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Rank #33 in Mental Health category

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Mental Health

Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

Updated 2 days ago

Rank #33 in Mental Health category

Education
Self-Improvement
Health & Fitness
Mental Health
Read more

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!

Read more

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!

iTunes Ratings

409 Ratings
Average Ratings
358
22
9
10
10

Amazing podcast, highly recommend!

By Lavenderpinkk - Oct 20 2019
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Thank you Dr. Burns this podcast and your book has helped me immensely in my life 🙏!

So Fun and Helpful

By Jrenee827 - Aug 22 2019
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Love the interaction with Dr Burns and Rhonda. Great chemistry.

iTunes Ratings

409 Ratings
Average Ratings
358
22
9
10
10

Amazing podcast, highly recommend!

By Lavenderpinkk - Oct 20 2019
Read more
Thank you Dr. Burns this podcast and your book has helped me immensely in my life 🙏!

So Fun and Helpful

By Jrenee827 - Aug 22 2019
Read more
Love the interaction with Dr Burns and Rhonda. Great chemistry.
Cover image of Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

Latest release on Jan 27, 2020

Read more

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!

Rank #1: 118: Self-Defeating Beliefs (Part 1) — The Beliefs That Defeat You

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Rajesh asked:

  • Is it possible to change an SDB?
  • Does the mere knowledge of an SDB change it?
  • How long does it take to change an SDB?
  • How do you change SDBs?

Nikola asked:

  • Aaron Beck said the SDBs never really go away. They just get activated and deactivated and activated again. Does this mean that depression is an incurable disease that will keep coming back over and over again?
  • What’s the point in battling against a core belief if it cannot be changed?

Fabrice and I appreciate your questions--they often give us ideas for shows! In today’s Podcast you'll learn the answers to several questions about Self-Defeating Beliefs.

What’s the difference between Self-Defeating Beliefs (SDBs) vs. Cognitive Distortions?

The thoughts that contain cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, Discounting the Positive, and Self-Blame are distortions of reality, they are the cons that trigger depression and anxiety. When you're upset, these thoughts will flood your mind. These thoughts can be show to be false, and when you crush a distorted negative thought, you'll immediately feel better.

Self-Defeating Beliefs are stipulations, values that you've set up for your self. For example, you may base your self-esteem on your accomplishments due to your belief that people who accomplish more are more worthwhile as human beings. SDBs like this cannot actually be shown to be false--they are simply your personal, subjective values, and they are thought to be with you all the time, and not just when you're depressed, anxious, or angry.

The question with an SDB is this: What are the advantages and disadvantages of having this value system? How will it help me--what are the benefits--and how might it hurt me? What's the downside?

Why are Self-Defeating Beliefs thought to be important?

When you challenge and defeat a distorted thought, you feel better in the here-and-now. When you challenge and change an SDB, you change your value system at a deep level. This is thought to make you less vulnerable to painful mood swings and relationship conflicts in the future.

What are the different kinds of SDBs?

  • David’s list of 23 Common SDBs is attached. This list is not comprehensive, as there are many more, but the ones on the list are very common. There are several categories of SDBs.
  • Individual SDBs are often “Self-Esteem Equations”
    • Perfectionism
    • Perceived Perfectionism
    • Achievement Addiction
    • Approval Addiction
    • Love Addiction
  • Interpersonal SDBs are expectations of what will happen in certain kinds of relationships, or relationships in general
    • What’s your understanding of the other person’s role in your relationship? What adjectives describe him or her?
    • What’s your understanding of your person’s role in the relationship? What adjectives describe you?
    • How would that kind of relationship feel?
    • What rules connect the two roles?
  • Other kinds of SDBs
    • Anger / conflict cluster
      • Entitlement
      • Truth
      • Blame
    • Anxiety cluster
      • Niceness
      • Conflict Phobia
      • Anger Phobia
      • Emotophobia
      • Submissiveness
      • Spotlight Fallacy
      • Brushfire Fallacy

How can you identify your own, or a patient’s, Self-Defeating Beliefs?

  • Look at the list of 23 individual SDBs (easiest). You might want to do that right now. Review the list, and you'll probably find many of your own beliefs!
  • Individual Downward Arrow
  • Interpersonal Downward Arrow

Dec 10 2018

34mins

Play

Rank #2: 155: Treating Depression, Emotional Eating, and Self-Image Problems with TEAM-CBT

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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.”

Estafonia wrote:

“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

Aug 26 2019

52mins

Play

Rank #3: 134: Smashing Shyness (Part 1) — Beating Social Anxiety

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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:”

Hi David,

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. 🙂

Kind regards,

Margaret

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.

Thank you.

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:

  1. I should say something impressive.
  2. I'm good looking so I should not be anxious.
  3. I should talk to girls.
  4. I should say hi to people.
  5. 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.

Apr 01 2019

56mins

Play

Rank #4: 053: Ask David — “I don’t feel like doing it!” Quick Cure for Procrastinators

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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:

  1. Walk into my office
  2. Choose one pile to start working on
  3. Pick up the top piece of paper on the pile
  4. Put it into a blank manila file folder
  5. 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:

  1. Five minutes won’t help, the job is overwhelming.
  2. Even if I get started, I’ll just relapse, so there will never be a permanent solution.
  3. It’s not such a big problem, I don’t need to do my filing now.
  4. I can watch Game of Thrones on TV instead. That will be more fun.
  5. It will be too anxiety provoking to get started.
  6. It’s too late to get started anyway.
  7. 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!

Sep 11 2017

53mins

Play

Rank #5: 065: The Five Secrets (Part 1) — Overview

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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.

Dec 04 2017

35mins

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Rank #6: 007: M = Methods (Part 1) — You FEEL the Way You THINK

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The three basic principles of CBT:

  1. Negative feelings, like depression, anxiety, and anger, do not result from what happens to us, but rather from our thoughts about what’s happening. In fact, our thoughts, or “cognitions,” create all of our emotions, positive and negative.
  2. When you’re depressed or anxious, the negative thoughts that trigger your distress, like "I’m no good," or "Things will never change," are distorted or illogical. In fact, depression is the world’s oldest con.
  3. When you change the way you THINK, you can change the way you feel.

Nov 09 2016

34mins

Play

Rank #7: 163: Ask David: Anxiety, Dreams, Cyclical Negative Thoughts, Secrets of Selling, Exposure, and more

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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.

Lisa

Hi Lisa,

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!

David

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.

Mike

Hi Mike,

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?

Thanks,

Rajesh

Hi Rajesh:

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!

david

Question #4. I’m in sales. How do I combat my Negative Thoughts about each person I approach?

Hi David,

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?

Hi Rudi,

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:

  1. 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.
  2. 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.
  3. 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!

Thanks, David

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,

Yes, I’ll be coming to Atlanta for a four-day intensive in November! Check my workshop tab at www.feelinggood.com for more information. (https://feelinggood.com/workshops/)

david

David D. Burns, M.D. & Rhonda Barovsky, Psy.D.

Oct 21 2019

51mins

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Rank #8: 022: Scared Stiff — What Is Anxiety? (Part 1)

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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
  • Phobias
  • Social anxiety
  • Public speaking anxiety
  • Shyness
  • OCD (Obsessive-Compulsive Disorder)
  • PTSD (Post-Traumatic Stress Disorder)
  • Panic attacks
  • Agoraphobia
  • BDD (Body Dysmorphic Disorder)

So stay tuned!

Feb 06 2017

28mins

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Rank #9: 164: How to HELP, and how NOT to Help!

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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

Karl

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.

DO NOT

  1. Give advice
  2. Try to help
  3. Try to cheer the person up
  4. Try to solve the problem s/he is struggling with
  5. Try to get the other person to think or act more positively
  6. Try to minimize the problem by saying it’s not that bad, or things will get better.
  7. 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?

DO

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

  1. down, sad or depressed?
  2. anxious, worried, pressured, or nervous?
  3. guilty or ashamed?
  4. inadequate, worthless, defective, or inferior?
  5. alone or lonely?
  6. humiliated or self-conscious?
  7. discouraged or hopeless?
  8. stuck or defeated?
  9. 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."

Example

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.

Oct 28 2019

51mins

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Rank #10: 093: 50 Methods in 50 Minutes (Part 1)

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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!

Jun 18 2018

1hr 6mins

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Rank #11: 109: David's Top 10 Techniques

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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!

  1. The list of Ten Cognitive Distortions
  2. The Disarming Technique and Law of Opposites
  3. The Externalization of Voices plus Acceptance Paradox
  4. The two classic Uncovering Techniques: the Individual and Interpersonal Downward Arrow
  5. The Feared Fantasy and Acceptance Paradox
  6. The Experimental Technique for extremely rapid treatment of patients with Panic Attacks
  7. 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
  8. Brief Mood Survey
  9. Positive Reframing
  10. The use of extended, two-hour therapy sessions

Oct 08 2018

36mins

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Rank #12: 082: Neil Sattin Interview — Cognitive Distortions and Relationships

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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.

Apr 02 2018

1hr 33mins

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Rank #13: 039: Uncovering Techniques (Part 1) — The Individual Downward Arrow

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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:

  1. Depression: You may be telling yourself that you’re a loser, or a failure, or that you’ll be miserable forever.
  2. 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!”
  3. 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.

[office src="https://onedrive.live.com/embed?cid=4C33CD5BBD389DD2&resid=4C33CD5BBD389DD2%21158&authkey=AMjeMe-n6Qmswxc&em=2&wdAr=1.3333333333333333"]

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!

Jun 05 2017

39mins

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Rank #14: 040: Uncovering Techniques (Part 2) — The Interpersonal Downward Arrow

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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.

Jun 12 2017

38mins

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Rank #15: 144: Ask David--Relationships, Relationships, Relationships!

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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.

  1. Mike #1: I love your Five Secrets of Effective Communication. Why does secret #4, “I Feel” Statements, not include Thought Empathy?
  2. Mike #2: I have seen communication models that include expressing and listening for needs. Aren’t needs and wants important and important to express?
  3. Al: How can I help my wife recognize her many cognitive distortions, like All-or-Nothing Thinking? It seems hopeless!
  4. 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 ….”?
  5. 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

Jun 10 2019

33mins

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Rank #16: 142: Performance Anxiety: The Story of Rhonda, Part 1

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"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:

  1. I sound stupid and inarticulate, and some of my comments were inaccurate, like when I said psychiatric diagnoses are meaningless labels.
  2. I’ve had feelings of insecurity ever since I was a child, and should be over this by now!
  3. David is going to regret having me as the podcast host!
  4. Everyone will know I’m a fraud, and no one will like or respect me.
  5. 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:

  1. You have one or more negative thoughts.
  2. 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

May 27 2019

55mins

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Rank #17: 014: The Five Secrets of Effective Communication (Part 1)

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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.”

Dec 12 2016

38mins

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Rank #18: 004: A = Agenda Setting (Part 1) —The Eight Most Common Forms of Therapeutic Resistance

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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.

Oct 31 2016

1hr 3mins

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Rank #19: 023: Scared Stiff — What Causes Anxiety? What’s the Cure? (Part 2)

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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.

Feb 13 2017

23mins

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Rank #20: 079: Live Session (Daisy) — The Secret of a "Meaningful" Life

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"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.

Mar 12 2018

1hr 47mins

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177: Our Beloved Fabrice returns! New Psychedelic Research!

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Rhonda, Fabrice, and David discuss psychedelic-assisted psychotherapy, Fabrice’s wonderful new marriage, his fascinating new podcast (http://peaceatlast.us/), and more.

David and Rhonda are thrilled to have our beloved friend and colleague, Dr. Fabrice Nye, as the special guest on today’s podcast. Many of you will remember Fabrice as the man who gave birth to the Feeling Good Podcast, and acted as host for the first 133 podcasts.

Fabrice describes many events since he turned over the reins to Rhonda earlier this year, including his recent marriage and move to the beautiful but fire-ravaged Russian River area roughly 100 miles north of San Francisco. However, Fabrice still maintains his clinical practice on a part time basis in Redwood City, in the San Francisco Bay area.

The main focus of today’s podcast is Fabrice’s participation in promising new research on the treatment of PTSD. The participants in the study are veterans receiving psychotherapy that is assisted by treatment with MDMA during extended treatment session. MDMD is also known as the party drug, Ecstasy. However, the MDMA used in the research is chemically pure, whereas Ecstasy is generally obtained on the street and may not be pure.

Fabrice describes MDMA as an “empathogen” that makes people more loving and more in touch with their emotions. This can make it easier for patients with PTSD to talk about their traumatic experiences and painful feelings, which people with PTSD usually try to avoid. Avoidance makes all forms of anxiety much worse, where as exposure is usually beneficial.

Patients in the study received three treatment sessions, and a preliminary analysis indicated that one third of them improved to the point that they no longer had symptoms severe enough to be diagnosed with PTSD. Further studies are in progress, including a study with a control group, as well as follow-up studies to find out whether the improvement continued and whether some of the patients relapsed.

Fabrice also describes the fascinating new trend in treatment of a variety of conditions with psychedelics, including psilocybin, mescaline, and ayawauska. I expressed my personal support for this trend, as these substances have been used by hundreds, if not thousands of years, for spiritual purposes by indigenous people throughout the world.

And perhaps the coolest thing we learned was that Fabrice will be starting his own terrific podcast entitled PeaceAtLast.us about the time today’s podcast will be published. PeaceAtLast.us will focus on the overlap between spirituality and psychotherapy, a topic that I have always found extremely interesting and helpful in my own clinical work using TEAM-CBT. You might want to check out the new Fabrice podcast! I know that Rhonda and I will!

After the podcast, we received the following email from Fabrice, which includes many resources for those of you wanting more information about psychedelics and psychotherapy, as well as his new podcast.

Hi David and Rhonda,

It felt so good to be reunited with you for an hour. Wish we didn’t have to cut it so short. Here are some of the links that you may want to provide to your listeners.

Fabrice Nye fabrice@life.net

Jan 27 2020

58mins

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176: My suicidal daughter refuses to talk with me / How can I deal with my jealousy?

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Rhonda and David discuss two challenging questions submitted by listeners like you. 

Question #1: Cindy asks: My suicidal daughter refuses to talk to me! What can I do?

Comment: Dear David,

I stumbled upon you teaching in another podcast a few months ago. Immediately I was stunned by how much your words echoed in my mind. I have listened to your book three times in Audible and many of your podcasts. You Changed my life!!!

I am much more relaxed now and I can sleep!!! I talked about you with my massage therapist and she bought your book for her daughter (who has anxiety attacks) and her niece. Her daughter is an aspiring artist who said that she would buy your book and give them away to teens when she becomes famous.

I now ask you to change another life, that of my daughter's. She has been depressed for more than 20 years, suicidal (bought a noose, watches suicide movies, talked about ways to kill herself) and no therapists could help. We went to therapy together this past summer and it only ended that she abruptly canceled and is no longer responding to me by any means: phone, text, card, or email. The last time I saw her was late August and she was very down and had very poor personal hygiene. I have since sent her a loving text at least every other day, I offer to drive to her city (an hour away) to have dinner with her, I sincerely apologized for everything I could think of that I have done wrong since she was a child, I sent gifts to her by mail, I invite her to come for holidays, I ask her cousins to call (she did respond to them). No response to me at all. I am wondering how to communicate with a loved one who just totally shut you off.

Always your fan,

Cindy

Thank you, Cindy. Sorry to hear about your daughter, very concerning. My heart goes out to you. Our own daughter had a rough time as a teenager, too, but now is doing great. I hope things evolve with your daughter, too.

This podcast may help: https://feelinggood.com/2019/10/28/164-how-to-help-and-how-not-to-help/ as well as this one:

https://feelinggood.com/2019/02/04/126-how-to-communicate-with-someone-who-refuses-to-talk-to-you/

The first podcast highlights common errors in trying to “help” someone who is hurting, and emphasizes how to respond more effectively, using the Five Secrets of Effective Communication.

The second podcast illustrates how to get people to open up using one of the advanced secrets called “Multiple Choice Empathy / Multiple Choice Disarming.

My book, Feeling Good Together, explains these techniques in detail, with practice exercises, and includes an entire chapter on how to talk to someone who refuses to talk to you. You can learn more on my book page. (https://feelinggood.com/books/). Some support from a mental health professional might also be helpful to you, as these techniques sound simple, but are actually challenging to master.

Your daughter might also benefit from my book, Feeling Good: The New Mood Therapy (https://feelinggood.com/books/). It is not a substitute for treatment from a mental health professional, but research studies indicate that more than 60% of the people who read it improve significantly in just four weeks. It is inexpensive, and I’ve linked to it if you want to take a look.

All the best,

David

Question #2: Lorna asks: How can I deal with my jealousy?

Comment: Hi David,

I've recently discovered your books and your podcast and CBT has really been helping me in my personal life. I really want to thank you for all the amazing work you do!!

The issue I'm having however seems to still really get my moods down and I was wondering if perhaps you could offer some general advice via the podcast.

I'm in a great relationship but the ex-girlfriend of my partner has recently moved back to the city where we live and now we are in similar social circles. They were together for a very long time and now I'm really struggling with the prospect of spending time with her.

When we all spend time together, it’s actually fine, but afterwards I really struggle with thinking about them together, getting to know her and thinking about her personality and how we compare.

I think most people would find this uncomfortable, but it really has triggered a downward spiral for me. My partner and I argued about it and I struggle to let things go that were said in arguments.

Do you have any advice on dealing with a situation of an ex-partner being on the scene and perhaps how to not dwell on things that were said during arguments?

Thanks,

Lorna

Hi Lorna,

Thanks, might work. What does this mean: “Do you have any advice on dealing with a situation of an ex-partner being on the scene and perhaps how to not dwell on things that were said during arguments?”

The rest of the email seems to suggest feelings of jealousy, insecurity, and so forth, as if she is a threat to your current relationship. is this correct?

David

Hi David,

Thanks so much for getting back to me!

I don't actually think she is a threat to our relationship, and don't feel that they have feelings anymore for each other, but it just makes me super uncomfortable to think about how long they spent together.

I'm always comparing our relationship to what I think their relationship was like in the past. I know I should stop thinking about those things but I really struggle to stop!

I know my partner and I are very much in love but I keep having thoughts like

  • “It’s not fair that I have to spend time with her,” or
  • “I feel really guilty because he wants to be friends with her but can't due to how I feel about the situation.”

I also feel like he blames me.

I was hoping you could shed some light on what you think in general is a good strategy for dealing with situations where an ex-girlfriend/boyfriend of your partner is on the scene and you all have to spend time together.

I do have feelings of jealousy and insecurity but I struggle to understand why as I don't believe they want to be together anymore at all.

We had a few arguments about it initially where he said things like “you are just angry that I have an ex-girlfriend” or “what's the big deal about it all?”

I was so hurt by the way he made my feelings seem petty and trivial. We have both apologized but I keep remembering what he said and how hurt it made me feel.

Do you have any advice on letting go of past arguments when the 'problematic situation' (ex-girlfriend being around) is still on-going?

Thank you so much!

Lorna

David and Rhonda discuss this question, and include David’s story in Intimate Connections as a medical student when David had a broken jaw and the ex-boyfriend of Judy, the girl he was living with in Palo Alto, charged into his house with a tough-looking friend and demanded to see Judy. David called the police, and the two fellows left and set, "we're going to get you!" David was terrified, since his jaw was still broken, and got some jaw-dropping advice the advice from his buddy, Sergio. You will be surprised to hear about what happened next!

In addition to learning to "let go" of jealousy, Rhonda and David discuss many additional strategies for dealing with jealousy, including:

  1. Use of Self-Disclosure
  2. Positive Reframing: do you really want to give up your jealousy and vigilance?
  3. Cost-Benefit Analysis: Is it worth the hassle of constantly being suspicious, as opposed to simply deciding to trust and let the chips fall here they may?
  4. Downward Arrow: What are you the most afraid of?
    1. Love Addiction
    2. Fear of Rejection
    3. Fear of Being Alone
  5. Overcoming the fear of being alone and the “need” for this man’s love, or any man’s love, is discussed in the first section of Intimate Connections.
  6. Exposure: You could fantasize the two of them together, making yourself as anxious and jealous as possible, until the feelings diminish and disappear.
  7. Self-Monitoring: Counting your thoughts about them on a wrist counter or cell phone for four weeks. David describes his work with an intensely jealous law student after his girlfriend broke up with him so she could date another fellow in his class.
  8. Understand the frequent ineffectiveness of apologizing, and why it doesn’t work! This is really important. David describes a powerful vignette about a troubled couple, where “I’m sorry” was CLEARLY a way of saying “shut up, I don’t want to feel about how hurt and angry you feel.” The Five Secrets of Effective Communication are a vastly more effective way of dealing with negative feelings. David and Rhonda contrast effective vs. dysfunctional “apologizing.”

While it can be important to say "I'm sorry," this formulaic response is usually insufficient because it often ends the conversation but the difficult or hurtful feelings remain. What's important to add is talking about the other person's feelings, thoughts and experiences of the conflict and sharing your own thoughts and feelings.

 When you say, "I'm sorry," it's sometimes insufficient because it often ends the conversation, but the difficult or hurtful feelings remain.

What's important to add is talking about the other person's feelings, thoughts and experiences of the conflict and sharing yours.

After David emailed Lorna with the outline for the podcast, Lorna replied:

Hi David,

Thank you sounds great! Can’t wait to listen to the episode. I think I will definitely order your book - I think it’s the only one missing for me to have the complete collection. Thanks again!

Lorna

Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast.

See below for details and links!

David

Jan 20 2020

42mins

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175: What if I REALLY AM a useless human being? The Cure for Therapeutic Failure!

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Rhonda and David address a question from Karolina, a therapist in Poland who was failing with a depressed patient who felt totally convinced he was a “useless” human being. I think you will find their discussion of this case fascinating, as it deals with the cause of practically ALL therapeutic failure, and illustrates the solution al well, using TEAM-CBT methods and concepts.

Today’s podcast is intended for therapists and patients alike!

For the show notes, we are including the email David received from Karolina, as well as his initial response.

Dear Dr. Burns,

I've been listening to your podcast for 6 months now and it's been so helpful with my work as a therapist as well as in my personal life. I'm starting to develop a habit of considering every unwanted state with a "what does it say that's awesome about me?" and I'm much happier now :).

I'm wondering if you'd consider helping me some more. I have a client who's been struggling with depression for many years. At the moment he's doing ok and his mood is up. Lately the topic of his uselessness came up again and he's willing to work on that. He said he'll consider the possibility that he's not a useless human being and asked me to not to dismiss the possibility that he is - that's how he'll know that I'm not just trying to cheer him up.

It's been bugging me ever since. Although I've agreed, I really can't find in me any part that is ready to think that. I strongly believe he's not a useless person. I can't imagine labeling anyone in that way and in his case it feels so personal as I like him very much and I care about him.

I'm starting to have dreams about our next session when I fail him by trying to convince him to think as I do. How can I be open about our conclusion when my mind is already fixed? Any thoughts on this would be deeply appreciated.

Best wishes from Poland

Karolina

Hi Karolina,

Thanks! The term has no meaning. It is just a vague put down, like what a bully might say.

I might ask him what time of day he was feeling useless, and then have him fill out a Daily Mood Log for that moment, step by step. We can only help him at one specific moment.

You can use a large number of techniques but must first get an A on Empathy, and then do effective paradoxical agenda setting, starting with the Paradoxical Invitation Step and then asking “what type of help would you be looking for?” then you can do the Magic Button and Positive Reframing.

All of the negative thoughts and feelings on the Daily Mood Log will be advantageous and will show something about him that is awesome and positive. You should be able to generate a list of at least 25 overwhelming positives. Then you can use the Magic Dial.

When you get to M = Methods, you can put the thought, “I am a useless human being” in the middle of a recovery circle, and then select a minimum of 16 methods to challenge it.

You can start with Identify the Distortions. There are likely at least 9 distortions in the thought, including AON, OG, MF, DP, MAG / MIN; ER; LAB; SH; SB.

You can try, “let’s define terms,” and ask what’s the definition of a “useless human being”? You’ll find that no matter how you try to define it,

    1. The definition will apply to all human beings.
    2. The definition will apply to no human beings.
    3. The definition does not apply to him.
    4. The definition does not make sense.
    5. The definition is based on some kind of arbitrary cut-off points.

You can do this as a role-play, being a close friend trying to find out if you’re useless, and asking him for guidance on how to find out.

You can do the Paradoxical Double Standard Techniques, Downward Arrow, Hidden Emotion, Externalization of Voices, Acceptance Paradox / Self-Defense Paradigm, Examine the Evidence, Semantic Method, and on and on.

The problem is NOT that he’s a “useless human being” but rather that he’s obsessing and wasting time on a meaningless construct, and beating up on himself.

The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge, since it may be working for him, and also reflects all those 25 wonderful things about him.

The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge, since it may be working for him, and also reflects all those 25 wonderful things about him. Remember that just about 99.9% of therapeutic failure results from Agenda Setting errors. Is this something you want to help him with, or something he is desperately asking you for help with? I am almost 100% positive that this is your agenda, not his. In fact, your need to “help” him with this may actually keep him stuck.

In fact, here is the proof. You write: “I'm starting to have dreams about our next session when I fail him by trying to convince him to think as I do. How can I be open about our conclusion when my mind is already fixed?”

If you don’t understand this, I recommend some supervision from a TEAM therapists or join one of the online classes, or attend my workshop on resistance, coming up in a month or so, check out my website workshop page for details. You can join online.

David D. Burns, M.D.

Hi Dr. Burns,

Thank you so much for your quick and thorough response!

I kinda felt that my "helping" is the issue here as I've felt my own frustration rising...

Thanks for reminding me that uselessness is just a meaningless concept, I needed that. And I love the idea of role-playing as a friend asking for help with defining his uselessness. I'll pace myself, though, and give us time to walk through all the steps, especially Empathy and Agenda Setting and check how it goes and what my clients wants, not I.

I appreciate information on the resources and supervision I can access online, so good to know there are options!

You can use my real name, can't wait to hear the podcast :).

Karolina

Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast.

See below for details and links!

David

Jan 13 2020

55mins

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174: Sadness as Celebration featuring Steve & Barbara Reinhard

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People in the featured photo for today's podcast. Back row: Amir, David, Rhonda, and Dave. Front row: Steve and Barb

This will be our first podcast of 2020, so we wanted to make it a really good one!

Rhonda, Dave and I are very proud to welcome Steve Reinhard and his wonderful wife, Barb, on today’s podcast. Steve and Barbara flew in from Colorado to join the Sunday hike and do this podcast in the “Murietta Studios” following the hike. Steve is a former electrical contractor and lay minister, and is the first certified life coach to be admitted into the TEAM-CBT certification program at the Feeling Good Institute in Mt. View, Ca, (link).

The following is a heart-warming email I received from Steve prior to the show.

Subject: Re: looking forward

Hi David,

Woohoo! We are partners in crime! I'm feeling super comfortable now.

Thanks David for your generous invitation! I'm happy to jump on any of the 3 options you suggested for the show. I'd love to hear your stories, especially those of undistorted sadness where you celebrated with tears, aware of the suffering we folks tend to keep hidden.

I cry a lot these days, laugh a lot too. In that regard I'd love to have my own personal Ask David session. David, I love the old, demented, weak human guy, while admiring the pioneering, genius who teaches so clearly & humanly. My questions wouldn't be so much for me to learn or be taught but to connect with you. I'm crying as I write. As a listener I want to connect with the human, David. May or may not be something you want to do. We have loads to interact with.

Yep, I take a "spiritual " approach & would love to interact with you being anti-religious. Listeners might find this helpful & it sounds fun to me. A great opportunity for me to experience a death of the ego & the acceptance paradox which I have found liberating before I knew what it was called.

I'd love to talk about what it's like to be diagnosed with blood cancer and holey bones & some of the nutty things we say to each other when we don't know what to say. Empathy in the Five Secrets way is extremely rare from my distorted perspective. Aging & being willing to challenge the many shoulds & shouldn'ts that accompany things being different than they were last year would be fun to talk about.

I can't keep track of the # of times folks repeat "getting old is hell", same with cancer, vision problems, walking problems, drug side effects. I would love to hear your stories & experience as an old demented guy who can't walk as fast as he did a couple years ago.

Thanks for your generous invitation. I still find it surprising that I get to have this experience with you all. I'm really looking forward to today’s show.

Steve

We began the podcast with a discussion of the role of lay therapists in the field of mental health. Coaching is newly emerging field of counseling that does not require graduate work in psychiatry, psychology, social work, or counseling. In the past, coaches have not been permitted to enter the TEAM-CBT certification program. However, Dr. Angela Krumm, who is the head of the FGI certification program changed that policy specifically so that Steve—and now, other certified coaches as well--can be certified in TEAM-CBT, and I applaud this change.

The role of lay therapists has always been highly controversial. I can recall that when I was in college in the 1960s, there was a lively debate about so-called “lay psychoanalysts.” Previously, you had to be an MD to be a psychoanalyst, but over time, non-MDs were permitted to become psychoanalysts. To my way of thinking, this debate has always been more about power and the protection of territory than about skill or the capacity to heal.

Now we are seeing the same questions being raised about certified life coaches. In my experience, graduate training doesn’t always guarantee that someone will be a skillful therapist, and sometimes the opposite is true. In fact, in my experience, the LESS previous training therapists have, the easier they are to train in TEAM-CBT, because they don’t have so much training they have to “unlearn.” The Buddhists say that an empty cup is better than a full cup, because the full cup spills over when you try to pour the wine.

Of course, there’s a downside, too, since therapists can also be sometimes exploitative and can be hurtful to patients. This includes coaches as well as mental health professionals with graduate training.

Next, we asked Steve about the role of spirituality in his TEAM-CBT counseling, since he is a also a lay minister. I am convinced that the spiritual dimension can be important and powerful in therapy, and that at the moment of our deepest change, the change is not only psychological, emotional, and behavioral, but also spiritual, because we may suddenly “see” things from a much deeper perspective. Much in TEAM-CBT is easily integrated with spirituality. For example, the Acceptance Paradox is an inherently spiritual technique that can play an important role in recovery from depression and anxiety.

One of Steve’s motives I doing this podcast was to have his own Ask David session, and one of his questions was, “What is it like to be regarded by many people as a guru?” I described the blessings as well as the occasional curses and problems that come with this moniker!

Then the conversation turns to Steve’s devastating diagnosis of blood cancer—multiple myeloma—just over a year ago, and how hard and frustrating it has been for Steve to get people just to listen and provide support, including his doctors, and how incredibly meaningful it is when people express simple compassion and love.

Steve also talks about how he has decided to accept his cancer, and not to “fight it” or to go to war with his body. And acceptance does not mean refusing treatment—Steve is receiving chemotherapy for his multiple myeloma. The acceptance we are describing is more of a mind-set of peacefulness. We also talked about the fact that the problems of aging are not unique, but are simply the problems of living, problems we can encounter at any age. The whole basis of cognitive therapy is that our feelings result from our thoughts, and not the circumstances of our lives. This is a very optimistic message because we often cannot change the facts of our lives, but we can do a great deal to change the way we think and feel.

I ended the podcast by raising the question of “Sadness as Celebration.” I asked whether tears and feelings of sadness in response to the suffering of others might actually be one of the highest experiences a human being can have, and is perhaps the deepest meaning of spirituality. I described a somewhat bizarre experience I had on the Nevada desert when I was a Stanford medical student in the 1960s—it was an experience I have kept secret for nearly 50 years, and talk about for the first time on this podcast.

After the podcast, I emailed Rhonda to get her “take” on the show. Usually, we focus on specific techniques our podcast fans might want to learn. But this time, we just kind of were “hanging out” together, so I was concerned and feeling a bit self-critical. I was also concerned that I may have sounded like a loony at times on the show, since my personal story was perhaps over the top.

Here’s how Rhonda replied:

Hi David,

As I was listening to the Steve podcast, it struck me that it was really friends talking, getting to know each other, sharing stories and joking around and being serious sometimes. That's why I thought it was really lovely.

I listened to Steve's podcast after dinner. I loved it!

You are so charming, and tell sweet stories that open up your life to the listener. I think everyone will love how endearing you are.

Steve was articulate, vulnerable and open. While it's not an episode where you are teaching anything specific, it is a lovely podcast and I think regular listeners will love the opportunity to get to know you.

Rhonda

So, let us know what you think!

Thank you, Steve and Barbara, for your generous appearance on today’s show.

And we also thank YOU for tuning in today!

Rhonda and David

PS After the show, Rhonda and I got this great email from Steve:

Hi David and Rhonda,

Just getting back to communicating after a full & thrilling trip to California! Arrived home Monday evening, then off to Chemo center most of Tuesday & now regaining energy.

I like your show notes David—mucho.

Really enjoyed the hike, lunch, getting to sit in on Amir's podcast, then to interact with David, Barb, & Rhonda. Loved your stories, David, and the whole experience of tears and celebrating sadness. Oh yea, and the big kiss on the lips!

A lot of other ideas & questions have popped into my thinking since the podcast. One being that us Christians are pretty judgmental. This is supremely true, and is probably one of the best-selling points of religion that's kept hidden behind the smoke and mirrors.

It's so much fun to judge folks, look down on everyone else and have that feeling of moral superiority! Probably better than LSD I'm guessing.

What bugs me about "religion" most is how many folks suffer under the whip of having to improve and become better and jump over impossible standards. Of course, they could move on to the Acceptance Paradox and right into celebrating sadness in a split second if they wish.

What wonderful time it was with you all.

Feeling grateful to share life with each of you.

Love you,

Steve

Second PS: If you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. See below for details and links!  David

Jan 06 2020

1hr 4mins

Play

173: Dr. Amir Sabouri on the Human Side of Medicine

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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.

Dec 30 2019

57mins

Play

172: Ask David: What's the Impact of Emotional Trauma on the Brain? And more

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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,

Jackie

Educational Consultant

Mountaintop School Division

Answer

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.)

Thanks,

Warmly, Malena

Answer

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.

Best Regards,

Mark

Answer

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

Dec 23 2019

42mins

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171: Ask David: "Burn Out," Physical Pain, and more

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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?

Comment: Hi!

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!

Sincerely,

Elisabeth

Hi Elisabeth,

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.

Thanks,

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

Dec 16 2019

37mins

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170: Ask David: Helping Abused Women, and the Case Against Wellness!

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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!!

Pennie

Hi Pennie,

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.”

Hi Georgina,

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!

You might also find our first and second podcasts on Mindfulness Meditation to be useful or interesting.

David

Dec 09 2019

33mins

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169: More on Social Anxiety-The Case for Vulnerability!

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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

David

Dec 02 2019

39mins

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168: Ask David: The Blushing Cure, How to Heal a Broken Heart, Treating Anorexia, and more!

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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?

Hi David,

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.

Best, Alex

Hi Alex,

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.”

You’ll find tons of additional ideas in the podcast and in one of my books, like the one you’re reading, When Panic Attacks, as well as The Feeling Good Handbook.

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.

Thanks, David

2. How can you get over a broken heart?

Hi David,

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,

Didi

Hi Didi,

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!

David

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.

David

Nov 25 2019

46mins

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167: Feeling Great: Professor Mark Noble on TEAM-CBT and the Brain

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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.

Nov 18 2019

1hr 3mins

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166: Escape from Physical Pain: An Interview with Dr. David Hanscom

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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.

  1. Physical pain could cause negative feelings, like depression, anxiety and anger. This seems plausible, since physical pain is so debilitating, and just plain awful.
  2. 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.

Nov 11 2019

44mins

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165: Ask David: Why do shrinks kill themselves? How to find out if your loved one is suicidal.

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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,

Sindhu

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.

  1. 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.
  2. 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.
  3. I am convinced that sometimes people commit suicide to get back at someone they are angry with, someone perhaps who rejected them.
  4. 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.
  5. 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.
  6. 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.”
  7. 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.

David

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.

Nov 04 2019

39mins

Play

164: How to HELP, and how NOT to Help!

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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

Karl

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.

DO NOT

  1. Give advice
  2. Try to help
  3. Try to cheer the person up
  4. Try to solve the problem s/he is struggling with
  5. Try to get the other person to think or act more positively
  6. Try to minimize the problem by saying it’s not that bad, or things will get better.
  7. 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?

DO

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

  1. down, sad or depressed?
  2. anxious, worried, pressured, or nervous?
  3. guilty or ashamed?
  4. inadequate, worthless, defective, or inferior?
  5. alone or lonely?
  6. humiliated or self-conscious?
  7. discouraged or hopeless?
  8. stuck or defeated?
  9. 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."

Example

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.

Oct 28 2019

51mins

Play

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

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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.

Lisa

Hi Lisa,

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!

David

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.

Mike

Hi Mike,

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?

Thanks,

Rajesh

Hi Rajesh:

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!

david

Question #4. I’m in sales. How do I combat my Negative Thoughts about each person I approach?

Hi David,

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?

Hi Rudi,

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:

  1. 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.
  2. 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.
  3. 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!

Thanks, David

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,

Yes, I’ll be coming to Atlanta for a four-day intensive in November! Check my workshop tab at www.feelinggood.com for more information. (https://feelinggood.com/workshops/)

david

David D. Burns, M.D. & Rhonda Barovsky, Psy.D.

Oct 21 2019

51mins

Play

162: HIgh-Speed Cure for OCD (Obsessive Compulsive Disorder)

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“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

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

Oct 14 2019

45mins

Play

161: Listening to a Different Kind of Music

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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:

  1. Angry friend who feels jealous / betrayed and says: You were hitting on my girlfriend last night!
  2. Irate mother, who feels neglected / used, and says: Forget it! I’ll just do it myself!
  3. Hurt colleague, who says: You didn’t support me during the meeting!
  4. 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

Into tears

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

Oct 07 2019

41mins

Play

160: Listening to the Music of TEAM

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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.

Song #1

 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

Song #2

 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!!!

Song #3

 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

Sep 30 2019

40mins

Play

159: Live Therapy with Marilyn: "What if I die without having lived a meaningful life?"

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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.

  1. What does this negative feeling show about you and your core values that’s beautiful, positive and even awesome?
  2. 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,

Marilyn

Thank you, Marilyn, for this incredible gift to all of us!

Matt, David, and Rhonda

Sep 23 2019

1hr 38mins

Play

158: Changing the Focus: One of the Advanced Secrets of Effective Communication

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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 🙏.

Rajesh

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.

  1. Changing the Focus. This technique can be tremendously helpful when there’s an “elephant” in the room.
  2. 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.
  3. 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 :)

Sep 16 2019

44mins

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Amazing podcast, highly recommend!

By Lavenderpinkk - Oct 20 2019
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Thank you Dr. Burns this podcast and your book has helped me immensely in my life 🙏!

So Fun and Helpful

By Jrenee827 - Aug 22 2019
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Love the interaction with Dr Burns and Rhonda. Great chemistry.