) I used in the sentence.
"Jim, it's painful to hear you say that, because you're right. ("I Feel" Statement; Disarming Technique) I was late and I let you down, and I feel embarrassed. (Disarming; "I Feel" Statement.) I wouldn't be surprised if you're feeling hurt and annoyed, and maybe even a bit angry with me, and for good reason. (Feeling Empathy) This is particularly uncomfortable, because you've told me that everyone you care about seems to let you down. ("I Feel" Statement; Thought and Feeling Empathy) I care about you and have tremendous respect for you. (Stroking) Although I was delayed by emergencies last week and this week, the fact is, you had to wait. (Disarming) I will try to correct the problem of getting emergency calls when I'm in the clinic, which definitely is irritating and unfair to you, and I'll gladly offer a free session to compensate the fact that you had to wait. (Disarming Technique, Feeling Empathy) I want to know more about how you've been feeling, and if there have been other times when I've let you down or perhaps said things that seemed uncaring? (Inquiry)"
Can you see that this response addresses the music, or feeling, or message behind the words, and not just the words?
And can you see the Law of Opposites in action? When this therapist agrees that he has let the patient down, and shows some humility, the patient will probably suddenly feel very cared about.
In today's podcast, Brandon, Heather, Rhonda and David play a kind of Disarming Round Robin, taking turns responding to unexpected criticisms, using the Disarming Technique as well as any other communication techniques that may be needed. For example, one of the therapists is attacked by a patient who is a person of color who calls him "one of the rich white privileged people."
You will also hear the immediate grading of each response--was it an A, a B, a C, or a D--along with what worked and what didn't work, followed in some cases by a second try. If you want to learn the Five Secrets, and especially the Disarming Technique, this type of practice will be a must! You can practice with a colleague, or with a friend. But be prepared to check your ego at the door so you can learn from failure, because it will be very challenging for you at first!
A neighbor who was helping with the recording, Dave Fribush, said that he really liked the podcast, but was disappointed it was so short--he wanted to hear more examples. So Rhonda and I recorded a brief supplement two days later, which we will edit in.
Here are the additional criticisms we practiced:
- Angry friend who feels jealous / betrayed and says: You were hitting on my girlfriend last night!
- Irate mother, who feels neglected / used, and says: Forget it! I’ll just do it myself!
- Hurt colleague, who says: You didn’t support me during the meeting!
- Indignant patient, who tells her therapist: You just called me Jane, but my name is Lisa!
If you are serious about learning the Disarming Technique, as well as the other Secrets of Effective Communication, I would strongly urge you to study this list of Common Five Secrets Errors in addition to practicing with a friend. I know I'm asking a lot from you, but we are giving you, or hoping to give you, something precious!
And here are the words to today's featured TEAM-CBT song!
She Used the Five Secrets
Lyrics by Heather Clagueto the tune of Blue Velvet by Bernie Wayne and Lee Morris.
She used the Five… Secrets
Madder than angry, oh was I
Pissed and unhappy, I could cry
At the start
She used the Five Secrets
She spoke my words to ‘ empathize
She ‘ guessed my feelings, oh she tried
From the heart
How could I stay harmed
When she so skillfully disarmed
How could I want to fight
When she asked, did I get it right with
With my Five Secrets
she told me plainly how she felt
Her stroking made my whole heart melt
And I can still hear her Five Secrets
In my ears
The Five secrets
Now I have learned to use them too
To give up blame and follow through
And face my fears
And I practice my Five Secrets
With my dears
I love the Five Secrets!
Conflict fuels intimacy
Not about me but about we
It’s more sincere!
So with the five secrets
Let love appear!
More about Brandon and Heather
Brandon Vance, MD and Heather Clague, MD are both psychiatrists and certified TEAM-CBT therapists. They practice in Oakland, California.
In addition to her brilliant work as a TEAM-CBT psychiatrist and teacher, Heather is a singer and improviser who collaborated in the creation of lyrics for some of Brandon’s songs. She is a member of the performance group, The Berkeley Players, and is the director of Berkeley Improv, a Bay Area school of improv that offers improv acting classes for adults and youth. Heather says, "Improv is a lot like TEAM CBT - full of laughter and enlightenment. The best moments tend to happen when we throw shame to the wind and let magic arise from the ordinary and let our 'mistakes' become gifts."
In addition to his brilliant work as a TEAM-CBT psychiatrist and teacher, Brandon has a musical group that is connected with the Justice Arts Collective at Chabot College in Hayward California. In that group, he works with students to create musical pieces with social justice themes, often in the style of hip hop with Latin beats. Most, if not all of the students have experienced personal trauma and social inequity. Through music, they can share their truths, their hearts and their wealth of experiences with each other and the community, while at the same time working for social change.
Brandon explains that “we form deep connections with each other, and it’s become something of a family . A couple of years ago, we made a music video for our song, ‘From Mt. Tamalpais to Fruitvale Station,’ and actually won first place in the My Hero International Film Festival and in the World Independent Film Festival, as well as awards in many other film festivals. Check it out! We’re now working on a new video about immigration with our song, 'Bring Down the Wall.'"
Brandon has also worked with Amy Specter in the creation of a company called Gameful Mind. He explains that “we wanted playful ways to support adults and kids in developing skills to be and stay emotionally well. So, we made the game TuneIN TuneUP, as well as some other games and playful shirts and such.”
David and Rhonda
Introducing Brandon Vance, MD & Heather Clague, MD
This podcast features the music of two beloved colleagues, Brandon Vance, MD and Heather Clague MD. Brandon and Heather are both certified TEAM-CBT psychiatrists practicing in Oakland, California. Brandon is a brilliant multi-instrumentalist and singer / song writer / performer who has transformed his vision of TEAM-CBT into music! Heather is brilliant and fun improv acting teacher and performer who is quick in her mind and on her feet! Brandon and Heather have performed at David’s annual South San Francisco psychotherapy intensive for the past several years, and we are delighted to bring them to you up close and personal today!
In today’s podcast, they’ll bring you their songs and amazing personal stories. And what is super cool is that you can follow the words for the music right here in the show notes.
Heather and Brandon begin with music about a familiar but painful theme for nearly all of us—the feeling of failure, and the belief that we are somehow defective or just “not good enough.” Brandon and Heather are extremely talented and successful individuals, but they are not immune from suffering. During the podcast, they describe their own painful personal experiences with depression, anxiety, shame, and defectiveness.
Most therapists, including David, were trained in the psychoanalytic tradition and told that we should NEVER disclose or reveal our own personal feelings or experiences to patients. But we believe that some personal disclosure can be very healing for patients if done with skill and compassion. Most patients want to hear this type of message from a therapist:
“I’ve been there myself, and know how much pain you’re in. And I can show you the way out of the woods, so you can experience feelings of joy and self-esteem again. And what a joy that’s going to be!”
So, with no further ado, Brandon and Heather perform their first song:
The Feel of Failure
Lyrics by Heather Clague and Brandon Vance to the tune of “The Sound of Silence” by Paul Simon
Hello failure my old friend
I’ve come to talk with you again
Because my ego softly creeping
Infects my thoughts while I am preaching
And that vision that was planted in my brain
Still remains; becomes the Feel of Failure
Fool, said I, you are so lame
Done something wrong to feel this shame
Perfect is the way that you should be
Self-blame coming like a tsunami
Negative thoughts one hundred - percent on my DML
I was in hell
Suffered the Feel of Failure
My self-esteem had turned to shit
I needed the magic button hit
Something told me my feelings weren’t lame
Began to do a positive reframe
Maybe my feelings say something about me that is pretty fly
I set the bar high
So I have a Feel of Failure
I saw that I was not alone
Dared go beyond my comfort zone
I took pride in my humility
Welcomed my faults as my humanity
And in a moment of enlightenment I cried and then I laughed
I’d finally grasped
The wisdom... of the Feel... of Failure
The next song is on social anxiety. Brandon explains:
“I wanted to introduce this song I wrote with Amy Specter who was on your podcast on August 5th #152 a month or so ago. It’s called, “Negative Thoughts Shut your Piehole Tonight.” And it’s about social anxiety and the idea that when you’re upset, it’s not the event or the other person who’s “making you” feel upset, it’s your own negative thoughts.
“Where it gets personal for me is that I was bullied in elementary school by a group of my former friends who made up a story that I was gay - as if that's a bad thing - and then yelled things, tried to get in fights with me, etc., for really the majority of the school year. And I got really down and felt ashamed, and didn’t tell my parents or anyone else about it because of that. But what they did, didn’t make me down - it was my negative thoughts. I wasn’t actually gay, but what was important was that I told myself that I was defective, and people didn’t want to be around me.
“The person who I thought was the ringleader was a blonde blue-eyed (as if those are good things) smart, handsome guy who had great social skills and apparent confidence - both seemingly more than I had. In my mind I made him into an evil person just interested in popularity. But he had many good qualities (and was a friend of mine before this). Seeing his good qualities reminds me of the concept of the disarm.
“In this song, the singer is anxious about going to a party. She feels envious of Anna, a woman who’s thin (as if that's a good thing) and gets a lot of attention - both because of our culture’s preoccupation with women being thin and also because she has great social skills. So, she feels bad about herself.
“But then realizes it’s just her negative thoughts and also sees that her negative thoughts and feelings helpful to her, and represent good things about her. Then she works successfully on changing the way she thinks and feels.”
Negative Thoughts, Shut Your Piehole Tonight!
by Amy Specter and Brandon Vance
Tiny Anna, you’ve been getting me down. But I know it’s not you; it’s the negative thoughts doing their doo-doo. And those negative thoughts I can leave behind. That’s right, you can walk right out of my mind. You can shut your pie-hole, though you’ve given me a lot during my days. But, I don’t need you now; you can get up and walk right out of that door - and shut your pie hole on the way!
You’ve been talking since the dawn’s early light
you’re an expert, attention getter, you’re quite the sight!
Anna please teach me
to talk at a party like the talkin' on the tv screen
Now I’m gonna say something and it may not be polite!
Cause I’ve realized that I’ve got some work to do
But this time I’m not going to shut down and stew.
My negative thoughts are bothering me
much more than Anna Lee
so negative thoughts, shut your pie holes tonight.
Negative thoughts you’ve served me well and
kept me from being in social situation hell
Rejection comfortably kept at bay
I don’t have to put myself out there
I can keep myself at home without judgments to fear
they can let me off the hook
No effort to change, to learn new things or swim in another lane
Negative thoughts you’ve kept me safe
But I’m going to try my mind on a different train
Maybe I don’t need negative thoughts and their kind
to tell me if I can have a good time
I can be myself and go at my own pace
Even with these tiny negative thoughts flapping their tiny lips in my face
Negative thoughts said there’s no room in this world for my kind
well that’s just bullshit created by my negative mind
I laugh about awkward autocorrects, Weird-Al and farting
So why not enjoy, the people, at the party?
So negative thoughts shut your pieholes tonight!
Negative thoughts you’ve served me well
Negative thoughts - farewell!
Negative thoughts shut your pie hole tonight
Tiny Anna will surely get some attention
That may be true
And that doesn’t mean I won’t get affection
But even if I don’t have things to say,
I’ll learn to chit chat the Anna way.
So Negative thoughts shut your pieholes tonight,
Negative thoughts shut your pieholes tonight.
That’s right, negative thoughts shut your pieholes tonight!
Cause I wanna have some FUN!!!
The last song by Brandon and Heather focuses on the “A” of TEAM therapy, formerly called A = Paradoxical Agenda Setting, and now given the simpler name of A = Assessment of Resistance. We address the patient’s resistance in this very crucial and paradoxical part of TEAM-CBT. When we address resistance up front by arguing for the status quo, the patient paradoxically argues for change, and therapy becomes much easier. After that point, it’s No Resistance No Cry.
NO RESISTANCE NO CRY
Lyrics by Amy Specter and Brandon Vance to the tune of “No Woman No Cry.” by Bob Marley.
No resistance no cry
No resistance no cry
No resistance no cry
No resistance no cry
Next week, Brandon and Heather will return for a second podcast on listening to a very different kind of “music,” the meaning behind the words when people are critical of you. We will discuss and illustrate, once again, the incredibly important Disarming Technique, which is arguably the most important of the Five Secrets of Effective Communication.
More about Brandon and Heather
In addition to her brilliant work as a TEAM-CBT psychiatrist and teacher, Heather Clague is a singer and improviser who collaborated in the creation of lyrics for some of Brandon’s songs. She is a member of the performance group, The Berkeley Players, and is the director of Berkeley Improv, a Bay Area school of improv that offers improv acting classes for adults and youth. Heather says, "Improv is a lot like TEAM CBT - full of laughter and enlightenment. The best moments tend to happen when we throw shame to the wind and let magic arise from the ordinary and let our 'mistakes' become gifts."
Dr. Brandon Vance has a musical group that is connected with the Justice Arts Collective at Chabot College in Hayward California. In that group, he works with students to create musical pieces with social justice themes, often in the style of hip hop with Latin beats. Most, if not all of the students have experienced personal trauma and social inequity. Through music, they can share their truths, their hearts and their wealth of experiences with each other and the community, while at the same time working for social change.
Brandon explains that “we form deep connections with each other, and it’s become something of a family . A couple of years ago, we made a music video for our song, ‘From Mt. Tamalpais to Fruitvale Station,’ and actually won first place in the My Hero International Film Festival and in the World Independent Film Festival, as well as awards in many other film festivals. Check it out! We’re now working on a new video about immigration with our song, 'Bring Down the Wall.'"
Brandon has also worked with Amy Specter in the creation of a company called Gameful Mind. He explains that “we wanted playful ways to support adults and kids in developing skills to be and stay emotionally well. So, we made the game TuneIN TuneUP, as well as some other games and playful shirts and such.”
David and Rhonda
The Secret of a Meaningful Life
One of my favorite podcasts of all time, and one of the most frequently downloaded, was the live session with Daisy (podcast #79): “What’s the Secret of a Meaningful Life?” You may recall that Daisy and her husband, Zane, were looking forward with dread to the possibility of childlessness, since their efforts at pregnancy had so far failed, and Daisy was asking if she could possibly have a joyful and meaningful life without children.
In today’s podcast we return to the same type of question from the other end of the spectrum. When we age and look back on our lives, and realize that our days are numbered, we may once again, "Have I lived a meaningful life?"
Do you know how to answer this question? What, in your opinion, is the secret of a meaningful life?
If the answer to this question is important to you, you might enjoy today’s podcast, which features, once again, two beloved friends and colleagues, Dr. Marilyn Coffee and Dr. Matthew May.
Matt and I first treated Marilyn for intense depression, anxiety, and anger two years ago at the time of her unexpected and shocking diagnosis of Stage 4 non-smoker’s lung cancer. Marilyn was incredibly depressed and panicky, as you might imagine. If you are interested, you can listen to our initial treatment of Marilyn in podcast #49, “The Dark Night of the Soul.”
One of Marilyn's concerns at that time was that she had lost her faith in God and had begun to doubt the existence of an after-life. She was intensely self-critical and ashamed, and was also extremely angry because she began doubting her spiritual teachers and thinking of them as frauds.
These doubts were all the more troubling to Marilyn, since she’d been a devout Catholic for her entire life. In fact, she even has a Master’s Degree in theology, along with several additional Master’s Degrees plus a PhD in clinical psychology! But now she was terrified by the prospect of her own death.
During that initial treatment session, Marilyn overcome her fears, depression, and doubts, and ended up in a state of joy, and even laughter. This rapid transformation confirmed the basis of cognitive therapy, that our emotional pain results from our thoughts, and not from what is actually happening to us. And the thoughts that cause depression and anxiety will be distorted and cruel--I've often said that depression and anxiety are the world's oldest cons.
Following that session, we were flooded with emails praising Marilyn. Oddly enough, many people said she was their spiritual hero. They said they were stunned and grateful her raw courage, testimony, and honesty.
Now, it’s two years later. Sadly, Marilyn has just learned from her doctors that she’s had numerous metastases, and that her lung cancer has spread to the opposite lung, as well as to her bones, brain, liver, and lymph nodes. Marilyn is understandably paralyzed once again by overwhelming feelings of depression, anxiety, shame, hopelessness, and anger.
Today’s podcast is based on our most recent session with Marilyn about two weeks ago. I have to warn you that the session may be sobering, and even a bit terrifying, but hopefully you will find it to be inspirational and helpful, because sooner or later, we’ll all have to share the prospect of facing our own inevitable death, and asking ourselves, “Have I had a meaningful life?”
We scheduled this follow-up live therapy podcast for three reasons. First, we hoped to provide Marilyn with some relief from the devastating depression that had returned when she learned of her metastases. Second, we wanted to give you, and all of Marilyn’s many fans, an update on what’s happened in the past two years. And third, Marilyn wanted the chance to tell you about some of the positives in her life, since she so often mentions her failures, such as her bouts with alcoholism, and the fact that she never found a loving partner.
Every TEAM session begins with T = Testing. You can see her scores on the Brief Mood Survey she filled out just before the session began. (link) All her scores reflect the most severe negative feelings a human being can experience. Marilyn has extraordinarily severe depression, anxiety, and anger, and her positive feelings are totally absent.
Marilyn brought a partially completed Daily Mood Log to the session. If you take a look, you'll see all of her intensely Negative Thoughts and devastating feelings about the spread of her cancer.
During the E = Empathy phase, Matt, Rhonda and I gave Marilyn the space she needed to vent and describe her despair and feelings of terror. We did not try to help or cheer her up. Marilyn cried as she described her fear of dying alone, and vividly recalled a friend who died a horrible death from lung cancer 20 years ago. Marilyn says he could barely breathe, and fears a similar horrific fate.
Marilyn cries, and confesses that she has not been able to cry up until now. She says she suddenly felt a spiritual presence being around Matt, Rhonda, and David.
During the Empathy phase, Matt made many tender comments to Marilyn, shared his own profound sadness, and told Marilyn that joining us today is a gift to him, and to all of us.
Matt and I asked Marilyn how we were doing in Empathy, in terms of understanding how she was thinking and feeling, and whether we were providing warmth, acceptance and support. She gave us high grades. When you listen, please notice that we didn’t do anything to try to help Marilyn, or to try to cheer her up. You can hear Matt simply paraphrasing much of what Marilyn had been saying, acknowledging her feelings, and sharing his own feelings of sadness and warmth toward Marilyn.
After about 25 minutes of empathy, we moved on to the next phase of the session called A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) We started by asking Marilyn if she wanted any help with the problems she'd been describing, or if she needed more time to talk while we listened and provided support.
She said that she did want help. Since her remaining time was potentially short, she said she didn’t want to spend it in the misery of overwhelming depression, anxiety, worthlessness, shame, loneliness, hopelessness, and rage.
Then I asked the Magic Button question—If we had a Magic Dial, and all of her negative thoughts and feelings would instantly disappear, with no effort at all, simply by pressing it, would she press the button?
Marilyn immediately said that she WOULD press the button. Almost everybody says this. And it seems obvious. Why would anyone want to feel intense, relentless and overwhelming negative emotions?
Matt, Rhonda, and David debated about whether or not the A = Assessment of Resistance would be needed, since it seemed like Marilyn was suffering so much that she would OBVIOUSLY want help.
We decided to address the resistance, since whenever we’ve skipped it, we’ve usually regretted it.
So just to be safe, we decided to do some Positive Reframing, and asked these two questions about each of the nine categories of intense negative feelings on Marilyn's Daily Mood Log, such as depression, anxiety, guilt, inferiority, loneliness, hopelessness, rage, and so forth.
- What does this negative feeling show about you and your core values that’s beautiful, positive and even awesome?
- What are some benefits of this negative feeling? How might it help you?
Surprisingly, Marilyn came up with a list of more than 20 positives with some help from Rhonda, Matt and me. You can take a look at her Positive Reframing List. This process seemed to have a profound calming effect on Marilyn, just as it does on most people.
I think one reason is that culture / society have trained all of us \to think about our negative feelings as defects, or “mental disorders,” like the many that are listed in the DSM5. Positive Reframing turns all of this upside down, and makes you proud of your negative feelings. Paradoxically, this make it possible for you to get rid of the feelings quickly.
We concluded with the Magic Dial, and asked Marilyn what she might want to dial her feelings down to, without getting rid of them completely, since they did have many benefits, and since they also reflected what was most beautiful about her.
You can see the result of the Magic Dial on her Daily Mood Log, in the “% Goal” column of her table of negative emotions. For example, she wanted to dial her depression down to 10%, but thought that she'd want to keep the anxiety in the range of 20 - 25. But she said she'd be happy to dial the guilt and shame all the way to zero!
After the A = Assessment of Resistance, which seemed to lift her mood considerably, we went on to M = Methods. After easily identifying the distortions in her thoughts, like All-or-Nothing Thinking, Self-Blame, hidden Should Statements, and more, Marilyn was able to challenge and crush her Negative Thoughts pretty quickly using the Paradoxical Double Standard Technique as well as Externalization of Voices. Two strategies seemed important—the Self-Defense Paradigm and the Acceptance Paradox.
I emphasized the overlap between the Acceptance Paradox and Marilyn’s Catholic faith. It is the idea that you cannot, and not have to, earn your way to heaven through your good works. Christianity is based on the idea that we are not saved by our achievements or good work, but rather by the grace of God--which is simply the acceptance of our flawed nature. David emphasizes that these ideas are not exclusive to Christianity, but are woven into most if not all religions.
During this phase of the session, Marilyn reflected on some of the experiences that she’s proud of, things she would like you to know about, like her trip to Nicaragua to attend seminary at the Franciscan School of Theology. During that time, she worked with the oppressed indigenous people in relocation camps following the bombings, and joined the Witness for Peace group. She describes this as "one of the most transformative and spiritual experiences of my life."
Many of you are probably not familiar with Marilyn's fairly extensive arrest record, which she is equally proud of! She explains:
"During the 80s and early 90s, I was arrested several times for political protests, primarily at the Federal Building in San Francisco. For example, I participated in a major non-violent prayful march at Lawrence Livermore Laboratory. Several of us were arrested and spent a month in jail (tents on the grounds of Santa Rita Jail.)"
Marilyn also wants to know that she was "a damn good therapist." That's something I can attest to, having presented with Marilyn on many occasions, including our empathy workshop at one of the prestigious Evolution of Psychotherapy conferences in Anaheim, California.
And still, all of her amazing accomplishments and contributions do not protect her, or any of us, from falling into a black hole of self-doubt and despair from time to time, and when Marilyn falls, the pain she inflicts on herself can be intense. You may notice that the Negative Thoughts on her Daily Mood Log today are very similar to the Negative Thoughts on her Daily Mood Log from two years earlier, during our first session with Marilyn. This confirms the concept of “fractal psychotherapy.” In other words, all of your suffering will be encapsulated in any one brief moment when you are upset. And when you suffer again in the future, it will be that same fractal--the same exact pattern of negative thoughts, distortions and feelings. This is really good news, because the methods that helped you recover initially will be helpful for you when you again fall into the black hole of depression.
The goal of TEAM-CBT is NOT eternal happiness--no human being is capable of that! Rather, the goal is to understand and master the tools that will be helpful for you.
One important teaching point is that Marilyn’s suffering, once again, does not result from her cancer, but rather from her self-critical thoughts, which are both cruel and distorted. She’s been telling herself that she is not religious enough, that she has lost her faith, and that her life has not been meaningful. Fortunately, these Negative Thoughts can easily be challenged and defeated, as you will hear on the podcast.
The entire basis of cognitive therapy is a spiritual idea, that “the truth shall make you free.” Although this is a core Christian teaching from the New Testament (John 8: 32), it is an idea that’s embedded in many religions, including Buddhism, and probably in every religion.
Toward the end of the session, Marilyn described inspiring moments when she feels the most spiritual and the most alive. It’s when she notices and profoundly appreciates the simple things in her life, like seeing a sliver of the moon in the evening when walking her dogs, watching a sunset on the beach at Santa Cruz, her first sip of latte in the morning or a bite of a delicious peach!
Marilyn also described the intense mourning she feels for people throughout the world who are in poverty or pain. She also grieves for animals who are suffering, and feels devastated by the destruction of our natural resources, such as the rain forests in Brazil.
You can see the final T = Testing . As you can see, she met or exceeded her goals for all of her negative feelings. You may be puzzled by the end of session rating for sadness and depression was "50%, but a GOOD 50%!"
Sometimes, feelings of sadness and grief, once the distortions have been eliminated, are are the experiences that can wake us up, and provide the profound sense of meaning we are craving in our lives. The highest human experience, perhaps, is the compassion we sometimes feel for ourselves and others who are suffering. In fact, this may be the true meaning of spirituality.
I call this feeling, "Sadness as Celebration," and hope to write and talk more about it in a future podcast.
At the end of the session, Marilyn said, “I feel light!” And gave us all big hugs.
Will it last? Matt wisely suggests some terrific Relapse Prevention Training that you will hear when you listen to the session. Of course, it will be up to Marilyn--and to all of us--to pick up these tools and use them when we again fall into a black hole. This is also an inherently spiritual idea, and is based on the idea that we have the freedom to chose light or darkness.
After the session, Marilyn emailed me and asked if I could include a few additional comments in the show notes. Here’s what she wrote:
Greetings David, my dearest friend,
Words cannot express my gratitude for you, Matt, & Rhonda - what special gifts you are.
I hope the podcast was ok. I am deeply embarrassed because I forgot to express my gratitude and surprise from all the e-mails we received - the compassion and support was/is overwhelming. I hope I can give back! I could never had done this, if I weren’t for you & Matt - and your amazing & compassionate skills.
I also forgot to mention that I probably will never get to New York or Ireland because of finances. I take one day at a time and try to be grateful for the small miracles.
I go to Stanford next Tuesday. I will definitely be in touch.
Thank you again.
I also forgot to mention this - which is VERY important is that I am going through this process sober - not avoiding with alcohol. I am going to more meetings & speaking up.
Thank you again. I cherish our friendship.
With deep gratitude and love. dear friend,
Thank you, Marilyn, for this incredible gift to all of us!
Matt, David, and Rhonda
David and Rhonda are joined again today by David's neighbor, friend, and hiking buddy, Dave Fribush. We appreciate his superb technical skills and thank Dave for his support of our podcasts!
Rhonda starts the podcast by reading a question from a podcast fan named Rajesh, who wrote:
I have often seen that estranged friends or family members do not talk or resolve a trivial conflict for years because one or both of them have ego issues or have fear of rejection. This problem of unfairness may even exist between a demanding parent and the child, ranging from secretly resenting to not talking at all. They might come face to face in family occasions or professional settings in case of friendship and bear the discomfort, but not attempt to reconcile.
They might be suffering deep down emotionally but they refuse to accept that it matters. One or both members might feel they have been treated unfairly and expect apologies. But, both parties are scared to even make the move for the fear of being hurt again or rejected.
On a personal level, I have faced such unfairness with a close friend. I see even if you forgive the other party, that element of resentment is still in their somewhere. How do you know you have truly forgiven someone and moved on? Whats the best that can be done at an individual level without involving the other party, at least till the time both are ready to talk it out, if it ever happens.
Once again I thank you for all the selfless Good work you do for people through your knowledge sharing. My sincere best wishes to you and great thanks 🙏.
I appreciate this question, and it is a great introduction for our podcast on Changing the Focus, one of the three Advanced Secrets of Effective Communication. We recently introduced the three advanced secrets in podcast #126, and you can listen to it for review if you like.
- Changing the Focus. This technique can be tremendously helpful when there’s an “elephant” in the room.
- Multiple Choice Empathy. This technique can be transformative when you’re trying to connect with a teenager, friend or loved one who refuses to talk to you.
- Positive Reframing. This technique can be invaluable when you’re fighting with a colleague, patient, friend or family member, and you’re both feeling frustrated, angry, and upset
Today we take a deeper dive into Changing the Focus. This technique can be extremely helpful when you feel tense or awkward in your relationship with someone. For example, you may be arguing endlessly, or there could be some unacknowledged feelings that no one is talking about, like shame, anger, hurt, or resentment. When you use Changing the Focus, you gently point out what's happening, and focus on your feelings, and drawing out the other person's feelings, instead of continuing in the same pattern of arguing or avoidance.
Although this technique can be tremendously helpful, it is very challenging, so I have written two memos explaining the technique in greater detail, with examples. One is for therapists and one is for the general public. If you are interested in learning this technique, this would be a great starting place, and it might not hurt to read both memos. In addition, you have to be skillful with the Five Secrets of Effective Communication before trying this technique. That's a lot to ask, I know!
David, Rhonda, and Dave (our new podcast co-host) model how Rajesh might use Changing the Focus with estranged friends or family members. Then Dave Fribush provides a terrific example of how he used the Five Secrets, plus Changing the Focus, in a troubled love relationship, after arguing and resisting for several years. Then I (David) provide an example with a patient I was failing with, and Rhonda provides two tremendous examples--one from her clinical practice, and one involving her sister.
See what you think about our new three-person format! Since our audience consists of therapists as well as the general public, we welcome Dave with open arms and hearts, and feel lucky!
David, Rhonda, and Dave :)
One Student’s Experience
In today’s podcast, Rhonda and I are super-pleased to interview Kyle Jones again. For some time now, Kyle has been telling me that he wants to talk about his psychotherapy training experiences on a podcast. This subject is near and dear to my heart, since I do a great deal of training, so Rhonda and I decided to do this second interview with Kyle, and it’s a good one, I think! You may recall our recent interview with Kyle on his interesting research and perspective on the treatment of LGBTQ individuals several weeks ago.
Kyle is a brilliant and super-friendly 5th year graduate student in clinical psychology at Palo Alto University, and has been a member of my Tuesday evening psychotherapy training group at Stanford for the past four years as well. Kyle now sees patients at the Feeling Good Institute in Mt. View, California. He has also been promoted to small group leader in our Tuesday group, and does superb work as a teacher.
During today’s interview, Kyle, Rhonda and I focus on many critically important training and treatment issues. Kyle states that he has been exposed to many fine teachers promoting a wide variety of popular treatment “packages” at the Palo Alto University and at his practicum sites, including traditional CBT, ACT, EMDR, psychodynamic therapy, and more. However, in all cases, the therapist was encouraged to “sell” this or that approach to the patient. Unfortunately, this has a tendency to trigger resistance, and is the main cause of therapeutic failure in clinical settings as well as controlled outcome studies as well.
Paradoxical Agenda Setting, which is the secret spice of TEAM Therapy, was never mentioned in his training at Palo Alto University. When you do Paradoxical Agenda Setting, you bring the patient’s subconscious resistance to conscious awareness, and then you melt it away with a variety of innovative techniques like the Magic Button, Positive Reframing, Magic Dial, Acid Test, Gentle Ultimatum and more. The rapid reduction the patient’s resistance often leads to the high-speed, mind-boggling recoveries we frequently see in TEAM-CBT.
Kyle emphasized that he has not see a single teacher or therapist even use the simple Invitation Step in therapy, in spite of the fact that it is so incredibly basic. Essentially, after empathizing with your patient, you ask if there is something she or he wants help with during the session, or if the patient needs more time to talk and get support. Most therapists wrongly believe that this question is unnecessary since the patient is coming to therapy, so he or she MUST want help.
But in fact, nearly ALL patients have some degree of ambivalence about recovery, and if this ambivalence is ignored, the patient may, and probably will, resist the therapist’s efforts to “help.” Rhonda enthusiastically agrees that the Invitation Step is incredibly powerful and admits that it took her several years to “get it,” and that she also resisted using the Invitation Step it at first, thinking it wasn’t needed. But she failed her Level 3 Certification Exam in TEAM-CBT because she didn’t know how to do it! Once she began using it, her practiced changed dramatically. And then she easily passed her exam with flying colors!
Intense therapist resistance to these new techniques is extremely common. I once supervised a clinical psychology post-doctoral fellow at Stanford who resisted using the Invitation Step with her patients for the first two months of our supervision. All she did was schmooze with her patients.
Finally, I asked her why she wasn’t using the Invitation Step. She told me she was afraid her patients would say, “Yes, I DO want some help with problem X, Y or Z.” And then she might not know how to help them solve whatever problem they had! She said, “As long as I just schmooze with my patients, I know that nothing will change, but they’ll think it’s good therapy!” Fortunately, after we discussed this dilemma, she began using the Invitation Step, along with many other Paradoxical Agenda Setting techniques, and her clinical work improved a ;pt.
Kyle also emphasizes the incredible value of the Brief Mood Survey and Evaluation of Therapy Session with every patient at every session, and yet most teachers and therapists in his graduate program, as well as those at his practicum sites, are not using these instruments. I think this is arguably an ethics violation, since therapists’ perceptions of how their patients feel can be wildly inaccurate. I predict that within ten years, all therapists will be required by licensing agencies and insurers to use these kinds of assessment instruments.
The importance of assessment instruments in clinical work and training was underscored by my experience several days ago with a patient who gave me incredibly poor grades on empathy as well as helpfulness at the end of a free, two-hour phone session. I had sensed the session had not gone especially well, but I didn’t realize just how awful it was until I saw my ratings! The scores on Empathy and Helpfulness were among the worst I’ve received in the past 25 years.
This was illuminating, but disturbing, as I’d been trying my best but I had clearly failed my patient in a big way, and he was ticked off! I would not have known just how angry and upset he was if I had not been using the Evaluation of Therapy Session.
I had a fairly sleepless night, and emailed him the first thing in the morning to find out what emotions I’d overlooked, and urged him to express his angry feelings toward me. This led to a tremendous and highly gratifying therapeutic breakthrough.
Kyle was generous in his praise for the training we do in our Tuesday group, and I feel extremely fortunate to have had the chance to work with Kyle! I am hopeful that the training methods my colleagues and I have been developing over the past 20 years will begin to catch on, but have to admit that I’ve run into fairly strong resistance from many therapists who fight and oppose our new training and treatment methods.
By the way, the Tuesday group is totally free for all clinicians in the San Francisco Bay Area, or from anywhere for that matter. We’ve had commuters and visitors from as far as Denver, Portland, and even China. If you want to dramatically improve your therapy skills, and have an interest in some of the new treatment and training methods we’re using, and want free personal work as well, this might be an option for you, and we’d be really happy to have you visit and maybe even join us!
David, Rhonda, and Kyle
Plus, Thomas Szaas, TV Shrinks, and more!
David and Rhonda are joined today by David's neighbor, friend, and hiking buddy, Dave Fribush. He has incredible technological skills, and wisdom. We thank Dave for his support of our podcasts!
We open the podcast with a wonderful email from a fan named Sushant who listened to Feeling Good Podcasts for nine hours during a rigorous hike to the "Tiger Monastery" in Bhutan. You can see Sushant and his phone, showing the podcast icon, just in front of the monastery.
Rhonda encourages podcast fans from around the world to send photos of yourself listening to the Feeling Good Podcast in additional unusual or exotic locations! Might be fun to see what you send to us!
Here are the questions for today's program:
Ann asks: Loved your podcast (on the exposure model, #26)! But I do have a question - I have suffered from panic attacks for years - the past 2 years I've become agoraphobic and don't want to be far away from my house. So, my phobia is now "having panic attacks." Does that mean I just need to go out and have a bunch of panic attacks in public to get over my fear? The thought seems terrifying.
Also, I am severely claustrophobic which affects me anytime I feel trapped (elevators, small cars, traffic, tight spaces, etc.) Is there a protocol you used to treat patients with this? Just wanted to suggest perhaps a podcast on this subject, or agoraphobia, as it does affect many people worldwide.
Nathan asks: Dear David, Love your podcasts. I am currently preparing a lecture for psychology honors students here at Monash University on assessment of depression and anxiety. In your podcasts you mention that you conducted a "study on the psychiatric inpatient unit at the Stanford Hospital, in which I evaluated how accurate therapists’ perceptions of patients were after an interaction. Student researchers interviewed patients for several hours as part of a research study on psychiatric diagnosis."
I was wondering if you could provide me with a reference to this study? I could not find a specific reference in your website and I would like to be able to highlight to student's the results of your research.
Richard asks: I listened to your podcast on being worthwhile and found it interesting. You say all people are worthwhile. This may be true but does the whole world think this?
If a person is worthwhile but the world thinks they are not worthwhile, isn't this almost as bad as not actually being worthwhile. Don't we have to play by the world’s rules, however bad, instead of our own or the Platonic rules? What do you think?
Robert asks: Dear David. I am up to podcast #108. I am heading to India next month for a three-week trek and am going to download the rest onto my phone. Perhaps by the time I get back, I will be up to date!
I have never heard you mention Tom Szasz, who, as I am sure you know, was making some of the same observations about the constructs of medicalizing you make back in the 1960s and maybe even in the 50s. In particular, his criticism of the psychiatric industry giving the names of diseases or syndromes to behavioral issues was very consistent with yours.
Robert also asks: My other question is an idea for future podcasts and it is...How about critiquing the therapeutic approach we see so often on television and in the movies? For the lay audience, these are probably the source of much of what they know about therapy. And because these therapists are well-known and fictional, it would give you an opportunity to make critiques without having to criticize an actual person. And it could introduce some levity into what can often be quite heavy.
Some of the Hollywood therapists people know best are:
- Judd Hirsch as the shrink in Ordinary People
- Lorraine Bracco as the shrink in The Sopranos
- Peter Bogdanovich as the shrink's shrink in The Sopranos
- Billy Crystal as the shrink in Analyze This!
- Robin Williams in Good Will Hunting
- Kelsey Grammer in Frasier
I am sure there are many others. These are the ones who quickly came to mind
I just found an article about this that might help make the case that what the public sees on TV and in the movies is not really reflective of the therapeutic process or good therapy. Here’s the link:
Thanks for tuning in!
David and Rhonda
References for Nathan
Burns, D., Westra, H., Trockel, M., & Fisher, A. (2012) Motivation and Changes in Depression. Cognitive Therapy and Research DOI 10.1007/s10608-012-9458-3 Published online 22 April 2012.
Hatcher, R. L., Barends, A., Hansell, J. & Gutfreund, M.J. (1995). Patients' and therapists' shared and unique views of the therapeutic alliance: An investigation using confirmatory factory analysis in a nested design. Journal of Consulting and Clinical Psychology, 63(4), 636 - 643.
The Story of Lorraine and “Anna”
In today’s podcast, David and Rhonda interview Dr. Lorraine Wong, a board-certified clinical psychologist, and her patient, “Anna,” who sought treatment recently for depression, anxiety, and self-image / self-esteem issues. But first, David and Rhonda answer a question submitted by Estafonia, a “public image consultant,” who asks about the treatment of a woman who sees herself as “fat.”
“Hi Dr. Burns,
“I am learning TEAM, CBT and implementing your techniques to help my clients change or improve their self-perception. In most cases, your techniques have been very effective. I am very grateful to you and I will happily join your list of fans!
“My question is this—What would be the best method to change someone’s self-image? How can you help people change the idea that they are fat for example?
“I have a patient who can't defeat the thought, ‘I am fat.’ We tried the method called Examine the Evidence,” and she has already found 20 people who see her as thin. So, the evidence clearly did not support her belief that she is fat. But this did not help.
“We also tried the method called Let’s Define Terms, and we both concluded that she is not fat. But now she tells me, ‘I know I am not fat, but I can't stop thinking about it.’
“We also did the Downward Arrow Technique to probe her deepest fears and Self-Defeating Beliefs, but that didn’t seem to help, either, and she keeps ruminating about being fat. I would greatly appreciate your guidance on how to help her overcome that thought!
“Thanks in advance! Estefania”
Lorraine, Rhonda, David and Anna quickly diagnose the most likely cause of Estefania’s stuckness—she is trying to “help” her patient without first melting away her patient’s resistance. This is the cause of practically all therapeutic failure, and you’re not really doing TEAM-CBT if you don’t know how to eliminate the patient’s resistance.
That’s because most people are ambivalent about change. As the Jesuit mystic, Anthony DeMello, has said: “We yearn for change but cling to the familiar.” Recognizing and modifying this inherent ambivalence is the heart of A = Paradoxical Agenda Setting, but you can also think of the A as standing for “Assessment of Resistance.”
How could we melt away this woman’s ambivalence / reluctance to stop bombarding herself with the message, “I’m fat”? It is important to realize that this self-critical thought, and, in fact, all of her negative thoughts and feelings have huge advantages for her, and also indicate some really beautiful and awesome things about her and her core values.
For example, telling herself “I’m fat” may motivate her to diet, to exercise, and to make extra sure that she doesn’t get complacent and gain a tremendous amount of weight. In addition, the thought, “I’m fat,” shows that she has high standards, and her high standards have probably motivated her success in many areas of her life. For example, she probably works really hard to stay in good health and in good physical condition.
The thought, “I’m fat,” also shows that she’s humble, and on and on and on. And that’s just one negative thought. But this woman probably has many negative thoughts and feelings, like anxiety, shame, inferiority and depression, and they ALL have tremendous advantages, and they ALL reveal what is beautiful and awesome about her and her core values.
In addition, the thought may be protecting this patient from things she fears, like intimacy. As long as she tells herself, “I’m fat,” she does have to risk trying to get close, or having sex, or risking rejection. So the thought, in a way, is a form of self-love and self-protection.
Once Estafonia and her patient list all these positives, Estafonia could ask her patient, “Given all these advantages and positive qualities, maybe it wouldn’t be such a good idea to stop telling yourself, ‘I’m fat.’ This thought seems to be working for you in a really positive way, and also reflects your core values.”
That’s the essence of Paradoxical Agenda Setting. We try, in a genuine way, to honor the patient’s resistance, rather than trying to sell the patient on change. This is very difficult for therapists to learn because of the compulsion to save, help, or rescue the patient.
In addition, obsessions (recurring illogical negative thoughts like “I’m fat”) frequently result from the Hidden Emotion phenomenon, and this has to be dealt with skillfully when treating any patient with anxiety. Estafonia’s patient may be upset about something she’s not dealing with in her life, and bringing the hidden problem or feelings to conscious awareness can often be incredibly helpful. For more information, see my book, When Panic Attacks, which you can order from my books page (link).
After focusing on Estafonia’s excellent question, David, Rhonda, Lorraine and Anna talk about the emotional challenges that brought Anna to treatment, including severe feelings of depression which came on when Anna returned to the United States after 13 years working abroad. She was also feeling anxious, stuck, angry, and hopeless, and was comforting herself by binging on her three favorite foods.
Anna describes previous partial treatment failures, and explains that her previous cognitive therapist had “the empathy of a prison guard,” and contrasts those experiences with her successful experience with Lorraine. In fact, Anna describes the TEAM-CBT she received at the Feeling Good Institute as “cognitive therapy on steroids.”
I (David) loved hearing that because this is how I think about TEAM-CBT, too! TEAM really is CBT on steroids! But, I’ve been too embarrassed to describe TEAM-CBT in this way, fearing it might sound crass or unprofessional.
Anna and Lorraine explain why the T = Testing and E = Empathy of TEAM were so critical to the success of the therapy. Anna says that Lorraine was, in fact, the first therapist “who really got me, and really understood me!”
Anna emphasizes the enormous importance of the A = Paradoxical Agenda Setting (aka Assessment of Resistance) as well. Lorraine helped Anna discover what was beautiful and awesome about all of her negative feelings, including severe depression, shame, anxiety, anger, loneliness, and even hopelessness. She said, “My depression and feelings of loss when I moved showed that I really care about what I do, as well as the people around me.”
Anna also said that her anger showed that she was overly nice, out of her love for people, but that she had the right to set boundaries and stick up for herself, and didn’t always have to be a people-pleaser.
The Positive Reframing proved to be a positive shock to the system, and Anna’s symptoms started to improve significantly even before starting the M = Methods phase of the TEAM-CBT treatment.
The Positive Reframing made it relatively easy for Anna to smash the negative, self-critical thoughts that triggered her depression, anxiety, shame, and hopelessness, and then they moved on to other goals, such as using the Five Secrets of Effective Communication in her interactions with colleagues and friends.
Finally, they focused on self-image issues, which brings us back to the question Estafonia had posed at the start of the podcast: How you can help patients with self-image problems and addictions to eating?
Anna explained that when she was depressed, she had gained weight because of her addiction to salami (Mmmm!), ice cream (Yummm!), and rice and beans (WOW!) Lorraine used David’s “Devil’s Advocate Technique,” to help Anna challenge the tempting thoughts that always triggered her overeating.
Rhonda and I are incredibly grateful to Lorraine (aka Dr. Wong) and “Anna” for this opportunity to bring TEAM to life in a very real and personal way. Thank you, Lorraine and Anna!
Dr. Lorraine Wong is a certified Level 4 TEAM-CBT therapist and practices at the Feeling Good Institute in Mountain View, California. She specializes in the treatment of body image concerns and emotional eating, as well as depression and anxiety, with TEAM-CBT.
Thanks for tuning in!
David and Rhonda
Ask David Five Secrets Relationship Questions
Kate asks: I love listening to your podcasts and am currently reading my way through your book, Feeling Good. I appreciate that you have written and spoken about relationship problems at length, but in what I have read and heard so far I do not see how this can apply to the current climate of casual dating and hook up culture which is fueled by apps such as Tinder.
I don't know how it's possible to build relationships when the dominant mentality is that people are disposable. It feels like no matter how much I find truth in what my date says, stroke them and empathize with them, that they will disappear ('ghost') at the drop of a hat.
I think this may be a significant problem for many of your listeners, and would greatly appreciate your thoughts, as well as any practical steps on how to date in today's world.* * *
Eli asks: Your work has helped me tremendously over the past 2 years. However, recently I’ve discovered something about myself that I don’t know how to change. I’d be really curious to hear your thoughts.
For some reason, when it comes to sex, it seems that I have a lot of self-worth wrapped up in my sex drive. I’m realizing when my wife and I have sex I feel like I’m on top of the world afterwards. I feel so positive the following few days and I feel mentally and emotionally healthy. But it’s devastatingly real that the reverse is true as well... when we don’t have sex (and particularly when I reach out and she’s not in the mood) and when a week or so passes that we don’t have sex, I find myself feeling very insecure. I feel ugly, unlovable and generally less valuable as a person.
Is there an exercise you would recommend for me to discover possible hidden thoughts/emotions that could be causing this? Is it possible to change this about myself?
I want to have a close, intimate relationship with my wife (sexually and non-sexually) but I also want to feel valuable and positive whether or not we’re sexually active.
PS - If, by chance, you address this on the podcast, could you refer to me as “Eli” or something else anonymous as you usually do.
Thank you for all you have do!* * *
Susan asks: You seem like a good person to ask this question partly because you are a man. Someone I know, I won’t say whom, told me he felt emasculated when I asked him to take my car to the gas station to get the wipers replaced.
He said that he should be able to replace them himself but doesn’t actually know how, so he would prefer if I took the car to the service station. I said that was stupid, granted not very diplomatic, and he said that’s what he gets for expressing his feelings, which I frequently complain he does not do.
To me “emasculated“ is more of a concept or a thought. I will not get into toxic masculinity and the patriarchy, but I am curious what you think. By the way, this person and I have benefited a lot from your relationship journal exercise, thankfully we did not need it this time :-)* * *
Knaidu asks: Here’s a specific example which occurred whilst I was trying to use the disarming technique. It is one where I failed to use the technique.
Anyway, I was meeting a friend of mine, and was a running a few min late for our lunch appointment. I couldn't send her text to let her know as I was driving. I arrived at least 5 min late. When I arrived she immediately said
"I knew it all along, you really don't want to meet with me or actually have lunch with me!”
I tried to explain that I was stuck in a traffic jam and couldn't text, but it didn’t work. Here’s what I said:
“Please Mrs. X, I was stuck in a traffic jam and that's why I am late. Have I ever said I don't want to meet with you? And if I didn't why have I bothered to arrive at all, I mean I could have just not arrived if I didn't want to meet you!"
After I said that she stormed off.
I am afraid I could agree with her idea that I didn't really want to meet with her, because the truth was I did want to meet but couldn't help being late. I could agree with something that was not real to me and if I did try to agree, I would be lying to her.
Please help me, David and Rhonda!
Thanks for tuning in, and keep the great questions coming!
David and Rhonda
New Ask David Questions
- Kelly asks: Would love to hear a podcast about to use or not to use touch in therapy. I personally feel touch is extremely helpful (what is more natural than to hug or put a hand on someone hurting), however I believe our profession has become so “professionalized” that is leaves out such a power act of healing. Did you ever use touch when you were practicing, and do you feel it is appropriate?
- Against Machines Taking Over asks: You say that depression always results from distorted thoughts. But the sadness that results from a failure, rejection, or disappointment is not distorted. Can you explain a bit more about this?
- Against Machines Taking Over also asks: Is there something you used to advocate for before but then you changed your mind?
- Eduardo asks: How do you treat hypochondriasis. Almost all articles and advices I've read for hypochondriasis try to cover the writer's back by first and foremost telling you that you should get yourself checked for real causes for your concern.
- Eduardo also asks: I've been struggling with anxiety, and after reading When Panic Attacks, I got very interested in giving The Hidden Emotion model a try, but it seems to be structure-less. It seems to require a lot of detective work with no clear sheet or procedure. It's just Detective Work, and then do something about it. Is there some newer technique to dig into what's eating you?
In today's podcast, Rhonda and I interview the incredibly brilliant, funny, and creative Amy Spector. Amy is a licensed marriage and family therapist and credentialed school counselor with over a decade of experience working with adolescents and their families. She is passionate about providing school-based mental health services and advocates for legislation to mandate universal mental health care for youth.
Amy works with "at risk" teenagers at Vicente High School in Martinez, California. This is a continuation high school, as well as teens at Briones School, an independent study school. Her students are credit deficient and at risk of not graduating from high school. Nearly all have experienced significant trauma and most are severely depressed, anxious and angry when first referred to Amy, and some have suicidal thoughts or urges as well.
Although you might think that this would be an exceptionally challenging, oppositional, and frustrating group to work with, Amy has had tremendous success treating these teenagers with TEAM-CBT. She measures symptom severity at the start and end of every session, just as we do with adults, and often reports a phenomenal reduction of 60% in depression and anxiety in a single, 30-minute therapy session. Although this may be hard, or even impossible, to believe, it is real, and you'll see why when you listen to this amazing interview. Amy's secret involves a combination of superb E = Empathy skills to form a meaningful relationship, along with A = Paradoxical Agenda Setting to reduce resistance, followed by truly creative applications of M = Methods. And, of course, she does T = Testing with every student at every session, and plots her effectiveness over time.
Amy describes her work with a severely anxious young man with artistic skills, who drew an "Anxiety Hero" figure who saves the world by worrying constantly about every little thing, plus a "Chilled Out" figure who never worries and ends up getting hit by a bus. In other words, Amy skillfully emphasized the many BENEFITS of the young's man's constant anxiety, as well as the downside of getting cured. This paradoxically boosted his motivation, and he improved rapidly.
This is prototypical TEAM, which is difficult for many therapists to learn, because therapists are so used to, and addicted to, "helping." Amy has developed expertise in aligning with the resistance of her students. paradoxically, she ends up on the same page, and this allows some awesome TEAMwork to emerge.
Amy, Rhonda and David talk about the idea of teaching TEAM through creative innovations, with many examples of games Amy has created. For example, she created a game with another one of our fabulous TEAM-CBT therapists, Brandon Vance, MD, which can be played with teens and adults, called "Tune In / Tune Up." This game provides a really fun way to learn the 5-Secrets of Effective Communication. If you're interested, you can check it out at www.gamefulmind.com.
Amy and her students have also created a podcast that you might want check out.
Although I (David) have been primarily an adult shrink, I have really enjoyed working with teenagers as well. A few years back, I tested hundreds of juveniles who had been arrested in California, many for violent crimes, including murder, at the request of the probation department, using my Brief Mood Survey to find out how depressed, anxious, suicidal, and angry the kids were.
Toward the end of the podcast, I describe what happened when I was invited to visit two groups of incarcerated gang members at the Juvenile Hall in San Mateo, California to find out how they felt about the tests I administered, and to get their take on the causes of so much teen violence.
I think you'll find this episode to be fun, funny, and inspiring! Amy is a strong advocate for including mental health training in high schools, and her experience illustrates the enormous potential for rapid and profound mental health growth and learning in teens.
If you would like to contact Amy, she can be reached at email@example.com.
Are there some special techniques therapists need to use when working with LGBTQ patients?
Does the therapeutic approach have to be different?
In today’s podcast, Rhonda and David interview Kyle Jones, a brilliant 5th year PhD student at Palo Alto University. Kyle has been a member of David’s training group at Stanford for the past four years, and now sees patients at the Feeling Good Institute in Mt. View, California. Today’s program is based on Kyle’s doctoral research on the treatment of LGBTQ patients.
To get the interview started, Kyle defines LGBTQ:
L = lesbian
G = gay
B = bisexual
T = transsexual
Q = questioning, or queer.
Then Rhonda asks the obvious question: How does the treatment of LGBTQ individuals differ from the treatment of individuals who are heterosexual? What are the key differences? What special techniques or procedures should therapists use? And what does Kyle’s research reveal about the important factors in the treatment of gay individuals?
Kyle emphasizes that most important factor is the therapist’s attitude toward the patient, as opposed to any special techniques or procedures that are unique to the treatment of the gay population. Sensitivity to and awareness of the unique challenges this population faces in terms of hatred and prejudice are tremendously important. Kyle points out that some therapists place an excessive focus on the patient’s gayness, while some tend to sweep this “uncomfortable” issue under the rug.
Kyle emphasizes that the therapeutic approach is largely the same for gay and straight patients. In TEAM, we first provide strong empathy, so the patient feels understood and accepted. This, of course, is crucial for all patients. Then we set the agenda, asking the patient if she or he wants help, and if so, what is the problem that he or she wants help with?
In other words, there is no special “agenda” that the therapist should impose on the treatment simply because the patient is gay. Kyle mentions that this is not a trivial point, because many therapists will try to set the agenda for the patient, thinking there is some “correct” way one should treat gay people, or some “correct” set of issues that must be addressed. David points out that thinking there is a special approach to gay patients could actually be viewed as a type of bias, thinking that the treatment of members of the LGBTQ community must be somehow “different” or special.
In TEAM, we do NOT treat disorders, diagnoses, or “types” of patients. We treat humans in a highly individualize way, using the fractal approach described in a previous podcast. In other words, we ask the client to describe one specific moment when he or she was upset and wants help. Then the treatment flows from the exploration of that specific moment, because all the patient’s problems will be encapsulated in how she or he was thinking, feeling, and behaving at that moment. The treatment might then focus on depression, anxiety, a relationship problem, or a habit or addiction.
Rhonda, Kyle and David discuss the problem of therapists who have a strong anti-gay bias. David talks about his father's work, trying to convert gay students at the University of Arizona after he retired from his work as a Lutheran Minister in Phoenix, and how much shame and anger David felt about this. David described his positive bias toward LGBTQ individuals, because of the suffering most have had to endure due to hatred and prejudice.
David asks whether gays therapists are obligated to announce their sexual orientation to their patients, and Rhonda and Kyle come up with some pretty cool answers! Rhonda points out that when and how to do self-disclosure is a question all therapists face, and that the goal of self-disclosure in therapy should be on how best to help the patient, not the therapist. Again, this question of the hows, whens and ifs of self-disclosure is a general therapy issue, and not something specific to gay therapists.
Kyle and David reflect on some of the personal work Kyle did during his training program, and how important that work has been to Kyle as he has evolved into a dynamic, compassionate therapist and teacher. They reminisce about the first personal work Kyle did with David on one of the Sunday hikes. Kyle was feeling depressed because he’d just been rejected, unexpectedly, by his boyfriend, and was able to turn the situation around dramatically and quickly using TEAM-CBT. Kyle also describes his own discovery during college that he was gay, and what happened when he shared his sexual orientation with his parents and brother.
The message of this podcast turned out to be pretty simple and basic. The key to the effective treatment of all of our patients is acceptance. The therapist needs to accept the patient, and the patient needs to learn to accept himself or herself. In fact, acceptance seems to be the path to recovery and enlightenment for all of us, whether gay or straight!
David D. Burns, MD, Rhonda Barovsky, PsyD and Kyle Jones (PhD candidate)
What can you do when you can’t identify your negative thoughts? Is it really true that our feelings always result from negative thoughts? How can I get over my public speaking anxiety?
Rubens, a faithful and enthusiastic Feeling Good Podcast fan, sent me an email with a terrific question that has both practical and theoretical implications. He wrote:
Dear Mr. David,
I've read "Feeling Good" and I'm reading "When Panic Attacks" now. Both have and are helping me immensely.
However, the one thing I have never understood is that my anxieties and worries often don't come as a thought. For instance, I have an academic presentation tomorrow, and I'm suffering from much anxiety because of that. But the symptoms did not appear because I thought in my mind the sentence "you are going to fail!". In my case, it is usually silent. I just remember that I have a presentation tomorrow, then I immediately feel worried. My chest hurts before any thought. How do I counter-argument my thoughts, if I have none?
Thank you for replying, Mr. David!
In today's podcast, Rhonda and I address this question and explain what to do when you can't pinpoint your negative thoughts. There are two really good methods.
We will also demonstrate how to deal with some of the negative thoughts that typically trigger public speaking anxiety. The cure involves changing the way you think, and changing the way you communicate with the people in your audience. If you've ever struggled with public speaking anxiety, this podcast may be helpful for you!
Thank you again, Rubens, for your excellent question!
David D. Burns, MD / Rhonda Barovsky, PsyD
I recently published the results of a survey of Feeling Good Podcast fans like yourself. The findings were overwhelmingly positive and illuminating. However, there were a few criticisms as well, like the excellent and thoughtful comments Rhonda and I will address in this podcast. I appreciate negative feedback, as this provides the greatest opportunities for growth and learning.
However, like most people, I sometimes find criticisms emotionally challenging and want to lash out, defending myself! Do you sometimes feel that way, too?
When I feel defensive, its because I think I have a "self" or some cherished "territory" that's under attack. When I let go of this "self," it can be incredibly liberating to find truth in a criticism and discover that the feedback is really coming from a trusted colleague or friend, rather than some enemy who is trying to destroy or defeat you!
Here's what s/he wrote:
Dr. Burns, you seem to disregard healing modalities outside of CBT. CBT is wonderful and nobody teachers it better than Dr Burns—I believe that it is a foundational practice to well-being. However, working with difficult emotions is very important and not always well addressed through CBT alone.
Thinking CBT is the answer for most issues is loaded with cognitive distortions. Example--Discounting the Positive in other practices, All or Nothing Thinking, Magical Thinking, and seeing CBT as a “cure all.” In my personal healing journey CBT has been absolutely essential--as has self compassion, learning to let things go, inner child work, mindfulness, somatic awareness and more. I have noticed there has repeatedly been a dismissive tone for other valuable practices.
Obviously. the Feeling Good Podcast is about CBT and sticking to your expertise is essential. However, I would be careful not to disregard other healing practices that could potentially help someone out.
I have such respect for Dr Burns and his team-but your words carry weight- please be thoughtful about discounting other methods that could be helping someone.
Thank you, whoever you are, for this thought-provoking feedback. And you are SO RIGHT. Cognitive Therapy has value for some problems, but it is definitely NOT a panacea. In fact, no treatment is! The belief that you have THE ANSWER for everything is incredibly misguided but unfortunately, way too common in our field.
I have no doubt that many people have shared your concerns. Let us know what you think after you hear today's podcast!
David and Rhonda
How would you overcome the fear of aging? Can you use TEAM for sports psychology? Describe your typical day, David-- do you ever get down or anxious?
Thanks for your many and awesome questions. I love to answer them! And there will be more to come in future podcasts. Your questions are GREAT!
- Vipul: Tell us about your new book, Feeling Great. How will it be different from Feeling Good? And can people with schizoaffective disorder be helped? (story with Stirling Moorey)
- Guy: What’s a nervous breakdown?
- Rob: How would you treat a field goal kicker who’s afraid of missing the winning field goal? Would you use positive visualizations?
- Michael: How would you treat someone with the fear of aging? I turn 60 in a few months, and have been experiencing anxiety around not be able to do some of the things I love as I age.
- Hidem: How fast is fast? I notice your frequent use of the term "High Speed Recovery" (and even Warp Speed) when describing the benefits of TEAM CBT. How rapidly does the average patient recover?
- Brittany: I had an idea that I think would benefit a lot of us. I’d like you to do a podcast on a week or a day in your life. The ups & downs of your moods, triggers, etc., & most importantly how you deal with them. Do you write out your own Negative Thoughts a Daily Mood Log?
Thank you for all of your great questions, comments, and testimonials! Rhonda and I really appreciate that!
David and Rhonda
PS Here's a great question we did not get to today. We'll do it in a future Ask David, as it's really important.
- Rubens: What can you do when you can’t identify your negative thoughts? I get anxious, but don’t seem to have any negative thoughts. Is it really true that our feelings always result from negative thoughts?
Is it REALLY Possible? And Can the Effects Last?
Rhonda and David interview Garry, a veteran who David treated for PTSD several years ago at a trauma workshop in Michigan. Garry describes how a repressed horrific memory from his childhood suddenly and forcefully re-emerged when he smelled some Queen Anne’s Lace that were in blossom. He suddenly remembered how a school bus he was riding home on hit a horse with a boy, Tommy, who was riding bareback, when the horse suddenly lurched in front of the bus. Tommy was Gary’s classmate.
The bus driver said, “Don’t look!” But Garry watched as his friend, who was trapped under the dead horse, “bled out” and died.
Once this totally forgotten memory re-emerged decades later, roughly 18 months prior to Garry’s session with David, it constantly intruded into Garry’s every interaction for the next year and a half. Garry says,
“I was seeing Tommy all the time, and having symptoms of anxiety, intrusive memory and dissociation experiences. I would often see the image of Tommy lying on the pavement superimposed over conversations I was happened with people in an intimate way. It was quite disturbing and anxiety provoking.”
Garry tearfully describes what he experienced during his TEAM-CBT session with David, including his dissociation at one point during the session, and the profound changes he experienced by the end of the session.
Can severe PTSD be treated in a single therapy session? Did Garry really improve? Were the changes real? Did they last? And how did the therapy work?
You’ll find out when you listen to this amazing and inspiring interview! We are incredibly indebted to Garry for his courage and openness to share this experience with all of you!
Most people do not do a very good at helping loved ones, colleagues, or friends who are upset and complaining. Have you ever noticed that when you try to help or give advice they just keep complaining? This can be very frustrating--fortunately there's a fabulous solution to this universal problem.
This special podcast features our guest, Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute. Jill is also one of the teachers at David's Tuesday evening psychotherapy training group at Stanford, as is our esteemed podcast host, Dr. Rhonda.
Jill describes the "helping" errors she made when her son became despondent after some painful foot surgery. Following the surgery, he was in a cast for weeks, and when the cast was removed, he discovered that he could not move or feel his toes. This is common, and results from muscle atrophy when you are in a cast, and is not dangerous.
However, Jill's son was very discouraged and frustrated, and told his mom that he didn't feel like going to school and thought he wasn't ever going to get better. Jill felt exhausted from all the demands on her that day, trying to get him off to school, and trying to get to work on time, and so forth, and gave in to the urge to say things like, "You're going to be fine," which were totally ineffective.
Jill describes a similar error that she made when her mother also complained about foot problems and the need for surgery. Her mother loves to hike and was upset that she'd be unable to hike for some time. Jill, perhaps feeling a little impatient with her mom, suggested other forms of exercise, like swimming, and this simply increased her mother's complaints.
I'll bet you've experienced this same thing when you tried to "help" someone who was complaining. Even therapists make this type of error all the time.
Rhonda, Jill, and I discussed the most common errors we all make when we lose patience with someone who's complaining, and illustrated the techniques that are effective. As usual, they involve the Five Secrets of Effective Communication, especially Disarming, Stroking, and Feeling Empathy, along with some compassionate I Feel Statements.
We also discussed the phenomenon of drifting in and out of Enlightenment, a concept first described by the Buddha. It is easy to drift out of enlightenment when we are rushing around, trying to get breakfast on the table, lunches made, kids to school, and ourselves off to work. It's so easy to feel overwhelmed and frustrated at those moments.
Part of the process may include forgiving ourselves when we make mistakes, and using the 5-Secrets to repair relationships with our loved ones when we do. In fact, this can even lead to deeper and more loving relationships.
We also discussed a closely related and possibly controversial theme--is it okay to use the Five Secrets just to get someone to stop complaining, especially if you're angry with that person and they tend to complain most or all of the time? Do you always have to use the Five Secrets in a totally sincere manner?
I want to thank Dr. Levitt for joining us in this inspiring and illuminating podcast. Whenever Jill teaches, the heavens open up, and this podcast is no exception. Jill is simply a fabulous therapist, teacher, and human being!
David and Rhonda
Many of our podcasts are inspired by listeners like you who send us really cool emails with show ideas. Sometimes the emails are from people wanting self-help with emotional or relationship conflicts. And sometimes, they are from therapists wanting more training and information about TEAM. Rhonda and I love your emails!
Yesterday, I got the following email from Dipti Joshi, one of our listeners and TEAM-CBT therapists from India. Dipti flew all the way from India to Canada with her lovely daughter last summer for my Intensive in Whistler, Canada. I am hopeful that Dipti will one day create the first TEAM Treatment and Training Center in India. How cool would that be!
Here’s the email that Dipti sent me:
I am really enjoying all the educational materials available on your website. Thank you! I will soon be taking my Level 3 TEAM certification exam, and am seeking your kind blessings for the same!
Also, I have a special request for you. Is it possible to have a workshop or podcast on “paradoxical techniques?” I feel this is a very challenging area, and that a lot of skill is needed. Perhaps you can also talk about why paradoxical techniques can be so effective.
Meanwhile can you suggest me something to read or listen to for this?
Thanks, Dipit! Today’s podcast will be an introduction to the use of paradox in TEAM therapy, a kind of overview. When my new book, Feeling Great, comes out, I am hoping to do a series of workshops on a variety of powerful paradoxical techniques. And of course, the new book will have a great deal of instruction on paradoxical techniques as well.
These are the four key components of TEAM:
T = Testing
E = Empathy
A = (Paradoxical) Agenda Setting
M = Methods
In today's podcast, Dr. Rhonda and I will explain why each of these components is inherently paradoxical. For example, when you do the T = Testing, you assess changes in the patient’s symptoms from the start to the end of the session, and the patient rates you on the Empathy and Helpfulness scales as well, When you look at the ratings, you will probably discover that you aren’t helping your patient much, if at all. You may also discover that your perxceptions of how the patient feels, and how the patients feels about you, are off-base, and sometimes alarmingly so.
This can be very disturbing, especially if you’re not use to this kind of information. However, in TEAM, we are actually hoping for failure, and welcome that kind of "disturbing" information. Why is this? Isn’t therapy all about recovery and making positive changes? Why in the world would the therapist want to know that he or she is not helping?
It's because many of the most important breakthroughs in therapy come from the therapist's discovery that he or she is failing. We WANT to fail! Why?
David illustrates this paradox by describing his discovery that he was not actually helping a patient he thought he’d helped enormously. David explains how and why this shocking information led to a tremendous breakthrough.
When you review how your patient rated you at the end of the session, you may discover that your patient gives you failing grades on the E = Empathy scale. The patient’s ratings may indicate that he or she didn't experience you as sufficiently warm and caring, or completely trustworthy, and that you didn’t really “get” how she or he was feeling inside.
Once again, as TEAM therapists we welcome failing grades on the Empathy Scale. Why? It’s because your worst therapeutic failure will nearly always be your greatest success in disguise.
How can this be? It seems absurd, or impossible. Karl Rogers told us that empathy is the necessary and sufficient condition for personality change. So why would a TEAM therapist hope to discover that he or she is failing in this category?
You’ll discover the explanation for this paradox on today’s podcast.
When the patient asks for help during the A = Agenda Setting phase of the session, the TEAM therapist doesn’t jump in and offer to help, using this or that therapy method. In fact, the TEAM therapist will often assume the role of the patient subconscious resistance and argue for the status quo, sincerely encouraging the patient to cling to the feelings of depression, anxiety, shame, worthlessness, hopelessness, and anger. The therapist will bring out all the reasons why the patient should RESIST change.
Why in the world would a therapist want to do that? It sounds crazy! You'll find out on this podcast.
And finally, during the M = Methods phase of the session, the TEAM therapist will be working with the patient on his or her negative thoughts, like, “I’m worthless,” or “I’m not as good as I should be,” or "I'm hopelessly damaged because of the abuse I experienced as a child." And the TEAM therapist’s goal is not success, but rather failing as fast as you can, trying technique after technique that DOESN'T work and the patient's belief in the Negative Thought is still 100%.
Why would a therapist want to fail over and over? Isn’t that the opposite of what a skillful, compassionate, and effective therapist would want to do?
Listen to this podcast and you’ll discover the answer to these questions. You’ll also see that the patient, not the therapist, is the expert in TEAM, and discover how the patient, and not the therapist, guides all the changing.
David and Rhonda talk about the important difference between healthy and unhealthy use of paradoxical ideas and techniques in therapy, and describe how narcissistic therapists may use paradoxical techniques in an effort to manipulate “resistant” or annoying patients. This dysfunctional use of paradox is unfortunately common, and will rarely or never be effective.
David and Rhonda
My wife claims that I never listen! How can I possibly agree with her? My wife left me! How can I correct the distortions in her criticisms? How can you deal with people who constantly wallow in self-pity? And more!
Hi podcast fans,
Today we've got some terrific Five Secrets questions that you have submitted.
- Mike #1: I love your Five Secrets of Effective Communication. Why does secret #4, “I Feel” Statements, not include Thought Empathy?
- Mike #2: I have seen communication models that include expressing and listening for needs. Aren’t needs and wants important and important to express?
- Al: How can I help my wife recognize her many cognitive distortions, like All-or-Nothing Thinking? It seems hopeless!
- Guy: If a loved one says, “You never listen,” how could I possibly find the truth in this statement? How could you genuinely agree with an All-or-Nothing statement such as, “You never ….”?
- Both Sonja and Eileen asked: How can you deal with someone who constantly wallows in self-pity and plays the role of victim. It's exhausting!
Thanks for tuning in, and keep the great questions coming!
David and Rhonda
Session with Rhonda, Part 2
Last week we published the first half of the session with Rhonda, who was struggling with severe performance anxiety about her work as the new host of the Feeling Good Podcast host. We did the initial T = Testing, which indicated many intense negative feelings, as well as E = Empathy phase of TEAM therapy session.
This week, we include the conclusion of the session, with A = Paradoxical Agenda Setting and M = Methods, plus final T = Testing to see how effective, or ineffective the session was.
As a reminder of the first podcast, plus the work done on this podcast, you can review Rhonda's Daily Mood Log here.
When you listen, you will see that the changes Rhonda experienced were amazing,. But were these changes real? It almost seem too easy, and too fast, especially for a problem that started in childhood and persisted right up to the present moment. Was the session just a publicity stunt, perhaps, or some kind of superficial quick fix? David asks Rhonda about this, as well as this question: 'If the changes were real, what caused the changes?
David and Rhonda used many TEAM-CBT techniques they during the session, including these:
- David Empathized with the Five Secrets of Effective Communication at the start of the session during the E = Empathy phase. Of course, good empathy is necessary throughout a therapy session.
- David melted away Rhonda’s resistance during the A = Paradoxical Agenda Setting. These techniques included:
- Straightforward Invitation
- Miracle Cure Question
- Magic Button
- Positive Reframing
- Pivot Question
- Magic Dial
- The M = Methods that were helpful in this session included included:
- The Individual Downward Arrow to identify the Self-Defeating Beliefs that triggered Rhonda’s feelings of inadequacy.Rhonda enjoyed this exercise and felt it was on target. We identified many beliefs, including:
- Perceived Perfectionism
- Achievement Addiction
- Approval Addiction
- Love Addiction
- Fear of Rejection
- Inadequacy schema
- Spotlight Fantasy
- Brushfire Fallacy
- The Interpersonal Downward Arrow to illuminate how Rhonda saw her relationship with her father, with David, and with some other people, including the podcast listeners. This is kind of like Psychoanalysis at warp speed. Rhonda said this felt uncomfortable, perhaps because it cast David somewhat as a dangerous ogre!
- David and Rhonda smashed several of Rhonda’s Self-Defeating Beliefs with the Feared Fantasy Technique
- Identify the Distortions
- Paradoxical Double Standard Technique
- Externalization of Voices
- Acceptance Paradox / Self-Defense Paradigm
- Self-Disclosure / Exposure
- The Experimental Technique
- Thinking in Shades of Gray
- The Individual Downward Arrow to identify the Self-Defeating Beliefs that triggered Rhonda’s feelings of inadequacy.Rhonda enjoyed this exercise and felt it was on target. We identified many beliefs, including:
Finally, if the changes were real, will they last? Or will Rhonda just slip back into more performance anxiety and self-doubt?
You can click on this link if you’d like to review the evolution of Rhonda’s Daily Mood Log during the session, and see her ratings on the Brief Mood Survey before and after the session at this link. You can also review her ratings of David on the Empathy and Helpfulness scales at the end of the session. You can also review her interesting comments on what she liked the least, and what she liked the most about her session with David.
I want to thank Rhonda, my esteemed colleague, friend, and wonderful podcast host, for giving all of this incredible gift of her humanness.
And I, Rhonda, want to thank the most marvelous, compassionate and incredible David Burns, for the gift of healing and facilitating me experiencing enlightenment and peace from these difficult feelings and negative thoughts that were devastating me. I feel so much gratitude, for all of our work together, for you trusting me enough to invite me to be the host of these podcasts, and for the gift of your friendship. Words can't express the full depth of my love for you and for everything you have given me both personally and professionally!
Did you like the personal work we did? Was it helpful for you personally? Rhonda took a chance and was courageous to share intensely personal experience with you. Let us know if you liked this!
If you are a therapist, or an interested patient, let us know if this was it a good learning experience. Would you like to hear more podcasts with live personal work?
We are here to serve you, so share your thoughts and feelings with us, as well as your wish list for future podcasts!
David and Rhonda
"I sound stupid! . . . Ouch!"
Have you every struggled with performance anxiety, thinking you might fail or not be good enough? I think it is fair to say that every therapist in my Tuesday training group at Stanford has struggled with fairly intense feelings of anxiety and self-doubt, and perhaps you have, too, thinking you should be smarter or better than you are, and fearing that others would judge you if they saw your “true self.” In fact, I would suspect that most of our podcast fans have struggled with these feelings at some time during your life, and maybe even recently or now.
Well, today, we’ve got a wonderful program in store for you. Our own Dr. Rhonda Barovsky asked me for personal help with her own anxieties about being the new podcast host. I asked if she wanted to do it live, on a podcast, and she generously agreed!
In this heart-warming and very human session, Rhonda shares the negative thoughts and feelings she had when she listened to herself on several podcasts and begin noticing this or that error she made. She felt intensely down, anxious, ashamed, inadequate, rejected, embarrassed, discouraged, frustrated, and angry, to name just a few of her negative feelings, and her mind was flooded with negative thoughts like these:
- I sound stupid and inarticulate, and some of my comments were inaccurate, like when I said psychiatric diagnoses are meaningless labels.
- I’ve had feelings of insecurity ever since I was a child, and should be over this by now!
- David is going to regret having me as the podcast host!
- Everyone will know I’m a fraud, and no one will like or respect me.
- People will judge and reject me, and I’ll end up ostracized and alone.
She believed these thoughts at 100%. You might recall that the Necessary and Sufficient Conditions for emotional distress are:
- You have one or more negative thoughts.
- You believe the negative thoughts.
In today’s podcast, you will hear the first half of the session, which included T = Testing as well as E = Empathy. During the Empathy phase, David also included two Uncovering Techniques, the individual Downward Arrow Technique and the Interpersonal Downward Arrow Technique, so that he and Rhonda could identify the Self-Defeating Beliefs under the surface, like Perfectionism, Perceived Perfectionism, the Approval Addiction, Superwoman, and more.
This is because there are two goals in TEAM-CBT. The first goal is to crush the negative thoughts in the here and now, so that you’ll feel relief. The second goal is to modify the Self-Defeating Beliefs so you’ll be less prone to similar thoughts and feelings in the future.
In next week’s podcast, you will hear the second half of the session, which included A = (Paradoxical) Agenda Setting and M = Methods. You’ll also hear the final T = Testing to find out how effective the session was, and how Rhonda rated David on Empathy and Helpfulness.
I think you’ll find that both sessions are incredibly inspiring and wonderful sources of learning as well. I want to give a shout out to Rhonda for being so courageous and vulnerable and real, and for making this live therapy session possible! After you’ve heard Part 2 next week, let us know what you think!
You’ve all responded very positively to the live therapy we’ve done on the Feeling Good Podcasts, and you’ve asked for more. Rhonda and I are committed to making that happen for you, and we are both so grateful for your support, which means a lot to both of us. Thank you!
David and Rhonda
Are the rapid changes real? And do they last?
In the Spring of 2017, we published our first live TEAM therapy session so our listeners could peak behind closed doors to see an actual TEAM therapy session. Although the session lasted about two hours, we broke it up into seven consecutive podcasts including expert commentary on each segment of the session.
If you have not yet heard them, they were Feeling Good Podcast #29, published on April 10, 2017 through Podcast #35, on May 1, 2017 which was exactly two years from the time today’s podcast was recorded.
My co-therapist for this session was Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mt. View, California. Our patient was a physician named Mark who’d had two goals for his life when he was growing up. The first goal was to become an outstanding doctor. The second goal was to have a large and loving family.
At the start of the session, Mark confessed that although he’d achieved his first goal, he’d failed to achieve his second goal because he wasn’t able to get close to his sons, especially his oldest son. At the start of the session he rated his relationship with his son on the Relationship Satisfaction Scale as only 2 out of 30, an extraordinarily low score. In addition, his scores on the Daily Mood Log indicated he felt very sad, unhappy, guilty, and ashamed. He also felt very inadequate, lonely, self-conscious, discouraged and defeated, frustrated, and somewhat resentful and upset, too. He confessed that he’d felt this way for years.
By the end of the session, these feelings had largely disappeared, and Mark was in a state of joy. In fact, we all felt elated—but will it last?
Many people complain that the rapid and dramatic change I experienced when I do TEAM therapy cannot be real, and cannot last, and that it has to be superficial or fake. They insist that real change can only unfold slowly, over years, or even after a decade or more of talk therapy. I respect critical thinking, and if you’d told me that such rapid and dramatic changes were possible ten years ago, before TEAM had emerged with all the new technology, I would have thought you were a con artist too!
Of course, others have argued the other side of the coin, pointing out that TEAM is research-based and genuinely appears to represent a significant, or even amazing breakthrough in psychotherapy for depression and anxiety, and that the changes ARE real. They have also argued that rapid change should be the goal of treatment, rather than just nursing people along for prolonged periods of time without tangible and measurable changes.
Rhonda and I had the wonderful opportunity of sitting down to interview Mark this last Sunday, following one of my Sunday hikes, so we could try to get some answers to these questions. We asked Mark whether he now felt that the changes were real, and how he’d been doing in the two years since the session. Did the changes last?
The interview with Mark was pretty mind-blowing. He confessed that at the start of the session he, too, was very skeptical that years and years of negative feelings could be reversed in a single therapy session. Then he summarized the session he’d had with Dr. Levitt and me in May of 2017, and his tears flowed once again, as he recalled his feelings of failure at being unable to connect with his sons.
Rhonda asked Mark what happened after the session. Did he just relapse back into the same way he’d been feeling?
Mark said that right after his session, there was an amazing and almost instantaneous transformation of his relationships with all of his sons. He used the Five Secrets of Effective Communication for the first time in his interactions with his sons, and they opened up immediately. He has felt extremely happy, over joyed, really, and reported that:
- The changes were VERY real!
- The changes DID last.
- His relationships with his children and grandchildren are now fantastic.
Rhonda and I are incredibly indebted to Mark for giving us such a transformative and inspiring interview! It probably won’t quiet all of the critics, but this information may be illuminating and inspiring for those who are intrigued by the many new developments in TEAM-CBT.
And my message to those who are still critical of TEAM, or critical of me—please continue to use your critical thinking and skepticism when you evaluate TEAM or any other approach. It was my own skepticism about the things I learned during my residency training and clinical work that actually led to the emergence of TEAM therapy. I don’t want to quiet my critics, I want to praise all of you!
David and Rhonda
Coming Up Soon
Follow-Up with Gary: Rhonda and David interview Gary, a veteran who David treated for PTSD several years ago at a trauma workshop. Gary describes how a repressed horrific memory from his childhood suddenly and forcefully re-emerged when he smelled some Queen Anne’s Lace that were in blossom, and what he experienced during his TEAM-CBT session with David.
Can severe PTSD be treated in a single therapy session? You’ll find out when you listen to this amazing and emotional interview with Gary!
Do I have ADHD? Is it a real disorder?
Hi podcast fans,
Today we've got some terrific questions that you have submitted.
- Jose and Bri both asked: How would you treat hypochondria?
- Christian: How would you treat an abuse survivor? I’ve heard that talk therapy is inadequate for healing trauma!
- Ted: Is there such a thing as healthy euphoria?
- Hillary: Would you do a podcast covering the treatment of mania?
- Jim: I think I have ADHD, but some doctors claim it’s not a true diagnosis. What do you think?
- Dan: What your thoughts are on LSD in the treatment of depression and anxiety?
I could not get to all of your excellent questions in the time provided. The next time we do Ask David with general questions, we will include these:
- Guy: What’s a nervous breakdown?
- Rob: How would you treat a field goal kicker who’s afraid of missing the winning field goal? Would you use positive visualizations?
- Michael: How would you treat someone with the fear of aging? I turn 60 in a few months!
- Hidem: How fast is fast? You seem to get super-fast recoveries from your patients most of the time. How about other therapists? How rapidly does the average patient recover>
- Rubens: What you can do when you're upset but can't identify any negtaive thoughts?
Next week, our Ask David will focus on questions about relationship conflicts and problems. Rhonda and I have lots of other cool programs planned in upcoming weeks.
Thanks for tuning in today, and over the past months. We will hit one million downloads in a week or two (this is April, 2019). Rhonda, Fabrice, and I deeply appreciate your support!
David and Rhonda
Hi podcast fans,David and Rhonda discuss and old controversy: Can a self-help book can really help? Or will you need psychotherapy and / or an antidepressant if you are seriously depressed?
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I (DB) wrote up the following overview of bibliotherapy research prior to today’s recording with Rhonda. I hope you find it interesting!
I have to admit that I’ve never had much respect for self-help books. Many of them seem to be written by narcissistic individuals with pretty superficial ideas who mainly want to promote themselves, and this has been my strong bias as well. When I pick one up in a bookstore, I nearly always get immediately turned off. And I get a flood of them in the mail as well, from authors asking for an endorsement. I have a policy of not doing book or product endorsements—it’s the easiest way to say no.
And I never thought of my book, Feeling Good: The new Mood Therapy, as a self-help book. My idea was that people receiving cognitive therapy could read it between sessions as a way of speeding up their recovery, so that the therapist could do the individual work and not have to do so much teaching about the basic concepts, like my list of ten cognitive distortions.
But at the same time, shortly after the book was released, I began getting letters, and later on emails, from individuals who said they book had actually caused them to recover from pretty severe depression. In fact, over the years, I would guess I’ve received more than ten thousand letters or emails like that, and probably way more than that, maybe even fifty thousand.
Still, it had not occurred to me that it might actually be a self-help book, in spite of the fact that lots of the people who wrote me said the book had helped them much more than the treatments they’d received over the years.
One day a colleague asked if I’d seen the article about my book in the New York Times. Apparently, Dr. Forrest Scogin, a research psychologist from the University of Alabama Medical Center, had studied the effects of reading a self-help book on patients seeking treatment for moderate to severe depression. In a nutshell, their studies indicated that simply reading Feeling Good may help some patients overcome depression and may help to prevent future relapses as well. This finding was a shock, but was not entirely unexpected due to all the testimonials I’d been received from people who’d read the book.
In their first study, Dr. Forest Scogin and his colleagues told patients seeking treatment for depression that they’d be placed on a four-week waiting list before beginning treatment. Half of the patients were given a copy of either my Feeling Good or a self-help book on depression by Dr. Peter Lewinsohn called Up from Depression. The researchers suggested that the patients could read their book while they were waiting for their first appointment with the psychiatrist.
The other half of the patients who were placed on the four-week waiting list did not receive a copy a self-help book. Both groups of patients were contacted each week by a research assistant who administered a test to assess the severity of depression. The goal of course was to find out if there were any changes in depression in any of the patients.
The results of the study were interesting. Approximately two-thirds of the patients who received one of the self-help books improved or recovered from depression during the four weeks, even though they received no other treatment with drugs or psychotherapy. In fact, they improved to such an extent that most of them did not even need any further treatment. In contrast, the patients who did not receive one of the books failed to improve during the four-week waiting period. As far as I know, this was the first time that the anti-depressant effects of a self-help book had ever been documented in carefully controlled research study published in a scientific journal.
Then the researchers did a number of additional experiments. First, they gave a copy of one of the two self-help books to the patients in the second group who had not improved. They asked them to wait four more weeks before beginning treatment, but suggested they read the book during their wait. Two-thirds of them also improved and did not need further treatment. This study was published in the medical journal, Gerontologist.
Some critics challenged the study, arguing that the improvement in the patients who received the self-help book might have simply been a placebo effect. In other words, maybe it was just the reading, and the expectation of recovery, that helped, as opposed to the ideas and techniques described in the books.
To test this, the investigators studied a new group of patients who were asked to read a “placebo” book while waiting for treatment. The researchers chose a classic book by Victor Frankl called Man’s Search for Meaning. If these patients also improved, it would confirm that the effect of reading on mood was simply a non-specific “placebo” effect. This is incredibly important, because almost any type of intervention can have a placebo effect, so that as many as 35% of patients will improve just because they think they’ll improve.
Surprisingly, the patients who read the Victor Frankl book did not improve. This exciting finding indicated that a self-help book can have a specific and fairly strong antidepressant effect, but that the book had to contain sound information that was actually helpful to individuals with depression.
Finally, the investigators also did several careful follow-up studies on these patients to find out if the antidepressant effects of Feeling Good and Up from Depression would last. In several additional publications, they reported that these patients did not relapse but maintained their improved moods for periods up to three years, and that they actually continued to improve following their initial Feeling Good “bibliotherapy.
However, they did not report that they were happy all the time. But when they hit bumps in the road, most of them picked up the book again, and re-read the sections that had been the most helpful, and then quickly recovered again.
It’s great that two thirds of the patients improved so rapidly. This result is at least as good as the effects of antidepressants or treatment with psychotherapy—and it’s far cheaper, and with no side effects either! But at the same time, one third of the patients did NOT improve. And of course, you see the same thing with treatment of depression by a psychiatrist or psychologist. In fact, recent research indicates that only 50% of patients, AT MOST, improve with professional treatment.
In my research, I’ve attempted to figure out what’s different about the patients who do not rapidly recover when treated with psychotherapy or Feeling Good bibliotherapy. And I believe I did find out why. To learn about that, you’ll have to listen to the Feeling Good Podcasts or read my new book, Feeling Great, when it comes out. Hopefully fairly soon!
I was pretty inspired by the terrific and important research by Forrest Scogin, and want to thank him!
If you or your patients would like to read one of my “self-help” books, the following table will show you which books are best for which kinds of problems. The reading list at the end is for individuals who might like to check out the original studies by Dr. Scogin and his colleagues.
David and Rhonda
Topic / Problem
Mild to severe depression
Depression and anxiety
All anxiety disorders
This is a simplified ten-step program to overcome depression and boost self-esteem. it is effective individually or in support groups.
- Ackerson J, Scogin F, McKendree-Smith N, Lyman RD (1998) Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology. J Consult Clin Psychol 66: 685-690.
- Floyd M, Rohen N, Shackelford JA, Hubbard KL, Parnell MB, et al. (2006) Two-year follow-up of bibliotherapy and individual cognitive therapy for depressed older adults. Behav Modif 30: 281-294.
- Floyd M, Scogin F, McKendree-Smith N, Floyd DL, Rokke PD (2004) Cognitive therapy for depression: a comparison of individual psychotherapy and bibliotherapy for depressed older adults. Behav Modif 28: 297-318.
- Jamison C, Scogin F (1995) The outcome of cognitive bibliotherapy with depressed adults. J Consult Clin Psychol 63: 644-650.
- Mains JA, Scogin FR (2003) The effectiveness of self-administered treatments: a practice-friendly review of the research. J Clin Psychol 59: 237-246.
- McKendree-Smith NL, Floyd M, Scogin FR (2003) Self-administered treatments for depression: a review. J Clin Psychol 59: 275-288.
- Scogin F, Floyd M, Jamison C, Ackerson J, Landreville P, et al. (1996) Negative outcomes: what is the evidence on self-administered treatments? J Consult Clin Psychol 64: 1086-1089.
- Scogin F, Hamblin D, Beutler L (1987) Bibliotherapy for depressed older adults: a self-help alternative. Gerontologist 27: 383-387.
- Scogin F, Jamison C, Davis N (1990) Two-year follow-up of bibliotherapy for depression in older adults. J Consult Clin Psychol 58: 665-667.
- Scogin F, Jamison C, Gochneaur K (1989) Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. J Consult Clin Psychol 57: 403-407.
- Smith NM, Floyd MR, Jamison CS, and Scogin F (1997) Three-year follow-up of bibliotherapy for depression. J Consult Clin Psychol 65: 324-327.
This is the second of two podcasts on the Story of Sherrie, who experienced some of the symptoms of PTSD after a traumatic event involving her husband. In the first podcast, we played the T, E, and A portions of the session. In this podcast, we will play the M = methods as well as the conclusion of this amazing session.
Dr. Rhonda and I will make some teaching comments on the session as well.
If you'd like to see Sherrie's end-of-session Daily Mood Log, click here.
After the session, Sherrie received some notes from others in the audience.
I think what stood out for me in that session was your authenticity. No mask, no defenses. I fell like we can't really appreciate what our clients are doing when they open themselves up to face their fears until we do it honestly ourselves, and you did--in front of all of us! I feel it was a gift you gave us and I thank you!
Here's another note for Sherrie:
Sherrie, You Rock--I love you--and never met you before tonight. :)
You said No.
You said Yes.
You woke up!
You're a Brave Woman!
What a lucky husband you've got!
A sister, a colleague,
Your session--that was brave!
Shows strong commitment to yourself and to the people you work with. You will be more effective stronger, real, fee, and go even deeper with your clients.
If you want to send a message to Sherrie, use the comment feature below, and I will be sure to forward your thoughts to her!
When people learn about the incredibly rapid recoveries that I am so often seeing with TEAM, they always ask about whether the effects last,or whether the dramatic changes are just a flash in the pan. Of course, Relapse Prevention Training is critical, as negative thoughts and feelings will tend to come back over and over for all of us. That's just part of the human experience. And if you know how to deal with these occasional "relapses," you don't have to worry about them, because you'll know how to crush the negative thoughts and feelings pretty fast.
At any rate, Sherrie's session was more than three years ago, and here's an email I got from her a couple weeks ago:
Hi David. I always enjoy hearing from you!
I agree for you to show the video at the summer intensives, I am actually quite proud of it all so have nothing to hide! You can also do it as a podcast, whatever is workable. I have looked at the podcasts you sent and they look wonderful so will certainly listen to what I can over time!
Okay, so for an update and thank you for asking. The year after my cancer, my husband had his heart attack, so that was four years ago. He is, thank G-d, wonderfully healthy. There is no heart damage and he can do everything he wants to do. And he is even getting better at taking his pills, so I don't have to remind him so much.
I have a question for you as what you do is not what I can or want to do. I think you said you were 75 when we met in the training. So what I don't get is how do you have the energy to see clients, write books, do podcasts, travel all over and do workshops etc? How do you fit all that in? You must want to!
All the best and enjoy spring!
Thanks for listening! David and Rhonda
Oh, my secret is that I am almost always doing what I want to do. Teaching and treating colleagues with TEAM give me tremendous energy, except when I screw up, which is fairly often! But I'm used to making errors by now, and I really love what I do, so I don't think of it as "work," but more like having fun hanging out with friends. It is a bit like when you were a kid and got to go out and play after dinner! That was THE BEST!
Hi Podcast Fans,
There have been many requests for more podcasts on how we would treat trauma, using the TEAM-CBT model. I have done at least 25 workshops on the treatment of trauma in the past several years, and always do a live therapy demonstration at the end of day 1, so people can see with their own eyes how TEAM-CBT actually works. About three years ago, I did a live demonstration with a wonderful woman named Sherrie who was extremely anxious about a traumatic event involving her husband a year earlier. Sherrie kindly and courageous gave me permission to share the audio tract with you. I think you'll really enjoy the session! I want to thank Sherrie for giving us this gift! I also want to thank my co-therapist during the session, Mike Christensen, who is Canada's top expert in TEAM-CBT. Here's our photo at the workshop:
While you are listening, you may want to take a look at Sherrie's Daily Mood Log, which describes the trauma, along with her negative thoughts and feelings. We will publish the first half of the session in this podcast, and the end of the session in the next podcast. We'll also include a live, three-year follow-up with Sherrie that we recorded recently.
Dr. Rhonda and I will make some teaching comments on the session as well.
David and Rhonda
Rhonda, Fabrice and I received a number of thoughtful emails following our recent podcast on mindfulness meditation, which seems to be quite popular these days, but there some push-back from listeners who all did not agree that mindfulness is an effective way of combating negative thoughts and feelings.
Email from Jeremy
I listened to the Feeling Good Podcast on meditation this morning and had some thoughts I wanted to share. For context I've been meditating daily for about 3 months.
First - I personally think that if someone is struggling with depression or anxiety, TEAM-CBT is a dramatically faster acting and more powerful tool than mindfulness. I've never seen or heard about someone having a dramatic recovering in just a few hours due to mindfulness. I've never seen the idea of resistance explored in any kind of mindfulness book or article.
I also don't really think much of mindfulness as a "method" in the TEAM model, because compared to the other methods for removing negative thoughts it's extremely weak. I imagine that with hundreds of hours of mindfulness practice you might reach a point where it's easier to let go of negative thoughts. (There are a lot of reports like that/) However, it's a very slow way of dealing with negative thoughts compared to externalization of voices etc.
I think for a therapist who knows TEAM to suggest mindfulness as a key practice to their patient is almost negligent, since TEAM is so much more effective.
That said, I've sensed a few benefits of mindfulness which is why I've been investing my time in it:
- I think you can view meditation as concentration practice, and I've found that meditation increases my ability to concentrate
- You can reach a very calm and relaxed state in meditation where you cease to have thoughts, and this state is extremely pleasurable
- I've noticed that mindfulness increase my ability to enjoy experiences, including experiences I might enjoy less if I was having even positive or neutral thoughts. As an example, after about 30 minutes of meditation the other day I went for a walk in the woods and stop for about 10 minutes to look at a ridge. My visual experience was completely immersive and I even started to feel like the trees were breathing with me. It was one of the high points of my week. I suspect that even someone who had no negative thoughts might be flooded with positive but irrelevant thoughts (like a yummy meal they might be headed to eat later) would have enjoyed this scene much less.
I've also run an experiment using the PAS and CBT to remove the motivation to have distracting thoughts. (ie write down the advantages to having distracting thoughts and disadvantages of focusing on the breath, and then talk back to those) I would classify it as a highly successful experiment, after talking back to all the good reasons to think about something besides my breath my focus got dramatically better. I wonder if this technique could be used to either improve meditation or even supplant the need for it. (because it gets rid of distracting thoughts directly, while meditation is basically practice for having fewer distracting thoughts)
Anyway, just thought I would share some thoughts and ideas with you.
Email from Paul
Hey, Dr. Burns!
I am with you in terms of the skepticism of mindfulness as a panacea. I also am not sure how particularly effective it is even as a tool in the fight against negative thoughts. I personally cannot seem to get anything out of it, but I am trying to make sense out of how so many people can find it useful.
Perhaps you could put it like this: Mindfulness is not a specific technique for specific problems, but a general method for psychological health. If you have a specific medical condition, you'll want to get a specific treatment. Sometimes specific conditions can be alleviated by taking care of your health generally (eating healthier, sleeping better, etc.) Still, depending upon the disease, in order to get rid of it, you'll need a specific treatment. However, even when you're not dealing with a specific disease, generally good health practices can lower your chances of getting any diseases and lessen the severity when they do arise. In sum, perhaps the goals of mindfulness and CBT are different.
I think that might respect what both you and Fabrice are getting at. I think this goes to answer partly a question I've had about TEAM. To what extent is alleviation of anxiety, depression, etc the final goal? Are there religious, spiritual, or psychological problems that are positive goals beyond relief? In Feeling Good, it sounded like you thought that happiness was just the absence of depression. Is that all there is to say about human flourishing? Or do you methodologically stick within the parameters of your client's value system, asking only "what can I help you with" because you're a psychologist and not a priest, for example?
David and Rhonda discuss several important points raised by these listeners, including:
Non-specific vs. / specific interventions. David describes an elderly man named Ezekiel who had escaped from Nazi Germany as a teenager, and still felt like a “totally worthless human being” in spite of incredible success in life. He’d start out shining shoes on the streets of New York City) and end up as a wealthy industrialist, but that did nothing to boost his self-esteem. He’d decades of psychotherapy as well, but it was not effective.
David encouraged him to jog long distances daily to boost the release of “endorphins” in the brain, but that did not work either. Nor would medication or meditation have worked, either.
When you learn why Ezekiel felt like a “worthless human being,” you’ll see exactly why! And you’ll also learn what did work to end decades of suffering and self-doubt.
The time required for meditation, not only during sessions, but in between sessions, is considerable. David would prefer his patients use this time for doing specific psychotherapy homework.
Formulaic treatment. Life has always been stressful, and people are always looking for some simple “solution” to emotional problems, which seem almost universal. The current wellness fad is a great example of that. So, people promote a healthy diet, daily exercise, daily meditation, daily prayer, relaxation training, deep breathing, expressing gratitude, and a host of other things as the secret of happiness and contentment.
These formulas, in my opinion (DB), do not have, and will never have, more than a placebo effect in the treatment of stress. depression, anxiety disorders, relationship problems, and habits and addictions. Sadly, those who are hugely enthusiastic about one of these fads, or formulas, will not want to hear what I just said, as sometimes we just don’t want to have our beliefs challenged. We see this resistance in politics, in religion, and in almost every aspect of our lives.
Mindfulness is already a TEAM technique, even without meditation--but not a terribly effective method, in David's clinical experience. However, for certain kinds of recurrent negative thoughts, Self-Monitoring and Reattribution can be helpful. These techniques are similar to Mindfulness Meditation, but are only two of more than 100 Methods David uses in treatment, and they are not for everybody. David gives an example of the intensely anxious eye doctor with OCD who was afraid of going blind, who responded to Self-Monitoring and Response Prevention.
There’s nothing wrong with a healthy diet, or meditation, or prayer, or anything that you enjoy, anything that gives you a sense of meaning. But these non-specific approaches should not be confused with specific treatments for depression, anxiety disorders, conflicts in relationships with others, or habits and addictions.
Thanks for listening!
David and Rhonda
How to Overcome Shyness
In a recent podcast, David and Rhonda emphasized the importance of specificity--selecting one specific moment when you want help. This is very true in the treatment of shyness.
Jason, who we introduced in the last podcast, wanted to work on the intense anxiety he felt in the locate grocery store. He thought the woman checking groceries was attractive, but he was terrified about talking to her, or trying to flirt. So he said nothing, and left the store feeling like a failure.
After this humiliating experience, he filled out a Daily Mood Log and listed all the Negative Thoughts and feelings he'd had while waiting to check his groceries. After doing Positive Reframing, he decided on the Negative Though he wanted to work on first: “People will think I’m a self-centered jerk if I try to flirt with her.” David and Jason put this thought in the Recovery Circle and selected more than 20 techniques Jason could use to challenge thought.
On the podcast, David and Rhonda illustrate how to challenge that thought using many of the methods listed on the Recovery Circle, including:
- Identify the Distortions. They found all ten distortions in this thought.
- The Straightforward Technique. This technique was not effective, since the Positive Thought Jason came up with was not valid, and it did not reduce his belief in the Negative Thought. However, this technique did reveal something important about Jason—he seems to see the world in an adversarial way, and imagines he is in competition with others who will try to put him down.
- The Cost-Benefit Analysis. What the are Advantages and Disadvantages of Jason’s Negative Thought? Jason did a remarkable job with this technique, and found it helpful and illuminating.
- The Individual Downward Arrow Technique. David and Rhonda illustrated how this works, using role-playing. They were able to identify five of Jason’s Self-Defeating Beliefs that are extremely common in Social Anxiety, including:
- Perceived Perfectionism
- The Approval Addiction
- The Spotlight Fallacy
- The Brushfire Fallacy
- The Paradoxical Double Standard Technique. What would Jason say to a dear friend who was also struggling with severe shyness? Would he say, “People will think you’re a self-centered jerk if you try to flirt with her.” If not, why not? What would Jason say to a friend? And would he be willing to talk to himself in the same compassionate way? This technique was also very helpful to Jason.
- Examine the Evidence. What’s the evidence that people will think he’s a self-centered jerk if he tries to flirt with a young lady he’s attracted to?
- Survey Technique. Have his friends ever struggled with anxiety when they were starting to date? Would they think of him as a “self-centered jerk” if he was more outgoing and flirtatious? This was a homework assignment, to ask his friends. The information he got was a huge surprise.
- Thinking in Shades of Gray. He thinks he has to sweep her off her feet or he’ll get totally rejected and ostracized by the human race. Is there some easier goal he could shoot for?
- He’s telling himself that if she shoots him down, it will prove that he’s a “loser.” Are there other reasons why a grocery checker might not respond favorably to a young man who is trying to flirt with her?
- Feared Fantasy / Acceptance Paradox. David and Rhonda illustrate this amazing technique, with role-reversals. This technique will help Jason crush the Self-Defeating Beliefs that cause his shyness in the first place, like the Approval Addiction.
These techniques were extremely helpful to Jason, and all of his negative feelings went down dramatically by the end of his first therapy session. However, he will have to do more work outside the office for homework, using Interpersonal Exposure Techniques to confront his fears of rejection, including:
- Smile and Hello practice
- Flirting Training
- Talk show Host
- Rejection Practice
- Shame Attacking Exercises
These assignments terrified Jason, but he courageously agreed and followed through. He had his share of rejections, as we all do, but had some successes, too, and soon was dating a lot and enjoying it, and his shyness became a thing of the past. The treatment only required four sessions.
How to Overcome Shyness
David and Rhonda begin with two emails (among many) from listeners asking for more help on the problem of social anxiety.
Email from “Margaret:”
How do you distinguish a personality disorder - say, for example, Avoidant Personality Disorder, from "just" (and I don't mean that in a derogatory way) being depressed and anxious?
I ask because I have a strong suspicion that I may be suffering from Avoidant Personality Disorder, and I think if you knew my history you would probably agree that there are strong signs (I have been having problems from my early childhood until now, and I am 30 years old now).
Also, a further question – is it possible to have severe anxiety without feeling like the confrontation with the thing you’re afraid of means you’re going to die? I have isolated myself completely, and I have no social life in any sense of the word – my only real contact with the outside world is through my job, because it is a necessity for living. But it’s not because I think I’m going to die if I hang around people – I just very strongly dislike it and ‘shut down’ or ‘freeze’ due to all the thoughts in my head about being negatively judged and watched, so I prefer to avoid contact with people, and in situations where I’m forced to endure it, I’ll usually find ways to ‘avoid’ or escape the situation.
There are many ways I do this – since I was very young I’ve had the habit of purposely looking annoyed, so that people would not approach me, even though I secretly wish they would (oh, the paradox..), and at work I will often be listening to music with earphones – both because the music calms my anxiety, and because it makes me appear less ‘available’ to other people.
In situations where I cannot escape crowds – say, in the canteen during my lunch break - I’ll sit by myself, as far away from everyone else as I can, and leave as soon as I have taken the last bite of my food. In college I would often hide in the bathroom by myself during breaks, or I would avoid interpersonal contact in some other way. And so on and so forth. These are just a few examples – I could give you a million others.
I am aware of my own behavioral patterns but still feel powerless to change them. It’s like being an observer, observing yourself committing the same mistakes over and over, but with an anxiety so strong that rationality alone is not enough to change the behavior. After 30 years of this, it’s getting old. I have never felt any other way, so I cannot fathom what it means to lead a normal life.
I have never had a friend in any usual sense of the term, and I literally never spend time with anyone in my spare time except for my parents. As a consequence, I have never learned or understood how to make friends, and I have never been in an intimate relationship, or taken part in any of the social activities that are normal to other people (parties, school dances, etc.) The simplest things are rocket science to me. So, I’m interested to know when a person crosses over from “simply” being depressed or anxious into having a personality disorder.
If you use any of this for a future episode I am fine with that - you can even quote me directly. But I only ask that you please don't use my real name as to not jeopardize my job and so on. Thank you. 🙂
David explains that there is no such thing as “Avoidant Personality Disorder.” It is just an imaginary concept created by the American Psychiatric Association, and is applied to individuals with shyness that is so severe that it causes significant problems in their lives.
And yes, you can definitely deal with mild, moderate, or even extremely severe problems with the TEAM-CBT as well as exercises in my books, such as The Feeling Good Handbook, When Panic Attacks, and Intimate Connections.
They also read an email from “Abdul,” a podcast fan who’s been struggling with shyness.
I’m from Pakistan. Please make podcasts on shyness and public speaking and other anxiety issues.
I have anxiety shyness. My father has also anxiety. I know he is not happy. I also sometime feel exactly like him.
And one of my cousins is very much depressed. He is a cleaner in a garments shop. He always use to pack clothes all the time even if they are kept properly.
Dr burns please guide us. It would be very very helpful.
Sorry if I wrote anything unprofessional.
Several days later, David received an additional email from “Abdul:”
My social anxiety has returned back. In my office I feel very lonely.
Here my negative thoughts:
- I should say something impressive.
- I'm good looking so I should not be anxious.
- I should talk to girls.
- I should say hi to people.
- I should mix with people.
Today and next week, David and Rhonda will describe how to treat / overcome shyness using TEAM-CBT. David explains that this is probably his favorite problem to treat, since he himself has struggled with every conceivable form of social anxiety, so he really knows how to defeat this problem.
But to start out, David and Rhonda want to see how shy YOU are, so they administered David's Shyness Test verbally to listeners. if you'd like to take the paper and pencil version, click here. You'll also find the scoring.
How did you do on the Shyness Test?
We'll publish them next week, too. You'll find Jason's Daily Mood Log, the Recovery Circle, the Downward Arrow Technique, and more. These visuals will help your learning!
We always start with a Daily Mood Log, focusing on how you were thinking and feeling at a specific moment when you felt shy. We don’t just throw techniques at patients based on a problem (shyness) or diagnosis (Social Anxiety Disorder). We're all different, so the treatment is highly individualized.
Rhonda and David describe a shy young man named Jason who wanted to flirt with an attractive woman checking groceries when he was inline at his local supermarket on a Saturday. However, he was flooded with Negative Thoughts and feelings, and by the time he got to the front of the line, he was so terrified that he avoided all eye contact with the checker, and didn't even say a word to her, when she checked his groceries. He left the store feeling like a total loser.
David and Rhonda talk about reducing the Outcome and Process Resistance before trying to “help” Jason, or any one who's anxious. Outcome Resistance means that Jason may have some pretty strong resistance to recovery, in spite of how much he's suffered, even if all he had to do was to press a Magic Button and be instantly cured.
Process Resistance, in contrast, means that if Jason does want to recover, he’ll have to use some Interpersonal Exposure Techniques that will be frightening to him. Is he willing to do that if David agrees to treat his shyness?
David and Rhonda illustrate how to do Positive Reframing , listing all the really positive things about Jason's negative thoughts and feelings. They encourage listeners to turn off the podcast briefly, and see if they can list some positives before listening to the list that David and Rhonda generated. I'd encourage you to do that, too, while listening. Try it yourself before you see the "answers."
They discuss how they might issue a Gentle Ultimatum, along with Dangling the Carrot and “Sitting with Open Hands,” to reduce Jason’s Process Resistance.
Once Jason's resistance has been reduced, they will go on to the M = Methods of the session, and focus on how to help Jason challenge the Negative Thoughts that Jason had while standing in line waiting to check his groceries.
Next week, they'll describe the methods they selected and describe what happened when David used them during his session with Jason.
Dear Feeling Good Podcast fans,
I am profoundly sad to say goodbye to my beloved friend and terrific podcast host, Dr. Fabrice Nye, who is leaving the podcast to start his own show this spring. I wish him well on his new podcast he'll be releasing soon. I'll share the specifics when they become available so loyal fans can tune in and follow him!
What a joyous experience it has been working with Fabrice for the last three years. He proposed the idea of a weekly podcast in the fall of 2016 and we produced episode #001 on October 27 of that year. Together we have been able to share TEAM-CBT with many enthusiastic listeners, and just exceeded more than 70,000 downloads monthly. Please join me in wishing him well!
My feelings of profound loss are comforted by welcoming another dear friend and colleague, Dr. Rhonda Barovsky, our new host. Rhonda and I look forward to creating many more fabulous podcasts for all of you.
Rhonda received her doctoral degree in Forensic Psychology from the Eisner Institute for Professional Studies in 2013. Throughout her career, she has been a champion of women’s rights and defender of the victims of childhood sexual abuse. Rhonda is the founder of the San Francisco Juvenile Sex Offender Treatment Program and has served as Director of San Francisco Family Court Services. She has also worked at the San Francisco Rape Treatment Center, providing crisis and short-term counseling for adult survivors of sexual assault and their families.
Rhonda is a certified TEAM-CBT therapist and esteemed teacher. In her clinical practice, she focuses on TEAM-CBT for adults struggling with depression, anxiety disorders, and relationship problems.
She brings warmth, enthusiasm and brilliance to her new role as host of the Feeling Good Podcasts:
"I am extremely honored to be invited to host the Feeling Good Podcast with Dr. David Burns. Fabrice Nye has been a visionary, and his shoes will be impossible to fill. I hope to add to the joy and excitement of learning and teaching TEAM-CBT along with David and having lively and productive discussions.” Dr. Rhonda Barovsky
Rhonda and I will be posting two surveys shortly on my website, www.FeelingGood.com, to find out more about you. I want to find out if you are a therapist or non-therapist, and what kinds of topics might interest you the most.
And unlike some tech giants, we promise to keep your information totally confidential. We don’t sell information; we just want to do the best job we can for therapists and non-therapists alike, for free. If you are a "patient," we want to accelerate your learning and your recovery as well. If you are a "therapist," we want to help you improve you skills and your joy in your clinical work.
I put the words, "patient" and "therapist" in quotes, because the line between the two is very narrow indeed! As "therapists," most of us struggle at times with the same human dilemmas that our patients face. And as we do our own personal work, as therapists, we bring far more healing and compassion to our work with our "patients!"
On the show, Fabrice and David share fondest memories of the show, and Rhonda talks about new directions as she becomes the host of the Feeling Good Podcast. Fabrice also gives some hints about his new show, which will be broadcast in French and English. Fabrice will describe and translate new developments in psychology research and relate the findings to our daily lives.
Thank you so much for your awesome support over the past 2 ½ years!
Today’s Ask David questions.
- Do depression and anxiety result from medical illnesses, like thyroid problems?
- Do we REALLY create our own interpersonal reality? What if you’re being raped? Are you saying that’s your fault? How can that be?
- I struggle with anxiety. Why is it a mistake to try to “calm down?”
- How do you deal with entitlement? I think my patients should do what I tell them to do! After all, I’m a highly trained professional!
- How do you deal with racism, sexism, and other societal barriers? What if the injustice is real and it isn’t “all in your head?”
And here are the longer versions. Fabrice and I hope you enjoy these thoughtful questions submitted by listeners like you!
1. Barbara asks: 1) How are hypothyroidism, depression, anxiety, and bipolar disorder related, and (2) how are heart disease, depression, and anxiety related?
2. Mark asks: I'm one of your most avid listeners to your podcasts. I've listened to most of Feeling Good Podcasts as well as the recordings of your Facebook live broadcasts with Jill. I absolutely love your content and extremely grateful for your insights and the material you put out for free. I've heard you say numerous times how in interpersonal relationship problems we create the poor behavior we see in the other.
At what point though, is a threshold crossed and you acknowledge the other in the relationship is creating problems? For example, if your client is being raped by their partner and is being threatened with violence if they dare leave, you wouldn't say to your client you're creating that kind of treatment from your partner.
Obviously the above is a very extreme example, but what if its scaled back in terms of severity of abuse, stopping short of physical attacks and threats? Where does a line in the sand get drawn where you acknowledge the client is not creating the problems themselves? I'd deeply appreciate your reply!
3. Angela asks: I was intrigued by your comment in your podcast #88 on Role-Playing Techniques that “trying to calm down is a big mistake. . . then your emotions become your enemies,” but then you said, “that’s a good topic for another podcast.” I hope you do a podcast on that topic!!! I’m eagerly waiting to hear more about that!
4. Julio asks: I’d like to share my experience. I am a therapist and I suffered from, and am still working on, feeling inadequate. I frequently questioned “am I good enough to be a therapist?” “How can I help others if I have issues of my own?”
After reading Feeling Good I realized I frequently jump to conclusions, engage in mind reading, and labeling whenever there is some uncertainty with my clients. At times I might even have blamed them when things didn’t go the way I thought they should go.
I believe I do that to protect my ego, and I might have developed some cognitive distortions related to entitlement such as
- “I’m a therapist, people are supposed to do what I say”
- “I worked too hard and too long and potential employers better give me what I deserve”
- “Because I practice evidence-based therapy, I’m better than 99% of all therapists.”
These entitled thoughts led me to become irate whenever someone didn’t act according to my expectations. I would vacillate between feeling angry and feeling depressed.
I guess when I initially emailed Fabrice I was confused as to how my entitlement develops, but now I’m realizing that it comes from the same distortions that can cause depression. I didn’t know that distortions could produce depression and entitlement.
I’m curious what you and Fabrice think about this. I thoroughly what you and Fabrice think about this. I thoroughly enjoy your podcast and often find myself re-listening to earlier episodes.
5. Holly asks: “ Burns: I have found tremendous value in your books and podcast. I have noticed that you discuss some emails/letters/etc. on your podcast and I have one I'd like to hear you discuss. What are your thoughts on dealing with racism, sexism, and other societal barriers?
For example, it is not uncommon for people with dominant identities (white, male, physically able) to tell women, people of color, or those with physical challenges that their issues are all in their minds and that if they thought differently, then they would have different outcomes.
I am an African-American woman and I don't believe this (the statistics on access to education, employment, and justice all suggest otherwise). What are you saying (if anything) in your writing, practice about thoughts related to injustice?
So there you have it! Great questions, and keep them coming!
Thanks, David and Fabrice
Debbie asks: Can you use TEAM-CBT to help people with medical disorders, such as Parkinsonism or Cancer?
Here is the promised link to Stirling Moorey's book on Cognitive Therapy for cancer patients.
Here is the link the first episode of live therapy with Marilyn, a woman who was diagnosed with Stage 4 lung cancer a couple days before her session with David and Dr. Matthew May. You may also want to listen to podcasts 50 to 52 and 59, which also feature David and Matt working with Marilyn. Marilyn described these inspiring podcasts as mind-blowing!
Mark asks: How can I help a depressed family member or friend who is passive and doesn’t want to do anything?
Paul asks: How can I get over death anxiety?
Sune asks: If you're super-shy, does this mean you have “Avoidant Personality Disorder?” What's the difference between garden variety shyness and a personality disorder?
Sly asks: “Do you believe in the big five personality traits model? And will your therapy tools change these big five traits? I got a score of 67 on neuroticism, which means I am more prone to anger, depression, anxiety, and vulnerability, and tend to think about things in a pessimistic way. If I do the exercises in your books, and develop a more realistic outlook on myself and others, does it follow that my “personality traits” will get more or less changed?”
Here's an important point I forgot to make on the podcast. According to Wikipedia, here's the definition of "Neuroticism:" People with high neuroticism indexes are at risk for the development and onset of common mental disorders. . . such as mood disorders, anxiety disorders, and substance use disorder, symptoms of which had traditionally been called neuroses."
Can you see that this is a tautology? In other words, they ask you if you tend to have these kinds of symptoms, then they tell you this is "due to" some "trait" you have called "neuroticism." But they are defining "neuroticism" as people who tend to have more of these kinds of symptoms! It's circular reasoning.
I hope you can "see" this! The reason I mention this is they make it sound like they discovered some "trait" you have which causes you to have depression, or anxiety, and so forth. But they haven't! It's just a word game. In fact, scientists don't yet know the causes of any of these problems, and "traits" do not actually "exist."
Haike asks: What if you’ve battled your negative thoughts and self-defeating beliefs and still don’t feel happy? An absence of depression and anxiety does not necessarily mean more joy in life. How can you help people find out where they want to go in life, who they want to be, and what it is that brings them happiness?”
If you’re my patient, and you want help, I will ask you what specific problem you want help with. These are the four most common problems I see: depression, anxiety, relationship conflicts, or habits and addictions. Then I’ll ask you to zero in on one specific moment when you were struggling with that problem.
For example, if you want help with depression and low self-esteem, I’ll ask you to describe one moment when you were feeling down. It could be any moment at all—it might even be right now, sitting in my office (or reading this text).
Then I’d ask you to tell me exactly what you were thinking and feeling at that moment. You might be telling yourself, “I’m no good. I shouldn’t have screwed up! I’m always doing that! I’ll feel like this forever.” These thoughts actually cause the feelings of depression, shame, inferiority, and hopelessness.
In contrast, if you want help with anxiety, I will ask you to identify one specific moment when you were feeling anxious, worried, nervous, frightened or panicky. For example, you might have been feeling shy and insecure at a party, or terrified just before you had to take a test or give a talk at work. Or it might have been a moment when you were having a panic attack and feeling like you were on the verge of passing out or losing control and going crazy.
If you’ve been having trouble getting along with a friend or family member, I would ask you to describe one brief interaction you’ve had with the person you’re at odds with, and I’d ask you to write down one specific thing they said to you, end exactly what you said next.
For example, a podcast fan told me that his wife said, “You never listen.” He responded by saying, “That’s not true! I’m listening to you right now.” He was puzzled when she got even more upset and then the argument escalated!
I recently did a one-day workshop on the treatment of unwanted habits and addictions, like procrastination, overeating, excessive cell phone use, or drinking too much. I encouraged the audience members to focus on one specific moment when they felt tempted to procrastinate, binge, or have a drink, or give in to their habit / addiction, and to write down all the Tempting Thoughts that were going through their minds, like:
- Oh, that beer looks SO GOOD!
- I’ve had a hard day, I deserve it.
- I’ll just take one little sip. That can’t hurt!
- There’s a good basketball game on TV. It will be way more fun to watch if I enjoy a few beers!
In each case—of depression, anxiety, a relationship problem, or a habit / addiction—I focus on one brief and specific moment when my patient was upset and having that problem. There are two reason for this concept of Specificity:
- When we understand what was happening at that one brief moment, we will understand everything of importance about that problem. As it turns out, all of your suffering will be encapsulated in that one brief example. So, when you understand why you were feeling depressed or panicky or whatever at that specific moment, you will understand everything you need to know about why you get depressed, or panicky, or whatever at any moment of your life.
- In addition, the moment you learn how to change the way you were thinking, feeling at that one brief moment, you will become enlightened, and you will suddenly grasp the solution to all of your problems. That’s because that one specific problem will simply repeat itself over and over, in slightly different disguises, every time you are depressed, or anxious, or arguing with a friend or family member, or struggling with temptations. So, once you understand the solution to that problem at one specific moment, you will understand the solution to that type of problem at any time in your life.
For example, if you were having a conflict with a loved one, you will not only learn how to resolve that conflict at that specific moment, but you will learn how to resolve any conflict you have with that person, or with practically anybody.
Fabrice and David link this Specificity concept to the amazing insights of the new branch of “fractal geometry.” Fractal geometry is a revolutionary form of mathematics in which a very simple formula, or shape, gets reproduced an infinite number of times. In the process, it morphs from a simple geometric shape and suddenly becomes a complex picture. For example, it may turn into a stunning green fern, or a gorgeous, multi-colored parrot, or a breathtaking landscape. But if you zero in on the tiniest piece of the picture, it will always look exactly the same—the same simple design that started the process.
Similarly, in “fractal psychotherapy,” we zero in on one very brief moment of your life, but the formula—or error—that caused you to become upset at that moment will always be the very same error you make every time you feet inferior or anxious or angry or tempted. And once you’ve changed at that one brief moment, you really will experience enlightenment! And your entire universe will become enlightened as well!
Fabrice provides another metaphor, that of a hologram. A hologram is a photograph that allows to display a fully 3-dimensional picture of an object. The hologram works differently from a regular photograph. Citing from Wikipedia, “When a photograph is cut in half, each piece shows half of the scene. When a hologram is cut in half, the whole scene can still be seen in each piece.” This remains true as you fragment the hologram into smaller and smaller pieces. So you could say that your problem is a kind of hologram of all the problems in your life, in a single moment so you can see the pattern that is repeated in many other situations.
David provides an example of how this works, using an example provided by a podcast fan we'll call Janine. Janine was convinced that her husband couldn’t deal with feelings because he had “Asperger's / high level autism.” David asked Janine for a brief simple exchange between Janine and her husband. what, exactly, did he say to her, and what exactly, did she say next?
That brief moment is all we need to understand her problem; and things suddenly began to look radically different when we examined how she responded to her husband!
You can see the first two steps of Janine's Relationship Journal if you can click here.
It turned out she was right--someone definitely WASN'T dealing with feelings? But who? You'll see two spiritual principles brought to life in the Relationship Journal.
- We create our personal reality at every moment of every day.
- We like to blame others for the problems in our relationships instead of pinpointing our own role in the problem.
- Intimacy, and enlightenment, require a painful death of the ego, or self. When you "look inward" for the cause of the problem, instead of blaming, you will find the answer you've been looking for--but the answer can sometimes be pretty painful.
- If you're willing to let your ego, or "self," die, you will receive a pretty awesome reward in heaven. But this heaven occurs when you are still alive!
In this role-reversal of the traditional Feeling Good Podcast, Dr. David Burns and his special guest, Dr. Rhonda Barovsky, interview Dr. Fabrice Nye, your beloved podcast host, on the topic of Mindfulness and Meditation, which are currently popular with the therapeutic community.
Fabrice answers questions like these:
- What’s mindfulness? How does it differ from meditation?
- What’s the history of mindfulness as well as meditation? Did it originate with the Buddha, or did it date back even earlier?
- What are some of the goals and potential benefits of mindfulness?
- Why specific exercises can you do to develop greater mindfulness ?
- Why is mindfulness helpful? How does it work?
- Some people meditate in silence for prolonged times, like ten days, for example. What is the goal here?
- Are there any dangers of meditation?
- How does mindfulness differ from yoga, relaxation training, and self-hypnosis?
- Some people seem to love and benefit from meditation, and others find it uninteresting or even annoying. Why is this? What's the difference in these two groups of people? Is it okay not to be interested in meditation, or is something that everyone “should” do?
- The goal of mindfulness seems to be learning to deal more effectively with stressful thought and feelings. Does it deal with motivation and the resistance to change? TEAM-CBT makes us aware of the incredible importance of resistance, and provides many methods for reducing or eliminating resistance before you try any Method to “help” the patient. Does Mindfulness Meditation deal with resistance, or would it best be viewed as a method that can help individuals who are already strongly motivated to invest time and effort in their personal growth?
You CAN Defeat Shyness!
Lately, I've gotten lots of emails from podcast fans who struggle with shyness, which is categorized in DSM5 (The Diagnostic and Statistical Manual of Mental Disorders) as "Social Anxiety Disorder." This is one of my favorite things to treat, since I struggled with practically EVERY type of social anxiety early in my life, so I really know how it feels and how to defeat it. It's incredibly common. In fact, when I give workshops for mental health professionals, I sometimes ask how many of them have struggled with shyness or public speaking anxiety, and nearly all the hands go up.
This podcast will be the first of several on this topic, because it's so common and relatively easy to overcome--IF you have the courage!
Here the are several different "flavors" of social anxiety recognized by the American Psychiatric Association, including:
- Public Speaking Anxiety
- Performance Anxiety (such as intense anxiety during a musical or athletic performance)
- Shy Bladder (or Bowel) Syndrome. This is the fear of peeing or pooing in a public restroom, for fear you'll freeze up or make too much noise and others will notice.
- Test Anxiety
One common theme is the fear that others will notice your anxiety or poor performance and judge you. Another common source of suffering is shame of feeling like you are inherently flawed and will be seen as defective or even as insane by others. Sometimes, these fears become so extreme that they can significantly interfere with relationships and leisure-time activities as well as work.
Dan is a podcast fan who courageously immigrated to the United States from Iran as a young man. When he arrived in America, he had little education and almost no knowledge of English. He also suffered from an extreme case of acne, which eventually cleared up, but left him with severe social anxiety.
In spite of these problems, Dan worked hard, learned English, and became a top student in college and in graduate school as well, and went on to develop an excellent career. But in certain performance situations, such as public speaking or interacting with strangers, he panics and trembles and his heart races; his mouth twitches and his voice gets shaky, and he has thoughts like these:
- I'm about to lose control over myself.
- Others will see my symptoms and think I'm mentally insane.
- In spite of making Herculean efforts to control these symptoms, I have failed.
- I will never overcome this.
- I am defective for life.
- I will lose my job.
David and Fabrice remind listeners that they cannot treat anyone through a podcast, and that there are large numbers of treatment techniques that can be extremely helpful in the context of a compassionate and skillful therapeutic relationship. Since Dan is seeing an excellent therapist, they suggest and illustrate five powerful Interpersonal Exposure Techniques that Dan might want to do under the supervision of his therapist, including:
- The Survey Technique
- The Experimental Technique
- Shame Attacking Exercises
- The Feared Fantasy Technique
David and Fabrice also discuss how to address patient and therapist fears of using powerful exposure techniques, and how the avoidance of exposure can sabotage the treatment. They describe four techniques David as developed to help therapists with this, including:
- Dangling the Carrot
- The Gentle Ultimatum
- Sitting with Open Hands
- Fallback Position
David describes "Reverse Hypnosis." This is where the patient hypnotizes the therapist into giving up on exposure thinking that it is "too dangerous," or that the patient isn't "ready" or is "too fragile."
And speaking of anxiety, listeners might want to consider the upcoming workshop by David and his colleague, Dr. Jill Levitt, on the treatment of anxiety disorders on May 19, 2019. Check it out below!
Also, I promised to post my list of 100 Shame Attacking Exercises, so here it is! It's not perfect, so please have low expectations. It does have some value.
Can the Five Secrets of Effective Communication Help Us in this Era of Intensely Polarized Politics?
Clearly, the nation is intensely divided, and passions on both sides of the political divide are characterized by hostility, frustration, and mistrust. Can the Five Secrets of Effective Communication help us communicate with colleagues, friends and loved ones who may have radically different political beliefs?
Find out on this edition of the Feeling Good Podcast, as the David and Fabrice respond to Eileen, a podcast fan who kindly allowed us to share her intensely painful conflict with her mother with all of you. Eileen’s mother is an ardent Trump fan, and Eileen is an equally ardent anti-Trumper, and there have been plenty of tears on both sides of the aisle!
“How can you talk to someone with whom you fundamentally disagree? My Mom is a big fan of the current regime (Trump) and I’m horrified by what’s happened in the past two years and what’s coming. It’s hard for me to get past my rage at her. . . intensely distorted and not-reality based beliefs, fed by right-wing media. To be clear, she thinks exactly the same about my beliefs and information sources. I feel so stuck. . . and I would love to repair this relationship with her before she dies.”
Can you identify with similar conflicts in your own family or circle of friends? I know that I can, and it’s quite painful. Fabrice and I will give you our take on a new approach to this widespread problem this Sunday!
While you're listening, you can take a look at Eileen's Relationship Journal. You may also want to review the Five Secrets of Effective Communication as well as the three advanced communication techniques we discussed in last week's podcast.
Let us know what you think after you've listened to the podcast!
Learning to use the Five Secrets skillfully requires strong motivation and lots of practice, but the benefits can be tremendous. The Five Secrets have transformed my clinical work as well as my personal and professional relationships. And they’ve also had a huge impact on my teaching.
But there are even more communication techniques that can be immensely helpful. In this podcast, we discuss three advanced techniques:
- Changing the Focus. This technique can be tremendously helpful when there’s an “elephant” in the room.
- Multiple Choice Empathy. This technique can be transformative when you’re trying to connect with a teenager, friend or loved one who refuses to talk to you.
- Positive Reframing. This technique can be invaluable when you’re fighting with a colleague, patient, friend or family member, and you’re both feeling frustrated, angry, and upset.
David emphasizes that these techniques may look easy, but they are actually difficult to learn and require lots of practice as well as the mindset of humility, as well as a strong desire to develop a more loving relationships with the person you’re not getting along with.
People who are serious about learning can read Feeling Good Together and do the written exercises while you read!
More Great Questions from Listeners
- Kevin asks: After your initial improvement from treatment or from reading your book, Feeling Good, what can one do moving forward to give yourself “booster shots?”
- Umatsagir asks a related question: I feel great right after reading your book, Feeling Good, but the effect diminishes over time. What should I do?
- Umatsagir also asks: Is there an anxiety masterpiece equivalent of your book, Feeling Good?
- Kyle asks: What can I do, as a therapist, about the passive patient who just shrugs when I ask what he wants to work on, and says, “My Mom thinks I should come to see you.” When I try to dig deeper to try to find out what patients like this want help with, I run into resistance and then they typically drop out of therapy. What should I do?
- Benjamin asks a somewhat related question: How do you treat chronic laziness? In your book, Feeling Good, you call this “Do-Nothingism,” which is a lack of motivation that you often see in depression. In your book, you talk about ten different types of procrastination, with a different approach for each. If the patient feels overwhelmed by many things he or she is procrastinating on, how can you help that person, since he or she probably can’t do the psychotherapy homework, either! It’s a Catch-22, since they cannot find the motivation to do anything, but have to do the homework to improve!
- Jim asks another related question: How about doing a podcast on psychotherapy homework? “What do you have your patients do for homework? This is particularly important since I have 45 minute sessions and can only see my patients for 45 minutes every two or three weeks.”
I hope you've enjoyed these episode on Common Therapist Errors, and I apologize in advance if any of the ideas I'm proposing in today's podcast seem "over the top" or simply off base.
I teach with great passion, but I'm not always right! Fortunately, my esteemed host, Dr. Fabrice Nye, challenges me quite a bit, and he is almost always right. Hopefully, you will enjoy our dialogue and the chance to think a bit more critically about psychotherapy.
And when you find I've made an error, or said something offensive to you, I hope you will put it in perspective. I'm kind of a mixed bag, to be honest. I believe I have a lot to offer, but I've got tons of flaws, too! I fight my flaws, but not always with success.
For better or worse, here are today's therapist errors!
1. Confusing psychoeducation with psychotherapy. Pyschoeducation can be helpful, but it's rarely curative. Effective psychotherapy requires much more.
Here are some examples of helpful psychoeducation:
- Teaching people about the list of ten common cognitive distortions from David's book, Feeling Good: The New Mood Therapy
- Teaching people how to pinpoint their negative feelings at any moment in time using David's Daily Mood Log
- Teaching people that your thoughts, and not external events, create all of your positive and negative feelings
- Explaining the Five Secrets of Effective Communication
- etc. etc. etc.
Psychotherapy means helping people CHANGE the way they think and feel, or helping people develop more loving and satisfying personal relationships. That requires a great deal of therapeutic skill and hard work on the part of the patient--during sessions and between sessions. it also requires a warm and trusting therapeutic alliance.
2. Belief in Gurus. Believing that the individuals who start schools of therapy are nice and well-balanced individuals! David describes conversations with the late Albert Ellis, PhD, who argued that many, and arguably most, are incredibly narcissistic and manipulative. Sometimes, individuals who appear incredibly charming and brilliant and inspiring have a dark underbellies they are keeping hidden!
David argues that it might be more desirable to have a science-based, data driven, systematic approach to psychotherapy, as opposed to a field dominated by therapeutic schools, which sometimes function almost like competing cults.
3. Reverse / “backward” statistical reasoning. Most therapists who work with patients with Borderline Personality Disorder as well as Multiple Personality Disorder, as well as patients who are prone to violence, believe that childhood trauma, deprivation, or abuse is the main cause of these problems. They believe this because patients with those diagnoses frequently describe traumatic experiences in their past, so they assume those experiences caused the patient's disorder.
This is a statistical and conceptual error, because most individuals who experienced traumas when growing up never developed Borderline Personality Disorder or Multiple Personality Disorder. This is not to say that traumas are unimportant—traumatic experiences at any phase of life can be very damaging. What this DOES mean is that most psychiatric problems have other causes.
What are those other causes? They are not known, for the most part.
This information is not easy for many people to accept. For example, I just found this statement on WebMd:
“As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood (usually before age 9)."
Here’s another web comment:
“Several studies have shown that a diagnosis of BPD is associated with child abuse and neglect more than any other personality disorders [7, 8], with a range between 30 and 90% in BPD patients [7, 9].” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472954/
The same source also stated that:
“. . . Widom and collaborators  followed 500 children who had suffered physical and sexual abuse and neglect and 396 matched controls, and they observed that . . . the presence of a risk factor, such as adverse childhood events, was not necessary or sufficient to explain the reason why some individuals developed BPD symptoms in adulthood, whereas others did not.”
If you are interested, you can find the references to these studies at the end of this blog.
Here is one way of understanding this error. Childhood sexual abuse is far more common in the population (typically estimated in the range of 15% of men and 25% of women), and if you add childhood trauma or neglect, these percentages in crease even more. AT the same time, the incidence of Borderline Personality Disorder or Dissociative Identity Disorder are typically estimated around 1%. That means that most individuals who have experienced childhood sexual abuse, neglect or trauma do not develop these disorders.
I do not in any way mean to minimize the importance of trauma, sexual abuse or neglect. The impact of these experiences can be profound and can include physical as well as psychological problems.
My only point, and perhaps it is an overly humble one, is that we simply do not know the causes of most (or any) of the problems listed in the DSM5 (Diagnostic and Statistical Manual of the American Psychiatric Association.) I think it is great that we have many treatments that can be helpful and effective for individuals, but it might not further our cause to jump to conclusions about the causes of things based on what we see before our eyes when we are doing clinical work.
Sometimes, seeing is believing, but sometimes, our "seeing" can be misleading.
I hope I have not offended anyone!
4. Believing in Mental Disorders. Do the so-called Mental Disorders” described in the DSM actually exist? Or are they simply the fabrics of our imagination?
Years ago, Thomas Szasz, a psychiatrist and psychoanalyst, wrote a popular and controversial book called The Myth of Mental Illness, in which he claimed that mental disorders do not exist. David argues that Szasz was only partially right. Most of what we see in the DSM are simply arbitrary constructs, and not real "disorders." For example, most people worry about things from time to time. Worrying is unpleasant but normal, and there is a wide range of worrying in the population. Some people rarely worry, and some people almost constantly worry, and most of us are in-between.
The American Psychiatric Association will take the group who worry the most, and give them a label of "Generalized Anxiety Disorder." But there is no such "thing." It is not a real brain disorder. The same problem afflicts a great many of the so-called "disorders" listed in the DSM. These are problems, not brain disorders.
However, there are several real brain disorders, such as schizophrenia, Bipolar I Manic-Depressive Illness, and Alzheimer's Disease. These are disorders of brain tissue or wiring, and are not simply variants of normal human behavior or experience.
When I work with individuals, I measure the severity of symptoms and say things like this, "Jim, I can see you tend to be very shy (or depressed or anxious, or whatever.)" I do not say, "Jim, I want you to know you have a brain disorder called "Social Anxiety Disorder," because I feel that is potentially upsetting to the patient and not really "true." In addition, shyness can be fairly easily treated in most cases without medication.
Most non-MD therapists do not make the mistake of confusing symptoms with "mental disorders." It seems likely to me (David) that psychiatrist are more likely to make this mental error, since psychiatry, as I understand it, is emulating the medical model of diagnosis followed by medication treatment or some other kind of biological intervention.
5. Ignoring a Diagnostic Evaluation. Most therapists skip a formal diagnostic evaluation, because the DSM is so difficult to work with, and since a formal diagnostic interview can be frustrating and time-consuming. And, as I pointed out in my discussion of the previous error, it is somewhat misleading to tell patients they have mental disorders, like "Generalized Anxiety Disorder" or "Social Anxiety Disorder," when, in reality, the patient is simply shy or has a tendency to worry a lot.
And yet, there can be significant negative consequences of NOT doing a thorough initial evaluation of the patient's many symptoms, since you can easily overlook something important, like drug or alcohol abuse, or suicidal or violent urges in new patient.
The EASY Diagnostic Survey provides a fresh and helpful option. patients can complete it on their own, between sessions, and it automatically diagnoses more than 50 of the most common "disorders" in DSM5. Then the therapist can review it during a session and assign the diagnoses in less than ten minutes in most cases.
This provides the therapist with an accurate map of the patient's problems. You do not have to think of them as a variety of "mental disorders," but rather as areas of suffering and difficulty. I don't tell myself I'm treating "Generalized Anxiety Disorder," but rather treating a human being who is troubled by constant and excessive worrying--and fortunately, that is very treatable!
Therapists who are interest in purchasing a license to use the EASY in your clinical work can check this link.
I was concerned that our recent “Ten Most Common Therapist Errors” show might antagonize people, but we got quite a lot of positive and encouraging feedback from listeners, which was surprising to me. As a result, Fabrice and I decided to take a chance and publish two more shows on common therapist errors this week and next week. We hope you like these shows!
Make sure you let us know what you think, and let me apologize in advance if I come across as annoying or overly cynical. All of the errors I describe are correctable; the goal is to improve the treatment of individuals struggling with depression, anxiety, troubled relationships, or habits and addictions. Thanks!
Here are the five errors discussed in today's show.
1. Failure to hold patients accountable. Example, the therapist may let the depressed patient slip by without doing psychotherapy homework, since the patient insists he or she doesn’t have enough time or motivation to do the homework; or the therapist may agree to treatment an anxious patient without using exposure, since the patient may resist exposure; or a patient may treat someone with a relationship conflict without exploring the patient’s role in the problem, and so forth.
David argues that this rarely or never leads to significant change, much less recovery. However, many therapists, and perhaps most, get seduced into this error for a variety of reasons.
2, The “corrective emotional experience.” This is the belief that the patient’s long-term relationship with the therapist will be sufficient for growth and recovery, without having to do any psychotherapy homework or be accountable. Therapist may imagine himself or herself as the loving and nurturing parent the patient never had.
David argues that this caters to the therapist’s ego and feeds into what the patient wants as well—a long-term relationship built on schmoozing.
But does it lead to recovery?
Here’s David’s short answer: Nope! Warmth, empathy, and trust are necessary ingredients for good therapy, but they are simply not sufficient. Your patient may think you’re the most wonderful and supportive listener in the world, but that will rarely or never lead to recovery from depression, an anxiety disorder, or an addiction, and it will not lead to the skills to heal troubled relationships, either.
3. Responding defensively to patient criticisms. David argues that therapists almost always react defensively to criticisms by patients, such “you don’t’ get me,” or “you aren’t helping,” or “you don’t really care about me.” He describes an interesting five-year study of psychoanalysts in Atlanta, Georgia, sponsored by the National Institute of Mental Health (NIMH), to find out how the analysts responded to patient criticisms. You may find the results surprising!
He gives an example of defensive responding during a workshop he conducted at a hospital in Pennsylvania. Therapists can learn to correct this error with lots of practice with the Five Secrets of Effective Communication, but this requires several things:
- Using the Patient’s Evaluation of Therapy Session after each session so can quickly pinpoint empathy / relationship failures.
- Lots of practice with the Five Secrets.
- Humility, and the willingness to see the world through the eyes of the patient. This requires the “Great Death” of the therapist’s ego!
4. Joining a school of therapy and treating everything with the same method or approach. Can you imagine what it would be like if medicine was organized like this, with “schools of therapy,” like the “penicillin school”? David apologetically argues that the abolition of all schools of therapy would be a good thing. Fabrice disagrees, and argues that the treatment of psychological problems is inherently different from the treatment of medical disorders.
Let us know what YOU think!
5. Confirmation paradox. I (David) majored in the philosophy of science in college, and this was one of the first topics, and it definitely applies to our thinking about the causes of emotional problems. I’ll try to make it really simple and understandable.
Here’s the essence of this error. If I have a theory that predicts the patient’s behavior you may conclude that your theory is correct. But this logic can be very misleading. Here’s a general science example
- Your theory: the sun circles around the earth.
- Your prediction: if my theory is true, the sun will come up in the east each morning and set in the west each evening.
- Your observation: the sun DOES come up in the east and set in the west, exactly as predicted.
- Your erroneous conclusion: the sun circles around the earth.
Now let’s consider a psychotherapy example. Many therapists believe that perfectionism and insecurity result from growing up with parents who emphasized hard work and high standards as a precondition for being loved. Now let’s assume that you have a perfectionistic and insecure patient who remembers feeling like s/he wasn’t good enough when growing up. So, you conclude that the patient’s interaction with demanding parents caused the perfectionism and insecurity.
But the perfectionism and insecurity may not have resulted from any childhood experiences or interactions with parents. It may have been strongly influenced by genetic factors, or social / environmental pressures.
We can put this in the same framework as the example about the sun:
- Your theory: Perfectionism and insecurity result from growing up in unloving families that emphasized high standards and achievement rather than unconditional love and nurture.
- Your prediction: Insecure, perfectionistic patients will report childhood experiences with unloving parents who pushed them to work harder, etc.
- Your observation: Your insecure, perfectionistic patients DO describe their parents as demanding and lacking in love and support.
- Your erroneous conclusions: The patient’s childhood experiences caused the perfectionism. 2. The patient will have to “work through” these childhood experiences if s/he wants to overcome the feelings of perfectionism and insecurity.
Do you have trouble saying "no"? Lots of people do—and it can sometimes get you into trouble.
In spite of many best-selling books on assertiveness, like Manuel J. Smith’s classic book, “When I Say No I Feel Guilty,” many people still have trouble saying no. For example, you may have led someone on in a romantic relationship because you were afraid of saying no and breaking the other person’s heart. Or, you feel burned out, because you're always giving, giving, giving because you can’t—or won’t—say no. Or, you may end up hopelessly over committed at work, putting in long hours and feeling secretly used and resentful, because you don't know how to say no.
In this Podcast, Fabrice and David interview Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mt. View, California. Jill confesses that she sometimes has trouble saying no—to new referrals when her practice is full, to her family, who she loves tremendously, as well as colleagues who request this or that. David admits he sometimes has similar problems.
There are lots of reasons why you may have trouble saying no. Some are negative, but some are actually positive, including:
- Conflict phobia. You are afraid that if you say no, the other person will get angry and annoyed with you.
- Fear of disapproval or rejection. You are afraid that if you say no, the other person will judge you, disapprove of you, or reject you.
- Perceived narcissism. You believe that other people will lash out if you don’t give in to their demands.
- Submissiveness. You believe that your role in relationships is to make others happy, even at the expense of your own needs and feelings.
- Joy / Love. Jill confesses that she often says yes to this or that request because she feels it will be fun, or because she doesn’t want to let the other person down. One example would be baking brownies for her sons when she’s exhausted. One consequences would be giving in, but resenting the person she’s saying yes to.
- Guilt. You may feel that if you say no, it means that you are somehow “bad,” and that it’s your duty to please other people.
- Achievement addiction. You say yes to almost everything because you think this or that activity will make you more productive and successful.
Fabrice, Jill and David discuss many strategies for overcoming this problem, including:
- Empathy--as a therapist, you always want to start with empathy, without trying to "help."
- Motivational strategies such as the Paradoxical Cost-Benefit Analysis, Positive Reframing, or even the Straightforward Cost-Benefit Analysis. This is crucial to find out if patients really want to change before using methods to help them become more assertive.
- Punting. This is a delay strategy that David uses to get himself off the hook when feeling ambivalent about a request. For example, you can say, “I’m really pleased and honored that you’ve invited me to do X. I’m going to check with my schedule and see what might be possible, and I’ll get back to you.” Then, he has a day or two to work up the courage to say “no” in a kindly way.
- Write down your Negative Thoughts. when you're feeling compelled to say yes because you're feeling anxious or guilty, Ask yourself, "What am I telling myself?" Those thoughts will nearly always be distorted. Then ask yourself how you could challenge and talk back to those thoughts.
- Fabrice, Jill and David also discuss how to say no effectively and demonstrate this skill in a role-play with Jill that is surprisingly challenging!
They also demonstrate the Feared Fantasy, a powerful technique to help patients say no, using Jill’s example. Her worst fear is that if she says no to colleagues, they will:
- Feel disappointed.
- Become angry and demanding.
- Will say they won’t work with her in the future if she says no.
- Will say they’ll get someone else to do whatever it is, and that Jill will miss out on all the fun.
David and Fabrice play the role of colleagues from hell who put demands on Jill to do another podcast and then get upset when she tries to say no. The dialogue is quite entertaining and dynamic, and Jill finds it helpful, though anxiety-provoking.
They also describe the importance of giving patients homework to actually say no between sessions to requests that are excessive or inappropriate.
Answers to Great Questions from Listeners Like YOU!
- Dylan asks: Do you believe in Freud’s “secondary gain,” in which patients resist change because they benefit from their symptoms?
- Juleann asks: Is Seasonal Affective Disorder (SAD) a real thing?
- Ismail asks: Should I use the Daily Mood Log just when I’m upset, or at the end of the day, or when? Do I have to stop what I’m doing when I get negative thoughts so I can write them down and work on them?
- Abe asks: What about negative thoughts that are valid? For example, I was interested in astronomy and physics as a teenager, but my SAT scores showed I had no aptitude for a career in these areas.
- Kevin asks: Can positive flooding be used to change the object of our desires—for example, our sexual desires, like the man in one of your books who had lost sexual interest in his wife?
- Valentina asks: Where do cognitive distortions come from? Our parents? Our genes? Societal messages?
This is David and Fabrice's top ten list for the worst errors therapists make.
1. Failure to Measure (symptoms, empathy and helpfulness). Research shows that therapists’ perceptions of how their patients feel, or feel about them, are not accurate.
TEAM therapists measure symptom severity at the start and end of every therapy session with brief accurate scales that assess depression, suicidal urges, anxiety, anger, relationship satisfaction, and happiness. This allows therapists to see, for the first time, exactly how effective or ineffective they are in every single therapy session. This can be threatening to the therapist’s ego, but has revolutionized clinical practice.
In addition, TEAM therapists assess the patient’s perception of therapist warmth, empathy, understanding, and helpfulness after every single session. The scales are extremely sensitive to therapist errors, and most therapists receive mostly failing grades from their patients initially when they use these scales, which can be a shock to the system! But dialoguing with the patient about the scores at the next therapy session can lead to breakthroughs in the clinical work and dramatic improvements in the quality of the therapeutic alliance.
2. Trying to help, “save,” “rescue” or “reassure” patients. Most therapists are addicted to this, but it simply triggers resistance. When therapists push in their efforts to help, most patients will push back. No one likes to be “sold” on anything. When patients are hurting, they want to be heard, not saved.
In TEAM we do Paradoxical Agenda Setting before trying to “help.” We emphasize, in a respectful way, all the really GOOD reasons NOT to change. We also highlight what the patient’s symptoms, such as shame, depression, panic, defectiveness, hopelessness and anger, show about him or her that’s positive and awesome, Then we raise the question: “Given all those positives, why in the world would you want to change?”
This strategy has led to breakthroughs in treatment, and I now see recovery from depression and anxiety at rates I would have impossible ten or fifteen years ago.
3. Reverse Hypnosis.
- Depressive hypnosis. The patient persuades the therapist that s/he really is worthless, inferior, and hopeless, and the therapist false into a trance and believes it! This dooms the therapy.
- Anxiety hypnosis. The patient persuades the therapist that s/he is to fragile to use exposure, or that the exposure is too dangerous, and the therapist buys right into it! This also dooms the therapy. Recovery from anxiety is more or less impossible without exposure.
- Relationship hypnosis. The patient persuades the therapist that s/he is the victim of some other person’s bad behavior, and that the other person is entirely to blame for the relationship conflict. Therapists almost always buy this message, and this also dooms the therapy.
4, Believing therapy must be slow and last a long time. This is taught in most graduate school programs, and tends to function as a self-fulfilling prophecy. I met a famous psychoanalyst who was proud that most of her patients had been in therapy for more than ten years, and a few were just now making baby steps, she said, toward change.
With TEAM, I usually see a complete elimination of symptoms at the first therapy session, although it has to be a double session (two hours). In addition, the recover usually occurs in a burst, all at once, in just a few seconds, or in several sudden orbital leaps during the session.
5. Believing that the purpose of therapy is to get in touch with your feelings (Emotional Reasoning). This message has been pushed for years, and was the basis of my training. The idea was that people bottle up their feelings, like anger, and then it comes out as depression. The message is still pushed today!
I’ve never seen much validity in this point of view. People can express their anger, their panic, and their feelings of worthlessness until the cows come home, but they’ll still be just as angry, panicky, and they’ll still feel worthless!
There is at least one notable exception to this rule. Most anxious patients are exceptionally “nice” and sweep their feelings under the table. Then the feelings come out indirectly, as OCD, panic attacks, GAD, or a phobia, or even as somatic complaints such as chronic pain, fatigue, or dizziness. Bringing the suppressed feelings to conscious awareness and expressing them is the basis of my Hidden Emotion Technique, and it often leads to a sudden and complete recovery from any form of anxiety.
6. Confusing your own feelings for how the patient feels. This is a psychoanalytic error. I read an article on the psychoanalytic view of empathy, which was defined as the analyst’s feelings when in the presence of the patient. This is a misguided and almost delusional notion. The analyst’s feelings are the complete creation of the analyst’s thoughts! And those thoughts will often be distorted and completely misleading.
Therapist’s perceptions of how their patients feel are less than 10% accurate if you put it to an empirical test! If you ask patients, “How are you feeling right now,” and you ask therapists the exact same question, “How is your patient feeling right now,” the therapist’s answer will usually be way off base.
The only way to find out is to use assessment instruments at the start and end of each session, like I described in the first answer above, on failure to measure.
7. Believing therapists should never express their feelings. I was trained never to reveal how I was feeling. But when you think about, that’s nutty! How can we validly encourage our patients to be more genuine and open with their feelings if we are hiding our own at the same time? Of course, there is an art form in how to share your feelings during therapy. It is a high skill, requiring training, and one that can lead to more human and effective treatment.
8. Believing that you are an expert and know the causes of things, and why patients think, feel, or behave as they do. The causes of all psychiatric disorders are unknown. End of discussion. And yet, almost all therapists promote some fraudulent theory about causality. For example, what is the cause of depression?
There are lots of theories, but none has been confirmed, and almost all have been disproven. For example, there is no evidence whatsoever that depression results from a “chemical imbalance in the brain,” or from “anger turned inward,” and so forth. Those are just theories that someone made up.
I simply tell my patients that we don’t yet know the causes, but have really terrific treatment tools now for rapid recovery. That’s more than enough for the people I treat!
9. Confusing the process of therapy with a good outcome. For example, as a therapist, you could be doing really great job of listening, and give yourself high marks as a therapist because you believe in the importance of empathy, even though your patient is not improving.
Therapists have all kinds of things they’ve been trained to do, like hypnosis, or EMDR, or cognitive therapy, exposure therapy, or meditation, or an exploration of childhood traumas, or whatever it is you do and believe in. But if you’re not seeing rapid and dramatic recovery in your depressed and anxious patients, as documented with session by session testing, you’re not really “helping.”
10. Believing that insight will lead to change. This has only happened once in my career! It was a woman who discovered that she thought she always had to be submissive servant in intimate relationships. Not surprisingly, she always felt burned out and broke up with her partners after a while. She said that the discovery of this pattern when we did the Interpersonal Downward Arrow Technique during our first and only session transformed her life.
But usually, much more will be required. That’s why I have developed 50 methods to help patients change the way they think, feel, and behave. Correction—I have recently developed 51 additional powerful techniques, so now we have 101 ways to untwist your thinking so you can enjoy greater happiness, intimacy, and productivity!
Now, here's the 60 thousand dollar question. Can therapists learn to stop making these errors? In most cases, the answer is NO! It's not so much a problem with intelligence or aptitude, although those are important factors, but it has to do with motivation. Many therapists simply do not want to change, and are committed to what they're already doing, in much the same way that people are committed to their religious beliefs, which they are unwilling to challenge.
That's why it is so much easier to train young therapists, whose minds are still open, as well as lay people who do not have so much prior "training" they have to overcome.
Well, that's my cynical side coming out, and I apologize! Still, I think I'm right for the most part.
Hey, if you liked my rant, I have at least five more common therapeutic errors on my list, so let Fabrice and me know if you'd like to hear about therapist errors in a future podcast. In addition, if you'd like to add to our list of therapist errors, let us know what your "favorite" (or most annoying) therapist error is!
How can you get rid of Self-Defeating Beliefs?
Although any of the 100 + TEAM-CBT methods can be used to modify an SDB, four methods will be highlighted in today's show.
- Cost-Benefit Analysis
- Semantic Method
- Experimental Technique
- Feared Fantasy
For more information on how to change SDBs, you might want to watch the extremely popular David and Jill FB Live show on Overcoming Perfectionism (recorded on November 11, 2018).
What research has been done on SDBs?
This topic was not discussed in the show, but individuals with an interest in research might want to read David’s study with Dr. Jackie Persons on the causal connections between depression and SDBs about dependency (attachment) as well as achievement (perfectionism) in several hundred patients in Philadelphia during the first 12 weeks of their treatment at David’s clinic.
The study confirmed That both types of SBS were significantly correlated with depression severity at intake and at the 12-week evaluation. In addition, changes in depression were correlated with changes in SDBs. However, a sophisticated statistical analysis with structural equation modeling techniques did not confirm that SDBs had causal effects on depression, or that depression had causal effects on SDBs. Instead, SDBs and feelings of depression appeared to share an unknown common cause.
- Persons, J. B., Burns, D. D., Perloff, J. M., & Miranda, J. (1993). Relationships between symptoms of depression and anxiety and dysfunctional beliefs about achievement and attachment. Journal of Abnormal Psychology, 101(4): 518 - 524.
- Is it possible to change an SDB?
- Does the mere knowledge of an SDB change it?
- How long does it take to change an SDB?
- How do you change SDBs?
- Aaron Beck said the SDBs never really go away. They just get activated and deactivated and activated again. Does this mean that depression is an incurable disease that will keep coming back over and over again?
- What’s the point in battling against a core belief if it cannot be changed?
Fabrice and I appreciate your questions--they often give us ideas for shows! In today’s Podcast you'll learn the answers to several questions about Self-Defeating Beliefs.
What’s the difference between Self-Defeating Beliefs (SDBs) vs. Cognitive Distortions?
The thoughts that contain cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, Discounting the Positive, and Self-Blame are distortions of reality, they are the cons that trigger depression and anxiety. When you're upset, these thoughts will flood your mind. These thoughts can be show to be false, and when you crush a distorted negative thought, you'll immediately feel better.
Self-Defeating Beliefs are stipulations, values that you've set up for your self. For example, you may base your self-esteem on your accomplishments due to your belief that people who accomplish more are more worthwhile as human beings. SDBs like this cannot actually be shown to be false--they are simply your personal, subjective values, and they are thought to be with you all the time, and not just when you're depressed, anxious, or angry.
The question with an SDB is this: What are the advantages and disadvantages of having this value system? How will it help me--what are the benefits--and how might it hurt me? What's the downside?
Why are Self-Defeating Beliefs thought to be important?
When you challenge and defeat a distorted thought, you feel better in the here-and-now. When you challenge and change an SDB, you change your value system at a deep level. This is thought to make you less vulnerable to painful mood swings and relationship conflicts in the future.
What are the different kinds of SDBs?
- David’s list of 23 Common SDBs is attached. This list is not comprehensive, as there are many more, but the ones on the list are very common. There are several categories of SDBs.
- Individual SDBs are often “Self-Esteem Equations”
- Perceived Perfectionism
- Achievement Addiction
- Approval Addiction
- Love Addiction
- Interpersonal SDBs are expectations of what will happen in certain kinds of relationships, or relationships in general
- What’s your understanding of the other person’s role in your relationship? What adjectives describe him or her?
- What’s your understanding of your person’s role in the relationship? What adjectives describe you?
- How would that kind of relationship feel?
- What rules connect the two roles?
- Other kinds of SDBs
- Anger / conflict cluster
- Anxiety cluster
- Conflict Phobia
- Anger Phobia
- Spotlight Fallacy
- Brushfire Fallacy
- Anger / conflict cluster
How can you identify your own, or a patient’s, Self-Defeating Beliefs?
- Look at the list of 23 individual SDBs (easiest). You might want to do that right now. Review the list, and you'll probably find many of your own beliefs!
- Individual Downward Arrow
- Interpersonal Downward Arrow
I recently did two terrific interviews (Podcasts #92 and #111) with Stephanie James on her superb radio show and podcast, The Spark. Today, Fabrice and I are bringing you my third and final interview with Stephanie, as we describe how to convert conflicted relationships into loving, rewarding ones.
Stephanie said it was her favorite interview, although all three were really fun for me. Today you will once again hear how dynamic, warm and positive she is!
My first interview with Stephanie was on the amazing inner power we all have to change our thoughts, feelings, actions, and lives. We talked about how to transform your automatic negative thoughts and create a more joyful present and a more fulfilling future.
My second interview with Stephanie was on the evolution of traditional Cognitive Behavioral Therapy (CBT) into the new TEAM-CBT. We highlighted the amazing new motivation-busting techniques that can lead to extraordinarily rapid recovery.
Stephanie also recently interviewed our beloved colleague, Dr. Matthew May, a psychiatrist who is a phenomenal TEAM therapist. Click here if you'd like to take a look and listen. Matt has worked with Fabrice and me on our podcasts--you may remember the amazing and inspiring podcasts featuring live therapy with Marilyn.
Stephanie is a outstanding therapist and radio personality from Colorado. It was an honor to be on her show on three occasions. Stephanie is co-authoring a book on how to live a “spark-filled life.” It should be completed soon, so you’ll likely be hearing much more from Stephanie during 2019!
This dynamic interview covers the integration of TEAM-CBT with Christianity as well as Judaism, Buddhism, Hinduism, the Muslim faith, and more. Mike, Fabrice and I describe many areas of overlap, as well as some potential conflicts, between the teachings and methods of TEAM-CBT and religious beliefs. Mike and I suggest that religion and TEAM-CBT are, in fact, attempting to do the exact same things using slightly different language and symbolism. We strongly agree that at the moment of recovery, a person’s religious beliefs are nearly always strengthened and deepened, and never challenged or belittled.
Mike, Fabrice and I also discuss topics like religious scrupulosity, religious obsessions, cognitive distortions (John 8:32: “The truth will set you free”), and the so-called “dark night of the soul” described by Christian and Buddhist mystics. We also talk about the spiritual and psychological aspects of enlightenment (e.g. salvation), Should Statements, the Disarming Technique, forgiveness, repentance, the death of the ego, pride vs. humility, and more.
If you have an interest in religious or philosophical topics, you will love this podcast! You might also enjoy the podcasts with Marilyn on what to do when you've lost your belief in God and find yourself in darkness and intense suffering!
Mike Christensen treats individuals throughout Canada via teletherapy and also offers online training for mental health professionals throughout the world. If you have a question for Mike, or wish to contact him, you can find him at www.FeelingGoodInstitute.com.
Fabrice and I were thrilled to interview our dear friend and colleague, Stephen Pfleiderer, who is the first therapist in the world using TEAM-CBT techniques in the treatment of habits and addictions, including
- life threatening addictions, like intravenous heroin or meth
- binge eating
- internet porn
- and more
Stephen begins with his personal story of excessive beer drinking starting in high school through his junior year in college when he hit a personal crisis, telling himself, "My life sucks. I can't live like this. I'm a loser." He decided to enter a 12-step recovery program, which helped tremendously, and eventually joined David's weekly TEAM training group at Stanford because of his dream of becoming a professional addiction therapist and interventionist.
Rebroadcast of a fabulous interview David did recently for “The Upgrade” Podcast (sponsored by the popular Life Hacker website with hosts Melissa Kirsch and Alice Bradley on a range of topics, including:
- Why did you write Feeling Good: The New Mood Therapy?
- Is depression caused by a chemical imbalance in the brain?
- What’s your experience with electro-convulsive therapy (ECT)?
- Why did you give up your research career in biological psychiatry?
- How can you tease out your negative thoughts when you know you're depressed but you just can’t think of any thoughts?
- How does TEAM-CBT differ from conventional CBT?
- Can you use TEAM-CBT with severe problems, or is it only for individuals with mild mood disturbances?
1. Steven asks about the best route to take if you want to learn and practice TEAM-CBT? Is the degree important? What's the best degree? Should you go to school to become a psychologist, clinical social worker, addiction counselor, psychiatrist, professional counselor, pastoral counselor, marriage and family therapist, life coach, or what? There are so many degrees and potential paths that my head is spinning!
2. Sandy asks how to overcome long-standing, entrenched perfectionistic tendencies.
3. Rin asks about the Burns Depression checklist and the criteria for depression in the DSM. He is (understandably) confused about the so-called "somatic" symptoms of depression, like insomnia or changes in appetite.
For example, some “experts” would argue that the following are all symptoms of clinical depression:
- insomnia or the opposite—sleeping too much;
- increased appetite or the opposite--decreased appetite;
- loss of interest in sex, or the opposite, sex addiction;
- loss of interest in work, or the opposite, being a workaholic.
How can opposite symptoms be symptoms of depression? Does this make sense? Are these really the symptoms of depression, or simply non-specific symptoms? What are the five key symptoms of real depression?
4. Kevin is a therapist with a simple question: How do I get over my desire to help?
5. Amanda asks how to use the Disarming Technique with a patient who thinks he or she isn’t making any progress in the therapy.
One of the goals for our Feeling Good Podcasts is to bring the TEAM-CBT techniques to life for mental health professionals, patients, and the general public as well. I (David Burns) use more than 50 Techniques when I'm working with individuals with depression, anxiety disorders, relationship problems, or habits / addictions. Today we will compare and contrast the four Truth-Based Techniques, including:
- Examine the Evidence
- The Experimental Technique
- The Survey Technique
These were among the first cognitive therapy techniques ever developed, and they were based on the work of Dr. Aaron Beck, from Philadelphia, as well as Dr. Albert Ellis, from New York. Dr. Ellis is the Grandfather of Cognitive Therapy, and he described many of these techniques in the 1950s. He called his treatment Rational Emotive Therapy, and it's still popular today. During the 1960s, Beck, who is considered the Father of Cognitive Therapy adapted the ideas of Dr. Ellis to the treatment of depression, and called his version of the treatment Cognitive Therapy.
Beck emphasized that depression results from a negative view of the self, the world, and the future. In other words, the patient may think:
- I'm a loser. (negative view of the self)
- Nothing i do will be successful or rewarding. (negative view of the world)
- Things will never change. I'm hopeless. (negative view of the future)
Beck claimed that the negative thoughts of the depressed individual are the actual cause of the depression. He also emphasized that the disturbing negative thoughts of depressed patients are nearly always distorted and illogical; however, depressed individuals don’t realize that they’re fooling themselves, so they think their negative thoughts are absolutely valid. Beck also claimed that depression could be treated without drugs in many cases, and focused his treatment on challenging the patient's distorted negative thoughts.
Beck often compared depressed patients to scientists who have a theory about the world that simply isn’t true. That's why scientists learn to test their theories by examining evidence and performing experiments. Beck suggested that depressed patients could also test the validity of their negative thoughts and beliefs by examining the evidence for and against what they're telling themselves, as well as by doing actual experiments to test their thoughts and beliefs.
David and Fabrice bring the four basic truth-based techniques to life with actual patient examples. They answer the question, "What's the difference between Examine the Evidence and the Experimental Technique?" And "How does the Survey Technique work?"
They emphasize the tremendous importance of warmth and empathy, as well as melting away patient resistance, before trying to implement any of these techniques. They also emphasize that these techniques, like all of the techniques, are powerful, and must be used with skill and compassion, or else they can backfire.
This is the second of three interviews with Stephanie James on her superb radio show and podcast, The Spark. Stephanie is an experienced therapist and dynamic radio personality from Colorado. She is co-authoring a book on how to live a “spark-filled life.”
This interview with Stephanie focused, in part, on the evolution of the new TEAM-CBT from traditional Cognitive Behavioral Therapy (CBT). Stephanie asks Dr. Burns questions on a wide range of topics, including:
- How would you treat a case of social anxiety?
- What is “therapeutic whitewashing” and how can therapists get over it? What should therapists do instead?
- How would you work with violent incarcerated teenagers, such as gang members?
- Why is it so important for therapists who are learning TEAM-CBT to check their egos at the door?
- After you published your first book, Feeling Good, and the first research study on CBT was published, cognitive therapy swept the world. After your initial euphoria, your enthusiasm dimmed somewhat. Why? And what new direction did your research lead?
- What are the most common errors that therapists make in thinking about the causes of therapeutic resistance?
- How can you overcome a patient’s resistance to change?
- Can TEAM-CBT work rapidly for someone with horrific abuse and decades of failed therapy?
- How can you prevent relapses following the patient’s initial recovery?
Dr. Burns' third interview with Stephanie will be on the interpersonal TEAM model—how to convert conflicted relationships into loving, rewarding ones.
Fabrice and David address several challenging questions submitted by individuals who listen to the Feeling Good Podcasts.
- Richard: Do you have to get along with everybody? How do you deal with a sociopath?
- Dave: Positive distortions can trigger mania, addictions, narcissism, and violence--but how can you get rid of them?
- Julia: What can you do if you've been depressed all of your life and wake up every morning with your mind flooded with negative thoughts? I spend two hours trying to dispute them, but they just keep coming back the next day.
- Omhur: How would you treat "Reading OCD?" I feel compelled to read every sentence and paragraph carefully and repeatedly so I won't miss anything!
- Unnamed fan (who left a negative review on iTunes): Isn't your concept of the death of the ego potentially dangerous to people with low self-esteem who are being abused?
Thank you for your terrific questions, your frequent praise, and your occasional criticisms and challenges. They keep us on our toes, and we deeply appreciate all of you. So keep your comments coming, as well as your suggestions for shows and topics you want to hear more about!
We are receiving more than 50,000 downloads a month. Please tell your friends about us so we can continue to build our audience.
Thanks! We really enjoy doing these shows for you.
A podcast listener asked about what techniques David is the most proud of. We briefly discuss each one on today’s podcast. So here they are!
- The list of Ten Cognitive Distortions
- The Disarming Technique and Law of Opposites
- The Externalization of Voices plus Acceptance Paradox
- The two classic Uncovering Techniques: the Individual and Interpersonal Downward Arrow
- The Feared Fantasy and Acceptance Paradox
- The Experimental Technique for extremely rapid treatment of patients with Panic Attacks
- My published research with colleagues in the mid-1970s did not support the popular notion that depression results from a chemical imbalance in the brain
- Brief Mood Survey
- Positive Reframing
- The use of extended, two-hour therapy sessions
David emphasizes that there are two issues. First, can your “self” be validly judged as not good enough, as inferior or even worthless? Or, can your “self” be validly judged as more worthwhile, or even superior? And is it really true that some people are more worthwhile, or less worthwhile, than others? Do more worthwhile, or less worthwhile human beings exist?
Second, do we even have a “self?”
Fabrice talks about the history of the concept of ego. For example, Freud divided the human mind into three parts: the id, ego and superego. Do these really exist as “things,” or are they just concepts, or metaphors for talking about the mind? When you try to think about the “ego” or the “self” as a thing, that’s when you get in trouble.
David argues that if you believe that someone people are “more worthwhile” or “less worthwhile,” you’d have to define what a of worthwhile human being is.
Fabrice and David are pleased to chat with Dr. Taylor Chesney who is an expert in the treatment of children and teenagers with TEAM-CBT. Taylor was a member of Dr. Burns’ Tuesday group at Stanford and his Sunday hiking group for two years before returning to her home in New York in 2014. She opened the Feeling Good Institute NYC, where she and her colleagues offer individual and intensive treatment as well as training for mental health professionals (in person and online). Today she reveals the inside scoop on how to use TEAM-CBT with children and teenagers, and their parents.
This is the second podcast on relationship problems. with Dr. Helen Yeni-Komshian. In today's podcast, we address four questions from listeners like you:
- Our marriage lacks intimacy. What can I do? A podcast fan named David explains that his relationship with his wife is no longer intimate; he complains that they only talk about day to day things on a superficial level. David wants to know if he needs to inject some conflict into the relationship to make it more meaningful or exciting.
- Why is my wife so critical of me? David wants to know why his wife constantly peppers him and batters him with critical questions, and what he can about it.
- Why is my friend so critical and dogmatic? Rajesh describes a friend who argues endlessly and accuses Rajesh of being irritating. His friend says, "Anyone would be upset when they try to talk to you!" What's up? Why is this happening? Who's really to blame?
- Adarah feels lonely and tells her husband what he can do to make her feel loved--but it just doesn't seem to work! Why? And what CAN she do to improve her marriage?
I think you will enjoy the lively dialogue between Fabrice, Helen and myself and see us struggling and making some mistakes, too, when we try to model more effective responses based on the Five Secrets of Effective Communication! We also stress, once again, the importance of Interpersonal Decision-Making any time you run into a conflict with a friend, colleague, or loved one.
For more information on healing troubled relationships, you can read my book, Feeling Good Together, which is available as a paperback on Amazon. In addition, you can listen to our previous podcasts on the Five Secrets of Effective Communication, beginning with Podcast #65 (Enjoy Greater Intimacy) and several of the podcasts that follow.
We have invited Dr. Helen Yeni-Komshian to join Fabrice and me for two consecutive podcasts on questions listeners have asked about troubled relationships. In today's podcast, we address a question from Mary about how to deal with a husband who constantly complains and exaggerates how awful things are at work, in politics, and in the world. But when Mary tries to dismiss his statements in an effort to "keep the peace," it just gets worse. His complaints escalate!
This is a common problem and you may have run into it as well. Do you have a friend or family member who loves to complain? And have you noticed that your attempts to help or point out the irrationality of his or her complaints are futile? So what SHOULD you do? What's the secret of dealing with a whiner or a complainer? Is it even possible.
Helen and David provide a myriad of information and describe techniques such as Forced Empathy, Interpersonal Decision Making, Changing the Focus, and the Five Secrets of Effective Communication. You'll LOVE this lively dialogue!
David describes research on the relationship between physical pain and negative emotions such as depression, anxiety, and anger. Does pain cause depression? Or does depression cause or amplify pain?
And what can we do to help patients with physical pain and intense negative emotions?
In addition, why do so many individuals struggle with somatic problems, such as physical pain, dizziness, or fatigue, when there is no apparent organic cause for the pain? Is there any hope?
Today we answer six questions submitted by listeners like you:
- Harald: How can I find the Show Notes for the Feeling Good Podcasts?
- Kristin: How do you help patients who obsess about past traumatic events, with intrusive thoughts about a cruel ex-lover or bullying by classmates? These thoughts can feed into the idea that their life is miserable and they can’t move forward because they feel blocked by these harmful memories.
- Valentina: How are cognitive distortions, self-defeating beliefs, and feelings of depression transmitted? What you describe in your books seems to describe my mother’s behaviors when I was growing up? Could it be that depression is transmitted by the family?
- Alicia: How would you treat someone with cyclothymic disorder who cycles between euphoria and suicidal depression? He’s happy now, so how do I get him to fill out the Daily Mood Log?
- Kathy: I’m a big fan, and I have a question about “bibliotherapy.” What’s the best way to use your books and other materials to help yourself?
- Matthew: Do you ever use drugs in the treatment of depression? Are medications sometimes necessary or helpful?
Suicidal thoughts and urges are very common among depressed patients. The vast majority of depressed individuals have thoughts of suicide from time to time, and some struggle with serious suicidal urges. The experts tell us that 10% to 15% of chronically depressed individuals do eventually commit suicide, even if they are receiving treatment for depression. It is hard for me to believe that suicide is that common, but even if it is only 2% or 3%, that’s still very significant, especially if you have a large clinical practice and you treat lots of depressed individuals.
Suicide attempts are shocking and devastating for the patient, for the family, and for the therapist as well. The loss of a patient through suicide is the dark side of our profession. The loss of life is a horrible and unnecessary tragedy, since the feelings of hopelessness that trigger suicidal urges are always the result of cognitive distortions; the belief that you are hopeless and cannot improve is never valid. Yet, the depressed patient does not realize this, and sometimes turns to suicide as the only way out of the suffering.
Sadly, clinicians' capacity to assess suicidal urges in patients they are treating is very poor, and not significantly different from zero. In this podcast, I describe how you can solve this problem with the use of the EASY Diagnostic System and suicide interview at the initial evaluation, and the use of the Brief Mood Survey at all subsequent sessions, with no exceptions.
In this podcast, I focus on two things. First, how can the clinician identify and evaluate a new (or old) patient who is struggling with suicidal thoughts and fantasies and determine if the patient is at risk for a suicide attempt? Second, how can the therapist make the patient accountable and guarantee that the patient will not now, or ever, make a suicide attempt? The “defensive psychotherapy” I recommend will sound unfamiliar to many therapists but can save lives and make your practice far more peaceful and rewarding! The approach to the suicidal patient involves Paradoxical Agenda Setting techniques, including the Gentle Ultimatum and Sitting with Open Hands.
The famed neuroscientist, Dr. Mark Noble, from the University of Rochester, has developed a strong interest in TEAM-CBT and has visited our Tuesday group and Sunday hikes on three occasions this year. I (David) feel very fortunate to have his collaboration and interest!
Mark is a Stanford-trained geneticist and molecular biologist who is considered one of founders of the field of stem cell research. He has been developing a model of how TEAM-CBT affects the brain, and graciously agreed to present his model at our Tuesday evening Stanford TEAM-CBT seminar last week. Although his model is not yet fully polished and refined, and involves considerable speculation, it is an exciting first step, kind of like the time when astronomers broke away from the Catholic church and started trying to make sense of the universe. In this instance it is the “inner universe” Dr. Noble, all of us, are trying to understand. His model will evolve and get more and more refined over time.
The participants in the seminar really liked his concept that we are doing micro-neurosurgery for depressed patients with TEAM-CBT! He is convinced that the rapid recovery we see with TEAM-CBT will probably never be equaled by medication, since the brain circuits that modulate happiness and unhappiness tend to use the same neurotransmitters. But with language, you can affect brain circuits far more selectively and effectively, almost like a micro-neuro-surgeon.
Dr. Noble describes brain function in terms of the SNEFF model. This stands for Structures, Networks, Emotions, Frames and Filters, and links these concepts to the prefrontal cortex, amygdala and sympathetic nervous system. Then he describes the four steps of TEAM (T = Testing, E = Empathy, A = (Paradoxical) Agenda Setting, and M = Methods), and links each step to the SNEFF model, making interesting speculations on how TEAM works and what makes it so effective.
Dr. Noble also discusses David’s “fractal” theory about psychotherapy and relates that to brain function as well as to the mathematics of complex structures. He describes how and why some people get stuck in the “homeostasis” of chronic, refractory depression and explains why TEAM-CBT is usually able to trigger sudden and dramatic changes in the brain, as well as in the way the depressed and anxious individual thinks, feels, and behaves. He also explains why conventional talk therapy is unlikely to be helpful for individuals struggling with depression and anxiety, and may, in some cases, make the depression worse.
This is because neurons that “fire together wire together.” In other words, if you go to therapy and complain or emote about your life and your problems over and over, without taking action to change, the circuits in your brain that support complaining and feeling depressed will just get more and more intensely wired together.
Dr. Noble also speculates on why Paradoxical Agenda Setting is such an important key in ultra-rapid-recovery and in the sudden transformation of brain function as well.
Years ago, when I was kid on vacation in Minnesota, I saw an article in a small newspaper published in a rural area. A local scientist had speculated that one day we would have guided missiles and satellites and drew a simple diagram for the newspaper of how they would work. At the time it seemed a bit like science fiction, and I wondered if an unknown scientist from a small rural Minnesota town could actually predict a major scientific development. But now we see that he was right.
Will we someday think about Dr. Noble in the same way? Listen to this exciting podcast, and you can decide for yourself!
Lisa Nicole Bell is the host of the highly regarded podcast, Behind the Brilliance. In this lively interview, Nicole and David talk about
- David’s path into the mental health field
- the difficulties and rejections David faced getting his first book, Feeling Good, published
- David’s advice to listeners interested in therapy
- how he approaches perfectionism, depression, and anxiety with patients
- the joys of a life free from the need to be special—
- and much more!
Lisa's show delivers a smart and funny take on pursuing ambitions, designing a life, and living joyfully. Lisa’s most recent media work includes producing an Australian documentary on identity and gender politics within sports and a digital docu-series produced by Academy Award-winning actress Viola Davis.
David and Jill do M = Methods, and show Lee how to respond to his wife more skillfully, using the Five Secrets of Effective Communication (link). Like everyone who is trying to learn the Five Secrets, Lee struggles with several blind spots:
- “I Feel” Statements. Lee has tremendous difficulties sharing his feelings openly, in a respectful manner. He seems indoctrinated with the cultural idea that men should not be vulnerable and express feelings.
- Lee makes the common error of “problem solving” instead of asking his wife to share more of her feelings.
- Lee makes another common error of apologizing and using the trite phrase “I’m sorry” instead of encouraging his wife to open up. David discusses the different between dysfunctional and effective apologies.
David and Jill do lots of role-play practice with Lee and give him a homework assignment.
T = Testing. After the session is over, Lee completes the Brief Mood Survey again. His scores indicated that his feelings of anxiety and anger have completely disappeared, and he also has a perfect score Positive Feelings Survey and the Relationship Satisfaction Scale. He also gave David and Jill perfect scores on the Empathy and Helpfulness scales and wrote what he liked the best about the session:
“My epiphany came at the moment I realized I had been afraid of emasculating myself and realizing that my vision of what a “man” should be was completely inaccurate.”
At the end, Jill reads an emotional email from Lee describing how he relapsed and started arguing with his wife, and then remember to empathize use the Five Secrets instead, with an amazing result!
David and Jill do A = (Paradoxical) Agenda Setting with Lee, starting with the Invitation: Jill asks Lee if he wants help with the relationship conflict, and if this would be a good time to roll up our sleeves and get to work. Lee indicates that he does want help.
They review the first two steps of his Relationship Journal, where Lee had recorded one specific thing his wife said to him, and exactly what he said next. Here’s what he wrote down:
Step 1 – She said: Write down exactly what the other person said. Be brief:
I was trying to convince my 18-month-old daughter to put her pajamas on. I was calm. Eventually, I raised my voice an octave or two and in a stern voice I told my daughter to put her pajamas on.
Afterwards, Liza said, “I don’t think you need to use that tone with a small child.”
Step 2 – I said: Write down exactly what you said next. Be brief:
I said, “I don’t think there was anything wrong with what I did. You can be stern without losing your shit*. There are times when she needs to know I am serious and not messing about anymore.”
It then devolved into a debate over a clash of values on how to raise our daughter.
* Transcribed as-is from Lee’s Relationship Journal.
Lee also circled all the emotions he thought she was having, along with all of the emotions he was having. He thought she was feeling:
- Sad and unhappy
- Anxious and worried
- Rejected and alone
- Discouraged, pessimistic, and despairing
- Frustrated and stuck
- Angry, annoyed, irritated and upset
- Other feelings: troubled, defensive, dismayed, downhearted, and disconnected
Here’s how he was feeling:
- Anxious and worried
- Guilty, remorseful, bad and ashamed
- Inferior, inadequate, defective and incompetent
- Embarrassed, foolish and self-conscious
- Hopeless, discouraged and despairing
- Angry, mad, resentful, annoyed, irritated, upset and furious
- Other feelings: hostile, loud, critical, agitated, defensive, stubborn, exasperated, sarcastic, powerless, diminished, low, resistant, confused, judgmental, vulnerable, inept
Step 3. Good vs. Bad Communication. When David and Jill ask Lee to examine his response to his wife, he had to admit that his response in Step 2 had all the characteristics of bad communication—he did not acknowledge any of her feelings, he did not share his own, and he did not convey love and respect. This was disturbing and surprising to Lee.
Step 4. Consequences. When David and Jill asked Lee to examine the impact of what he said to his wife, they suddenly ran into a wall of resistance, which is almost universal in relationship work. The Relationship Journal is an incredibly powerful tool, and it can be extremely painful because you have to stop blaming the other person and examine your own role in the relationship.
Lee suddenly and painfully discovered the answer to his question of why his wife was so controlling and critical of him—it was NOT because of the influence of her mother, but rather because he was forcing her to treat him like that almost every time he interacted with her.
This insight cannot be denied when you do the Relationship Journal, and it’s potentially incredibly empowering, but it can be incredibly painful at the same time.
You will also hear a masterful and paradoxical response by Dr. Levitt when Lee resists—and as a result, his resistance suddenly disappears, and he jumps on board!
For the past couple months, Fabrice has asked me to set up a live therapy session to illustrate how to treat troubled relationships using TEAM-CBT. I was fortunate to get an email request from a colleague named Lee who wanted help with his marriage. He explained that his wife was very controlling and critical of him and attributed this to the fact that she had a controlling mother. This is very typical in troubled relationships, most of us are convinced that the problem is the other person’s fault. Of course, Lee told us that his wife, in turn, blames back and feels that Lee is the one who needs to change.
Lee initially thought we’d do couples therapy, but in TEAM-CBT we actually prefer to treat just one person in a troubled relationship.
Two weeks ago, Jill and I sat down with Lee on a Saturday morning, linking to each other on the internet since he lives abroad, for a three-hour treatment session. The session has been broken down into three separate podcasts plus commentary from Fabrice, Jill and David on each of the three segments.
By way of disclaimers, Lee is a colleague who does coaching for individuals with alcohol addiction problems. We are not entering into a formal treatment relationship with Lee. Instead, he has offered to help us illustrate a therapy technique, using a real person problem, as part of his training and personal growth. We are deeply grateful to Lee for letting us share his intensely personal “session” with you!
Today, you will hear the first segment on T = Testing and E = Empathy. Lee will tell his story. Jill and I will listen without trying to “help” or “rescue” Lee. On the Brief Mood Survey, he indicated no depression or suicidal urges. He was mildly anxious and slightly angry. His Positive Feelings Survey indicated that he was quite happy except in two areas: He felt only moderately close to people and only slightly connected to others. You will also hear him say that he felt like one of the loneliest people we would ever meet toward the end of the empathy phase of the session.
How to select the techniques that will be most helpful for various kinds of problems, and how to individualize the treatment for each patient.
For a long time, Fabrice has wanted to do a show on my list of "Fifty Ways to Untwist Your Thinking" called "Fifty Ways in Fifty Minutes." So we finally did it, and it was fun!
If I'm helping you overcome depression or anxiety, I'll ask you to fill out a Daily Mood Log, so you can list your negative thoughts and feelings at some specific moment when you were upset. You may be thinking, "I'm a failure," or "I should not have made that mistake," or "I'm unlovable."
Your negative thoughts will nearly always be distorted, but you'll still believe them, and that's why you're feeling depressed and anxious. And the moment you discover that your negative thoughts aren't true, you'll immediately feel better. But that's not going to be easy, because you've probably been giving yourself the same negative messages for years, or even decades. And friends and family members, and even your therapist, may have been trying, unsuccessfully, to talk you out of them.
That's why I've developed more than fifty methods to help you crush the negative thoughts at the heart of your suffering. So today, you'll take a look at the landscape!
For a long time, Fabrice has wanted to do a show on my list of "Fifty Ways to Untwist Your Thinking" called "Fifty Ways in Fifty Minutes." So we finally did it, and it was fun!
If I'm helping you overcome depression or anxiety, I'll ask you to fill out a Daily Mood Log, so you can list your negative thoughts and feelings at some specific moment when you were upset. You may be thinking, "I'm a failure," or "I should not have made that mistake," or "I'm unlovable."
Your negative thoughts will nearly always be distorted, but you'll still believe them, and that's why you're feeling depressed and anxious. And the moment you discover that your negative thoughts aren't true, you'll immediately feel better. But that's not going to be easy, because you've probably been giving yourself the same negative messages for years, or even decades. And friends and family members, and even your therapist, may have been trying, unsuccessfully, to talk you out of them.
That's why I've developed more than fifty methods to help you crush the negative thoughts at the heart of your suffering. So today, you'll take a look at the landscape!
I recently did the first of three interviews with Stephanie James on her superb radio show and podcast, The Spark. Here’s how Stephanie described the interview (with minor changes):
We have amazing power within us to change our thoughts, our feelings, our actions, and our lives.
This episode is an inspirational way to take control of your automatic negative thoughts today and transform them in order to create a more joyful present and a more fulling future.
Join us as we talk with the legendary Dr. David Burns about how we can break through the old thinking habits that bind us and begin to live a more happy, harmonious life where we can feel good now.
Stephanie is a superb therapist and dynamic radio personality from Colorado. It was an honor to be on her show. She is co-authoring a book on how to live a “spark-filled life.” It should be completed soon, so you’ll likely be hearing from Stephanie a lot next year!
Following the interview, Stephanie visited my Tuesday training group at Stanford and participated in one of our Feeling Good Podcasts with some students in the group. She suggested we might want to broadcast the Tuesday group live so that therapists from all over the world could join us. We are thinking about that, but will have to check with the powers that be to see if we could get permission to broadcast from Stanford, as well as our Tuesday group members who may have mixed feelings, due to the intensely personal nature of the training.
Let me know what you think about this idea!
My second interview with Stephanie was on the evolution of traditional Cognitive Behavioral Therapy (CBT) into the new TEAM-CBT. Fabrice and I will publish it for you shortly. My third interview with Stephanie will be on the interpersonal TEAM model—how to convert conflicted relationships into loving, rewarding ones.
I had a magical fantasies of what would happen once I was an “author.” The reality was quite the opposite and quite painful, with almost endless rejections accompanied by feelings of self-pity and defeat. For example, soon after publication, I learned my book was at the top of my publisher's "loser list." Then I discovered that magazines, newspapers, and TV and radio shows had no interest in it whatsoever.
I hope you enjoy the story. It’s all about the celebration of failure and the conversion of failure into success.
I was recently interviewed by author, professor, and documentary filmmaker Roy Germano for his outstanding Other Side Podcast. Fabrice and I thought you might enjoy this interview, and Roy graciously gave us permission to share it with you.
You will get some personal glimpses into the early days of my career, including why I left academics to pursue a full-time private practice, along with some of controversies about antidepressants. You will also hear a story of what happened when I was trying, rather unsuccessfully, to get my first book, Feeling Good, published. It wasn’t easy, and it almost didn’t happen!
Roy is terrific and his podcasts cover a wide range of topics. You can find his podcasts on iTunes.
David and Fabrice answer five intriguing questions submitted by listeners:
- Joshua: How can I cope with panic attacks during job interviews?
- Dan: I feel traumatized by criticisms from my boss at work. what can I do?
- Susan: How fast can you taper off of anti-anxiety drugs and antidepressants?
- Ross: What if a patient who's been the victim of trauma or abuse asks for a male therapist? Isn't this a form of avoidance? Should patients be matched to therapists based on gender? Isn't it best to avoid the situations that trigger you?
- Sumit: I think I have "endogenous depression." Can TEAM-CBT help me? Or will I have to rely on medications? What is endogenous depression?
If you have a question, make sure you email david and we will try to answer your question on an upcoming Ask David Podcast!
The Devil’s Advocate Technique is another one of the role-playing techniques in TEAM-CBT. You can use this technique for any habit or addiction, such as:
- Drug or alcohol abuse
- Overeating / binge eating
- Shopping addiction
- Internet addiction
- And procrastination, which is our problem for today.
David and Fabrice are joined by Sara Shane, a member of David’s Tuesday evening psychotherapy Stanford training group for northern California mental health professionals. Sara has volunteered to demonstrate the technique to see if she can get some help with procrastination.
David describes watching Dr. Maxy Maultsby do a demonstration of the Double Standard Technique when he was a psychiatric resident in the 1970s at the University of Pennsylvania medical school. He was quite surprised when the patient, who was severely depressed and suicidal following a break-up with her boyfriend, improved dramatically within an hour. David modified the technique in several ways, and tonight will present what is probably the most powerful way to use this technique.
The technique is based on the idea that most of us operate on a double-standard. When we are upset about some failure, mistake, or inadequacy, we tend to beat up on ourselves mercilessly. But if we were talking to a dear friend with the exact same problem, we'd be far more compassionate and realistic. Once you make the patient aware of this double-standard, you ask if he or she would be willing to talk to himself or herself in the same way he or she would talk to a dear friend.
But the unique feature of the way David does it, is that you, the therapist, "become" a dear friend of the patient, kind of like a long-list identical twin who is actually virtually identical to the patient, but a different person. Then the therapist (playing the role of the friend) describe the problem the patient is struggling as if it is your own problem.
David's explains that he began developing role-playing techniques in the early days of cognitive therapy because many of the Beckian techniques, such as Examine the Evidence and the Socratic Technique--while sometimes very helpful, were sometimes a bit dry, and he wanted to include punchier and more powerful and dynamic techniques in his therapeutic toolkit. These role-playing techniques are just one part of what sets TEAM-CBT apart from traditional, Beckian CBT.
Today, he explains and demonstrates the Externalization of Voices, which is always combined with the Self-Defense Paradigm and the Acceptance Paradox. He is joined by Fabrice, of course, and "Sarah," one of the members of his Tuesday training group at Stanford. Sarah has volunteered to use a personal example in the podcast to help demonstrate the Externalization of Voices.
This interview was first published on Neil Sattin's highly regarded Relationship Alive Podcast. Although some of the material may be familiar, there's much that's new, and you will enjoy the chemistry between Neil and David as they discuss each of the ten cognitive distortions and raise many challenging questions, such as:
- Is it really true that only our thoughts--and NOT external events--can change the way we feel?
- If someone has the belief, "I'm unlovable," isn't that type of thought immutable? How could you possibly change or modify a thought that may be rooted in traumatic experiences and so deeply embedded in a patient's psyche?
- Should we try to change other people's cognitive distortions, or just our own?
- How can we challenge each of the ten cognitive distortions?
And much more!
David's first interview with Neil received more than 25,000 downloads in the first month, and this riveting interview promises to be every bit as popular. If you want to download a transcript of this exciting interview, you can do so at www.neilsattin.com.
In this podcast, David and Fabrice answer five challenging questions submitted by listeners:
- Galina asks whether we always have to face our fears? Isn't it okay to be anxious sometimes?
- Courtney asks how to find the supplemental written materials, tests, and diagrams if you have purchased the eBook or audio-book copy of Feeling Good: The New Mood Therapy.
- Carlos asks about the best treatment for smoking cessation. During the discussion, Fabrice asks if Paradoxical Agenda Setting is important for therapists using hypnotherapy.
- Avi asks whether humans have a dark side, with dark negative motives that sometimes compete with positive, loving motives. And if so, how do therapists help patients deal with their own negative motives?
- Ben asks what to do if you're very anxious but simply can't pinpoint your negative thoughts.
In this podcast, David and Fabrice answer several fascinating questions submitted by listeners:
- Jackie asks where our distorted thoughts come from, since they are so often irrational and distorted, and inconsistent with the facts. Why do we sometimes beat up on ourselves relentlessly with negative thoughts?
- Tyler asks if it possible to do TEAM-CBT in conventional, 45 minute sessions. And if so, how? It seems my patients are just warming up by the end of the session, and then we have to start all over again the next week.
- Jess asks if it is possible to use the Five Secrets of Effective Communication in non-therapy settings. For example, if you are in a position of authority, like a high school teacher, will your students lose respect for you if you use the Five Secrets? Could you use the Five Secrets if you are working with violent gang members?
"I'm a failure. . . I'm not good enough. . . My life will be empty and meaningless without . . . "
Sound familiar? Sometimes, the messages we get from society, and the impossible standards that we accept, can lead to enormous, intense suffering.
Several months ago I received a compelling email from a young woman named Daisy who asked about the message we get from society that lead to suffering. Fabrice and I were so inspired that we devoted an entire Feeling Good Podcast to it (Podcast 038: Negative Messages from Society) The theme of the podcast, as well as the three subsequent podcasts, was how to pinpoint and modify the Self-Defeating Beliefs (SDBs) that lead to depression, anxiety, and relationship problems.
Today, Fabrice and I are thrilled and honored to present an entire TEAM-CBT therapy session with Daisy, along with her husband Zane.
Let's face it--nearly all of us fall into the black hole of depression, anxiety, shame, and self-doubt at times. Then it's time to ask yourself what you're telling yourself, write down your negative thoughts, identify the distortions in them, and substitute thoughts that are more positive and realistic. Sound too easy? The results can be mind-blowing!
David and Fabrice discuss a therapy session with a woman who had been hiding something about herself for nearly ten years due to feelings of shame. When she receives a phone call from someone in her church, her feelings of anxiety and shame hit the ceiling. Learn how she overcomes her feelings of angst and self-doubt using TEAM-CBT.
David hopes to make the actual video of this dramatic therapy session available soon right here at www.feelinggood.com in his new Feeling Good Store! (still under development at the time of this write-up.)
While listening, you can download pdfs about each of seven steps to help you break out of bad moods and boost your self-esteem.
Procrastination is one of the most common causes of unhappiness, and this bad habit is almost universal. We all put off the tasks we dread because they make us anxious, and because we're tempted to do other things that are way more rewarding. But the longer you procrastinate, the worse you feel, and this robs you of motivation. As a result, you fall into a vicious cycle where procrastination triggers negative feelings like depression, anxiety, and guilt, and your negative feelings, in turn, reduce your motivation and trigger more procrastination. A vicious cycle.
Fabrice and I are going to show you how to break the cycle and boost your happiness. To get started, please think of ONE thing you've been procrastinating on. It could be anything, such as working on your taxes, cleaning your garage, filing papers, working on a paper or presentation you've been avoiding, reading something you have to read for school or work--anything at all.
Now I want to ask you a question. Would you like to overcome the procrastination so you can get started on that task? If your answer is no, you can come back and listen later when you do want to solve this problem.
If the answer is yes, then I have a second question for you. WHEN would you like to overcome your procrastination and get started? Today? Or later on?
If your answer is today, then we're ready to rumble. If you say, "tomorrow," or some later time, then I'd encourage you to come back to this podcast when you are ready to solve the problem. I can ONLY help you overcome your procrastination today! NOT tomorrow.
Finally, I want to know if you'd be willing to devote a very small amount of time to getting started TODAY. I'm asking you to invest something like five minutes, and I'm also asking you to agree to limit your work this small amount of time. This is crucial, because if you tell yourself you have to do the entire job, that may take hours, and you'll probably feel so overwhelmed that you won't do a thing!
Finally, I want to know if you'd be willing to get started for five minutes even if you're not "in the mood," and even if you're completely unmotivated, and EVEN if the very thought of the task makes you anxious and guilty. If the answer is YES, then we've got a deal. But if you want to wait for the motivation, I urge you to turn off the podcast and come back to it at some later time.
One philosophical principle is the approach we're going to teach you is NOT to wait for motivation. Most procrastinators think that motivation comes first, followed by productive action, but this is an illusion, because you'll probably NEVER feel motivated to do some awful task you've been putting off. If you're waiting for motivation, you'll be waiting forever!
As I wrote in my first book, Feeling Good: The New Mood Therapy, highly productive people know that ACTION comes first, followed by motivation. In other words, you have to get started on some task before you'll feel motivated. You're not entitled to feel motivated until you've start accomplishing something! Waiting for motivation is the trap that keeps your procrastination alive and prospering.
I'm going to make things simple for you using a tool I created years ago called the Anti-Procrastination Sheet! To make this podcast experiential, think about the specific task you've been putting off, like filing papers, preparing your taxes, cleaning the garage, a paper or report you have to prepare--anything at all.
Now take a look at the Anti-Procrastination Sheet. As you can see, it has five vertical columns, but they're different from the columns on the Pleasure Predicting Sheet that we discussed in last week's podcast. In the first column you break the task into small, or even tiny, steps, and number them. Make sure that each step can be completed quickly and easily--for example 30 seconds, or a minute or two.
You don't have to outline the entire task, just the first four or five steps. And make sure the steps are small enough so you can complete all or most of them in five minutes or so. The philosophy behind this is called "little steps for big feats!" If you aim to do just a little, you may end up doing a great deal. But if you aim to do it all at once, the odds are high that you'll just end up procrastinating, because the task will seem overwhelming.
After you've outlined the first few steps, predict how satisfying or rewarding each step will be in the second and third columns, on a scale from 0% (not at all satisfying) to 100% (tremendously satisfying.) Make sure you complete this column before you do the activity. And make sure you do it on paper, and not just in your head!
Now complete the first step, and indicate how satisfying and rewarding it turned out to be on the same scale, from 0% to 100% in the fourth and fifth columns. That's all there is to it! Now do the same thing for the second step of the task.
David begins with a brief discussion of the philosophy of happiness, including the ancient Buddhist idea that everything in the universe is transitory and constantly changing, including our positive and negative moods, so the idea that you will be hopelessly depressed forever, or endless happy, are both illusions. Happiness, or pleasure, are transitory, and can only be achieved at specific moments. However, you can significantly increase the number and duration of the happy periods in your life.
David briefly discusses research evidence that simply doing potentially satisfying and rewarding activities, whether or not you're "in the mood," can reduce depression and enhance feelings of happiness and joy in daily living. This simple treatment method, called "Behavior Therapy," was pioneered by Dr. Peter Lewinsohn, from the Oregon Research Institute, and has been shown to have significant anti-depressant effects.
One way of doing this is with David's famous "Pleasure-Predicting Sheet." It's pretty simple to use. As you can see from the link, it is a sheet with four vertical columns. In the first column, you schedule activities with the potential for pleasure, learning, personal growth, or helping others. You can include activities that are not overly time consuming or burdensome. In the second column, record who you plan to do each activity with. If you do the activity alone, put "self" in the second column, since you're never truly alone. You're always with your "self."
In the third column, predict how satisfying or rewarding the activity will be, on a scale from 0% (not at all satisfying) to 100% (tremendously satisfying.) Make sure you complete this column before you do the activity! And make sure you do it on paper, and not just in your head!
Once you've completed each activity, indicate how satisfying and rewarding it turned out to be on the same scale, from 0% to 100%. That's all there is to it!
Then you can compare the last two columns (the predicted and actual satisfaction). Sometimes, depressed individuals think that things they used to enjoy will be boring or unrewarding, so they give up on things, fail to answer the phone, and mope around at home in a state of hopelessness and self-pity. Of course, that's a self-fulfilling prophecy and a vicious cycle, because when you stop doing things, you will probably become more depressed, and then you'll be even more likely to give up doing things for pleasure. In contrast, when you do things, you may discover that many activities are more rewarding than you anticipated.
You can also compare the satisfaction you experience when doing things by yourself versus the activities you do with others. Many depressed people with the Love Addiction believe they cannot be happy when they're alone, thinking they must be loved to feel truly happy and fulfilled. David describes a woman who tested this belief, and made an unexpected discovery, after her husband rejected her for another woman. You can see her Pleasure Predicting Sheet if you click here.
Finally, David gives an example of how a depressed, perfectionistic medical professor made another unexpected discovery with a modified version of the Pleasure-Predicting Sheet.
The Pleasure-Predicting Sheet is one of only 50 to 100 methods that David has learned or created for defeating depression and anxiety. He doesn't see it as a complete treatment for depression, but it usually has some nice mood-elevating effects. Fabrice and I encourage you to try it this week, so you can let us know how it works for you!
Next week, we'll have another cool tool you can use to boost your happiness by overcoming procrastination!
We address five questions submitted by listeners who listened to the recent series of podcasts on the Five Secrets of Effective Communication.
You definitely do NOT want to lose weight. You probably DO want to be thin and attractive, and in great physical condition, but you DON'T want to lose weight. Do you know why? There are only two things that you can do to lose weight--diet and exercise. And they both suck!
David describes two new, powerful techniques he has created for resolving this dilemma--the Double Paradox and Devil's Advocate Technique. David and Fabrice bring these techniques to life for you. If you are interested in losing weight, make sure you do the two exercises on paper while listening to this podcast.
- What do I do if I am using the Five Secrets and I feel angry? If I use the Disarming Technique, isn't there a danger that I might not express my own feelings? And isn't this the same as your "Hidden Emotion" Model, where we don't express our feelings due to excessive niceness?
- How would you use the Five Secrets if you're attacked in public by a narcissistic boss? Should you use the Disarming Technique? Won't that make you look weak? Should you only use the Five Secrets in one-on-one situations?
- Why is the Self-Monitoring technique rarely effective?
- How would you help young people who are being bullied in social media?
David and Fabrice discuss Inquiry, the third of the Five Secrets of Effective Communication. Inquiry means asking gentle, probing questions to learn more about what the other person is thinking and feeling.
David encourages listeners (that includes you!) to try using Inquiry five times each day, even in superficial interactions with people in any setting, such as the grocery store, and gives examples of how to do this. Although this will not be the deepest application of Inquiry, the practice will give you a clear understanding of how this technique works.
David addresses a question submitted by a listener after he heard the introductory podcasts on the Five Secrets of Effective Communication. He questioned the value of the Disarming Technique, and protested that every time he "turned the other cheek" he simply ended up with two sore cheeks!
A great question, and David and Fabrice share their thinking. Many people, including therapists, are afraid of the Disarming Technique, thinking that something terrible will happen if they agree with someone who is criticizing them.
They emphasize the value of questions submitted by you, the listeners, and also suggest giving specific examples when they are having trouble using the Five Secrets. Specifically, if you write down exactly what the other person said to you, and exactly what you said next, David and Fabrice will gladly analyze the interaction and show you what errors you made that caused a bad outcome, as well as how to correct those errors!
David and Fabrice then discuss Thought and Feeling Empathy, the second of the Five Secrets of Effective Communication. The definition of Thought Empathy is repeating or paraphrasing what the other person is saying, so he or she will see that you listened and got the message. Feeling Empathy, in contrast, involves acknowledging how the other person is likely to be feeling, given what he or she just said. You can often follow this with Inquiry, asking if you got it right, and inviting the other person to tell you more about what he or she is thinking.
Although David does not like formulas, they can sometimes help you get started. So here's the formula:
- Thought Empathy: Let me see if I got what you just said. You told me that A, B, and C. (A, B, and C would be what the person said to you, using his or her words.)
- Feeling Empathy: Given what you just said, I can imagine you might be feeling X, Y, and Z. (X, Y, and Z would be words from the Feeling Words list.)
- Inquiry: Did I get that right? Can you tell me more about what you've been thinking and feeling?
These techniques are invaluable in therapy, and go back to the pioneering work of Karl Rodgers, who argued that therapist empathy is the necessary and sufficient condition for personality change. Although subsequent research did not confirm this idea, there is still little argument that empathy is absolutely necessary for good therapeutic work.
In addition, skillful empathy is for everyone, and can greatly enhance your relationships with family members, friends, and colleagues, and strangers as well. For example, if you have a family member or friend who is feeling anxious, down, angry, or depressed, the skillful use of Thought and Empathy will almost always be far more effective than trying to help, rescue, or "fix" that person.
David brings Thought and Feeling Empathy to life with an example of a patient who criticizes his therapist, and then asks listeners, including you, to pause the podcast briefly so you can write down, from memory, what the patient just said. Most therapists who try this end up "forgetting" or editing out important portions of what the patient said. This irritates the other person, because you clearly did not "get it," and his or her attack or complaining will usually escalate.
David and Fabrice discuss common errors therapists and general public make when trying to use Thought and Feeling Empathy. The most common error involves using the techniques in a robot-like manner, parroting back the other person's statements repeatedly, without using "I Feel" Statements. They illustrate this error with a humorous example.
Other common errors when using Thought and Feeling Empathy include:
- Giving advice
- Correcting distortions
- Making interpretations
- Failing to acknowledge the other person's anger
David encourages listeners (that includes you!) to try using Thought and Feeling Empathy three times each day, even in superficial interactions with people in any setting, such as the grocery store, and give examples of how to do this. Although this will not be the deepest application of these techniques, the practice will give you a clear understanding of how these techniques actually work.
David and Fabrice end this podcast with a powerful example of Thought and Feeling Empathy during an actual therapy session in David's weekly psychotherapy training group. The "patient" in the therapy is a TEAM-CBT therapist named Rhonda who became depressed and anxious after receiving some critical therapy from a participant in a therapy group she was teaching.
Even if you are not a therapist, you can perhaps identify with the "ouch" we all feel when we are criticized by someone, and it hits a vulnerable spot. This is an almost universal human concern. It is so easy to feel hurt, depressed, ashamed, anxious, inadequate, and perhaps even a bit angry!
David invited one of the therapists in the group to empathize with Rhonda, as a part of his training, but he ended up with a less than stellar grade. David, Fabrice and Rhonda explain the errors he made--which actually made her feel worse.
Making errors is totally okay in a training and learning situation, as well as in real therapy sessions--as long as you get feedback and try to correct your errors with humility. This can actually deepen the therapeutic relationship.
David then asked Dr. Jill Levitt to try to model empathy again, and to address Rhonda's concerns. Jill hits the ball out of the park and gets an A+ on empathy. David and Fabrice explain why her intervention was so effective, and why the Five Secrets have to come from the heart if they are to be maximally effective.
Jill is a master therapist and co-teaches the weekly TEAM-CBT training group, along with David and Dr. Helen Yeni-Komshian. If you would like to hear more of Jill's fabulous empathy work, make sure you listen to the live therapy podcasts with Mark, the physician who felt like a failure as a father!
Next week, Helen returns for the remaining Podcasts on the Five Secrets!
David, Helen and Fabrice focus on the Disarming Technique, which is the first of the Five Secrets of Effective Communication. The definition of the Disarming Technique is finding truth in what the other person is saying, even if it seems blatantly wrong, or illogical, or exaggerated. And it's based on the Law of Opposites.
Is there someone in your life who just
- won't listen?
- won't open up?
- always has to be right?
- always has to get his or her way?
- doesn't seem to understand how you feel?
- doesn't seem to care?
- is relentlessly critical?
- whines and complains endlessly, but always ignores your attempts to help?
Would you like greater intimacy and respect, and more rewarding relationships with the people you care about?
If so, this podcast series on the Five Secrets of Effective Communication will be right up your alley. Although the Five Secrets have been introduced in previous podcasts, David and Fabrice will bring them to life with clear explanations and vignettes, and will give you homework assignments so you can practice them, one at a time, between podcasts. In the first two Five Secrets podcasts, David and Fabrice will be joined by Helen Yeni-Komshian, MD. Helen was David's student during her psychiatric residency training at Stanford roughly 15 years ago, and she now teaches David's at weekly psychotherapy training group at Stanford, and is on the adjunct faculty there.
David, Helen, and Fabrice begin with a brief definition of each of the Five Secrets of Effective Communication. They emphasize the importance of intense desire if you really want to learn and master these techniques. They compare the Five Secrets to the notes on a musical instrument. Lots of dedication and practice will be necessary if you hope to use them skillfully and effectively in your relationships with the people you care about. The goal is to help you develop greater satisfaction in your interactions with others and to resolve conflicts and arguments with others.
Helen emphasizes that these techniques must be applied in a genuine fashion if they are to be effective. If they are used simply as techniques to manipulate another person, they will not be effective.
David mentions that the Five Secrets exist on two levels. One the one hand, they are sophisticated and powerful psychological techniques that can change your life and your relationships with others. But on the other hand, they are profound spiritual techniques that require the death of the ego. And they also require us to relearn our usual knee-jerk habits of arguing, blaming, and defending ourselves when we're at odds with another person.
These podcasts will be for mental health professionals and for the general public. We will give vignettes illustrating challenging therapeutic logjams that were resolved with the skillful use of the Five Secrets, as well as examples how you can use the Five Secretes with loved ones, friends, colleagues, customers, and even aggressive or irritating strangers.
The Five Secrets require lots of hard work and practice, in much the same way that learning to play a musical instrument will require lots of practice. In addition, when you practice you may initially find them difficult to use, and you may experience some failures. David, Helen, and Fabrice emphasize the spirit of "joyful failure" or "learning through failure," and urge you to check your ego at the door, since the rewards of the learning can be immense.
How would you treat excessive worrying? a listener asks.
David describes a new patient who had struggled with 53 years of failed therapy for excessive, relentless worrying, and describes how she was "totally and irreversibly cured" in just two therapy sessions, which was the "good news." The Hidden Emotion Technique was the key to her remarkably rapid recovery. David explains that the "even better news" was that her relentless worrying would come back over and over in the future, and that this was actually a really good thing!
David also emphasizes the importance of using all the four models, along with a Daily Mood Log, when treating any form of anxiety: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. To learn more about how these four powerful treatment models work, you can listen to Podcasts 022 through #028.
The DSM5 is the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. It is used to assign diagnoses to patients. David critiques the DSM5 diagnostic criteria for "Generalized Anxiety Disorder" (GAD) and emphasizes that while worrying exists, and can easily be treated in most cases, the "mental disorder" called Generalized Anxiety Disorder does not exist, and is simply a fantasy made up by the psychiatrists who have created the DSM.
Soon, David and Fabrice will launch a series of five podcasts on the Five Secrets of Effective Communication, focusing on one technique each week. Say tuned, because these podcasts could change your life and show you the road to more loving and satisfying relationships with friends, patients, colleagues, and family members--and "enemies" as well!
Is there anything positive about hopelessness or an addiction ? What does it take to be a "worthwhile" human being, or to have a valuable life?
In today’s podcast, David and Fabrice address three questions submitted by listeners:
- Avi asks another great question about the importance of Positive Reframing in TEAM-CBT. But how can we possibly find something positive in the feeling of hopelessness. After all, Dr. Aaron Beck has taught us that it's the worst emotion of all!
- Avi asks a similar question about an addiction. How can an addiction possibly be a good thing?
- Eugene asks a tremendous question about a passage in Dr. Burns' book, Feeling Good: The New Mood Therapy, on the topic of what it means to be a worthwhile human being, and what it takes to make a life valuable. Eugene hints that Dr. Burns may have the wrong idea, and asks what he would say to a patient who doesn't "cry uncle!"
David and Fabrice love your questions so keep them coming!
Will people manipulate you if they catch on to the fact that you're using the Five Secrets of Effective Communication? Is it fair to ask depressed patients to do psychotherapy homework between sessions when they're already struggling with a loss of motivation?
In today’s podcast, David and Fabrice address two questions submitted by listeners:
- Robert asks whether it would be a problem if you are using the Five Secrets of Effective Communication (the Disarming Technique, Thought and Feeling Empathy, Inquiry, "I Feel" Statements, and Stroking) with someone who is already familiar with these techniques. Isn't there a danger that they might see through you and therefore thwart your efforts and manipulate you?
- Avi asks about the importance of psychotherapy homework in TEAM-CBT. He points out that the loss of motivation is one of the central symptoms of depression, so aren't we in a catch 22 type of situation since patients might not have the strength and perseverance to do their homework?
David and Fabrice love your questions so keep them coming!
We address a number of excellent questions submitted by listeners:
- Are the scales on your Brief Mood Survey reliable and valid?
- How can I identify my Negative Thoughts when I'm upset but I can’t figure out what I'm thinking and telling myself?
- I have social anxiety and don’t want to get out of bed. I'd rather just lie in bed and watch Game of Thrones. Help me! What should I do?
- I saw an article in the paper that claimed that bacteria in the gut cause anxiety. Is this true? If not, what does cause depression and anxiety?
- Could your tools, like the Cost-Benefit Analysis, help with problems that aren’t necessarily emotional problems? Like what career to pursue, or what college to go to?
- What should you do if you feel great at the end of a therapy session, and then become severely upset again during the week?
- How does Dr. Burns deal with resistance from colleagues when he is trying to teach these new TEAM-CBT techniques? Does he run into much resistance? How does he feel about the resistance?
David describes one of the more obscure methods called “Self-Monitoring”. He thinks of it as “Meditation in Daily Life.” The whole idea is to note a negative thought that suddenly pops into your mind, and then to track it, or count it, with some type of counting device, list the wrist counters golfers wear to keep track of their scores, and then to simply let go of the thought and continue with what you were doing, instead of dwelling on the thought and getting distracted and upset.
David explains that Self-Monitoring often is not effective, but occasionally it can be life changing for individuals who are struggling with anxiety, depression, or anger. He brings the method to life with the story of an eye doctor with severe OCD who recovered completely because of Self-Monitoring in combination with Response Prevention.
He also explains how this technique, along with the Daily Mood Log, was curative for a retired carpenter with severe depression following a stroke. The type of stroke is called “Pseudo Bulbar Palsy,” and the symptoms include uncontrollable sobbing or laughing after the slightest sad or funny event or comment.
This case was particularly interesting because the therapist for the carpenter was one of David’s students, a clinical psychologist who had raised the question, “How could cognitive therapy possibly help someone if his or her depression is caused by a chemical imbalance in the brain?” And in this instance, since we know the carpenter’s depression was caused by thousands of microscopic hemorrhages in the deep structures of his brain, how could any kind of psychotherapy possibly help?”
This podcast was recorded eight weeks after the initial session with Marilyn. As you may recall, Marilyn became severely depressed when she discovered that she had Stage 4 Lung cancer. In spite of that horrific and real trauma, she completely overcame her negative feelings in the first session, which was broken down into a series of three consecutive podcasts, with commentaries as the session unfolded.
Sadly, Marilyn experienced severe pain in her left rib cage from a metastasis from her lung cancer roughly two months later. This physical relapse triggered an understandable emotional relapse as well, with an understandable return of severe depression, anxiety and anger, so Marilyn agreed to record another podcast to illustrate how a tune-up works following the initial treatment.
I would like to point out that the Relapse Prevention Training was critically important, so that Marilyn would know that relapses are a certainty, and that they can be dealt with effectively using the same techniques that worked the first time. This message is important so that the patient does not feel broadsided when the negative feelings return. Some patients have the false expectation that they'll be happy forever after they've recovered.
But no one is entitled to be happy all the time! If the therapist and patient know how to deal with a relapse, and have practiced ahead of time, it will still be painful, but the patient and therapist will know what to do to make sure the patient can recover from the relapse quickly, instead of getting caught in another length episode of depression or anxiety.
The entire session has been included in this single podcast. That’s why we’ve offered this as a bonus session between our weekly podcasts. You will need nearly two hours to listen to it, but I think you will find it’s a great investment of your time.
David and Fabrice begin by reading several incredibly touching reader comments on the live therapy with Marilyn. Marilyn experienced a severe depression relapse eight weeks after her initial session with Matt and David, because of a painful metastasis to her rib cage which frightened and demoralized her. She graciously agreed to come in for a tune-up with David and Matt which will be published as a special podcast within the next week or so. You will not want to miss this session!
David addresses two questions posed by listeners. The first question has to do with so-called “third wave” CBT as well as Mindfulness-Based CBT and other innovations in CBT. David stresses the difference between specific and non-specific therapeutic techniques. He also discusses the distressing but exciting fact that few or no therapies have proven to be much more effective than placebos in the treatment of depression, and why this is the case.
Another listener asked why David did not use Exposure initially in his treatment of the woman who was afraid that her baby would be switched at the hospital, and that she’d end up with the wrong baby. David concedes that if he’d thought of using Cognitive Flooding initially, it likely would have been effective. He also argues that Exposure and Response Prevention are not treatments for OCD, or for any anxiety disorder, but are simply tools one can use in treatment. David argues that for an optimal outcome, he combines four treatment models with every anxious patient: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. These models are discussed in detail on previous podcasts.
David emphasizes that the goal of the RJ is not simply to learn how to transform troubled, adversarial relationships into loving ones, but also how to achieve Interpersonal Enlightenment, which is the empowering but shocking realization that we are creating our own interpersonal reality—for better or worse—at every moment of every day! And although the reward of the RJ is greater love and joy in your daily living, the price is steep—it requires the death of the ego, which the Buddhists have called “the Great Death!”
Together, David and Fabrice walk you through the five steps in the RJ, using real examples of individuals David has worked with in his workshops for the general public or for mental health professionals. One vignette involves a woman who complained bitterly that her husband had been relentlessly critical of her for 25 years. She said she came to the workshop because she wanted to know why men are like that. She found out why her husband was so critical, but the answer was not the one she expected!
The other vignette involved a minister’s wife who complained that her husband was overly “nice” and unable to deal with negative feelings. As a result, she said their marriage was superficial and lacking in intimacy. She discovered precisely why their relationship was superficial—but it wasn’t exactly the answer she was looking for!
Bob, a psychiatric resident named was treating a divorced woman who complained bitterly about her ex, and constantly argued with him whenever he came to visit with the children.
Their relationship was clearly acrimonious, so Bob asked the woman if she wanted some help with the way she was communicating with her ex. She bristled and said that she was an attorney and that she could communicate just fine, thank you! Bob’s error was the same that many therapists make—of thinking that people with troubled relationships want help. Clearly, Bob’s patient was not asking for help. She just wanted Bob to agree that her ex was a bum!
In many cases, and perhaps most, individuals who aren’t getting along with someone—such as their spouse, sibling, parent, colleague, or friend—aren’t really asking for help. They just want to vent and persuade you to buy into their negative view of the person they aren’t getting along with. They just want you to know what a loser the other person is!
So how do we help people with troubled relationships? David emphasizes that empathy is always the first step. You try to see the world through the eyes of the patient without jumping in to try to “help.” Empathy, of course, is the "E" of TEAM therapy.
Once the person feels understood and supported, the next step is called Agenda Setting. That’s the A of TEAM. One of the most important tools in Agenda Setting for individuals with troubled relationships is to first ask, “Is this relationship conflict something you want help with?” In many cases, the patient will say no, so you can ask if there’s something else he or she wants to work on.
In the language of TEAM, this is called “Sitting with Open Hands.” The therapist has to let go of his or her attachment to “helping.” This is difficult for many therapists, due to the therapist’s compulsive urges to help.
If the patient does want help, the next step is called Interpersonal Decision-Making. You ask what kind of help the patient wants, and make it clear that the patient has three choices.
- To leave the relationship.
- To improve the relationship.
- To stay in the relationship and behave in a way that will guarantee that the relationship will remain miserable.
David emphasizes that the last choice is by far the most popular. The second most popular choice is the decision to leave the relationship. And occasionally, you’ll find a person who wants help improving the relationship. As you can see, Interpersonal Decision-Making is simply a more sophisticated way of asking the patient if she or he wants help!
If the answer is still yes, the next Agenda Setting step is the Blame Cost-Benefit Analysis (CBA). You can ask the patient something along these lines:
“Who, in your opinion, is more to blame for the problems in the relationship? You? Or the other person? And who, in your opinion, is the bigger jerk? You? Or the other person?”
At least 80% of the time, the patient will say, “the other person!” You may feel the same way if you’re in a conflict with someone right now. However, blame is the most formidable barrier to intimacy, so before we can continue with the treatment, this issue must be skillfully addressed, or the treatment will probably fail.
David and Fabrice guide the listener in doing a written Blame CBA, listing the advantages and disadvantages of blaming others for the problems in our relationships with them. They encourage you to pause the recording and to the written exercise during the podcast, but warn you not to do it if you are driving!
Then they discuss how to process the results of the Blame CBA. If you would like to see a completed Cost-Benefit Analysis, click here. As you can see, the weightings at the bottom have not been filled out, so you can do that for yourself if you like. Make sure you put two numbers that add up to 100 in the two circles. Put the larger number in the circle under the column that feels more desirable. For example, if the advantages of blame greatly outweigh the disadvantages, you might put a 70 in the circle on the left and a 30 in the circle on the right.
If the patient concludes that the disadvantages outweigh the advantages, you can proceed to the M = Methods phase of the TEAM therapy session, which involves the Relationship Journal (RF). This is a powerful tool that David has designed to create interpersonal enlightenment and the death of the ego. David and Fabrice will discuss and illustrate the RJ in the next podcast.
David describes the three assumptions of the Interpersonal TEAM Therapy:
- We cause the very relationship problems we are complaining about, but don’t realize this, so we blame the other person and feel like victims of his or her“badness.” David describes a man who endlessly complained about his wife during therapy sessions--she didn't like having sex with him, she spend money behind his back, and never bragged about him when they were out to dinner with friends. He had even taken notes for years on all the “bad” things his wife had been doing every day throughout their marriage, but overlooked the many hurtful and self-centered things he was doing to break her heart every single day.
- We do not want to have to look at our own role in any relationship conflict because it is too painful to have to confront our “shadow,” to use a Jungian concept, and because we want to do our dirty work in the dark. So we will deny our role and angrily punish anyone who tries to shed light on our role in the problem. David describes a severely depressed woman who complained that she was the victim of "loneliness in marriage," a concept she'd just read about in a popular women's magazine. She explained that her husband would not and could not express his feelings, and felt that he was to blame for their marital problems as well as the severe depression and loneliness she’d been struggling with for 25 years. And yet, in a therapy session when he tried to express his feelings, she exploded angrily and told him to shut the F__ up! When Doctor Burns asked her to reflect on what had happened in the session with her husband, she angrily threatened to fire him if he ever brought up the topic again!
- The first two principles paint a dark picture of human nature. The third principle is more optimistic—namely, that we have far more power to heal a troubled relationship than we realize, and this can often happen quickly, but there’s a stiff price to be paid. First, we have to be willing to stop blaming the other person so we can examine and pinpoint our own role in the conflict. Second, we have to focus all of our energy on changing ourselves, rather than trying to change the other person. This can be extremely liberating and joyful, but it involves the exceedingly painful death of the ego. The Buddhists have called this type of enlightenment “the Great Death.’
In the next podcast, David and Fabrice will show you how to transform your own troubled relationships into loving ones--if that's what you want to do!
First in a series of podcasts on how to transform troubled relationships into loving ones—if that's what you want to do!
David begins with the story of how he got into working with troubled couples as well as individuals with troubled relationships shortly after his first book, Feeling Good, was published. Because cognitive therapy was beginning to generate excitement worldwide as the first drug-free treatment for depression, everyone thought it might also be effective for other kinds of problems, including troubled relationships.
And there were fairly good reasons to suspect that cognitive therapy might be helpful. When you’re in conflict with a loved one, friend, colleague or stranger who you can't get along with, you’ve probably noticed that you will usually have negative thoughts like these running through your brain:
- It’s all his fault. (Blame, All-or-Nothing Thinking)
- She’s a jerk. (Labeling, Should Statement, Mental Filter, Hidden Should Statement)
- He’ll never change! (Fortune Telling, All-or-Nothing thinking, Discounting the Positive, Emotional Reasoning)
- All she cares about his herself. (Mind-Reading, Discounting the Positive, Mental Filter, Over generalization)
- I’m right and he’s wrong about this! (Blame, All-or-Nothing Thinking)
- She shouldn’t be like that. (Should Statement, Blame)
And as you can see, these thoughts contain all the same kinds of cognitive distortions that depressed individuals have, as I've indicated in parentheses. If you're familiar with the cognitive distortions, you may be able to pinpoint even more than the ones I've listed. The only difference is that when you're in conflict with someone, the distortions will usually be directed at the person you’re not getting along with, rather than yourself.
Although these thoughts will usually be distorted, you may not realize this (or even care) when you're upset. You'll probably be convinced that the person you're mad at really is a jerk, or really is to blame, or really is wrong. In addition, these thoughts will tend to function as self-fulfilling prophecies. For example, if you think someone is a self-centered jerk, you will usually treat him or her in a hostile or unfriendly way, and then he or she will get defensive and hostile, and will look like a jerk. Then you'll tell yourself, "See, I was right about him (or her)!"
David got excited about these insights and wrote a draft of a book called Couple in Conflicts, Couples in Love, and sent it to his editor in New York to see what she thought. The new book was about how to modify the distorted thoughts and self-defeating beliefs that trigger and magnify relationship problems. David's editor called the next day with an offer of a large advance, exclaiming excitedly that the book was sure to be a #1 best seller.
David was ecstatic, and set out to edit the book for publication. In the meantime, he was using the new approach with troubled couples as well as individuals with relationship conflicts. But after six months of repeated treatment failures, he concluded that cognitive therapy was not at all effective in the treatment of relationship problems. The approach sounded great on paper, but it didn't work in the real world.
David sadly returned the advance to his publisher and cancelled the contract. He promised that if he could figure out why cognitive therapy didn't work for troubled relationships, and if he could find a better treatment method, he’d write another book. Figuring it out took 25 years or research and clinical experience, and the name of the book he eventually did publish is called Feeling Good Together, now available on Amazon.com.
David and Fabrice then discuss some of the most popular theories about the causes of relationship problems:
- The skill deficit theory: We want loving relationships, but don’t have the communication and negotiation skills to get close to the people we’re not getting along with.
- The barrier theory: We want loving relationships, but something gets in the way, such as unrealistic expectations or distorted thoughts about the person we’re not getting along with. Other barrier theories include the idea that women are from Venus and men are from Mars popularized by John Gray, Deborah Tannen, and others. According to this theory, women use language to express feelings, and men use language to solve problems, so they both end up frustrated and not understanding one another. Another popular theory is the idea that we project childhood conflicts with our parents onto others, and thus recreate the same dysfunctional patterns repeatedly in every new relationship.
- The self-esteem theory: You can’t develop loving relationships with others if you don’t know how to love yourself.
- The motivational theory: We have troubled relationships because we WANT them!
David emphasizes that the first three theories are all very optimistic--they all are based on the idea that human beings are basically good and want loving, peaceful, joyous relationships. But something gets in the way, such as a barrier of some type, or the lack of communication skills, or the lack of self-esteem. And they are all very hopeful, since we can teach people better skills, or remove the barriers to intimacy, or help people develop better self-esteem.
David also emphasizes that these theories have only two problems. First, the theories that they're based on are false. Second, the treatments that have evolved from these theories are not effective. David and Fabrice describe research on the validity (or total lack of validity) for these theories as well as the effectiveness (or lack of effectiveness) of the treatment techniques and schools of therapy that have evolved from these theories.
David then discusses the motivational theory which is much less optimistic about human nature, and emphasizes that humans have competing positive and negative motives.
In the next podcast, they will discuss the basics assumptions of the new treatment approach David has created for relationship problems, based on the motivational theory.
A listener named Benjamin asks about procrastination. He wrote:
“The live therapy with Marilyn was very interesting - like other listeners, I was impressed by her character and strength.
“Towards the end of this most recent podcast, you were musing on what topics to cover in future podcasts. I would love to hear about how you treat people suffering from chronic laziness ("Do Nothingism"). In particular, there seems to be a strong potential of a Catch-22 with Process Resistance: The patient cannot find the motivation to do anything, yet they have to carry out the process (do the homework) to improve.
“Even worse, in "Feeling Good", you categorize "Do Nothingism" into around 10 different categories, and suggest a different approach for each one. What should a lazy person do, who identifies with multiple categories, but is already starting to feel overwhelmed at the prospect of doing one of those activities, let alone five of them?
“I would love to hear David's thoughts on this!”
David and Fabrice begin by thanking Benjamin, and David emphasizes how helpful and inspiring it is to receive specific questions like this, which makes it easy to create a (hopefully) informative and interesting podcast.
David says that his thinking about the treatment of procrastination has changed greatly since he wrote Feeling Good. One big change is that he no longer tries to “help” individuals who procrastinate, since this will cause them to continue to procrastinate, and the failure will now be the failure of the therapist, who’s “helping” wasn’t good enough.
Instead, David outlines a multi-step approach, based on someone who has ten years of unfiled papers that have piled up in his office, so that by now 15 feet of desk space is completely covered by piles of papers roughly one foot high. Fabrice plays the role of the resistant patient, and David plays the role of the therapist.
The steps include:
Paradoxical Agenda Setting: David asks, “The procrastination seems to be working for you. Why would you want to change? Let’s make a list of all the benefits of procrastination, and all the reasons NOT to change.” David emphasizes that the patient has to convince the therapist that this is something he really does want to change. It’s NOT the therapist’s role to help or to convince the patient to change!
Miracle Cure Question: What kind of help would you like in today’s session? Most patients say they need help with motivation. David declines to offer this, explaining that it isn’t on the therapeutic menu today—only the “Blue Plate Special!” The patient must agree to begin working on the filing in spite of having no motivation.
David also explains the underlying concept behind this strategy: most procrastinators are waiting for motivation, but that never works. You’ll be waiting forever, because you’re NEVER going to feel like doing all that filing! You aren’t entitled to motivation!
Productive individuals know that action comes first, and motivation comes second.
Specificity: What time would you like my help in overcoming your procrastination? The patient’s requests for help yesterday or tomorrow are declined by the therapist, so they settle on 6 PM today.
Little Steps for Big Feats: Let’s list the first five things you would need to do tonight at 6 PM, making sure that every step can be completed in 15 to 30 seconds. They list these steps:
- Walk into my office
- Choose one pile to start working on
- Pick up the top piece of paper on the pile
- Put it into a blank manila file folder
- Label the file folder
Let’s Be Specific: David asks if Fabrice needs help with Step 1? Step 2? Etc. Fabrice finally admits he can do these five steps.
Five Minute Rule: David asks if Fabrice will agree to do these five steps between 6 PM and 6:05 PM, and if he will agree to work on his filing for ONLY those five minutes. At the end of the five minutes he has completed 100% of the assignment. The rationale is that if Fabrice tries to do it all, he’ll get so overwhelmed that he won’t do anything. But if he agrees to ONLY five minutes, that will be do-able. And if he surprises himself, and gets motivated to do more, he can, be he only gets credit for the first five minutes.
Problem – Solution List: David asks Fabrice to put a line down the middle of a piece of paper, from top to bottom, and list all the problems that will get in the way at 6 PM, and then to list convincing solutions to each problem in the right-hand column. Fabrice lists two problems: 1. I won’t feel like it. And 2. Traffic might be heavy, so I might not get home by 6 PM.
“I Stubbornly Refused” Technique: David asks Fabrice to agree to an unusual phone call at 6:05 PM!
TIC – TOC Technique: David plays the role of Fabrice’s “Task-Interfering Cognitions” (TICS) that will tempt him to procrastinate, and asks Fabrice to play the role of the “Task-Oriented Cognitions” (TOCS) he can use to combat the TOCs. The TICS include the familiar ones such as:
- Five minutes won’t help, the job is overwhelming.
- Even if I get started, I’ll just relapse, so there will never be a permanent solution.
- It’s not such a big problem, I don’t need to do my filing now.
- I can watch Game of Thrones on TV instead. That will be more fun.
- It will be too anxiety provoking to get started.
- It’s too late to get started anyway.
- Tomorrow will be a better day.
David confesses the problem is one that he actually had, and describes how he solved it, using this exact approach!
The responses to the Marilyn session were extremely positive. At the start of the podcast, Fabrice reads a response from a listener who was moved and inspired by the work Marilyn did.
David and Fabrice discuss two questions commonly raised by people who have seen David's live demonstrations with individuals experiencing severe depression and anxiety. Since the change in Marilyn’s scores were so fantastic, some skeptical listeners have asked, “Was this real, or was it staged?” Others have asked if patients are simply giving favorable answers on the Brief Mood Survey and Evaluation of Therapy Session forms as a way of being “nice” to the therapist.
David points out that the opposite is true. If patients are in treatment voluntarily, without some kind of hidden agenda such as applying for disability, they tend to be exceptionally honest in the way they fill out the forms. In fact, most therapists find that they get failing grades from nearly every patient on every scale at every session at first. This can be very upsetting, especially to therapists who are narcissistic and defensive about criticism. But if the therapist is humble and open to the feedback, the patient’s feedback on the Brief Mood Survey as well as the Evaluation of Therapy Session forms can provide a fabulous opportunity for growth and learning.
So in short, it is not true that patients fill out the forms just to be “nice” and to please the therapists. The scores are brutally real! If you are a therapist and a doubters, you can give the assessment instruments a try, and I think you’ll be surprised, and perhaps even shocked when you review the data!
Still, David acknowledges that the rapid and phenomenal changes he now sees most of the time when using TEAM-CBT are hard to believe, especially when you've been trained to think that recovery is a long, slow process. David discusses a model of brain function proposed by a molecular biologist / geneticist, Dr. Mark Noble, that allows for extremely rapid change.
David and Fabrice also address the question—can these kinds of miraculous results last, or are they only a flash in the pan? David emphasizes the importance of ongoing practice whenever the negative thoughts return. The “one and done” philosophy is not realistic. Part of being human is getting upset during moments of vulnerability, and that’s when you have to pick up the tools and use them again!
David describes experiencing three hours of panic just a few days ago, and Fabrice asks what techniques he used to deal with his own negative feelings, including Identify the Distortions, Examine the Evidence, Reattribution, and the Acceptance Paradox.
David agrees with the Dalai Lama that happiness is one of the goals of life, but emphasizes that it is not realistic to think one can be happy all the time. Fortunately, you can be happy most of the time--but you have to be willing to pick up the tools and use them from time to time when you fall into a black hole!
Crushing Negative Thoughts
In this third and final podcast featuring live therapy with Marilyn, David and Matt move on to the M = Methods phase of the session along, and encourage Marilyn to challenge the Automatic Negative thoughts on her Daily Mood Log using techniques such as Identify the Distortions, the Paradoxical Double Standard Technique, the Externalization of Voices, and Acceptance Paradox. Marilyn emerges as a powerful partner and begins to crush the negative thoughts that had seemed so real and overwhelming at the start of the session.
David emphasizes that the perceptions of therapists can often be way off base, so even though Marilyn appeared to change—fairly dramatically—during the session, David, Fabrice, and Matt will not know for sure until they review Marilyn’s end of session ratings on the Daily Mood Log, Brief Mood Survey, and Evaluation of Therapy Session.
David defines a relapse as one minute or more of feeling lousy. Given this definition, all human beings will “relapse” frequently, including Marilyn. But relapses following recovery do not have to be a problem if the patient is prepared for them ahead of time. You will hear David and Matt doing relapse prevention using a number of techniques, including the Externalization of Voices.
Fabrice, Marilyn, Matt and David discuss the session, and what it meant to Marilyn from a personal and spiritual perspective. You can view this session as a powerful psychological experience—a “mind-blowing” single session “cure,” if you will—or as a profoundly healing spiritual experience: the emergence, resurrection, or rebirth from the “Dark Night of the Soul.” And you can ask yourself—did a genuine miracle happen here today?
I, David, am very indebted to Marilyn for making this phenomenal and intensely personal experience available to all of us. What a gift! Thank you, Marilyn. We love you!
I also want to thank my co-host, Fabrice, for making these podcasts happen! What a joy it is to work with you every week, Fabrice.
And I want to thank my fantastic co-therapist, former student, and colleague, Matthew May, MD, for support and friendship over these many years! Matt, as you know, I often sing your praises in my workshops around the country, telling people how amazing you are. Now they will see what I mean first-hand!
I hope that through these three podcasts, Marilyn will touch large numbers of people for years, even decades, to come. If you were touched by these recordings, please let your friends and colleagues know, so that they might have the chance to “tune in” as well.
In the first session with Marilyn, I mentioned the highly controversial theory that our pain usually results from our thoughts, and not from the circumstances of our lives. What do you think now?
The Hidden Side of Depression, Anxiety, Defectiveness, Hopelessness and Rage
We nearly always think about negative feelings, such as moderate or severe depression, as problems that an expert must try to fix, using drugs and / or psychotherapy. There are a multitude of theories about why humans become depressed, including, but not limited to:
- We get depressed because reality sucks. We believe our mood slumps result from the circumstances in our lives, such as being alone following a rejection, experiencing the loss of a loved one, not having enough money, education or resources, social prejudice, or (as in Marilyn’s case) facing some catastrophic circumstance, such as severe illness.
- We get depressed because of insufficient love and nurturing in childhood, or because of traumatic childhood experiences.
- Biological factors. We get depressed because of our genes, or diet, or because of a chemical imbalance in our brains.
Certainly, there can be some truth in all of these theories. Reality does kick us all in the stomach from time to time, and the pain we feel is understandable. My wife and I lost her father to Parkinson’s Disease a few years ago. We loved him tremendously, and his loss was extremely painful for everyone in our family.
And most of us have experienced less than ideal circumstances when growing up, and many have even been victimized by horrific and tragic circumstances, such as child abuse. And clearly, some severe psychiatric illnesses, such as schizophrenia, do result from some kind of brain abnormality.
But the problem with all of these theories is that they put us at the mercy of forces that are largely beyond our control—since we often cannot do much to change reality, rewrite our childhoods, or modify our brains short of taking this or that medication.
In this podcast, Matt and David take a radically different approach, and argue that Marilyn’s intense feelings of depression and anxiety are not “mental disorders” that reflect some defect in Marilyn, but rather the expression of what is most beautiful and awesome about her. They also argue that there are large numbers of advantages, or benefits, of feeling the way she does, using several Paradoxical Agenda Setting techniques such as the Miracle Cure Question, Magic Button, Positive Reframing, and Magic Dial. The results are stunning and unexpected. Or, as Marilyn put it, this portion of the session was “mind-blowing.”
The third and final podcast next week will include the M = Methods phase of the session along with the end-of-session T = Testing and wrap-up, including Relapse Prevention Training.
The Dark Night of the Soul (Part 1)
The first live therapy podcasts with Mark (the man who felt like a failure as a father: podcasts 29 – 35) were enormously popular, and many people have asked for more. David and Fabrice were delighted with your responses, so the next three podcasts will feature a therapy session with Marilyn by David and his highly-esteemed colleague and co-therapist, Dr. Matthew May. These three podcasts will include the entire session plus commentary the session unfolds.
We are extremely grateful to Marilyn for her courage and generosity in making this extremely private and intensely personal experience available to all of us. I believe the session will touch your heart, inspire you, and give you courage in facing any problems and traumas that you may be struggling with.
According to the theory behind cognitive therapy, people are disturbed not be events, but rather by the ways we think about them. This notion goes back nearly 2,000 years to the teachings of the Greek Stoic philosopher, Epictetus, who emphasized the incredible importance of our thoughts—or “cognitions”—in the way we feel. Fifty years ago, this notion gave rise to a new, exciting, drug-free treatment for depression called “cognitive therapy,” which was based on this basic notion: When you CHANGE the way you THINK, you can CHANGE the way You FEEL—quickly, and without drugs. That’s why I wrote my first book, Feeling Good: The New Mood Therapy, because I was so excited about this notion and the powerful new “cognitive therapy” that was rapidly emerging.
The idea behind cognitive therapy is simple. When you’re upset, you’ve probably noticed that your mind will be flooded with negative thoughts. For example, when you’re depressed, you may be beating up on yourself and telling yourself that you’re a loser, and when you’re anxious you’re probably thinking that something terrible is about to happen. However, it may not have dawned on you that your thoughts are the actual cause of your negative feelings.
In addition, you’re probably not aware that your negative thoughts will nearly always be distorted, illogical, or just plain unrealistic. In Feeling Good, I said that depression and anxiety are the world’s oldest cons, because you’re telling yourself things that simply are not true. In that book, I listed the ten cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, and hidden Should Statements, that trigger negative feelings.
In the years since I first published Feeling Good, my list of cognitive distortions has gone worldwide, and is used by enormous numbers of mental health professionals in the treatment of individuals struggling with depression and anxiety. The notion that depression, anxiety, and event anger result entirely from your thoughts, and not upsetting events or circumstances external events is enormously liberating, because we usually cannot change what’s actually happening, but we can learn to change the way we think—and feel.
But a lot of people don’t buy, or understand, this notion which seems to fly in the face of common sense. For example, you might argue that when something genuinely horrible happens, such as failure, losing a loved one, or being diagnosed with terminal cancer, it is the actual event and not your thoughts, that triggers your negative feelings. And you might also argue, perhaps even with some irritation, that your thoughts are definitely not distorted, since the actual event—such as the cancer—is real.
Would you agree? I know that’s what I used to think! The next three podcasts will give you the chance to examine your thinking on this topic, because Marilyn is struggling with a negative event that is absolutely real and devastating.
As the session with begins, Marilyn explains that she was recently diagnosed with Stage 4 (terminal) lung cancer, which came as a total shock, especially since she’d never smoked. As Drs. Burns and May go through the T = Testing and E = Empathy phases of the TEAM-CBT session, they learn that Marilyn has been struggling with extreme levels of depression, anxiety, shame, loneliness, hopelessness, demoralization, and anger, to mention just a few of her negative feelings.
If you’d like, you can review a pdf of the Brief Mood Survey and Daily Mood Log that Marilyn completed just before the session began. You will see that her negative thoughts focus on several themes, including
- Her fears of cancer, pain, and death.
- Her thoughts of spiritual inadequacy, doubting her belief in God, wondering if there really is an afterlife, feeling that she’s not spiritual enough, and thinking that she’s perhaps been duped by religions.
- Her feelings of incompleteness at never having had a truly loving life partner.
- Her feelings of self-criticism, beating up on herself for excessive drinking during her life.
The next Feeling Good Podcast with Marilyn will include the A = (Paradoxical) Agenda Setting phase of the TEAM therapy session, and will include the Miracle Cure Question, the Magic Button, the stunning Positive Reframing Technique, and the Magic Dial. The third and final podcast will include the M = Methods phase, including Identify the Distortions, the Paradoxical Double Standard Technique, Externalization of Voices, and Acceptance Paradox, end of session testing, and wrap-up.
Although the subject matter of these podcasts is exceptionally grim and disturbing, we believe that Marilyn’s story may transform your thinking and touch your heart in a deeply personal way. Because Marilyn is a deeply spiritual person who suddenly finds herself without hope and totally lost, we have called part one, The Dark Night of the Soul.
A reader ask how to handle relapses following recovery from depression. David emphasizes the importance of this question, since there is a 100% probably that every patient will relapse following recovery. And if the patient has not been properly prepared, the relapses can be disastrous. But on the other hand, if the patient has been prepared, the relapses do not have to be problematic.
What is a relapse? David defines a relapse as one minute or more of feeling crappy. Given that definition, we all relapse pretty much every day. However, some people can pop out of a bad mood really quickly, while others can get stuck in these “relapses” for weeks, months, or even years.
David describes the Relapse Prevention Training (RPT) techniques he has developed, but cautions that RPT does not make sense until the patient has experienced a complete elimination of symptoms. If the patient is being treated for depression, that means that the score the depression test has fallen all the way to zero (no symptoms whatsoever) and that the patients feel joy and self-esteem.
There are four keys to David’s RPT, including:
- The patient must be informed that relapse is an absolute certainty. The question is not “will this patient relapse” but rather, “when will this patient relapse?”
- Patients have to know that the therapy technique that worked for them the first time they recovered will always work for them. It might be the Cost-Benefit analysis, Pleasure-Predicting Sheet, Acceptance Paradox, Double Standard Technique, Five Secrets of Effective Communication, Hidden Emotion Technique, or Experimental Technique, or simply recording their negative thoughts on the Daily Mood Log and identifying the distortions in them.
- Patients need to identify and modify the Self-Defeating Beliefs (SDBs) that triggered their depression and anxiety in the first place, such as Perfectionism, Perceived Perfectionism, or the Achievement, Love or Approval Addictions. In several previous podcasts, David and Fabrice have described the Uncovering Techniques that can be used to quickly pinpoint any patient’s SDBs.
- Patients need to write down and challenge the Negative Thoughts that will inevitably emerge at the time they relapse, such as “This relapse proves I’m hopeless after all,” or “This relapse proves the therapy didn’t work,” etc.
David and Fabrice illustrate step #4 using a powerful technique called Externalization of Voices. David has patients record this role play procedure on a cell phone or other recording device so they can play it and listen if needed during an actual relapse.
David explains that he used this approach with every patient he discharged, and encouraged them all to come back anytime they had a relapse that they couldn’t handle. In spite of having more than 35,000 therapy sessions with individuals with severe depression and anxiety, David says that he can count on two hands the number who every returned for “tune-ups” following termination of therapy, and in most of those cases, the patients were able to recover once again in just or two sessions.
In the next Feeling Good Podcast, David and his highly esteemed colleague, Dr. Matthew May, will begin their live work with Marilyn, a severely depressed colleague who is facing “The Dark Night of the Soul.” Fabrice, as usual, will narrate and elicit enlightening commentaries on the therapeutic strategies that David and Matt are using as the session with Marilyn unfolds.
The title of David's TEAM-CBT eBook for therapists is Tools, Not Schools, of Therapy. David explains that the field of psychotherapy is dominated by numerous schools of therapy that compete like religions, or even cults, each claiming to have the answer to emotional suffering. So you’ve got the psychodynamic school, and the psychoanalytic school, the Adlerian school, the Beckian cognitive therapy school, the Jungian school, and tons more, including EMDR, behavior therapy, humanistic therapy, ACT, TMT, EMT, and so forth. Wikipedia lists more than 50 major schools of psychotherapy, but there are way more than that, as new schools emerge almost on a weekly basis.
David describes several conversations with the late Dr. Albert Ellis, who argued that most schools of therapy were started by narcissistic and emotionally disturbed individuals. Ellis claimed that most were self-promoting, dishonest individuals who claimed to know the true “causes” of emotional distress and insisted they had the “best” treatment methods. And yet, research almost never supports these claims.
David, who is a medical doctor, points out that we don’t have competing schools of medicine. Can you imagine what it would be like if we did? Let’s say you broke your leg, and went to a doctor who prescribes penicillin. You ask why he’s prescribing penicillin for a broken leg, and he explains that he’s a member of the penicillin school. He says he always prescribes penicillin—it’s good for whatever ails you!
That would be like an Alice in Wonderland world. And yet, that’s precisely how psychiatry and psychotherapy are currently set up. If you’re depressed and you go to a psychiatrist, you’ll be treated with pills. If you go to a psychoanalytic therapist, you’ll get psychoanalysis. Or if you go to a practitioner of EMDR, TFT, or Rational Emotive Therapy (RET), you’ll get EMDR, TFT, or RET. David argues that this just doesn’t make sense.
David argues that the fields needs to move from competing schools of therapy to a new, science-based, data-driven psychotherapy. He emphasizes that we’ve learned a lot from most of the schools of therapy, and that many have provided us with valuable insights about human nature as well as some useful treatment techniques. But now it’s time to move on, leaving all the schools of therapy behind. David acknowledges that this message may seem harsh or upsetting to some listeners, and apologizes for that ahead of time.
David and Fabrice also discuss the spiritual basis of effective psychotherapy, and David describes the reaction of his father, a Lutheran minister, on the day that David was born, as well as a tip his mother gave him when he was in third grade.
In the next Feeling Good Podcast, David and Fabrice will describe Relapse Prevention Training, since the likelihood of relapse after successful treatment is 100%. But if the patient knows what to do, the relapse doesn’t have to be a problem.
The Beatles tell us that all we need really need is love, and in her famous song, “People,” Barbara Streisand proclaims that “People who need people are the luckiest people in the world.” But is this really true?
Fabrice asks David whether love is a human need? David describes hearing Dr. Aaron Beck proclaim that love is not an adult human need, and feeling shocked, during one of Dr. Beck’s cognitive therapy seminars in the 1970s. Although initially skeptical, David did a number of experiments to test this belief, and came to a startling conclusion. David describes the impact of needing love on his depressed and anxious patients, including lonely individuals who were constantly being rejected in the dating scene.
You’ll find this podcast provocative, controversial, and hopefully interesting. We’ll also include a survey you can complete below, indicating your thoughts about this topic!
In the next Feeling Good Podcast, David and Fabrice will discuss Tools, Not Schools, the title of David’s TEAM-CBT eBook for therapists, and the following podcast will discuss Relapse Prevention Training, since the likelihood of relapse after successful treatment is 100%. But if the patient is prepared and knows what to do ahead of time, the relapse, while often painful and disturbing, doesn’t have to be a significant problem.
Fabrice begins with another question on OCD—if you successfully extinguish the symptoms with Exposure and Response prevention, would they just resurface in some other form, such as worrying, or some other anxiety disorder. David agrees, and describes the solution to this problem.
Then David describes his treatment of a pregnant woman with OCD who was afraid her baby would be switched at the hospital so that she’d end up with the wrong baby. Although she rationally recognized that this fear was irrational, she could not shake it from her mind, and obsessed about it constantly.
After trying more than 30 CBT techniques that did not work, David used the What-If Technique to pinpoint her deepest fear, which turned out to be quite shocking, to say the least. He then encouraged her, with some reluctance, to confront this fear using Cognitive Flooding.
After describing the surprising outcome, David and Fabrice discuss the fact that 75% of American therapists are afraid to use Exposure Techniques because of the fear that the patient is too fragile, or they will re-traumatize the patient. David reminds us that this is “reverse hypnosis,” where the patient hypnotizes the therapist into believing something that is not true. If the patient is successful, and the therapist agrees not to use Exposure, the prognosis for effective treatment is quite poor. David gives an example of a therapist who was afraid to ask an OCD patient to drink one ounce of coca cola—something the patient feared would drive him into insanity!
David describes his treatment of a physician with OCD who was tortured by the fear that he would impulsively throw his newborn baby over the railing of his second-floor apartment. He also describes a psychologist with OCD who washed her hands more than 50 times a day for fear of contamination. In addition, she spent hours every day making sure that nothing in her house was arranged in groups of three—including furniture, table settings, decorative objects, magazines on tables, and so forth. Arrangements in groups of 2 were okay, as were groups of 4, 5 or more objects. Why was she so obsessed?
What were the hidden emotions that fueled these obsessions and compulsions? David and Fabrice will give you the chance to pause the recording on three occasions to jot down your hypotheses before they give you the answers. It won't be important to get it "right," but it is highly desirable to take a stab at it.
This podcast will be of interest to you if you or a loved one is struggling with OCD, or any form of anxiety, including phobias, panic attacks, chronic worrying, and so forth. That's because the hidden emotion phenomenon, or excessive “niceness,” may be a the root of your fears as well. Bringing those feelings to conscious awareness will often lead to sudden relief, or even a complete elimination of your symptoms.
In the next Feeling Good Podcast, David and Fabrice will describe dramatic examples of exposure and response prevention in the treatment of OCD, including a woman who was tortured by the fear that she’d received the wrong baby at the hospital after her first child was born. What causes these bizarre symptoms, and what’s the most effective treatment? Stayed tuned and you’ll find out!
Listeners submitted questions on OCD (Obsessive-Compulsive Disorder): Is it an organic illness? Are drugs necessary in the treatment? What’s the best book to read if you want to heal yourself? What’s the prognosis?
Drs. Nye and Burns begin by explaining OCD and answering the questions. David emphasizes the importance of using four treatment models when working with OCD—the cognitive model, the motivational model, the exposure model, and the hidden emotion model if you are hoping for a rapid and complete elimination of symptoms. Treatment that focus on only one treatment method, such as exposure and response prevention, may have only limited success.
He describes his treatment of a medical student named Ralph with classic OCD. Ralph was frequently plagued by the fear he was dying of AIDS; then he’d get so anxious that he’d go to the emergency room and insist on having a blood test for HIV. These always came out negative, and this brought temporary relief, but within a few days Ralph would be worrying about AIDS again and feeling the overwhelming compulsion to get yet another blood test.
The case was especially curious because Ralph was engaged and faithful to his fiancé, so there was no rational reason for him to think he had become infected with the HIV virus. However, he’d tell himself, “Maybe I drew blood on a patient with AIDS and then pricked myself with the needle, and then forgot. And how can I know that this didn’t happen?” This are extremely typical of the kind of obsessions that plague OCD patients. Ralph would torture himself with these thoughts until he succumbed to the urge to get another blood test for AIDS.
Although years of conventional psychotherapy had failed this patient, the Hidden Emotion Technique led to an incredible recovery in just a few minutes during a therapy session. You will find this true story inspiring and amazing! And David provides an even more amazing 40-year follow up report!
In the next Feeling Good Podcast, David and Fabrice will describe more examples of patients with severe OCD who experienced dramatic relief because of David’s Hidden Emotion Technique. This technique can be helpful for all anxiety disorders, and not just OCD. However, David emphasizes that this is just one of many techniques he uses in the treatment of anxious patients. He cautions therapists against thinking three is just ONE best technique for any anxiety disorder, including OCD.
See link to podcast #027: Scared Stiff — The Hidden Emotion Model.
The late Dr. Albert Ellis developed a technique to help individuals struggling with shyness. It’s called Shame-Attacking Exercises. Essentially, you do something bizarre in public to overcome your fear of making a fool of yourself; and you will probably discover that the world doesn’t come to end. When used skillfully, this method can be incredibly liberating.
However, there are several ethical considerations. First, before therapists can ask their patients to do Shame Attacking Exercises, therapists have to do Shame-Attacking Exercises themselves! David explains his first, terrifying Shame-Attacking Exercise in a Chinese restaurant in New York after giving a talk at a workshop sponsored by Dr. Ellis.
In addition, therapists have to be careful in the way they use Shame Attacking Exercises, and who they use them with. You have to have an excellent therapeutic alliance with your patient, and the patient has to trust you. In addition, the exercises have to be in an appropriate location—for example, it would be disrespectful to do them in a hospital. And you have to be careful that the Shame Attacking Exercises is not aggressive or frightening to other people.
He also describes how Shame-Attacking Exercises helped a man and a woman he treated who were both afraid to flirt with people they were attracted to, and in both cases, he had to push fairly hard since the patients put up stiff resistance to the idea.
TEAM-CBT includes many powerful techniques, and while they have the potential to bring about rapid and often fantastic change, they also have the potential to hurt if not used skillfully and appropriately. Any listeners who are interested in using these techniques should first consult with a mental health professional to make sure the techniques are appropriate and likely to be helpful to you.
All that being said, you will (we hope) LOVE this podcast!
In upcoming podcasts, David and Fabrice will address questions on OCD (Obsessive-Compulsive Disorder) submitted by several listeners. Is OCD an organic illness? Are drugs necessary in the treatment? What’s the prognosis? David will describe powerful, drug-free treatment methods based on the four models he uses to treat all anxiety disorders: the Motivational, Cognitive, Exposure, and Hidden Emotion Models.
The third uncovering technique is called the “What-If” Technique, developed by the late Dr. Albert Ellis. The What-If Technique can will help you identify a terrifying fantasy under the surface that fuels your fears. David brings this technique to life with an inspiring story of a woman from San Francisco suffering from more than 10 years of mild depression and paralyzing Agoraphobia—the intense fear of leaving home alone. You may be surprised when you discover the Negative Thoughts that triggered her fear of leaving her apartment alone, as well as the core fantasy at the root of her Agoraphobia. David and Fabrice also discuss the dramatic techniques that helped her completely defeat her fears and overcome her depression.
Below, we have included a PowerPoint presentation for you so that you can follow along when David and Fabrice do the What-If Technique together on the podcast.
In the next podcast, David and Fabrice will discuss Shame-Attacking Exercises. This is a powerful and bizarre exposure technique that can helpful in the treatment of shyness--but there’s a hook. Therapists must be willing to do Shame Attacking Exercises themselves before they can ask patients to do them! And that can be intimidating!
The Roles and the Rules—Psychoanalysis at Warp Speed!
Most of us run into conflicts with other people from time to time, or even frequently. In this podcast, you will discover precisely why this happens, and how you to change the beliefs that get you into trouble, if that’s what you want to do.
Psychoanalysts sometimes help people discover what they call “core conflicts.” According to the highly regarded psychoanalytic researcher Lester Luborsky, PhD, an example of a core conflict might be, “My needs will never be met in my relationships with others.” If you believe this, it will tend to function as a self-fulfilling prophecy, so you’ll constantly feel hurt, lonely, and rejected, and perhaps resentful when you try to get close to others. And you probably won’t realize you’re creating your own painful interpersonal reality. You’ll think that this is just the way it is. Once you bring the painful system to conscious awareness, you can use a variety of powerful techniques to change your expectations and beliefs so you can enjoy far greater satisfaction and intimacy in your relationships with others.
David and Fabrice will illustrate a powerful, high-speed method that to bring your own Interpersonal Self-Defeating Beliefs to conscious awareness. David has called it the Interpersonal Downward Arrow Technique. David and Fabrice will revisit the same clinical example from the last Podcast—the psychologist named Harold who felt devastated when his favorite patient unexpectedly committed suicide, but in this podcast they will examine how Harold sets up his relationships with his colleagues in a way that causes him to feel lonely, anxious, and resentful.
You can use the Interpersonal Downward Arrow Technique to identify anybody's Self-Defeating Beliefs in five to seven minutes, as opposed to spending five years or more free-associating on an analyst’s couch to get the same information. Not a bad deal!
During the podcast, you may want to download and print “The Rules and the Roles” form that David and Fabrice will be using during the podcast. There will be an exercise for you to do while you are listening. But don’t do the written exercise if you’re listening while driving in your car!
In the next podcast, David and Fabrice will discuss a third powerful uncovering technique developed by the late Dr. Albert Ellis, a former psychoanalyst from New York who is considered the "Grandfather of Cognitive Therapy." It’s called the “What-If Technique," and Dr. Burns will bring it to life with an inspiring and dramatic story of a woman from San Francisco who had been suffering from years of mild depression and severe Agoraphobia—the intense fear of leaving home alone.
So stay tuned! And feel free to comment below or ask questions. Fabrice and I greatly appreciate your feedback and guidance!
If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients!
Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.
What are the root causes of depression? Anxiety? Relationship problems? In this, and the next two podcasts, you will discover the answer!
Cognitive Therapists believe that negative thoughts, or cognitions, can exist on two different levels. When you’re upset, you’ll have Automatic Negative Thoughts (ANTs) in the here and now, and they’ll usually be something like this:
- Depression: You may be telling yourself that you’re a loser, or a failure, or that you’ll be miserable forever.
- Anxiety: You’re probably telling yourself that you’re in danger, and that something terrible is about to happen. “When I get up to give my talk at my church group, my mind will probably go blank and I’ll make a total fool of myself!”
- Relationship conflicts: You may be telling yourself that someone you’re ticked off at is a self-centered jerk who only cares about himself or herself and shouldn’t be that way!
Individual Downward Arrow
But why do we get these ANTs in the first place? Cognitive therapists believe that Self-Defeating Beliefs, and other deeper structures in the brain, make us vulnerable to painful mood swings and conflicted relationships with the people we care about. To help you pinpoint your own Self-Defeating Beliefs, David has created two uncovering techniques called the Individual Downward Arrow and the Interpersonal Downward Arrow, and Albert Ellis, the noted New York psychologist, created a third called the “What-If” Technique. In today’s podcast, Drs. Burns and Nye illustrate the Individual Downward Arrow technique, using as an example a psychologist named Harold who was understandably devastated when his patient unexpectedly committed suicide.
You can follow along on this PowerPoint presentation starting with Harold’s Daily Mood Log with David and Fabrice while they illustrate the Individual Downward Arrow technique.
Once they come to the “bottom of the barrel,” they will ask you to pause the recording, and see if you can pinpoint five or six or more of Harold’s Self-Defeating Beliefs, using the list of 23 Common Self-Defeating Beliefs.
David emphasizes that we create our own emotional and interpersonal reality at every moment of every day, but we aren’t aware of this, so we often feel like victims of forces beyond our control. We are really talking about emotional and interpersonal enlightenment, and the uncovering techniques will make this ancient Buddhist concept more understandable for you.
If you’d like more tips on precisely how to do the Individual Downward Arrow Technique, you can read David’s recent Feeling Good Blog on this topic!
In our next Feeling Good Podcast, David and Fabrice will illustrate the Interpersonal Downward Arrow Technique, which will allow you to complete a course of psychoanalysis in just 5 to 7 minutes, rather than the 5 to 7 years free associating on the couch. It is truly psychoanalysis at warp speed, and is pretty amazing! And when you change the beliefs that trigger interpersonal conflicts, you can change them and enjoy greater satisfaction in your relationships with the people you care about. But sometimes, that requires a little bit of courage!
And in the third Feeling Good Podcast on the uncovering techniques, David and Fabrice will illustrate Dr. Albert Ellis' famous "What-If Technique." If you struggle with any type of anxiety, including fears and phobias, this technique can help you uncover the feared fantasy at the root of your fears, so you can challenge the monster and attain freedom from the fears that hold you back!
A listener named Daisy describes her despair at being unable to have a baby, despite intensive efforts at a fertility clinic. She gets well-meaning messages from friends, family and support groups that she really needs a baby in order to feel truly happy and fulfilled, and these messages make her feel anxious and depressed. But she wonders whether this is really true. Does she really need a baby to feel happy?
In fact, we we get all kinds of messages from society that we need certain things in order to feel worthwhile, including:
- Achievement / Success / Wealth
- Good looks
Are these things really needs? Listen to today’s podcast and you may be surprised by the answer!
In the next three podcasts, David and Fabrice will discuss three powerful uncovering techniques that can help you pinpoint the Self-Defeating Beliefs that may be at the root of your own unhappiness and anxiety. These include the Individual Downward Arrow Technique, the Interpersonal Downward Arrow Technique, and the What-If Technique. After that, David and Fabrice will also describe some powerful techniques to help you change the way you think and feel!
“My problems are real! The world really IS screwed up! And that’s not a distortion. So what can I do about my severe depression and anxiety?”
David and Fabrice discuss two questions submitted by Feeling Good Podcast listeners.
#1. Shari writes:
“I read your book Feeling Good and now I am reading your book When Panic Attacks--thanks to April's podcast with you. I still struggle but recently our current political situation and environmental research about our negative impact on earth—has triggered severe anxiety and depression again. The problem is that I don't think my thoughts are distorted—it certainly seems logical to assume that life on earth is threatened. So I am not sure how to do this. How can I make progress with my mental and emotional health while being aware of situations around the world? Any advice or thoughts would be deeply appreciated.”
This is a wonderful note, and I’m sure that huge numbers of people feel the same way, in varying degrees. So how can we attend to our own emotional well-being in the face of genuine adversity?
Dr. Burns discusses this from the perspective of Paradoxical Agenda Setting, which is the key component of TEAM-CBT, and emphasizes the most common therapeutic error of all—jumping in to try to help, without seeing all the really GOOD reasons for the patient NOT to change. From this perspective, Shari’s question becomes the most important question in all of psychiatry and psychotherapy—how do we help patients who may not want to change?
#2. After listening to the A = Agenda Setting portion of the live therapy with Mark, Paul submitted this question:
Thanks to you, Fabrice and Jill for this episode - as with the previous episodes with Mark, this has really helped in bringing the TEAM approach to life. As I have been using your books in the past few years to self-treat feelings of anxiety and depression, I was very keen to hear how the new agenda setting step works.
I am wondering what your thoughts are on how effectively the "A" step can be carried out by a patient on his/her own (i.e. without someone else verbalizing the reasons not to change / playing the part of the patient's sub-conscious)? Do you have any tips? I think I heard Mark say something to the effect that, on his own, he wouldn't have thought of all the positives that you came up with in the session.
Thanks again for sharing these great tools and techniques - looking forward to the "M" step soon.
This was another terrific question on a topic of great importance. David explains that it is actually easier for patients to learn to use Positive Reframing and the other Paradoxical Agenda Setting techniques than for therapists to learn them. Because of his excitement over this prospect, David has just begun a new book which will show depressed and anxious individuals exactly how to do this on their own in a step-by-step manner. He is optimistic that the new TEAM-CBT techniques, in book form, may be even more helpful to patients than his first book, Feeling Good: The New Mood Therapy. Research studies indicate that 65% of patients with moderate to severe depression improve substantially within four weeks of receiving a copy of Feeling Good, even without any other treatment. Dr. Burns is hopeful that his new book will provide the answers for the 35% who were not helped by Feeling Good.
So the answer is yes, I think many individuals WILL be able to do the “A” step on their own, and I am hopeful the positive impact will be great!
If you would be interested in David's new book, please indicate this in the Survey attached to this podcast.
David and Fabrice have exciting plans for upcoming podcasts. They will be addressing these two questions in one or two podcasts:
- Is it possible to measure our “worthwhileness” or “worthlessness” as human beings?
- Do we even have a “self”?
These two questions have been discussed by experts for thousands of years, going all the way back to the Buddha, and most recently by the incredible Austrian philosopher, Ludwig Wittgenstein. And although the answers are tremendously simple, people can’t seem to “get it.” The issues are not simply philosophical, but eminently practical, since most depression and anxiety result from the perception that one is “worthless,” or “inferior,” or simply “not good enough.”
In addition, David and Fabrice are hoping to create a second live therapy session broken into smaller podcast chunks, but featuring David and a totally awesome former student and now highly esteemed colleague, Matthew May, MD. For the past ten years, David has been telling workshop audiences that Matt is one of the finest therapists in the world. So this is an event you won’t want to miss!
Click here to listen to Fabrice being interviewed on Dr. Carmen Roman's podcast.
A blog reader made a fairly strong and impassioned comment that sometimes asking the patient to examine ways she or he may be contributing to the problem may be a mistake when the patient really IS a victim, and cautioned against blaming the victim. David’s goal is never to blame patients, but rather to empower you.
David and Fabrice begin by discussing the fact that sometimes people vacillate between other-blame (it’s all his/her fault) and self-blame (it’s all my fault), and emphasize that neither approach is helpful. If you blame the other person, the problem escalates and may turn to violence, but if, instead, you blame yourself, you’ll probably end up feeling worthless, guilty, unlovable, and depressed.
So what’s the solution to this dilemma? Dr. Burns encourages patients to use the Five Secrets of Effective Communication and make a radical change in the way they communicate with others, along the lines of EAR. E stands for Empathy, A stands for Assertiveness, and R stands for Respect. You can examine each of the Five Secrets if you CLICK HERE.
David gives five compelling examples of how to deal with people who REALLY ARE violent and abuse, including a raging psychiatric patient who was threatening the staff and on the verge of exploding, a serial killer who kidnapped a social worker who had attended one of David’s communication workshops, some drunken, abusive teenagers in a huge jeep who threatened David, an insulting, demoralizing, critical boss who put down everyone who worked with him. He includes with the story of a Lutheran minister, Dietrich Bonhoeffer, who was imprisoned and mistreated by the Nazis during world war two.
This is a controversial topic that David included in the podcasts somewhat reluctantly, so give a listen and tell us what you think! Right now the world seems to be spiraling into greater and greater hostilities. Does David have a point? Or is he way off base?
This is the last live therapy podcast with Mark, the physician who was convinced he was a failure as a father because of his difficulties forming a close, loving relationship with his oldest son. Although the session appeared to go well, we can’t be sure until we see Mark’s end of session mood ratings on the Daily Mood Log and on the Brief Mood Survey and and Evaluation of Therapy Session. David emphasizes that therapists’ perceptions of patients are notoriously inaccurate, but most therapists are unaware of this because they don’t use the rigorous testing procedures at the start and end of sessions.
To review Mark's partially completed Daily Mood Log, CLICK HERE. Jill and David will ask him to complete the additional negative thoughts on his own after the session.
To review mark's end of session Brief Mood Survey and Evaluation of Therapy Session, CLICK HERE.
After David review’s the phenomenal changes Mark reported from the start to the end of the session, David asks if the ratings were genuine, or, as some listeners might suspect, faked in order to try to please the therapists. Mark bursts into tears and says, in a choked voice, that it was a life-changing experience.
After the end of the session, David and Fabrice discuss a number of highlights from the work with Mark:
- The testing indicated a complete or near-complete elimination of symptoms. In 2 ½ hours, Jill and David have essentially completed an entire course of psychotherapy. Although there may still be some work to be done with Mark, the hard part has already been completed.
- David emphasizes that he now views psychotherapy as a procedure to be done at one sitting, much like surgery, with brief follow-up visits, rather than a long, drawn out procedure meeting once pre week for months or even many years. And although a single 2 or 2 1/2 hour session may be more costly than a traditional 50-minute hour, it can be vastly more cost-effective Than dozens of sessions with little or no progress. In addition, it is vastly better for the patient who walks out feeling good today, rather than having to endure weeks, months, or even many years of traditional talk therapy or antidepressant drug therapy.
- David and Fabrice talk about the fact that no one is permitted to feel happy all the time, and that Mark’s negative thoughts and feelings WILL return, David defines a “relapse” as one minute or more of feeling lousy. Given that definition, we will ALL relapse forever! But it doesn’t have to be a problem for Mark if he is prepared for this, and knows how to pop out of the relapses quickly, rather than getting stuck in them. This is where Relapse Prevention Training (RPT) becomes so important following the initial dramatic recovery. RPT only takes about 30 minutes and is easy to learn, and will perhaps be the topic for a future Feeling Good Podcast if our listeners express an interest in it.
- David discusses the difference between an Internal Solution and an External Solution. In this session, David and Jill have guided Mark in the Internal Solution—this means crushing the negative thoughts that triggered Mark’s feelings of unhappiness, anxiety, shame, failure, and anger for years, if not decades. Now that he is feeling so much better about himself, he may want some help with the External Solution. This will involve learning how to develop a more loving relationship with his son using tools like the Relationship Journal and the Five Secrets of Effective Communication. This will be far easier now that Mark is no longer using up all his energy beating up on himself and feeling depressed and inadequate.
- David wraps up by talking about the true wealth we have as therapists. Although we won’t develop the riches of a Bill Gates doing psychotherapy, we do have the fabulous and precious opportunity to see people as they really are inside, and to witness miracles like the one we saw in the session with Mark.
- David expresses the hope that listeners have benefitted by listening. Although we are all different, most of us have had the painful experience, like Mark, of believing we were somehow failures, or inferior, or defective, or simply not good enough. We are deeply indebted to Mark’ courage and generosity in giving us the opportunity to see the solution to this ancient and almost universal human problem!
There are many resources for listeners who want to learn more about TEAM-CBT, including:
- David’s exciting two-day and four-day training workshops, listed on his website, feelinggood.com.
- Tons of free resources for patients and therapists at feelinggood.com. Please sign up using the widget in the upper right hand corner of any page on his website and you will receive email notifications and links to every post.
- David’s psychotherapy eBook entitled Tools, Not Schools of Therapy.
- David’s Tuesday psychotherapy training groups at Stanford, which are co-led Jill Levitt, PhD and Helen Yeni-Komshian, MD. The training is free of charge to Bay Area and northern California therapists. You will have the chance to do free personal work, too!
- David’s famous Sunday hikes, also free to members of the training groups.
- Paid online and in-person weekly TEAM-CBT training groups, plus intensive TEAM-CBT treatment programs, at the Feeling Good Institute in Mt. View California.
- In addition, many TEAM-CBT training and treatment programs are now offered in many cities throughout the US and Canada. For more information, visit feelinggood.com or www.feelinggoodinstitute.com.
Using the Externalization of Voices, which is arguably the most powerful Cognitive Therapy technique ever created, David & Jill continue encouraging mark to challenge his negative thoughts. The goal of the Externalization of Voices is to create genuine and lasting change at the gut level.
Although it is one of the first cognitive Therapy techniques Dr. Burns created, it is rarely used by cognitive therapists in the United States, perhaps because it is so edgy, or perhaps because it is sophisticated and requires a high degree of therapist skill. The Externalization of Voices is often paired with another technique Dr. Burns created called the Acceptance Paradox. The goal of the Acceptance Paradox is a profound and lasting change in the patient’s core beliefs and values, and it sometimes triggers spiritual enlightenment, although it is an entirely secular method.
Jill and David also use the Semantic Method and Re-attribution in this segment, and end with a brief illustration of how Mark might interact differently with his son using the Five Secrets of Effective Communication. David and Jill emphasize that this is the "External Solution," and that up to this point in the session they've been working on the "Internal Solution."
In the next podcast, Jill and David will return to T = Testing to find out how Mark feels at the end of the session, and how he rates Jill and David for Empathy, Helpfulness, and other measures of the therapeutic relationship. At the end of the session, Dr. Burns asks Mark if the change was real, or simply something fake for the purpose of the podcast. At that point, something stunning happens, which turned out to be the highlight of the entire session. So stay tuned!
And thank you, so much, for your ongoing support of our efforts! We all greatly appreciate your many kind and encouraging comments and emails on our podcasts. That motivates us to work really hard (and joyously) to bring more of this kind of teaching to you!
One quick note. I do not answer messages from Facebook, as I am getting far more than I could ever attend to. Which is great, but sad for me since I don't want people to feel ignored. The best way to contact me is to make comments at the end end of my blogs, as I often respond to those, or simply to contact me through my website, feelinggood.com.
David and Jill begin using M = Methods to challenge the Negative Thought Mark wants to work on first: “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” You may recall that Mark believed this thought 90%.
Do you know what the necessary and sufficient conditions are for feeling emotionally upset? The necessary condition is that you have a negative thought in your mind, such as “I’m a failure as a father,” or “There’s something defective in my brain,” but the mere presence of a negative thought will not generally trigger shame, depression, or anxiety. The sufficient condition for emotional upset is that you believe the negative thought. And if you review his Daily Mood Log from the last session, you’ll see that Mark does have a high degree of belief in all his negative thoughts. When you’re feeling depressed, anxious, inadequate, or hopeless, I suspect that your mind is also flooded with negative thoughts that seem entirely true to you.
Do you know the necessary and sufficient conditions for emotional change?
The necessary condition is that you can challenge the negative thought with a positive thought that is 100% true. Rationalizations and half-truths will never help anyone, at least not in my experience. But having a valid positive thought is not sufficient for emotional change. For example, Mark could tell himself that he’s a very high powered physician in a world-famous medical center, and that thought would be 100% true. But that thought won't help Mark because he’ll still believe there’s something defective in his brain that prevents him from having a loving relationship with his son.
The sufficient condition for emotional change is that you can generate a positive thought that is 100% true, and in addition it has to crush the negative thought. In other words, the very moment you stop believing the negative thought that triggers your angst, in that very instant you will experience emotional relief, and the change will usually be dramatic.
But how can we challenge Mark’s belief in the NT. Remember, he is incredibly intelligent, and he’s been hooked on this NT for decades. So we can’t just tell him to cheer up, or encourage him to think more positively, or reassure him that his brain is A-Okay. Not only will those simplistic approaches fail, they would likely annoy him because they sound patronizing and might convey the message that’s he’s an idiot for believing something so ridiculous.
Instead, as a TEAM-CBT therapist, I think of 15, 20 or even more powerful and innovative techniques that I can use to gently guide the patient to his or her own discovery that the negative thought is simply not true. That's what we do during the M = Methods portion of a TEAM-CBT session.
You will listen as David and Jill generate Next, Jill and David generate a Recovery Circle, selecting 16 techniques they could use to help Mark challenge the Negative Thought in the middle of the Recovery Circle. To see the Recovery Circle, CLICK HERE. David and Fabrice discuss the rationale for the Recovery Circle--you never know what technique is going to work, since people are quite different. One of the many unique and arguably powerful aspects of TEAM-CBT is the use of more than 75 techniques drawn from more than a dozen schools of therapy.
One of the first methods we use is so basic that it is programmed right into the Recovery Circle, and it’s called Identify the Distortions. Fairly early in today's recording, Jill and David will ask Mark to identify the distortions in his Negative Thought (NT), “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” At that point, Fabrice will ask you to pause the recording and see how many distortions you can identify in the thought. You can write them down on a piece of paper, or simply print the linked PDF and identify them with check marks on the list of 10 cognitive distortions from my book, Feeling Good: The New Mood Therapy. CLICK HERE FOR TEN COGNITIVE DISTORTIONS
After Mark identifies the distortions in his Negative Thought, Jill and David encourage him to challenge it, using a variety of techniques on the Recovery Circle, starting with the Paradoxical Double Standard Technique. This is a gentle technique that is often effective for people who are compassionate. Because this technique seems to be helping, they ask Mark to record his positive thought in the Daily Mood Log, and to indicate how strongly he believes it. Then you will see that Mark's belief in the Negative Thought is reduced to zero if you CLICK HERE.
In the next podcast, David and Jill will continue with the Methods portion of the session using additional techniques on the Recovery Circle. This will be a unique opportunity to hear many of these techniques in real time with a real person, as opposed to simply reading about them in a book. So--stay tuned to our Feeling Good Podcasts--and thank you so much for your enthusiastic support!
Jill and David encourage Mark to develop his list of positives. Mark draws a blank at first. This is very common among patients and therapists alike. Most of us have not been trained to think about depression, anxiety, shame, defectiveness, hopelessness and anger as being good or positive. In fact, we think of them as symptoms of “mental disorders,” according to the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association.) So we think of them as bad, something to get rid of, something needing treatment.
But after David and Jill prime the pump, Mark is surprised that they quickly come up with a list of 16 positives that are real and powerful. At this point, they ask Mark why in the world he’d want to press the Magic Button and have all of his symptoms suddenly disappear--given all these positives. This is called the Acid Test and it's also paradoxical. David and Jill have now become the resistant part of Mark's subconscious mind--the part that clings to these symptoms. And when the therapists become the voice of the resistance, the patient will nearly always become the voice that argues for change.
The paradox is resolved with the Magic Dial. Toward the end of this podcast, you will want to review Mark’s Daily Mood Log, with the Goal column filled out on the table of negative emotions.
David points out that there is no single tool or technique that triggers recovery in patients. Instead, each component of T E A M contributes in radically different ways to the substantial or even dramatic improvement the therapists are hoping to bring about it today's session.
In the next Podcast, David and Jill will begin the M = Methods portion of the session.
In the early days of my career, I (Dr. Burns) would have assumed that Mark definitely wanted to change--after all, he'd been in a lot of pain for a long time, and he came to the session because he wanted help. So, following the empathy phase of the session, I would have jumped in with a variety of cognitive therapy techniques to help Mark challenge his Negative Thoughts, such as “I’ve been a failure as a father,” or "my brain is defective." Although this might have been effective, there’s a good chance that it might not have worked. That's because Mark might have “yes-butted” me or insisted that he really was a failure and that I just wasn’t “getting it.”
In fact, the attempt to help the patient without first dealing with the patient’s resistance is the cause of nearly all therapeutic failure. But most therapists make this mistake over and over--and don't realize that their well-intentioned efforts to help actually trigger and reinforce the patient's resistance.
Instead, TEAM Therapists use a number of Paradoxical Agenda Setting (PAS) techniques designed to bring the patient’s subconscious resistance to conscious awareness. Then we melt the resistance away before attempting to change the way the patient is thinking and feeling. I (DB) have developed 15 or 20 PAS techniques, and Jill and I used several of them in our session with Mark:
- The Invitation Step
- The Miracle Cure Question
- The Magic Button
- Positive Reframing
- The Acid Test
- The Magic Dial
When Jill and I use Positive Reframing, we are hoping that Mark will make an unexpected discovery--that his negative thoughts and feelings, such as his sadness, shame, discouragement, and inadequacy actually reflect his core values and show what a positive, awesome human being he is. In other words, he will discover that his core values are actually the source of his symptoms as well as his resistance to change.
This approach represents a radical departure from the way many psychiatrists and psychologists think about psychiatric symptoms as well as resistance. When I was a psychiatric resident, I (DB) was trained to think about resistance as something negative. For example, we may tell ourselves that resistant patients cling to their feelings of depression and worthlessness because they want attention, because they want to feel sorry for themselves, because they fear change, or because they are afraid will lose their identity if they recover. While there’s some truth in these formulations, they may not be helpful because they tend to cast the patient in a negative light, as if their symptoms and their resistance to change were somehow bad, or childish, or based on some kind of chemical imbalance in their brains. As you will see, the TEAM-CBT approach approaches resistance is radically different manner.
We will give you the chance to pause the podcast briefly and try your own hand at Positive Reframing before you hear it live during the session. Specifically, we will ask you to review Mark's Daily Mood Log, and ask yourself these two questions about each of his negative thoughts and feelings:
- What does this negative thought or feeling show about Mark that is beautiful, positive, and awesome?
- What are some benefits, or advantages, of this negative thought or feeling? Are there some ways that this thought or feeling is helping Mark?
As you so this, make a list of as many Positives as you can on a piece of paper. See what you can come up with.
I want to warn you that it may be difficult to come up with your list of Positives at first. If so, this is good, because when you hear the next podcast, you'll have many "ah ha!" moments and it will all become quite obvious to you. Then you will have a new and deeper understanding of resistance--an understanding that can help you greatly if you are a therapist or if you are struggling with your own feelings of depression and anxiety.
Jill gives a great overview of why the paradoxical approach is necessary during the Paradoxical Agenda Setting phase of the session.
To learn more about Paradoxical Agenda Setting, you can read David’s featured article in the March / April 2017 issue of Psychotherapy Networker entitled "When Helping Doesn’t Help." You will see how he helped a woman struggling with intense depression, anxiety and rage due to decades of horrific domestic rape and violence.
After reviewing Mark’s scores on the Brief Mood Survey, the Empathy phase of the session unfolds. During this phase of the session, David and Jill will not try to help, rescue, or save Mark. They will simply try to see the world through his eyes and provide some warmth and compassion.
Mark explains that he had two goals in life when he was a young man. He hoped to have a large, loving family; and wanted to become a skillful and compassionate physician. Although he has achieved the second goal, he has felt sad and guilty for decades because of his failure to develop a loving relationship with his oldest son from a previous marriage.
While Mark tells his story, David and Jill encourage him to record his negative thoughts and feelings on a form called the Daily Mood Log, and to rate how strong each feeling is, on a scale from 0% (not at all) to 100% (the most extreme).
As you can see, Mark has many different kinds of negative feelings ranging in severity from 30% (moderate) to 80% (severe).
If you've been listening to the Feeling Good Podcasts, you know that negative feelings do not result from what’s actually happening in our lives, but rather from our negative thoughts about what's happening. David and Jill encourage Mark to record his negative thoughts on the Daily Mood Log as well, and to indicate how strongly he believes each one on a scale from 0% (not at all) to 100% (completely).
You can also see that Mark is telling himself that he's been a failure as a father, that his brain is defective, and that he is not doing a good job for David and Jill. These thoughts all involve self-blame. You'll notice that he also has two other-blaming thoughts. This is not unusual. When you’re not getting along with someone, you may spend part of your time telling yourself that the problem is all your fault, and part of your time telling yourself that it’s someone else’s fault. As a result, your negative feelings may shift back and forth from guilt and shame to anger and resentment.
Most therapists would not interrupt and ask their patients to record their negative thoughts and feelings while they are venting. However, this information will prove to be incredibly valuable later in the session.
Jill and David ask Mark how they’re doing on empathy. If Mark gives them a high rating, they will go on to the next phase of the session, called Paradoxical Agenda Setting. That’s where they will find out what, if anything, Mark wants help with, and see if he has any conscious, or subconscious, resistance to change.
This is the first in a series of podcasts that will feature live therapy. As you listen, you’ll have the opportunity to peak behind closed doors to see how TEAM-CBT actually works in a real-world setting, and not role playing.
The patient is a physician named Mark who has been haunted for decades by a problem with his oldest son, and he feels like a failure as a father. Although the facts of your life are likely to be very different, you might understand what it’s like to feel like a failure, or to tell yourself that you’re defective, or simply not good enough.
The two co-therapists include David and his highly-esteemed colleague, Dr. Jill Levitt. We have broken the session down into a number of podcasts that will include excerpts from the session along with commentaries on the thought patterns of these two master therapists as the session unfolds.
Part 1—T = Testing
As the session begins, David and Jill review of Mark’s scores on the Brief Mood Survey (BMS), which he completed just before the session began. The scores indicate that Mark is only feeling mildly depressed, anxious, and angry, but is extremely dissatisfied with his relationship with his son.
At the end of the session, David and Jill will ask Mark to complete the BMS again. By comparing his patient’s scores at the start and end of the session, they will be able to see exactly how effective, or ineffective, the session was. Mark will also rate David and Jill on Empathy, Helpfulness, and several other important dimensions.
Testing at the start and end of every therapy session is one of the new and unique components of TEAM therapy. The testing can revolutionize psychotherapy, because therapists can fine-tune their therapeutic strategies based on the scores, and make critical important changes if the session was not particularly helpful. However, the assessment instruments are extremely sensitive and pick up the smallest therapeutic errors. This can be quite threatening to therapists who don’t want to be held accountable.
The key is bringing the patient’s subconscious resistance to conscious awareness, and melting it away with paradoxical techniques. This is absolutely critical if you are hoping to see a complete elimination of symptoms in any type of anxiety.
You may recall that the Outcome Resistance for anxiety disorders usually results Magical Thinking—the anxious patient may be suffering intensely and asking for help, but secretly believes that something terrible will happen if the treatment is successful and the anxiety disappears. In other words, most anxious individuals are convinced that the anxiety is protecting him or her from some catastrophic event.
David brings this concept to life with a dramatic description of his treatment of a young man named Sam who’d been struggling with intense PTSD—Post-Traumatic Stress Disorder— for six months following a traumatic interaction with two sadistic gunmen.
David and Fabrice also discuss metaphors for understanding how healing actually occurs. Most therapists think of depression and anxiety as mountains that have evolved slowly, over years or decades. They sometimes also believe that treatment and recovery will also requires years and years of treatment, with very slow progress. Of course, if the therapist and patient believe this it will function as a self-fulfilling prophecy.
In sharp contrast, David describes a new way to think about recovery, as something extremely rapid, a personal transformation that happens suddenly, within a very brief time period within a therapy session. But this remarkable phenomenon is only possible when the patient’s resistance to change has been skillfully and compassionately addressed by the therapist. At that point, the patient and therapist are on the same TEAM, working together collaboratively. Then, amazing changes can often unfold quickly.
Plans for future Feeling Good Podcasts will include a series of fascinating podcasts that will feature an actual live therapy session, with David and his colleague, Dr. Jill Levitt, acting as co-therapists, including commentaries on how each step of T.E.A.M. is being implemented. This will give you the unique opportunity to look behind closed doors so you can observe actual healing taking place.
In addition, a future “Ask David” podcast is planned, as well as a podcast on “The Truth about Benzodiazepines,” plus podcasts featuring more treatment methods for anxiety such as Interpersonal Exposure Techniques and Cognitive Flooding. Dr. Burns also promises a fascinating Feeling Good Podcast on the use of the Five Secrets of Effective Communication with violent individuals who are threatening, hostile, and dangerous.
David reminds us about the differences between healthy fear and unhealthy, neurotic anxiety, or an anxiety “disorder” like a phobia, or OCD, and so forth. He explains that negative thoughts, and not events, trigger all our emotions, healthy or unhealthy. However, healthy fear results from negative thoughts that are valid and undistorted, and does not need treatment. For example, if you are walking around Chicago in an area dominated by gangs, you may have the thought, “I could get shot. I better be careful because it’s dangerous here!” Your fear is healthy and can keep you vigilant and alive in a genuinely dangerous situation.
In contrast, neurotic, unhealthy anxiety results from thoughts that contain the same ten cognitive distortions that cause depression, such as All-or-Nothing Thinking, Jumping to Conclusions (e.g. Mind-Reading and Fortune-Telling), Emotional Reasoning, Magnification, Should Statements, and more.
David explains that the Hidden Emotion Model is radically different from CBT, exposure therapy, and most other current treatments for anxiety. The theory behind Hidden Emotion Technique is that “niceness” is the cause of (almost) all anxiety in the United States at this time. In other words, people who are prone to anxiety typically think they have to be nice all the time, and please other people, and not have certain kinds of forbidden feelings, such as anger, or loneliness, or even wanting something you are not supposed to want.
David brings this powerful treatment technique to life with a vignette involving Terry, the woman with ten years of terrifying panic attacks described in previous podcast. When David asked about her very first panic attack, ten years earlier some amazing and illuminating information emerged.
David gives tips on how therapists can use the Hidden Emotion Model,
- The hidden emotion or conflict is buried in the present, and not in the past.
- It is something very ordinary, such as not liking your job, or your major in college, or a conflict with a friend, family member or colleague.
- The anxiety is nearly always a symbolic expression of the feeling or problem the patient is not bringing to conscious awareness. David gives listeners an exercise to see if they can pinpoint the symbolic meaning of Terry’s panic attacks.
Fabrice asks the important question—what do you do when the anxious patient insists that there aren’t any hidden feelings? David explains that most anxious individuals will say that, and describes how to bring the hidden feeling or problem to conscious awareness.
He emphasizes the three things he really likes about the Hidden Emotion Model:
- It explains the timing of anxiety attacks, so it has tremendous explanatory power. Freud said that anxiety is the mysterious emotion, that comes out of the blue, and strikes like lightning, without rhyme or reason. David disagrees, and emphasizes that anxiety rarely or never comes from out of the blue.
- The Hidden Emotion Model can have powerful and rapid healing effects for patients with every type of anxiety, as well as individuals struggling with hypochondriasis and those who go to medical doctors with complaints of pain, fatigue, or dizziness that does not appear to have a valid medical cause.
- The Hidden Emotion Model teaches us that the ultimate cause of most anxiety is the fear of the self, of our emotions and how we genuinely feel as human beings.
- The Hidden Emotion Model teaches us that recovery from anxiety does not involve recovery from some “defect” or “mental disorder,” but rather the discovery of what it is like to be human being, with all of our feelings, and that it is okay to have an express those feelings.
Finally, David explains that while this technique traces to the teachings of Freud, Freud might turn over in his grave and find it superficial or silly, since David simply tells anxious patients that they are suppressing or repressing something that’s bothering them, and insists they bring it to conscious awareness right away. David accepts this criticism, but also adds that the Hidden Emotion Technique works and frequently triggers complete recovery with patients who are only partially helped by the skillful use of cognitive techniques and exposure techniques.
However, the “niceness” phenomenon only seems to affect about 75% of anxious patients; sometimes, a phobia is just a phobia, with no hidden feeling or conflict. Those individuals will not be helped by this technique. Fortunately, we have dozens of other powerful techniques that will be curative!
We begin by describing the three different deaths of the ego that are required for recovery from depression, anxiety, or a relationship conflict, respectively. For depression recovery often results from the “Great Death,” A Buddhist concept that involves the discovery that there is no such thing as a “self” that could be worthless, or inferior, or judged by another person. David and Fabrice only touch on this theme and promise an entire future podcast on this fascinating and helpful spiritual notion that can lead to recovery from depression.
For anxiety, the death of the ego is quite different, and involves surrendering to the monster the patient has always feared and avoided using a wide variety of exposure techniques. David traces the origin of Exposure Therapy to teachings in the Buddhist hold scriptures, the Tibetan Book of the Dead, more than 2,000 years ago. David describes the amazing and hilarious phenomenon of “laughing enlightenment,” which often happens when anxious individuals confront their fears.
David describes how he used Flooding, an extreme form of exposure, to get over his own blood phobia, which he’d had since childhood. His fear of blood caused him to drop out of medical school at Stanford for a year on two separate occasions. He finally decided to confront his fear by working for a month in the Emergency Room of Highland Hospital, a major trauma treatment center, in Oakland, California. David explains what happened when a totally bloody man on the verge of death was rushed into the ER after a bomb he was building in his basement blew up.
In the podcast David forgot to mention something fascinating about his experience at Highland. David had had a blood phobia since he was child, and blood phobia is thought to have genetic causes, and perhaps be inherited. And yet, David was totally cured in roughly 15 minutes without any medication at all. The important point is that even if things are biologically caused, they can often be treated with psychological techniques.
Most therapists hate the word, “cure.” David explains why he sometimes uses this term when treating anxious patients, and also explains the difference between a 100% cure and a 200% cure.
David emphasizes the importance of motivation and resistance in the treatment of anxiety, since few patients, if any, will want to use exposure techniques, because it is so terrifying. David and Fabrice will describe the Motivational Model in the next podcast.
David and Fabrice raise questions about the mechanism of recovery during exposure. Why does it work? Is it due to the change in thinking, or is there some other healing mechanism at work?
Fabrice asks about patients who resist exposure and protest that it won’t work. For example, a patient with the fear of heights might say, “Oh, exposure can’t possibly help, because every time I get in a situation where I’m exposed to heights, like when I’m in looking over a railing on the third floor of a building or hiking on a mountain trail, I get terrified. This has happened hundreds of times and it never helped!”
Finally, David describes a humorous but real example of his 8-minute treatment of a therapist with 20 years of failed therapy (several times a week of psychoanalysis) for her elevator phobia.
David and Fabrice end by talking about the enormous amount of information they have to share with listeners, including large numbers of creative exposure techniques that fall into three categories:
- Classical Exposure
- Cognitive Exposure
- Interpersonal Exposure
They promise future podcasts describing these fascinating techniques with more amazing vignettes based on patients Dr. Burns has treated, as well as his treatment of his own many fears and phobias!
David answers these questions: How do you deal with a patient (or friend) who is boring? How do you deal with a patient (or friend) you don’t like? How do you get patients to do their psychotherapy homework?
- How do you deal with a patient (or friend) who is boring? David describes a technique he learned from a mentor, Dr. Myles Weber, during his second year of psychiatric residency at Highland Hospital in Oakland. The technique works instantly 100% of the time, and is guaranteed to make any boring interaction with any patient instantly exciting! David and Fabrice emphasize that the same technique can be used with a friend, colleague, or loved one who seems boring, including someone you are dating and can’t seem to connect with at anything other than a superficial level.David also describes powerful, shocking and illuminating experiences he had when attending psychodrama marathons sponsored by the Human Institute in Palo Alto during his medical school years, and what he learned about the differences between the off-putting “outer” selves we display to others and the more genuine “inner” selves we often try to hide.
- How do you deal with a patient (or friend) you don’t like? David describes a method he always used with patients he didn’t like, including one who he found intensely offensive—even disgusting. He explains that the patients he disliked the most almost always became the ones he liked the most, and ended up feeling the closest to, once he used this radical technique. The technique can also be effective with friends or colleagues you’re at odds with.Fabrice reminds us that the approaches David describes in this podcast involve several of the Five Secrets of Effective Communication discussed in previous podcasts. He warns us that they require considerable training, skill and practice, and are likely to backfire if done crudely.
- How do you get patients to do their psychotherapy homework? Every therapist who assigns psychotherapy homework is keenly aware that many patients, perhaps most, “forget” or simply refuse to do the homework. And these are the patients who don’t improve much, if at all. Dr. Burns explains how he tried dozens of techniques that didn’t work early in his career, and finally discovered an approach that was almost always effective.
The cognitive model of anxiety is based on three powerful ideas:
- Anxiety always results from negative thought (NTs) that involve the prediction of danger. For example, if you have public speaking anxiety, you are probably telling yourself something like this: “I just know I’m going to blow it. My voice will tremble. People will know I’m anxious. My mind will go blank. I’ll mumble and make a total fool of myself.” Or, if you struggle with panic attacks, you probably have thoughts like this: “I think I’m about to die. I can’t breathe properly. I’m about to pass out!” Or, “I’m about to lose control and go crazy.”
- The NTs that trigger anxiety are always distorted and illogical. In contrast, valid NTs cause healthy fear.
- When you put the lie to the distorted NTs, the anxiety will disappear. This can sometimes happen in an instant.
Dr. Burns describes his treatment of a woman named Terry who had suffered from ten years of incapacitating panic attacks and severe depression prior to contacting Dr. Burns. During each panic attack, Terry would experience tightness in her chest and tingling skin and tell herself she was about to pass out, suffocate, or die of a heart attack. Multiple emergency room visits, medical tests, and reassurances from doctors did not help. In addition, years of medication and psychotherapy were not at all helpful.
After trying a number of cognitive techniques that did not help, Dr. Burns persuaded her to let him induce an actual panic attack during an office visit so he could use the Experimental Technique, which is arguably the most powerful technique ever developed for the treatment of anxiety, and he televised the session. What happened next will blow your mind!
In the next podcast, Drs. Burns and Nye will describe the Exposure Model of treatment, and Dr. Burns will describe his personal struggles with his fear of blood during medical school.
There are 4 powerful treatment models for anxiety, including
- The Cognitive Model
- The Exposure Model
- The Motivational Model
- The Hidden Emotion Model
Each approach has a completely different theory about the causes of anxiety and utilizes completely different treatment techniques. For example, cognitive therapists believe that distorted thoughts trigger all anxiety, and that the most effective treatment involves challenging these distortions. In contrast, exposure therapists argue that avoidance is the cause of all anxiety, and that exposure is the only effective treatment. Those who adhere to the Motivational Model emphasize the role of resistance. In other words, anxious individuals are reluctant to let go of the anxiety because they secretly believe that the anxiety will protect them from danger. And those who adhere to the Hidden Emotion Model claim that “niceness” is the true cause of all anxiety in the United States at this time, and that hidden problems and feelings may need to be brought to conscious awareness before the patient can recover.
Dr. Burns argues that, in fact, all four theories are correct, and that if you skillfully integrate all four approaches, you will often see a rapid and total elimination of anxiety in the great majority of your patients.
Dr. Burns describes how he created the Hidden Emotion Model when he was treating a woman with mysterious and intractable case of Panic Disorder. Every time her boss walked past her desk, she became nauseous and panicky, and had the overwhelming urge to vomit on him. Then she would have to rush to the ladies’ room to rest until the nausea and panic diminished, and she sometimes had to go home because the symptoms were so severe. This was all the more puzzling because she insisted she had the best boss in the world and that there were no problems at work. She explained that her boss constantly praised her and gave her promotions and generous raises, and that she had no complaints whatsoever.
Cognitive and exposure techniques were only partially effective, until an unexpected discovery suddenly emerged during a therapy session that led to a surprising outcome. What do you think the hidden emotion was? Tune in and you’ll find out!
In the next several podcasts, Drs. Burns and Nye will bring these four models to life, using real life examples, including some of Drs. Burns’ personal struggles with anxiety early in his career.
David and Fabrice answer these questions:
- What is anxiety?
- How does it differ from depression?
- Do anxiety and depression always go hand in hand?
- How does anxiety differ from healthy fear?
- What are the most common forms of anxiety?
- How common is anxiety?
Anxiety, like depression, has been called the world’s oldest con. That’s because you are always fooling yourself, and buying into negative thoughts that aren’t true, when you’re feeling anxious and insecure. Dr. Burns highlights the most common cognitive distortions that trigger anxiety, and discusses the powerful role of shame in anxiety.
In the next several podcasts, Dr. Burns will describe powerful, fast-acting, drug-free treatment methods that can help you defeat every type of anxiety, Including
- Chronic worrying
- Social anxiety
- Public speaking anxiety
- OCD (Obsessive-Compulsive Disorder)
- PTSD (Post-Traumatic Stress Disorder)
- Panic attacks
- BDD (Body Dysmorphic Disorder)
So stay tuned!
A listener with OCD is plagued with intrusive and shameful sexual fantasies. David discusses his treatment strategies for a young man from Argentina who was struggling with forbidden fantasies of Jesus having sex with the Virgin Mary in all positions of the Kama Sutra, but the harder he tried to control them, the more intense and tantalizing they became. Being a good Catholic lad, he was terrified and tearful he would burn in hell if he didn’t overcome this problem.
If you’ve ever struggled with shameful sexual fantasies, you might be intrigued by this fascinating discussion of Cognitive Flooding, therapeutic resistance, and the Hidden Emotion Technique!
Discussion of recent startling and disturbing research studies by Dr. Irving Kirsch and others that suggest that the chemicals called “antidepressants” may, in reality, have few or no true antidepressant effects above and beyond their placebo effects. Dr. Burns illustrates the placebo effect with a thought experiment, and explains why it is so confusing to researchers and the general public alike.
In addition, David and Fabrice discuss additional troubling research by Dr. David Healey and others that indicates that the chemicals called “antidepressants” appear to cause a doubling or tripling of the likelihood that a depressed individual will commit suicide or become actively suicidal, as compared with depressed individuals treated with placebos. David concludes with a discussion emphasizing that the needs of marketing are in conflict with the needs of sciences, and proposes some solutions to this serious problem.
Dr. Burns emphasizes that he is only providing his interpretation of some extremely controversial studies, based on his research training and clinical experience. He urges listeners to do their own research and critical thinking on this disturbing topic, and emphasizes that many may come to different conclusions.
Can the EAR techniques help a listener deal more effectively with a defiant, oppositional child. Dr. Burns reveals a fantastically helpful secret that he and his wife stumbled across in raising their own children. If you have ever struggled in your attempts to deal with an oppositional child or adolescent, you will find this podcast enlightening!
David and Fabrice address this question submitted by a listener:
Dear Dr. Burns,
I read Feeling Good twenty years ago. It was a wonderful relief and help to me. Your book has helped me live a better and balanced life. The best part was passing the knowledge on to my daughter. I thought I read a wonderful description of how to handle death anxiety in the book. I was describing it to a friend, but could' find it in the book.
Is it in another book?
Your reply would be considered an act of generosity.
Thank you! Mary
Existential Therapists believe that the fear of death is universal and is at the root of most emotional problems. Dr. Burns argues that the fear of death is actually quite rare, but does occasionally occur and is extremely treatable. In this podcast, David’s describes his quick, three-part “cure” for the fear of death.
Oddly, every patient he treated in this way insisted at the end of the session that it didn’t help. And even stranger is the fact that 100% of them returned the next week and announced that they actually had been cured and were, in fact, no longer afraid of death!
David answers a challenging question posed by a listener:
Dear Dr. David:
In your Feeling Good Handbook, you suggest that the reader just allows himself or herself to be an ordinary person instead of trying to be perfect. Contrary to your opinion in the book, you're an outstanding therapist in reality. You’ve studied in one of the world’s top colleges, you’re well-educated with a doctor degree, and successful in your career and life. How can I believe your claim? I'm quite confused!
David first distinguishes perfectionism from the healthy pursuit of excellence, and then describes a painful incident when he was a Stanford medical student. One afternoon, he attended an afternoon Gestalt encounter group at the home of a friend and mentor in Palo Alto. During the group he was ripped to shreds by the other participants. At the end of the group, the other participants seemed elated, but he felt intensely humiliated, ashamed, and discouraged. This led to an unexpected interaction with his mentor that helped to change his life.
David also discusses his clinical work years later with a depressed and anxious professional who had never experienced even one minute of happiness in spite of a life of fabulous success and achievements.
At the end, David and Fabrice promise a future podcast on this topic: “Self-Esteem: What is it? How do I get it? How can I get rid of it once I’ve got it?”
David and Fabrice are joined by Lisa Kelley, a certified TEAM-CBT therapist and former journalist from Littleton, Colorado. Lisa interviews David about an interview / blog David has just published on this website.
Lisa begins by asking how people responded to a survey on David’s website asking this controversial question: “Do you believe that a depressed individual could experience a complete elimination of symptoms in a single, two-hour therapy session?” More than 5,000 individuals completed the survey and most were extremely skeptical.
David states that ten years ago, he would have felt exactly the same way, and would have dismissed anyone making such a claim as a con artist. However, he has now changed his mind and believes that sometimes it is possible.
David explains that he has done more than 50 live demonstrations in workshops and other teaching settings with individuals who are struggling with severe feelings of depression, anxiety, shame and anger. Many of these individuals who volunteer to be the patient have experienced horrific personal traumas. This gives David the opportunity to demonstrate how TEAM-CBT works with someone who is really suffering, and not just a role-playing demonstration. Usually, these live demonstrations are the highlight of a workshop because they are intensely emotional and real. Surprisingly, in the vast majority of these sessions, the individuals who were in the patient role experienced a complete, or near-complete, elimination of symptoms in roughly two hours.
David emphasizes that while we would not expect this to generalize to a clinical practice situation, it does seem to suggest significant improvements, or even breakthroughs, in psychotherapy. Many of the new developments have to do with helping patients overcome their resistance to change. Although David makes these techniques look easy, they are challenging to learn, and require a radically new and different way of thinking about why patients sometimes resist change and fight the therapist.
Lisa, Fabrice, and David explain exactly how the new techniques work, using as an example an Asian-American woman who had experienced decades of domestic violence and rape.
How can you help a depressed friend or family member? You may be surprised to discover that the attempt to “help” is rarely effective, and may even make the problem worse. In contrast, the refusal to help is nearly always helpful. But to understand that paradox, you’ll have to give a listen to this fascinating edition of "Ask David!"
David and Fabrice also address a related problem nearly all of us confront from time to time: How do you deal with a friend who is a relentless whiner and complainer? When you try to help them or suggest a solution to the problem, they just say, “That won’t work” and keep complaining. You end up feeling frustrated and annoyed, because the other person just won’t listen! David and Fabrice illustrate a shockingly easy and incredibly effective solution to this problem.
Finally, David discusses some disturbing recent research indicating that the ability of therapists—as well as friends or family members—to know how suicidal someone is, is extremely poor. David and Fabrice explain how to assess how suicidal someone actually is, and what to do if you discover that he or she really is at risk of a suicide attempt.
If used skillfully, the Five Secrets can resolve nearly any relationship conflict and transform hostility, resentment and mistrust into intimacy and warmth, often with amazing speed. And although this may seem easy when you first learn about the Five Secrets, it’s extremely difficult in real world situations.
In this Podcast, David and Fabrice discuss a number of predictable emotional and mental errors nearly everyone makes when trying to use the Five Secrets to get close to someone he or she is at odds with.
Practically all of us have a friend, colleague, client, customer or family member we aren’t getting along with very well. Perhaps the difficult person in your life is excessively critical of you, complains constantly, won’t express his or her feelings, always has to be right, or never listens to you. Does anyone come to mind?
In this podcast, David and Fabrice discuss five communication secrets that can rapidly transform conflict and misunderstanding into intimacy and trust. David describes an experience that suddenly changed the direction of his life and career when he was working with an insecure medical student from England early in his career. The Five Secrets of Effective Communication can be remembered using the acronym, EAR:
E = Empathy
- The Disarming Technique: You find truth in what the other person is saying, even if it seems illogical, self-serving, distorted, or just plain “wrong.”
- Thought and Feeling Empathy: You summarize what the other person just said (Thought Empathy) and acknowledge how he or she is probably feeling, given what he or she just said (Feeling Empathy)
- Inquiry: You as gentle, probing questions to learn more about what the other person is thinking and feeling.
A = Assertiveness
- “I Feel” Statements: You express your own feelings and ideas openly according to the formula, “I’m feeling X, Y, and Z right now,” where are X, Y and Z refer to any of a wide variety of feeling words, such as anxious, attacked, hurt, or sad.
R = Respect
- Affirmation (formerly called Stroking): You convey warmth, caring and respect, even in the heat of battle
David and Fabrice also describe the Five Secrets of Effective Communication and emphasize the incredible power of the Law of Opposites, with a vignette about a severely depressed patient who told David that he was “too young to be my doctor.”
A fan points out that many of the examples in David’s book, When Panic Attacks, are high functioning individuals with lots of education and good jobs. She asks Dr. Burns if depression and anxiety are inevitable among people who are poorly educated and without many assets. Dr. Burns again addresses the ancient but persistent question of whether our suffering results from the actual problems in our lives, or rather by our distorted thoughts about them.
Discuss of "Should" Statements, Labeling, and Blame. Dr. Burns brings these distortions to life with a case of a severely depressed woman who felt profoundly guilty and devastated after her brother’s tragic suicide.
Three common distortions: Jumping to Conclusions (including Mind-Reading and Fortune-Telling), Magnification and Minimization (also called the Binocular Trick), and Emotional Reasoning.
Common thought distortions that trigger negative feelings: All-or-Nothing Thinking, Overgeneralization, Mental Filter, and Discounting the Positive.
When we’re feeling depressed, anxious, or angry, should we accept our feelings or try to change them?
A session with a severely depressed, suicidal, hospitalized woman with rapidly cycling bipolar illness, who’d had 15 years of failed treatment with drugs and psychotherapy.
The three basic principles of CBT:
- Negative feelings, like depression, anxiety, and anger, do not result from what happens to us, but rather from our thoughts about what’s happening. In fact, our thoughts, or “cognitions,” create all of our emotions, positive and negative.
- When you’re depressed or anxious, the negative thoughts that trigger your distress, like "I’m no good," or "Things will never change," are distorted or illogical. In fact, depression is the world’s oldest con.
- When you change the way you THINK, you can change the way you feel.
Responses to questions submitted by listeners:
- What causes an “identity crisis?” And how do you treat it?
- Why is it so hard to find a therapist trained in cognitive therapy?
- In a relationship, should you change yourself in order to get along with someone?
Dr. Burns suddenly abandons the role of healer and instead assumes the role of the patient’s angry, paranoid and defiant resistance.
What is therapeutic resistance? You will find out that therapeutic resistance is NOT what you were taught in graduate school or read about in the writings of Sigmund Freud! You will also discover why overcoming therapeutic resistance can be the key to high-speed, dramatic recovery for many depressed and anxious individuals.
- How an encounter with a patient with paranoid schizophrenia dramatically changed the course of his career
- The 5 Secrets of Effective Communication
- How to talk with your EAR
Dr. Burns also discusses what therapists can do when
- you are angry with a patient
- you don’t like a patient
- or when a patient is angry with you
In this podcast, Dr. David Burns describes the “Testing” part of the T.E.A.M. model. Topics include:
- The shocking results of a study of therapist accuracy at Stanford
- Why therapists who don’t test usually get it wrong
- How session-by-session testing can revolutionize your practice
In this podcast, Drs. Fabrice Nye and David Burns discuss an exciting breakthrough in psychotherapy.
Leave your questions and comments below. Also, let us know if you’d like to see certain topics addressed in future podcasts.