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Rank #42 in Mental Health category

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

Updated about 1 month ago

Rank #42 in Mental Health category

Education
Self-Improvement
Health & Fitness
Mental Health
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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

452 Ratings
Average Ratings
397
24
9
12
10

Thank you

By jessicabarrett - Apr 23 2020
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This podcast has helped me so much with my anxiety and depression.

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 🙏!

iTunes Ratings

452 Ratings
Average Ratings
397
24
9
12
10

Thank you

By jessicabarrett - Apr 23 2020
Read more
This podcast has helped me so much with my anxiety and depression.

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 🙏!
Cover image of Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

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

Latest release on Jul 06, 2020

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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: 189: How to Crush Negative Thoughts: All-or-Nothing Thinking

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This is the second in a series of podcasts by David and Rhonda focusing on the best techniques to crush each of the ten cognitive distortions I first published in my book, Feeling Good: The New Mood Therapy. Today, we focus on All-or-Nothing Thinking. that's where you look at the world in black-or-white categories, as if shades of gray do not exist. For example, if you're not a complete success you may tell yourself that you're a complete failure.

All-or-Nothing Thinking is one of the most common cognitive distortions, and it causes or contributes to many common forms of emotional distress, including:

  • perfectionism
  • depression
  • Social anxiety--
    • performance anxiety
    • public speaking anxiety
    • shyness
  • hopelessness and suicidal urges
  • anger, relationship conflicts, and violent urges
  • habits and addictions
  • and more

However, this distortion can be also be helpful to you, and may reflect some of your core values. For example, your perfectionism

  • shows that you have high standards, and won't settle for second-best
  • may motivate you to work hard and do excellent work
  • prevents you from glossing over your failures and mistakes
  • intensifies your emotional life, which may feel like a glorious roller coaster ride, with intense ups (when you do well) and equally intense downs (when you fall short.)

So, before you can challenge a negative thought with this, or any distortion, you'll have to decide why in the world you'd want to do that, given all the benefits of your negative thoughts and feelings.

One of the possible down sides of All-or-Nothing Thinking is that it simply does not map onto reality. There is little in the universe that is 100% or 0%. Most of the time, or even all of the time, we're somewhere between 0% and !00%. For example, this podcast is not incredibly fantastic, or absolutely horrible. It is somewhere in-between, and will hopefully be of some value to you. While it clearly won't solve ALL of your problems, it may be a useful step forward.

We describe a number of example of All-or-Nothing Thinking, including a physician who was trying to diet and ended up binging on a half gallon of ice cream, and a suicidal young woman with incredibly severe depression who was involved in self-mutilation.

There are many ways of crushing the negative thoughts that contain All-or-Nothing Thinking, including Thinking in Shades of Gray. Although that might sound rather drab in comparison to the drama of All-or-Nothing Thinking, you may discover that the world becomes far more colorful when you learn to think in shades of gray!

In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Overgeneralization. David argues that Overgeneralization is arguably the cause of all depression and much anxiety, and that the first person to recognize and solve this dilemma was the Buddha, 2500 years ago. More on that topic next week!

David D. Burns, MD / Rhonda Barovsky, PsyD

May 04 2020

37mins

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Rank #2: 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 #3: 188: How to Crush Negative Thoughts: The Cognitive Distortion Starter Kit!

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

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

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

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

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

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

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

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

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

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

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

David D. Burns, MD / Rhonda Barovsky, PsyD

Apr 27 2020

43mins

Play

Rank #4: 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

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Rank #5: 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

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Rank #6: 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

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Rank #7: 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 #8: 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 #9: 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 #10: 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

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Rank #11: 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 #12: 184: What Comes First? Negative Thoughts or Feelings? Solving the Chicken vs. the Egg Problem, and More!

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

  1. What schools of therapy are embedded in TEAM?
  2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither?
  3. “Can TEAM-CBT help bipolar patients during the depressed phase?”
  4. How do you make Externalization of Voices work? I get stuck! For example, my patient said, "It's unfair that I cannot get a job!"
  5. Is there a cure for OCD?

1. What schools of therapy are embedded in TEAM?

Dear Dr. Burns,

I have some questions specifically about T.E.A.M. therapy. You mention in a blog post that T.E.A.M. therapy "integrates features and techniques from more than a dozen schools of therapy." I'm aware of many of the CBT techniques you use, but I don't think I've read yet of any technique belonging to any other schools of therapy. Would you be so kind as to mention such techniques?

Madelen

Hi Madelen,

This is important because I believe we need to get away from competing schools of therapy and need to create a new, data-driven structure for therapy based on research on how therapy works, which is what TEAM is. At the M = Methods part of the session, you can include methods from any school of therapy.

Here are some of the schools of therapy that I draw upon TEAM-CBT.

      1. Individual / Interpersonal downward arrow: same (psychoanalytic / psychodynamic)
      2. Flooding / Experimental technique: behavior therapy (exposure)
      3. Externalization of Voices: Gestalt / Psychodrama / Buddhism
      4. Acceptance Paradox: Buddhism
      5. Self-Defense Paradigm: REBT
      6. CBA / Paradoxical CBA / Devil’s Advocate: Motivational techniques
      7. Identify the distortions / examine the evidence: cognitive therapy
      8. Empathy: Rogerian (humanistic) therapy
      9. Five Secrets / Forced Empathy: Interpersonal therapy
      10. Shame-Attacking Exercises: Humor-based therapy / Buddhism
      11. Be Specific / Let’s Define Terms: Semantic
      12. Feared Fantasy: Role-Playing / Psychodrama / Exposure
      13. One-Minute Drill / Relationship Probe: Couple’s Therapy
      14. Time Projection / Memory Rescripting: Hypnotherapy
      15. Anti-Procrastination Sheet: Behavioral activation therapy (Lewinsohn-type therapy)
      16. Brief Mood Survey / Evaluation of Therapy Session: data-driven therapy
      17. Talk Show Host / Smile and Hello Practice / Flirting Training: Modeling / teaching effective social behavior
      18. Storytelling: indirect hypnosis.
      19. Positive Reframing: Paradoxical psychotherapy.
      20. Hidden emotion technique: psychoanalytic / psychodynamic
  1. Do you need more? Can provide if you want. Let me know why you have this particular interest!At any rate, I really enjoyed and appreciate your thoughtful questions, thanks!David

2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither?

Hello Dr Burns,

I would like to thank you for your podcasts. I greatly enjoy listening to them and find them very much helpful both in my personal life and my work as a psychologist.

I do have a question: you talk about how cognitive distortions cause anxiety and depression. Are cognitive distortions also a result of depression and anxiety? For instance, if a person was to become depressed after experiencing loss, would they then discount the positive in their lives to a larger extent, for example?

Thank you very much!

Audrey

Hi Audrey,

Yes, depression creates a negative bias in perceptions, so you pick out information and details that support your distorted thoughts, like "I'm a loser" or "my case is hopeless." My research, which I'll report in my new book, Feeling Great (sept 2020) indicates that negative thoughts trigger feelings of depression and anxiety, which, in turn trigger more negative thoughts. This is a negative vicious cycle. There is also a positive cycle, in that positive thoughts that you believe to be true trigger positive feelings, which, in turn trigger more positive thoughts! Thanks for the question, Audrey.

david 

3. “Can TEAM-CBT help bipolar patients during the depressed phase?”

Name: Sarah

Comment: Hi, Dr. Burns.

I am a big fan of your work and very much enjoy reading your blogs and listening to you and Fabrice on you weekly podcasts.

I am writing with a question that has to do with the depression side of bipolar disorder and the potential usefulness of CBT. I have not heard you speak about this topic before.

My sister in law lives in Switzerland and has been diagnosed with a fairly severe case of bipolar disorder. She does not cycle rapidly, but her manic and depressive states are quite severe. In fact, she has been hospitalized several times during her manic episodes.

For the first time in her life, I believe my sister in law has finally accepted the fact that she is bipolar, and she is actively pursuing treatment and trying to get better. After hearing me talk about all the great information I have learned from you, my husband has hunted down several CBT practitioners in Switzerland, in the hopes that changing my sister in law’s thoughts will help her navigate the overwhelming depression she is currently experiencing. Unfortunately, most of the practitioners she has contacted have said that they cannot help her, because she has bipolar disorder. Of course, this is only adding to her sense of hopelessness.

In your opinion, could CBT and challenging negative thought distortions be helpful to someone who is bipolar and currently experiencing the depressive side of the disease?

In my mind (a layperson who has used CBT to help with panic disorder) it seems so obvious that it could help, but several Swiss psychotherapists seem to disagree with me! Are these therapists afraid to take on a complicated case or is there really nothing they can do?

I would love to hear your take on it. Thank you so much for your endless work helping people to feel good!

Sarah

David will describe his experience running the lithium clinic in Philadelphia at the VA hospital, and will discuss the very important role of good psychotherapy for bipolar patients, although medications will also play an important role in the treatment.

4. Externalization of Voices: How do you make it work? I get stuck! "It's unfair that I cannot get a job!"

Dear Dr Burns and Rhonda,

I've just finished listening to all of the Feeling Good Podcasts. What a gift! My immense gratitude to you and Fabrice for the time and effort that has gone into these podcasts, as well as the wonderful show-notes.

I am a family physician and I work with impoverished patients, many of them refugees. Depression and anxiety are common. We can't find CBT therapists for our patients within their means, so I end up trying to provide some counselling despite not having much background or training (a dangerous proposition, I know, but we have little choice.) Medications tend not to be too helpful, as David points out. I am starting to try to integrate TEAM concepts.

I have a question about Externalization of Voices. In all of the examples you've shared in the podcast, whenever David does a role reversal and models the positive voice, he always seems to "win huge". I'm less experienced and find I'm not batting 1000. What do you do when neither you nor the patient have been able to win huge?

Many thanks again for all you do,

Calvin

PS The episode on How to Help and How Not to Help was one of the best yet!

Hi Calvin,

Thanks for the kind comments! Can you tell me what the thought is that you’ve failed with?

All the best,

David D. Burns, M.D.

Hi David,

There have been a couple of examples where we could only get a small win.

With the first patient, the thought he was tackling was: "It's not fair that I've worked so hard in life, but I can't get a job."

I tried modelling self-defense, along the lines of "I've accomplished a lot given how many challenges I've faced." I also tried suggesting the Acceptance Paradox with something like: "It's true that life's not fair. Who said it should be fair?" This was only a 'small win.' I felt stuck.

Another patient felt her chronic insomnia was driven by anxiety. She feared she would never sleep well again. The though was "I'm going to be chronically tired and no longer able to enjoy life the way I used to." We tried: "Sure, I may be more tired than I used to be, but I'll still be able to enjoy life to some extent." Again, this was a small win, not enough to crush it.

Thanks again for your willingness to help!

Calvin

David’s response

Hi Calvin,

All therapeutic failure, pretty much, results from a failure of agenda setting. I’m not sure you’ve been trained in A = Paradoxical Agenda Setting. The A of TEAM is now also called Assessment of Resistance. When people can’t easily crush a Negative Thought, it is nearly always because they are holding on to it. This is called “resistance.”

Let’s focus on the first thought, "It's not fair that I've worked so hard in life, but I can't get a job."

This thought triggers anger, and anger is the hardest emotion to change because it makes us feel morally superior and often protects us from feelings of inadequacy, failure, or inferiority. If you do not deal with the underlying resistance to change, the patient will defeat your efforts.

When you do Positive Reframing, you start with a Daily Mood Log with one specific moment when the patient was upset and wants help. The anger will be only one of a large number of negative emotions the patient circles and rates, and there will always be numerous negative thoughts as well.

The negative feelings might also include sad and down, anxious, ashamed, inadequate, abandoned, embarrassed, discouraged / hopeless, frustrated, and a number of anger words like annoyed, resentful, mad, and so forth.

This is super abbreviated, but you would then do A = Paradoxical Agenda Setting (also now called Assessment of Resistance.)

You would start with a Straightforward or (better in this case) Paradoxical Invitation—does the patient want help with how he’s feeling? You might tell him he has every right to feel angry and upset and might not want help with his negative feelings as long as he has no job.

If he insists he DOES want help, you can ask the Miracle Cure Question, and steer him toward saying he’d like all of his negative thoughts and feelings to disappear, so he’d feel happy.

Then you can ask the Magic Button question. If like most patients, he says he WOULD push the button, you can tell him there is no Magic Button, but you DO have lots of powerful techniques that could be tremendously helpful. But you’re not sure it would be a good idea to use these techniques.

When he asks why not, you could say it would be important to look at the positive aspects of his negative thoughts and feelings first. Then you do Positive Reframing, and together you can list up to 20 or more positives that are based on each negative emotion and each negative feeling. To generate the list of positives, you can ask: 1. What are some benefits, or advantages, of this negative thought or feeling? 2. What does this negative thought or feeling show about me, and my core values, that’s positive and awesome?

For example,

      1. My sadness is appropriate, given that I don’t have a job. If I was feeling happy about this, it wouldn’t make sense.
      2. The sadness shows my passion for life, for work, and for being productive.
      3. My anger shows that I have a moral compass and value fairness.
      4. My anxiety motivates me to be vigilant and to look for a job, so I don’t get complacent and starve.
      5. My anxiety, in other words, is a form of self-love.
      6. My anger shows self-respect, since I have a lot to offer and contribute.
      7. My hopelessness or discouragement shows that I’m honest and realistic, since I have tried so often and failed.

This is just an example, and with a real patient, it can be very powerful as I have the facts and know the patient, whereas in this example I am just making things up.

Then once you have a long and incredibly compelling list, you can ask, “Well, given all of those positives, why would you want to press that Magic Button? If you push it, all these positives will go down the drain at the same time that your negative thoughts and feelings disappear.

Then you resolve the patient’s dilemma with the Magic Dial.

All this is done AFTER E = Empathy (you have to get an A from your patient) and BEFORE using any M = Methods, like externalization of voices.

If you do this skillfully, the Externalization of Voices technique will go way better, because the person will be determined to reduce the anger and other negative feelings. But if the patient says he or she does not want to change, and wants to be intensely angry, that’s fine, too!

If this is not clear enough, you could also get some paid case consultations from someone at the Feeling Good Institute, which could be invaluable. This is the most challenging and valuable tool of all!

Not sure how much training you’ve had in TEAM.  There are online classes that are excellent. Also, on my workshop page you can check out my upcoming workshop with Dr. Jill Levitt on resistance.

There are podcasts, too, on resistance / paradoxical agenda setting as well as fractal psychotherapy.

Thanks!

David

5. Is there a cure for Obsessive Compulsive Disorder (OCD)?

Hi Dr. Burns,

I have been suffering from OCD and depression post the delivery of my daughter and have been on antidepressants for the last 7 years. I have recently start going for counseling too with a psychologist. In fact, she is the one who recommended your book which I am finding very useful. Your website is very helpful too.

I had just one general question: Are OCD and Depression 100% curable or are they only controllable and one has to be on medicines for the rest of their lives?

Reason why I am asking this is the last time we tried to taper down the medicines I ended up having a worse relapse. I want to know if I can plan for a second pregnancy.

I know you do not reply to personal messages but would really be grateful if you could reply to this mail

Looking forward to hearing from you

Regards

"Betsy"

In my dialogue with Rhonda, I emphasize that I rarely use medications in the treatment of anxiety and depression, including OCD, and I would urge this listener to use the search function on my website to search for podcasts and blogs on antidepressants, anxiety, OCD, and Relapse Prevention Training, and you will find lots of specific resources. For example, if you type in OCD, you will find the Sara story (episode 162) plus lots of additional great resources on OCD, including podcasts 43 - 45 (this page provides links to all the podcasts), and more.

Also, my books, When Panic Attacks, and the Feeling Good Handbook, could be very helpful, and you can link to them from my books page. I use four models in the treatment of OCD, and you can find them if you listen to the basic podcasts on anxiety and its treatment. They are the Hidden Emotion Model, the Motivational Model, the Exposure Model, and the Cognitive Model. All are crucial important for recovery, and clearly explained in the podcasts on anxiety.

Thanks for listening today, and thanks for all the kind comments and totally awesome questions!

David and Rhonda

Mar 16 2020

39mins

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Rank #13: 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

Rank #14: 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 #15: 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.

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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 #16: 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 #17: 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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Rank #18: 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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Rank #19: 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 #20: 125: Ask David — How Do You Treat Chronic Laziness?

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More Great Questions from Listeners
  1. Kevin asks: After your initial improvement from treatment or from reading your book, Feeling Good, what can one do moving forward to give yourself “booster shots?”
  2. Umatsagir asks a related question: I feel great right after reading your book, Feeling Good, but the effect diminishes over time. What should I do?
  3. Umatsagir also asks: Is there an anxiety masterpiece equivalent of your book, Feeling Good?
  4. Kyle asks: What can I do, as a therapist, about the passive patient who just shrugs when I ask what he wants to work on, and says, “My Mom thinks I should come to see you.” When I try to dig deeper to try to find out what patients like this want help with, I run into resistance and then they typically drop out of therapy. What should I do?
  5. Benjamin asks a somewhat related question: How do you treat chronic laziness? In your book, Feeling Good, you call this “Do-Nothingism,” which is a lack of motivation that you often see in depression. In your book, you talk about ten different types of procrastination, with a different approach for each. If the patient feels overwhelmed by many things he or she is procrastinating on, how can you help that person, since he or she probably can’t do the psychotherapy homework, either! It’s a Catch-22, since they cannot find the motivation to do anything, but have to do the homework to improve!
  6. Jim asks another related question: How about doing a podcast on psychotherapy homework? “What do you have your patients do for homework? This is particularly important since I have 45 minute sessions and can only see my patients for 45 minutes every two or three weeks.”

Jan 28 2019

28mins

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198: Ask David: What if Your Negative Thoughts Aren't Distorted? Do Demons Cause Depression? And more!

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Today, Rhonda and David discuss ten great questions submitted by podcast fans like you!

  1. I can’t find any distortions in my thoughts! What’s the cause of this?
  2. Crushing Negative Thoughts. Do you have to write them down? Can’t you just do them in your head?
  3. PTSD Question: Does the trauma have to be life-threatening and experienced in person/
  4. How can I get over anxiety and panic?
  5. Do demons cause depression?
  6. How is Sara now? Is anger just “ossified tears?”
  7. How do you explain the basic concepts of CBT and cognitive distortions to patients who are not familiar with your work?
  8. Can I help myself as much as Rameesh did?
  9. How can I start a self-help group based on your book, Ten Days to Self-Esteem?
  10. How can I find my favorite podcast?
  1. I can’t find any distortions in my thoughts! What’s the cause of this?

A new comment on the post "001: Introduction to the TEAM Model" is waiting for your approval https://feelinggood.com/2016/10/27/001-introduction-to-the-team-model/

Hi Dr. Burns,

I just ordered your book and am writing my cognitive distortions daily. I ran into one I did not know how to label it.

I am a 73-year-old, attractive woman, When I see a young beautiful woman having a great time, say in an ad, I feel angry, sad and jealous. This does not apply to family members only strangers.

charlotte

  1. Crushing Negative Thoughts. Do you have to write them down? Can’t you just do them in your head?

A new comment on the post "190: How to Crush Negative Thoughts: Overgeneralization" is waiting for your approval https://feelinggood.com/2020/05/11/190-how-to-crush-negative-thoughts-overgeneralization/

Dr. Burns,

Why is writing the negative thought down important? Can’t I just pinpoint it in my head and simply switch the negative thought to positive one?

I know it will not work but i am not able to convince others or myself why I have to write them down. Why is the writing process so important?

After practicing for a while will you have the habit of think positively? I am wondering why some people have this way of positive thinking without even practicing?

Toni

  1. PTSD Question: Does the trauma have to be life-threatening and experienced in person/

A new comment on the post "147: High-Speed Treatment of PTSD?" is waiting for your approval https://feelinggood.com/2019/07/01/147-high-speed-treatment-of-ptsd/

Hi David,

I am a fan of your great work and contribution to psychology.

I have a question about PTSD: does it necessarily have to be life-threatening in person or can it be caused for example by a threat via online message?

Thank you!

MB

Thanks, MB, great question.

Only your thoughts can upset you, not the actual trauma, so the answer is yes. Anything that is profoundly upsetting is profoundly upsetting, period! There is no objective way to measure the impact of any trauma other than via your own thoughts and feelings! This is so important, and yet most of the world, including those who have written the DSM-5 (and all earlier editions) / don't yet "get it." The DSM states that for a diagnosis of PTSD, you have to have some trauma that is “objectively horrific.” But there is no such thing!

david

  1. How can I get over anxiety and panic?

Debby asked a question about podcast 189: How to Crush Negative Thoughts: All-or-Nothing Thinking

I have your book When Panic Attacks. I am at a loss at what to use to get over anxiety and panic. It is exciting because you said that you can get rid of both fairly soon; which would be great

Hi Debby,

Thanks for your excellent question!

The Daily Mood Log described (I believe) in chapter 3 of When Panic Attacks is a great place to start. Do it on paper, and not in your head, focusing on one specific moment when you were anxious. Thanks!

One teaching point is to focus on one specific moment, and not try to solve anxiety or any mood problem in generalities. A second teaching point is to record the situation, your feelings, and your negative thoughts you were having at that moment. This is always the starting point for change!

You’ll find tons of resources on my website, feelinggood.com, including the show notes for all the podcasts with links, search function, and way more, all for free. You can learn a great deal if you put in the time and effort.

For example, I am now creating a free class on anxiety and it will soon be available on my website!

David

  1. Do demons cause depression?

Brian W. commented on Podcast 189 on All-or-Nothing Thinking

Hi Dr. Burns,

Amazing podcast as always doctor Burns! Question: have you ever encountered anything in your patients that you might consider supernatural? I'm Catholic and there's the idea that demons can cause depression or mental illness. I know it sounds crazy, but I've seen weird things.

Thank you.

Brian

Thank you for your question, Brian. Depression results from negative thoughts, not demons. That's good because you can learn to change the way you think and feel. The type of therapy I do is entirely compatible with all religions, including Catholicism, and there is often a spiritual dimension in recovery.

All the best,

david

  1. How is Sara now? Is anger just “ossified tears?”

Dear Dr Burns,

Though doubting that you’ll ever read or answer this, nevertheless I’ll cast it to the cloud for something-or-other!

I’m an old fossilised blind British harpsichordist (good combo?!!) and a devoted fan of your podcasts, as well as selectively slowly making my happy way through the 27 hours of RNIB’s Talking Book version of ‘Feeling Good’ (Must tell you that the Braille Music Translation Programme I use invented by a great buddy in Pa. is called ‘Goodfeel’, so you guys must have something in common!).

Alas I have 2 questions.

First, as a ‘floating’ OCD sufferer for 70 years or so, I wildly enjoyed Sara’s ‘high speed cure’ in podcast 162. However, surely with this new Coronavirus threat – the virus remaining on cardboard for around 24 hours and other surfaces including shopping for at least 2 days or more -, her cure must have now been reversed? The fact, and I mean from much research ‘fact’ is that ‘what you touch could kill you’. Sure, it might not but, in as bad health otherwise as I am, I believe it’s imperative to be as careful as pos. which, courteously put, is screwing my brain! How about Sara?!

Finally, well I suppose it’s a comment more than a question. I’ve been enjoying and, indeed, beginning to benefit from your section in the book on anger. I wonder though whether, unless I haven’t got there yet (which is eminently possible!!), you might have left out one aspect of anger? I’ve often thought that it, as well as hatred and violence could be designated ‘ossified tears’ and, believe me, in my case, if so, they’ve turned into unbreakable rocks!!

Keep up the great work, Dr Burns. We all need such an unique communicator and erudite intellect as you, oh and I fervently hope you can stay clear of this virus.

Very best and thanks,

John Henry (Not the old American horse, . . . but rather a British, almost human John Henry!!

David and Rhonda respond to both of John's questions!

  1. How do you explain the basic concepts of CBT and cognitive distortions to patients who are not familiar with your work?

Hi David and Rhonda,

You previously answered a question of mine on your podcast. It was quite helpful, thanks! I have a new unrelated question.

While the live sessions have been very illuminating in many ways, your patients have always been trained therapists who are already familiar with the concepts of CBT and cognitive distortions. I understand this is an ethical necessity.

As a family physician I struggle with that first step - how do you introduce the concepts of CBT and the cognitive distortions to non-therapist clients? I imagine it must take at least a full session just to do education on the distortions. This may be a question best for Rhonda.

Thanks again!

Calvin

Hi Calvin,

Thank you for another great question. If you prescribe the book, Feeling Good, it can help you and your patients in three ways. First, they’ll get all the concepts and some sound psychoeducation, saving you time. Second, the book is at least as effective as antidepressants, so it is prescribing something that may be very helpful with no side effects. Third, it will be a test of their motivation. Motivation appears to have a massive effect on recovery from depression.

Also, there are tons of great classes in TEAM for beginners if you check them out at FGI (www.feelinggoodinstitute.com).

There are also free classes on depression and other topics on my website, www.feelinggood.com. These classes may also help your patients.

On the show, Rhonda will explain how she introduces these topics to her patients as well!

All the best,

David

Rhonda’s note to Calvin:

You flatter me, because all questions are best answered by David, but I will give it a try.

I do ask all my patients to read David's book Feeling Good, which is superb at describing what CBT is and why it is effective.

I have an intake telephone call with all my new patients before we start working together, and before they read Feeling Good. In that call I explain CBT like this, imagine a triangle that has Thoughts, Feelings and Behavior at each point. Your thoughts drive your feelings and your behavior. So, if you can change the way you think, you can change the way you feel. David gives the example of someone walking in the woods who hears a twig break. Imagine that hiker thinking that a murderer is creeping behind him or her, what do imagine he or she would feel? But imagine that same hiker thinking that his or her best friend is joining the hike? What would he or she feel then? There are lots of examples like that: two students who have studied the same amount. One walks into the test room thinking, I did a good job studying, the other walks into the test room thinking I should have studied more. Who do you think will do better on the test? This is an actual study that has been done, and if you guessed the student thinking more confidence did better, you would be correct. It makes logical sense.

I don't explain cognitive distortions in my intake discussion, but when we first start working with a Daily Mood Log, after we have gone through T = Testing, E = Empathy, and after A = Assessment of Motivation, when we are going through the M = Method "Identify the Distortions" for the first time. I explain that cognitive distortions are embedded in our negative thoughts, and they are simply ways that our mind convinces us of somethings that aren't really true. By this time patients have read part of Feeling Good, so they have more psychoeducation.

But I find if patients still don't understand the concept of cognitive distortions, as we go through the Identify the Distortions method, they soon understand what distortions are.

I hope that makes sense, and that you find this helpful,

Rhonda

  1. Can I help myself as much as Rameesh did?

Hello Dr David,

I saw how Ramesh changed dramatically and I want that kind of change in my life. but I am doubtful. It was you who managed to melt away his resistance using different techniques. Is it possible that we can manage to change ourselves so effectively?

Shivam

Hi Shivam,

Thank you for this incredibly important question. Research indicates that many people have been helped by reading my books and doing the exercises, such as Feeling Good. Motivation and hard work are critically important in personal change and recovery.

I am also working on a new app, and hope to get data to answer this exact question!

Best of luck! Will make this an Ask David question, as it is so important!

David

  1. How can I start a self-help group based on your book, Ten Days to Self-Esteem?

Dr Burns,

I know your book, Ten Days to Self Esteem, has a group leaders manual. Can anyone start one of those groups of do you have to be a therapist of some sort?

Has anyone told you that they started one?

How did they say it went?

Any tips for starting one?

Thanks

Richard

Hi Richard,

Many pilot studies using this program with lay leaders have been effective. The program at my hospital in Philadelphia, also using lay leaders, was very effective.

David

  1. How can I find my favorite podcast?

Hi David

I am a therapist and was reminded of one of your podcasts as I was listening to a particular patient. I wanted to share the episode and then couldn’t find it so felt silly.

It was an episode where a father (perhaps Indian? Maybe a doctor?) empathizes and listens in a whole new way to his adult son and has a miraculous turn of events in the relationship- simply by being present and not being defensive when the son tells him how he feels about his father. It was beautiful and moving. A great example of “opposite action”- agreeing with the criticism rather than defending against it.

Does that episode ring a bell and can’t you point me in the right direction to retrieve it?

I know how busy you are. Thank you for your wonderful podcast and for any help you can provide.

Thanks,

Pam

Hi Pam,

It might be the follow-up to the live therapy with Mark. Use the search function on my website. He is from Iran, and is an OB-GYN doctor who has faithfully attended my Tuesday training group for years. He is one of my favorite people.

Learning the Five Secrets takes lots of commitment and practice. He has formed his own Five Secrets practice group with friends and colleagues who are not shrinks. They’ve met weekly for years, so his skills are quite refined now.

Thanks!

David

On the podcast, I emphasize the search function you can easily find on every page of my website, www.feelinggood.com. Pam’s comment on the Five Secrets is also important. Desire, commitment and ongoing practice are the keys to mastery!

Rhonda and David

Jul 06 2020

40mins

Play

197: Dating Anxiety and the Secret of Sex Appeal Featuring Special Guest Dr. Matthew May

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Loneliness has existed since the dawn of time.  I frequently receive questions from lonely individuals wanting to know how to connect, and how to find companionship, intimacy and love.  Lonely men ask me, "How do I talk to women?"  Lonely women ask, "How can I find a good man?" Regardless of your gender or gender identity, you may struggle to find a loving romantic partner for a variety of reasons, some of which I have outlined in my book, Intimate Connections.

Although dating can be an incredibly stressful, disappointing, and time-consuming hassle, there are tremendous rewards for those fortunate enough to connect and develop an intimate relationship. So today, we address some of those issues.

Our special guest today is Dr. Matthew May.  He is a former student of mine, a good friend of David and Rhonda, a regular on the podcast, and a loving wonderful man. Today, Matt brings us a wealth of information for those interested in improving their dating lives, based both on his clinical work, as well as his own experiences overcoming social anxiety, falling in love and being in a loving relationship.

Matt begins with an inspiring reminder of why we would go through all the trouble, stress and disappointment inherent to dating, highlighting some of the rewards that await those who are persistent, including how good it feels to be understood, accepted, loved and cherished by someone who feels the same towards us.  The poetry of his writing is beautiful and inspirational. He also provides some common-sense guidelines for individuals who are interested in dating, so they can do so safely.  We then delve into more psychologically complex and personal matters.

Here are Matt's tips on maintaining safety when you are dating someone you don't know for the first time--for example, it might be someone you may have met on the internet. Although these tips are primarily for the protection and safety of women, they may also be helpful to men who are dating.

1.      The first time you meet someone you've met on the internet, meet in a public place, like a restaurant or coffee shop, where you'll be safe.

2.      Use your own transportation. Don't let someone you've never met pick you up, because then you'll be vulnerable in case things don't go well.

3.      Tell someone you know where you're going, and when you're going to return.

4.      Get to know the other person as much as possible. What does s/he do, who are his or her friends, and so forth.

5.      Don't provide any identifying information, including your date of birth, to anyone you've just met on the internet, as you could be vulnerability to identity theft. Sometimes the most charming people are scam artists.

6.      Listen to your intuition. If you have a creepy feeling about someone you're thinking of dating, pay attention to it. Something might be "off" about the other person.

7.      Don't drink too much, as you could become a victim of date rape, especially if the man slips a sedative chemical in your drink.

8.      Give (or ask for) consent prior to any touching.

Matt emphasizes that emotional vulnerability is the price tag on intimacy, and this can be frightening because we all naturally fear rejection. Matt defines emotional intimacy as being seen as our true and vulnerable self, so we are accepted for who we really are. He talks about how most of us have a deep yearning for this kind of relationship, and yet struggle to be vulnerable and open in ways that make intimacy possible.

Rhonda, Matt and David describe the delicate balance between game playing--which can be crucial in the early stages of dating--and vulnerability, which can lead to a meaningful and lasting relationship. Some people try to skip the game-playing stage, thinking it is too superficial, and try to jump right into vulnerability the moment they meet someone they like. This often leads to rejection. People like to have fun, and you don't always have to be "heavy" or overly "sincere."

But too much game-playing can leave you feeling lonely as well. I describe a patient I once treated who was almost unbelievably successful in the dating arena. You might even say he was an incredibly effective womanizer. But he felt tremendously lonely and anxious on the inside. He was handsome and charismatic, and got tons of sex, but wasn't really happy.

Matt describes another common barrier to successful dating, especially in men: entitlement and anger. He says that he, like many lonely men, used to think that "women should like me the way I am," and "I shouldn't have to put on airs to date."

Years ago, I pointed out that Matt was not dressing in a very sexy way, and suggested a change might be in order. Matt insisted that he shouldn't have to, and that women should love him just as he was!

I asked Matt to fantasize about his ideal woman. Matt described a woman who's looking terrific--great clothes, nice hair, makeup, and so forth. Then I pointed out that most women are looking for pretty much the same thing--a man who dresses well and looks his best. I urged Matt to get a good "sex uniform" for dating--in other words, get some great, sexy clothes and look your best--it can make a tremendous difference.

Rhonda and Matt discuss the fear of being alone, which is one of the great barriers to finding love. Overcoming the fear of being alone must be done first; then dating will become far easier because you will no longer be needy.

The Neediness Problem--telling yourself that you NEED love to feel happy and fulfilled--can drive people away and lower your attractiveness. That's because of the Burns Rule:

People NEVER want what they CAN get, and ONLY want what they CAN'T get.

So if you're needy, you'll be desperate, and you'll be what people can get. Then they won't want you. Life works like this on many levels, and not just romance. When you think you need something, it eludes you. When you let go, and no longer "need" that thing, it tends to come to you.

When you discover  that you can be completely happy when you're alone, then you won't "need" a loving partner any more. This will put you in a much stronger position, and people will be more attracted to you because you won't be so needy and available.

I can show you how to overcome the fear of rejection and the fear of being alone in the first section of my book, Intimate Connections. Although it's perhaps one of my lesser books, it can be helpful if you're struggling in the dating arena. Many people have told me that this book helped them find someone to love and marry after years of frustration and loneliness.

So, what's the secret of sex appeal? Some people think it's based on looks. Other people think it's based on power, status, or wealth. Well, if you're gorgeous, powerful, and wealthy, you will find that dating is a lot easier because lots of people will be attracted to you. But those are not the secrets of sex appeal, and they do not guarantee a successful marriage. I have treated many people who were gorgeous and tremendously successful, but they still suffered from severe depression and intense loneliness.

Matt and Rhonda reveal the real key to sex appeal for individuals of any gender or gender identity:  self-confidence. This is pretty basic: if you think you're hot, you're hot. And if you think you're not, you're not.

When you're feeling depressed, lonely, and insecure, developing self-confidence and sex appeal might  seem impossible, but we are convinced that the magic of sex appeal and happiness can happen for pretty much anyone. For those who are interested, there are lots of step by step tools to help you achieve greater self-confidence in Intimate Connections.

Matt describes how I helped him with his own social anxiety when he was a psychiatric resident, and how his love life suddenly went from rags to riches. One of the techniques that helped him the most was when I gave him a homework assignment to do "Rejection Practice." This exercise helps you get over your fear of rejection. I asked Matt to collect 25 rejections from attractive women as fast as possible, so he could confront this fear and discover that life still goes on after rejection. You will be entertained and charmed by his delightful and surprising story.

Dating problems and social anxiety have always been my favorite topics because of my own fairly severe social anxiety when I was a young man. In addition, when I was in clinical practice in Philadelphia, 60% of my patients were single. Some of them were divorced, and unable to get into the dating game, and some of them had never found a loving partner in the first place. I just loved working with this population. it was so rewarding to help my patients find self-love first, and then the love of another special person.

In fact, that's why I wrote Intimate Connections. I just love to show people how to overcome their shyness and "singleness" and get partnered up!

With love, Rhonda, Matt and David

Jun 29 2020

54mins

Play

196: Ask David: Is There a Dark Side of Human Nature? Is "Forcefulness" Ever Needed in Therapy? Perfectionism, Racism, Schizophrenia & More!

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in today’s podcast, Rhonda and David address eight fascinating questions submitted by fans like you:

  1. What’s the difference between David’s Therapist Toolkit, his eBook (Tools, Not Schools, of Therapy), and the EASY Diagnostic system?
  2. Is there a dark side to human nature?
  3. Is being “forceful” or confronting patients ever important in therapy?
  4. What’s the 5-session schizophrenia cure?
  5. How do you suddenly switch into “Sitting with Open Hands” during a session?
  6. Questions about OCD
  7. Questions about racism
  8. What if there are more advantages than disadvantages in perfectionism?
  1. What’s the difference between the Toolkit, the eBook, and the EASY Diagnostic system?

I am a Licensed Clinical Social Worker (LCSW) and I am interested in either the Toolkit or the EASY diagnostic tool. It looks like the Toolkit includes quite a few questionnaires so I am wondering if I would need both. I would love to have a comprehensive checklist to give to clients during their initial assessment so I originally looked into the EASY Diagnostic tool. I’m just looking for a little guidance on which one would be the most helpful and if I would actually need both.

Thanks so much!

Cindy

  1. What do you think about the idea that there’s a dark side to human nature?

Are humans inherently good, as so many mental health professionals seem to believe? It could be entitled, “The Dark Side of Human Nature,” or “Is there REALLY a dark side to human nature?”

Jeremy

Rhonda and David believe that human beings have positive loving impulses and dark violent impulses as well, and that both are an inherent and basic aspect of human nature. They discuss several aspects, including:

The example of cats. They are genetically little serial killers. They love to capture and torture rodents, even if they have had a loving childhood.

Many people love violent revenge movies and video games.

Many people love killing animals, chopping their heads off, and mounting them on the wall, in much the same way that human serial killers get intense excitement from their killing and torturing, and they also keep trophies.

David argues that it is important for therapists to recognize and address the dark side—areas where therapists will typically get in trouble due to blindness / denial / rationalization of negative motives, and excessive idealism. Problematic areas for therapists can include:

  1. the suicidal patient
  2. the violent patient—David describes a woman who was plotting to kill her husband.
  3. disability patients with a hidden agenda of remaining disabled.
  4. patients who don’t want to do their therapy homework
  5. people, for the most part, don’t get addicted because they’re depressed, anxious, or lonely, but because it’s really awesome to get plastered / high.
  6. Many, and perhaps all humans, like to judge others and feel superior to them, and also enjoy exploiting others, but our denial can be intense.
  7. People enjoy bullying people. It makes you feel powerful and generates feelings of excitement.

We acknowledge that although the dark side to human nature may be strongly influenced by our genes, the environment we grow up in can also have a strong impact on our thoughts, feelings and impulses.

  1. Is being “forceful” or confronting patients ever important in therapy?

This is another great question submitted by Jeremy Karmel.

David gives many examples of times when it is absolutely necessary to be forceful and confrontational in therapy, but this requires a strong therapeutic relationship with the patient and perfect empathy scores and high levels of trust and mutual respect.

Therapeutic examples where forcefulness or confrontation may be important include:

Exposure techniques in the treatment of anxiety. The patient will nearly always “wimp out” at the last minute, and here is where the therapist needs to push—but most therapists will back off out of misguided “niceness.”

Pushing the patient to view his/her own role in a relationship conflict instead of buying into the idea that the patient is the innocent victim of the other person’s “badness.”

The new CAT technique in the Externalization of Voices is yet another example where gentle confrontation can often lead to rapid enlightenment.

Another example is use of Changing the Focus, suddenly drawing the patient’s attention to “Have you notice what just happened here between us?” This can be helpful when there’s an awkward or adversarial or evasive dynamic going on between therapist and patient.

Yet another example is the Gentle Ultimatum in dealing with Process Resistance.

In all of these examples, many, and likely most therapists don’t do well, due to “niceness” and fear of conflict.

  1. What’s the 5-session schizophrenia cure?

Hello David:

I recall you saying in one of your trainings given in San Diego a while back that you could "cure Schizophrenia in 5 sessions" using the T.E.A.M. protocol you taught us. Is there a special protocol for this disorder? One of my clients would very much like to know.

I hope that this finds you, your family and everyone at the Feeling Good Institute doing well and being healthy.

Kind regards,

Leslie

David explains that he has always insisted that schizophrenia is an organic brain disorder that sadly cannot be cured with drugs or psychotherapy. However, drugs often plan an important role in treatment, and compassionate psychotherapy can also be extremely helpful. The goal is to help the patient develop greater self-esteem and improved relationships with others. He describes the innovative group CBT program he developed at his hospital in Philadelphia which served a large population of homeless individuals as well as individuals suffer from severe schizophrenia.

He also points out how easily one can get severely misquoted, and appreciates the chance to set the record straight!

  1. How do you suddenly switch into “Sitting with Open Hands” during a session?

This is yet another great question from our friend and colleague, Jeremy Karmel.

David and Rhonda compare good therapy to dancing, having to often change courses instantly when the patient begins to resist and fight the therapist.

  1. Questions about Obsessive Compulsive Disorder (OCD):

I hope this a place where I can submit questions for "Ask David."

Are there manifestations of OCD that have common links or hidden emotions? Do you hear one person's description of their OCD and immediately have an idea of what might cause it? For example: do a majority of contamination OCD sufferers have a common reason for that specific "type" of OCD?

Do sufferers of something deeply distressing like pedophile OCD all have feelings of shame that manifest in that OCD, where the "what if" would result in probably the most shame they could ever feel?

David and Rhonda discuss the Hidden Emotion Technique which can be invaluable in the treatment of OCD.

  1. Questions about racism

Hello David and Rhonda,

Thanks for your amazing podcasts, I have listened to a lot already.

And thanks Rhonda for bringing this important subject to the table. :) What if “Steve” had said that indeed he is racist and can't stand African Americans or South Americans, what would Rhonda answer to that?! It would become difficult for me to keep a friendship-like relationship with someone who is at the extreme opposite on sensitive subjects.

I am open to any point of view, I don't need to be disarmed here. :)

David, I'm so looking forward to your Feeling Great book!!!

Rhonda and David discuss two opposite strategies for dealing with someone with strong racist tendencies.

  1. What if there are more advantages than disadvantages of perfectionism when you do a Cost-Benefit Analysis?

This is a question from a user who wishes to remain anonymous. Rhonda and David talk about the fact that perfectionism, like all Self-Defeating Beliefs, has many advantages as well as disadvantages. And if the advantages outweigh the disadvantages, it’s working for you, and it’s not something the therapist would need to help you with.

There’s a difference between neurotic and healthy perfectionism. Many of the great historical figures, like Edison, for example, worked relentlessly and would not settle for failure. And we are all the beneficiaries of that type of genius and intense commitment to the healthy pursuit of excellence!

Therapy is all about helping people who ask for help. It’s not about evangelism!

David and Rhonda

Jun 22 2020

37mins

Play

195: How To Crush Negative Thoughts: Magnification/Minimalization

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Today, the Cognitive Distortion Starter Kit Continues with

Magnification and Minimization

Rhonda begins by reading two beautiful, inspiring emails from Heather Clague, MD and Dipti Joshi, PhD.  Heather and Dipti are dear friends and esteemed colleagues of David and Rhonda.

Rhonda and David begin with a brief overview of distortion #6: Magnification and Minimization. Magnification is when you blow things out of proportion. This is common in anxiety and is also called “Catastrophizing.” For example, during panics patients often tell themselves—and believe—that they are on the verge of something catastrophic, like a stroke, a sudden, fatal heart attack, or losing their minds and becoming hopelessly psychotic.

Minimization is just the opposite. You shrink the importance of something like your good qualities or the things you’ve accomplished. Minimization is common in depression.

Magnification and Minimization almost always play a big role in procrastination as well. For example, you may Magnify the enormity and difficult of the task you’ve been putting off, and Minimize the value of just getting started on it today, even if you only have a few minutes.

I sometimes call this distortion the “binocular trick” because it’s like looking through the opposite ends of a binocular, so things either appear much larger or much smaller than they actually are.

Techniques that can be especially helpful include Examine the Evidence, the Semantic Technique, Little Steps for Big Feats, the Experimental Technique, the Double Standard Technique, and Externalization of Voices / Acceptance Paradox.

Rhonda brings these techniques to life in a description of a depressed man she recently treated who’s been divorced for 2 to 3 years, and living alone due to the Shelter in Place orders during the Covid-19 pandemic. Although he’s lonely, he’s telling himself that he’s “too depressed and scattered” to be in a relationship.

At the start of the session, he feels:

  • sad, 90%
  • panicky, 50%
  • ashamed, 50%
  • worthless 50%
  • alone, 90%
  • hopeless90%
  • frustrated, 90%
  • upset, 90%.

Rhonda describes her skillful and compassionate TEAM treatment of this man, starting with the Magic Button, Positive Reframing, and Magic Dial, followed by Identify the Distortions, the Paradoxical Double Standard Technique, and Externalization of Voices (including the Acceptance Paradox, the Self-Defense Paradigm, and the Counter-Attack Technique, or “Cat”)

Rhonda brings these techniques to life in a description of a depressed man she recently treated who’s been divorced for 2 to 3 years, and living alone due to the Shelter in Place orders during the Covid-19 pandemic. Although he’s lonely, he’s telling himself that he’s “too depressed and scattered” to be in a relationship.

At the start of the session, he feels:

  • sad, 90%
  • panicky, 50%
  • ashamed, 50%
  • worthless 50%
  • alone, 90%
  • hopeless90%
  • frustrated, 90%
  • upset, 90%.

These techniques were tremendously helpful, and at the end of the session, he no longer believed his negative thoughts about himself and his negative feelings all fell to zero. He recovered, essentially, in one extended (3-hour) TEAM therapy session.

David and Rhonda discuss the impact of this type of experience on the therapist as well as the patient. Obviously, the patient feels fantastic, but Rhonda said she also felt “rejuvenated,” with much warmth and kindness. I (David) always feel this as well at the end of an amazing session.

Rhonda and David

Jun 15 2020

45mins

Play

194: How To Crush Negative Thoughts: Jumping to Conclusions

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Today, the Cognitive Distortion Starter Kit Continues with

Jumping to Conclusions

Rhonda opens today’s podcast by reading beautiful email comments from Kevin Cornelius and Thai-An Truong. Both are dear friends and colleagues of Rhonda and David.

Then Rhonda and David discuss Jumping to Conclusions, which is the fifth cognitive distortion. It’s defined as jumping to conclusions that aren’t necessary supported by the evidence. There are two common forms: Fortune Telling and Mind-Reading.

Fortune-Telling: You tell yourself that bad things are about to happen. There are two common examples:

Hopelessness: You tell yourself that things will never change, that you’ll never recover, or that your problems will never be solved. David explains why this distortion is impossibly distorted and virtually never true. And yet, when people are depressed, they nearly always fall victim to the belief that things will never change. It’s much like being in a hypnotic trance, because you are telling yourself and believing things that can’t possibly be true.

Anxiety: You make catastrophic predictions that gradually exaggerate any real danger. All anxiety results from this distortion. For example, if you have a fear of flying, you may be telling yourself that the plane could run into turbulence and crash. Anxiety is also a self-induced hypnotic trance, because you are giving yourself and believing highly irrational messages. For example, one of David’s graduate students screamed loudly when she saw his meek little kitten, Happy, because she had a cat phobia and was telling herself that cats are extremely violent and dangerous.

Mind-Reading: You assume that you know what other people are thinking when you really don’t. There are three common examples:

Social Anxiety / Shyness: For example, other people are judging you and can see how anxious you are. You may also assume that other people rarely or never get anxious and that they wouldn’t be interested in you.

Relationship Conflicts: You may tell yourself that the other person only cares about himself/herself and that s/he is intentionally being “unreasonable.” You may also do the opposite type of mind-reading and assume that others are quite impressed with you when they’re actually turned off or feeling annoyed with you.

Anxiety: You make catastrophic predictions that gradually exaggerate any real danger. All anxiety results from this distortion. For example, if you have a fear of flying, you may be telling yourself that the plane could run into turbulence and crash. Anxiety is also a self-induced hypnotic trance, because you are giving yourself and believing highly irrational messages. For example, one of David’s graduate students screamed loudly when she saw his meek little kitten, Happy, because she had a cat phobia and was telling herself that cats are extremely violent and dangerous.

Depression: You tell yourself that nobody loves you or cares about you.

Many of the Truth-Based Techniques can be useful, such as Examine the Evidence, the Experimental Technique, or the Survey Technique. Motivational Techniques like Positive Reframing can be tremendously helpful. And Role-Playing Techniques like Externalization of Voices with the Acceptance Paradox can also be very useful.

David and Rhonda play a short audio clip from the treatment of a severely depressed man named Bradley with a history of extreme abuse growing up. He is struggling with feelings of hopelessness, which he rated at 80 (on a scale of 0 to 100) due to these two thoughts:

  1. I’m damaged beyond repair so nothing can help.
  2. Psychotherapy homework can’t possibly help so there’s no use trying it.

Prior to the audio clip, David and Bradley have done Positive Reframing asking:

  1. What do your negative thoughts and feelings show about you and your core values that is beautiful and awesome?
  2. What are some advantages, or benefits, of your negative thoughts and feelings?

David and Bradley then attack his negative thoughts using a variety of role-playing techniques, with many role reversals. By the end of this approximately 13-minute excerpt, Bradley no longer believes these two thoughts and his feelings of hopelessness have dropped to zero.

We are incredibly grateful to “Bradley” for giving us permission to publish this very personal and inspiring audio clip!

Thanks for listening!

Rhonda and David

Jun 08 2020

52mins

Play

193: Sarah Revisited: A Hard Fall--and a Triumphant Second Recovery

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On February 24, 2020 we published Podcast 181, "Live Therapy with Sarah: Shrinks are Human, Too!" This was a live session with Sarah, a certified TEAM-CBT therapist, conducted at my Tuesday psychotherapy training group, because Sarah was struggling with intense anxiety, bordering on panic, during  therapy sessions with her patients. It was a phenomenal session with outstanding results. The Hidden Emotion technique was the main focus of that session, bringing to conscious awareness some feelings of anger and resentment that she'd been sweeping under the rug. This is a common cause of anxiety.

But a month or so after that session, Sarah relapsed in a big way, so I agreed to treat her again during the psychotherapy training group at Stanford, and Dr. Alex Clarke was my co-therapist. This time, we used very different treatment techniques.

Once you've recovered, the likelihood of relapse is 100%--that's because no one can be happy all the time. We all hit bumps in the road from time to time, and when you do, your "fractal" will come into prominence again. This means that the same kinds of negative thoughts and feelings will return in an almost identical form. This can give you the chance to defeat them again and strengthen the positive circuits in your brain.

That's exactly what happened to Sarah. Approximately one month after the first treatment session, she had a viral infection, and began taking large amounts of Advil to combat the symptoms. This led to severe feelings of nausea, followed by panic. Multiple trips to the doctor failed to reveal any diagnosable cause for her somatic symptoms, aside from the possibility of Advil side effects. However, the discomfort was so severe that she panicked, fearing that she had a more severe medical problem that the doctor had overlooked. She lost 13 pounds over the next two months, and requested an emergency TEAM-CBT session, which Dr. Clarke and I were very happy to provide, since live work almost always make for superb teaching.

If you take a look at Sarah's Daily Mood Log, you'll see that the upsetting event was waking up Sunday morning still sick and anxious for the 100th day in a row. She circled nine different categories of negative emotions, and all were intense, with several in the range of 80 to 100. and she had many negative thoughts, including these. Please note that she strongly believe all of these thoughts:

Negative Thoughts % Now 1.    I should be able to defeat my anxious thinking and reduce my suffering. 95 2.    If I can’t heal my own anxiety, I’m an inadequate hack of a TEAM-CBT therapist. 95 3.    I was strong, confident, vivacious. Now I’m fragile, weak, and self-doubting. 100 4.    My anxiety is slowing me down—I should be able to do more and take on more. 100 5.    Something serious is wrong with my stomach, but now with Covid-19, I won’t be able to get medical intervention and testing. 70 6.    I’m not as effective in my clinical work when I’m upset and anxious. 85 7.    I might get panicky during a session and screw up. 80 8.    I should always do more. 85

After empathizing, I asked Sarah about her goals for the session. She said she wanted greater self-confidence and less anxiety, and said her husband had theorized that if the anxiety disappeared, her somatic symptoms would also go away. But when we did Positive Reframing, Sarah was able to pinpoint more than 20 overwhelming benefits of her intense negative feelings, including many awesome and positive qualities and core values that her negative thoughts and feelings revealed about her. This always seems to be a shocking and pleasant discovery for the patient!

At this point, we used the Magic Dial to see what Sarah wanted to dial her negative feelings down to, as you can see here. Then we went on to the Methods portion of the session, using techniques like Identify the Distortions, Externalization of Voices, Acceptance Paradox, and more. We also had to revert back to the Assessment of Resistance once again when Sarah began to fight strenuously against giving up her self-critical internal voice. We did a Cost-Benefit Analysis on the advantages and disadvantages of being self-critical and not accepting her fragileness, weaknesses, and flaws.  Once we "sat with open hands" and listed all the reasons for her to continue criticizing herself, she suddenly had a change of heart and really poured herself into crushing her negative thoughts. It was interesting that as she began to blow her negative thoughts away, she suddenly got hungry for the first time in months!  If you click here, you can see how she felt at the end of the session.

It was a mind-blowing session, with much potential for learning. Rhonda, Dr. Clarke and I hope you enjoy it!

Here were some "teaching points I sent to the tuesday group members after the session.

  1. This could not have been done in a single session. At least in my hands, a two hour session is massively more cost-effective than a bunch of single sessions. But even then, you have to have a plan and move quickly.
  2. Although you all said wonderfully admiring things to our “patient” during the E = Empathy phase of the session, few or none of you used Thought Empathy or Feeling Empathy, which is vitally important. I thought that Fabrizio did a magnificent job with “I Feel” Statements, expressing genuine warmth and compassion.
  3. As usual, resistance was the key, and could not have been overcome with efforts to “help” or attempts to use more M = Methods. Learning the dance of reverting instantly to A = Assessment of Resistance is key (revisiting this when the patient resists during M = Methods. But this requires “sensing” that the patient is resisting during Externalization of Voices, for example. You have to kind of “smell” what is happening, and then suddenly change direction. You also have to be able to “see” that the patient is absolutely committed to some underlying schema or belief, like “I should always be strong and vivacious,” etc. The Assessment of Resistance cannot just be an intellectual exercise, as it might then revert to “cheer-leading.”
  4. Emotion and tears are crucial, and amazing work was done by Sarah, our “patient,” during the tears. She gave herself compassion at that moment. But tears alone without the structure would not have had nearly the impact. Skillful therapy integrates multiple dimensions at the same time. It cannot be formulaic. It's an art form, based on science, and it is data-driven, based on the patient's ratings at the start and end of the session.
  5. During the Externalization of Voices, I would recommend that you NEVER settle for a “big” win. Shoot for huge, and stick with the same thought for as many sessions as necessary to get to “huge.”
  6. During the role playing I switched back and forth from Ext of Voices to Paradoxical Double Standard and then back frequently, as they both draw on different sources of pretty incredible healing power.
  7. As a therapist, I never give in to a patient’s feelings of hopelessness, because rapid and dramatic recovery is usually possible.
  8. Relapse Prevention Training (RPT) will now be necessary, since NTs always return. RPT only takes about 30 minutes.
  9. I apologize for taking over last night, but felt my strongest commitment is to provide relief for the person in the “patient” role.
  10. Sometimes what you think of as your worst “flaw” (eg being suddenly weak and fragile and fearful) can be your greatest asset in disguise, once you accept your flaw(s). But we fight against acceptance, thinking that if we beat up on ourselves enough, something wonderful will happen. And, of course, the self-criticism can sometimes reap big dividends. At the same time, I try to remind myself that self-acceptance is the greatest change a human being can make.
  11. The goal of therapy is not just feeling somewhat better, but getting to enlightenment and joy. That's what happened tonight!

After the session, I received this awesome email from Sarah:

Thank you from the bottom of my heart, David, Alex, and all members of our training group who were present tonight.

Such beautiful contributions from all, and I appreciate so deeply this 2nd opportunity to do personal work, especially given that we are ALL going through difficulties during this Covid-19 crisis (or in general).

I feel so much lighter, even enlightened, ate some pot roast for dinner (What??? I haven't had an appetite for something like that in a LONG time... and find myself looking forward to my sessions with my patients tomorrow). And I also know I'll have moments of relapse, but I really felt like I finally defeated those thoughts and especially the core belief.

Stay healthy and safe everyone, I look forward to opportunities in the future when we reunite, to be in support of YOU.

Best,

Sarah

Rhonda, Alex and I want to thank you, Sarah, once again, for your tremendous courage and generosity!

David and Rhonda

Jun 01 2020

2hr 12mins

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192: Matter & Anti-Matter

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"I don't matter!"

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

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

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

Have you ever been suddenly and unexpectedly triggered like that?

What triggered Rhonda’s feelings?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Rhonda, Matt, and David

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

Dear David and Matt:

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

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

Rhonda

May 25 2020

1hr 54mins

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191: How to Crush Negative Thoughts: Mental Filter/Discounting the Positives

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This is the fourth in our podcasts series on the best techniques to crush each of the ten cognitive distortions from my book, Feeling Good: The New Mood Therapy. Today, we focus on Mental Filtering and Discounting the Positive. (This will be the last Episode recorded remotely with poor sound quality.  We thank  you for your perseverance listening to it, and guarantee better sound quality in the future with our new recording equipment.)

  1. Mental Filtering, You focus on something(s) negative, like a mistake you made, and ignore or overlook the positives. This is like the drop of ink that discolors the beaker of water.
  2. Discounting the Positive(s). this is an even more spectacular mental error. You insist that the positives about yourself or others don't count.  In this way, you can maintain a uniformly and totally negative view of yourself, the world, or other people.

David and Rhonda discuss the fact that humans can be very biased in our perceptions of things that are emotionally charged. For example, if you are firmly committed to some belief, you might look for evidence that supports your belief, and discount evidence that contradicts your belief.

Similarly, if there is someone you strongly admire, you may selectively focus on the positive things they do or say, and discount or dismiss things they do or say that might be quite offensive. And when you're ticked off at somebody, you probably focus on all the things they do or say that turn you off (mental filtering) and discount the positive things that they do or say. For example, when they say something kind or supportive, you might think, "S/he doesn't mean it," or "isn't being genuine. They're just acting fake." In this way, you convince yourself that he or she really is "bad."

When you're depressed or anxious, you'll do this to yourself as well, thus intensifying your negative thoughts and feelings. For example, a teenager with extremely intense depression, strong suicidal urges, and anger told me that human beings were inherently selfish, insensitive, and bad. When I asked her how she'd come to this conclusion, she described seeing some kids in her dormitory who were joking in a cruel, insensitive way about girl with depression, and said that if you're looking for her, you can probably find her sitting on the edge of her dormitory window, meaning that she's probably about to jump.

She also described seeing a homeless man on her way her therapy session, and said that no one really cared about him. Of course, these observations were at least partially valid, since human beings certainly DO have the capacity for great self-contentedness, insensitivity, and cruelty. But was she involved in Mental Filtering, and focusing only on the negatives?

I asked her if she could think of any times in the past several weeks when someone had been cruel or insensitive to her. She couldn't think of a single instance.

David and Rhonda provide additional examples, some personal, of Mental Filtering and Discounting the Positive, and suggest techniques that can be helpful when combating these distortions, including Positive Reframing, Examine the Evidence, the Straightforward Technique, and Double Standard Technique.

David tells a moving story that he also told on his Tedx talk in Reno, about an elderly Latvian immigrant who made a suicide attempt because she thought she'd never accomplished anything worthwhile or meaningful.

In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Jumping to Conclusions.

David D. Burns, MD / Rhonda Barovsky, PsyD

May 18 2020

27mins

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190: How To Crush Negative Thoughts: Overgeneralization

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This is the third in our podcasts series on the best techniques to crush each of the ten cognitive distortions from my book, Feeling Good: The New Mood Therapy. Today, we focus on Overgeneralization. There are two common forms of Overgeneralization:

  1. You generalize from some specific flaw or failure to your "Self." So, instead of telling yourself that you failed at this or that, you tell yourself that you are "a failure" or "a loser."
  2. You generalize from right now to the future, using words like "always" or "never." For example, you may tell yourself, "Trisha (or Jack) rejected me. This always happens! I must be unlovable. I'll be alone forever."

Overgeneralization is also one of the most common cognitive distortions, and it causes depression as well as anxiety. I believe it is impossible to feel depressed or hopeless without Overgeneralization.

The antidote to Overgeneralization is called "Let's Be Specific." Instead of thinking of your self as a "bad mother" or "bad father," you can focus on the specific thing you did that regret, like shouting at your kids when you were upset. Then you can think of a specific plan to correct this problem, like talking things over with your kids and letting them know that you love them and feel badly that you snapped at them.

David and Rhonda also talk about the idea that abstract concepts like "worthless" or "bad" or "worthwhile" or "good" human beings are meaningless. Good and bad thoughts, feelings and behaviors certainly exist, but there is no way to measure or judge the value of a human being.

In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Mental Filter and Discounting the Positive.

David D. Burns, MD / Rhonda Barovsky, PsyD

May 11 2020

33mins

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Corona Cast 7: My Sruggle with Covid-19! Is it REALLY True that only Our Thoughts Can Upset Us?

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Rhonda begins by reading several brief heart-warming endorsements from listeners like you. We are grateful for all of your kind and thoughtful emails endorsing our efforts!

Announcement: My upcoming one-day workshop with Dr. Jill Levitt on the “Cognitive Distortion Starter Kit” on May 17, 2020 WILL happen. It will be exciting and entirely online so we hope you can join us from wherever you are. See the write-up below.

We are joined in today’s podcast by Michael Simpson, who was among the first to contract the Covid-19 virus in New York. Michael was the star of Feeling Good Podcast #169: More on Social Anxiety. The Case for Vulnerability.

I have repeatedly pointed out that our feelings do NOT result from what happens—but rather, from our thoughts about what’s happening. This idea goes back at least 2,000 years, to the teachings of Epictetus, but people still don’t “get it.” People still think that negative events can have a direct impact on how you feel. But that belief makes you the victim of forces beyond your control, because we cannot, for the most part, change what happens—there’s no way we can snap our fingers and make the Covid-19 virus disappear, but we CAN change the way we think about it.

I have also pointed out that the negative thoughts that upset us when we’re depressed and anxious will nearly always be distorted and illogical—remember, depression and anxiety are the world’s oldest cons!

But is this really true?

Michael explains that when he contracted the Covid-19 virus on March 12, 2020, his first reaction was not fear, but excitement because he thought, “I’m getting it early, and when I recover, I’ll probably have some immunity.”

But he WAS fearful. Of being intubated? Of a long hospital stay? Of death? No! What were his negative thoughts? Michael was telling himself things like this:

People will shun me because I’ve got the virus.

  1. People won’t want to hang out with me any more.
  2. People will judge me as weak and unappealing.
  3. Women won’t be interested in me.
  4. My friends won’t want to talk to me.

These thoughts triggered powerful feelings of shame and anxiety. Can you see any of the familiar cognitive distortions in Michael’s thoughts? Here are a few of the ones I spotted:

  • Mind-Reading: Thinking you know how others are thinking and feeling without any real evidence:
  • Fortune-Telling: Making frightening predictions that aren’t based on any real evidence.
  • Emotional-Reasoning: Reasoning from how you I feel. Michael feels anxious and ashamed, so he thinks others really will judge and reject him.
  • Should Statements: Michael seems to be telling himself that he should be far better than he is to be loved, admired, and accepted by others.
  • Self-Blame: Michael seems to be beating up on himself and telling himself that he’s not good enough.

Michael describes his decision to start posting his symptoms and insecurities on Instagram as a way of testing his fear which he described as intense. To his surprise and relief, he received something like 150 responses that were overwhelmingly loving and supportive.

Michael was so excited by this feedback that he is thinking of starting his own podcast, where his guests will openly discuss vulnerable and personal topics. We look forward to that! I think it could be quite popular because so many people feel lonely and anxious due to hiding how they really feel, and putting up a false front to the world.

Michael also expands a bit on David’s concept of “fractal psychotherapy.” That’s the idea that all of our suffering results from one tiny pattern of irrationality that repeats itself over and over in many different situations, and ever single time you get upset—whether it’s depression, anxiety, anger—it will be that same fractal flaring up again. Michael said that his fractal is “others will judge me and leave me.”

Other fractals might be “I’m defective,” or “I’m not important,” or “I’m inferior to others.” The goal of therapy is to give you specific skills that you can use to blast your own fractal every time it’s causing problems for you.

On a future podcast, (May 25, 2020) we will, in fact, do live therapy with a professional woman you might recognize who had the belief that she wasn’t important. So stayed tuned!

May 07 2020

35mins

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189: How to Crush Negative Thoughts: All-or-Nothing Thinking

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This is the second in a series of podcasts by David and Rhonda focusing on the best techniques to crush each of the ten cognitive distortions I first published in my book, Feeling Good: The New Mood Therapy. Today, we focus on All-or-Nothing Thinking. that's where you look at the world in black-or-white categories, as if shades of gray do not exist. For example, if you're not a complete success you may tell yourself that you're a complete failure.

All-or-Nothing Thinking is one of the most common cognitive distortions, and it causes or contributes to many common forms of emotional distress, including:

  • perfectionism
  • depression
  • Social anxiety--
    • performance anxiety
    • public speaking anxiety
    • shyness
  • hopelessness and suicidal urges
  • anger, relationship conflicts, and violent urges
  • habits and addictions
  • and more

However, this distortion can be also be helpful to you, and may reflect some of your core values. For example, your perfectionism

  • shows that you have high standards, and won't settle for second-best
  • may motivate you to work hard and do excellent work
  • prevents you from glossing over your failures and mistakes
  • intensifies your emotional life, which may feel like a glorious roller coaster ride, with intense ups (when you do well) and equally intense downs (when you fall short.)

So, before you can challenge a negative thought with this, or any distortion, you'll have to decide why in the world you'd want to do that, given all the benefits of your negative thoughts and feelings.

One of the possible down sides of All-or-Nothing Thinking is that it simply does not map onto reality. There is little in the universe that is 100% or 0%. Most of the time, or even all of the time, we're somewhere between 0% and !00%. For example, this podcast is not incredibly fantastic, or absolutely horrible. It is somewhere in-between, and will hopefully be of some value to you. While it clearly won't solve ALL of your problems, it may be a useful step forward.

We describe a number of example of All-or-Nothing Thinking, including a physician who was trying to diet and ended up binging on a half gallon of ice cream, and a suicidal young woman with incredibly severe depression who was involved in self-mutilation.

There are many ways of crushing the negative thoughts that contain All-or-Nothing Thinking, including Thinking in Shades of Gray. Although that might sound rather drab in comparison to the drama of All-or-Nothing Thinking, you may discover that the world becomes far more colorful when you learn to think in shades of gray!

In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Overgeneralization. David argues that Overgeneralization is arguably the cause of all depression and much anxiety, and that the first person to recognize and solve this dilemma was the Buddha, 2500 years ago. More on that topic next week!

David D. Burns, MD / Rhonda Barovsky, PsyD

May 04 2020

37mins

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Corona Cast 6: Love Story, Part 2 -- The Surprise Conclusion

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

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

Dear Dr Burns, Rhonda and Taylor,

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

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

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

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

Stay safe. Take care.

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

Nivedita Singh

(Your biggest fan this side of the Pacific).

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

Listen to this powerful podcast and you will find out!

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

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

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

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

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

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

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

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

Certain activities are required, while others are more flexible. Since my kids are just 2, 4, and 6 years old, there are fewer "requirements" but over time I plan to try to push them a little more to stick to the schedule. Since social distancing and being home is something we have not had any practice with, I want to ease into our new schedule.

3. Independent play. I schedule some time for independent play each day. This is a skill I've really been focusing on with each child, and find that it's important for them to learn to play by themselves. Social playing is great, but learning to be alone is important as well!

For my 6 year old the goal is 20 mins, for my 2 year old it's 10 mins with minimal help from mommy. We make it a fun game, and they get a  small reward if they are able to reach their goal. The rewards could include a hug, high-five, praise, stickers or even a new action figure. I try to switch the types of rewards to keep it fun and interesting, and also so they're not just doing it so that they get X privilege or Y toy.

4. Little Steps for Big Feets. I try to set small, manageable goals each day for each child as well as myself. Sometimes it's something I impose on the kids such as "today each of you will help me with one chore, such as taking the garbage out, cleaning up your toys, washing the table, etc."

At other times it's something they want to learn. For example my daughter wants to learn to write her name so for several days her goal was to practice writing her name four times. For me it's usually a small manageable goal related to work or house-cleaning. This is similar to David's principle of "little steps for big feets!" For example, instead of saying I'll clean my entire apartment today, I focus on one small goal that I can attain.

Taylor gives an awesome example of how to use the Five Secrets of Effective Communication with small children, especially when they are angry or upset. This is an example every parent might want to emulate! And it's the first example I've heard of how to do this!

Thanks for tuning in, and please let us know what you thought about today’s program!

Rhonda, Taylor, and David

Apr 30 2020

33mins

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188: How to Crush Negative Thoughts: The Cognitive Distortion Starter Kit!

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

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

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

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

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

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

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

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

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

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

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

David D. Burns, MD / Rhonda Barovsky, PsyD

Apr 27 2020

43mins

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187: Live Therapy with Michael--The Awesome Atlanta TEAM Therapy Demo!

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Recently we did a follow-up podcast with Dr. Michael Greenwald, who bravely volunteered to be the patient in the live therapy demonstration on the evening of Day 1 of the fall Atlanta intensive. My co-therapist was Thai-An Truong from Oklahoma City. Although it was a total blow-away session, we did not think the audio was good enough for a podcast, because we only recorded it on Michael's cell phone. However, our beloved colleague, Dr. Brandon Vance from Oakland, offered to improve the audio quality, so we are now presenting it to you! The audio is not quite as good as a typical podcast, but is good enough, especially after the first few minutes.

The podcast includes the entire session, without commentary, as well as the 15 minute Relapse Prevention Training at the end of the workshop on day 4. Because the entire audio is about two hours long, feel free to take a break half way through, perhaps after the E = Empathy portion of the session, or the A = Assessment of Resistance, and then listen to the last half later on. If you like, you can take a look at his Daily Mood Log while you are listening.

The session was incredible, and half of the audience were in tears at the end. You may be, too! And thanks, once again, for your bravery and incredible gift to all of us, Michael!

Michael works in Woodland Hills and is offering free monthly TEAM therapy practice sessions at his office to therapists in the greater Los Angeles area. I am hoping these will eventually morph into the first Feeling Good Institute in Southern California. Make sure you contact Michael if you are interested joining his weekly practice group (drmichaeldg@gmail.com). He is a skillful therapist and teacher, and, as you're about to discover, a totally delightful person!

Thanks for listening today, and thanks for all the kind comments and totally awesome questions you submit every day! We greatly appreciate your support!

Let us know if you like these extended live therapy sessions. We can break them up, if you prefer, into shorter podcasts with commentary, or even publish them as optional extra podcasts on a different day of the week.

If you would be interested in some awesome training with Thai-An Truong, ncluding free monthly TEAM-CBT webinars, you can contact her at www.teamcbttraining.com.

David and Rhonda

Apr 23 2020

2hr 8mins

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186: Mark Your Calendars -- The Evolution of Psychotherapy Conference is Coming in December 2020. An Interview with Dr. Jeffrey Zeig

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Today, Rhonda and David have the honor and pleasure of interviewing Dr. Jeffrey Zeig, the beloved founder and head of the Milton H. Erickson Institute in Phoenix, Arizona. Every four years, Jeff sponsors the awesome Evolution of Psychotherapy Conference, which draws more than 7,000 mental health professionals to hear all of the most famous and best psychotherapy teachers and innovators in the world to beautiful Anaheim, California for five days. This year, it will be December 9 to 13, 2020.

In this far-reaching interview, Jeff talks about the history of psychotherapy, beginning with Freud's work beginning in 1885, all the way up to the first Evolution of Psychotherapy Conference on the 100th anniversary of Freud's origins, in 1985. He explains that up until the beginning of World War II, psychotherapists were focused on the WHY of emotional problems, in spite of the fact that the causes of depression and anxiety were then, and still are, completely unknown.

Then, around 1944, therapists began to focus on the question of how we can best help people heal, change, and grow, in spite of the fact that the causes have yet to be discovered. This was a welcome and sensible shift, but led to a proliferation of hundreds of competing "schools" of therapy, most of which claimed to "know" the causes of psychological problems and also claimed to have the "best" treatment methods.

Jeff's goal in creating the Evolution conference in 1985 was to bring together the best from all the schools of therapy to share ideas and focus on the common healing factors that all forms of effective therapy share. To Jeff's surprise and delight, the conference was an immediate hit, with more than 7,000 participants from around the world, and was sold out well ahead of time.

Jeff also discusses his own creative and imaginative philosophy and approach to therapy, which he describes as a magical experience, requiring great skill, much like a musical creation or theatrical, and not a cookie cutter formula taken from the pages of the latest treatment manual for depression or this or that anxiety disorder. Jeff is one of the pioneers and masters of "indirect hypnosis," which originated with his mentor, Milton Erikson.

Jeff fondly and tenderly describes his early days with Milton Erikson, who he describes as a wizard and genius, and likely one of the greatest therapists of all time. Erikson was also an inspiration to Jeff, and to all who had the good fortune of knowing him, because of his own extremely physical limitations caused by polio, and how he transcended those limitations and transformed them into strengths.

So, mark your calendars for the Evolution Conference this December 9 - 13. It will be a chance for you to hear and meet many your own therapy heroes first-hand and to learn from superb teachers. I'll be there too, so make sure you say hello. I don' t know yet what topics I will be speaking on, but will post them on my workshop page as soon as I find out.

And if you're a struggling, starving student, as I once was, Jeff wants you to know that they will need many helpers at the conference, and the helpers receive generous discounts!

Now, that's a deal you can't beat! You'll network with colleagues from around the world in a gorgeous setting.

Thanks for listening today, and thanks for all the kind comments and totally awesome questions you submit every day! We greatly appreciate your support!

David and Rhonda

Apr 20 2020

39mins

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Corona Cast 5:The Corona Cast Survey. Have Our Negative or Positive Feelings Changed? And by How Much? Are Men or Women Hurting More?

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David and Rhonda are joined in today’s podcast by Drs. Alex Clarke and Diane Schiano, as well as Jeremy Karmel, who are all members of David's Tuesday training group at Stanford. Alex is a clinical psychiatrist and TEAM therapist who practices at the Feeling Good Institute in Mountain View, California, and Diane is a research psychologist and licensed marriage and family therapist. All three helped in the design and analysis of the survey data. We published the survey in a blog entitled "How Are You Feeling Now?" on March 26, 2020 . To review the full report of our findings, you can click here.

I (David) have been curious about occasional polls of our listeners to see if we can get  meaningful results to potentially interesting questions. So this was a kind of pilot study to see if negative and positive feelings have changed in our fans since the advent of the corona pandemic.

You are probably aware of the Brief Mood Survey that TEAM therapists ask patients to complete prior to and just after each session to find out how effective the session was. This tool has been incredibly powerful, because therapists and patients alike can find out right away how much improvement the patient experienced in depression, suicidal urges, anxiety, anger, happiness and relationship satisfaction in every single session.

I developed an even shorter version of my Brief Mood Scale to measure similar negative and positive feelings, and all variables can range from 0 (not at all) to 100 (extremely.) So for example, a score of 25 on depression would indicate mild depression, and a score of 100 on happiness would indicate extreme happiness. In other words, high scores on the negative feelings indicate greater distress, while high scores on the positive feelings indicate greater feelings of happiness and relationship satisfaction.

In the survey, we asked people like you how you are feeling right now, and how you were feeling just before learning about the corona virus. The goals of the informal survey were to answer these questions:

  1. Will people respond to the survey and can they provide meaningful information that can be analyzed statistically?
  2. Are people feeling more distress now?
  3. If so, have the negative feelings of depression, anxiety, anger and hopelessness changed more in men or women?
  4. Have the positive feelings of happiness and relationship satisfaction changed in men or women since just before the start of the pandemic?
  5. How have therapists fared, as compared with non-therapists?

The five of us discussed the survey findings, which can be summarized in this way:

205 of the people who subscribe to my WordPress blogs completed the survey within a couple days. 62% of them were women and 37% were therapists. There were no gender differences in the therapists.

How are You Feeling Now?

Changes in Negative Feelings Since Corona

  1. Prior to the corona pandemic, the means of the negative mood variables varied from 13.2 (on a scale of 0 to 100) for hopelessness to 24.1 for anxiety. Keeping in mind that a score of 25 indicates "mild" symptoms, this means that all of these negative feelings were slightly elevated, but the elevations were minimal to mild.
  2. At the current time, all four negative feelings have increased significantly, ranging from 23.7 for hopelessness to 38.5 for anxiety, so the negative feelings are now mild to moderate.
  3. Prior to the corona pandemic, there were no significant differences in any of the negative mood variables in men vs. women. There have been significant increases in negative feelings since that time, but the greatest increases occurred in women. In fact, in women, the negative feelings approximately doubled. This means that the women who completed the survey, on average, now report feeling moderately  depressed, anxious, angry and hopeless.
  4. For men, in contrast, the only negative feeling that increased significantly was anger.
  5. There were no statistically significant differences in anger levels in men vs. women before the corona pandemic and there are no significant differences now.

How are You Feeling?

Changes in Positive Feelings Since Corona

  1. Prior to the corona pandemic, the means of the happiness and relationship satisfaction scales were 55.6 and 58.6 (on a scale from 0 to 100), meaning they were just a tad better than moderate. This indicates that there was quite a bit of room for improvement in positive feelings prior to the pandemic.
  2. At the current time, the mean of happiness has dropped to 41,1 but relationship satisfaction has held steady at 56.8 (not a significant change.)
  3. There were no significant differences in happiness in men vs women before the pandemic, and there are no differences now. Happiness has decreased in both men and women, and the decreases have been similar in men and women.
  4. In contrast, relationship satisfaction did not differ in men vs. women at either time point, and there have been changes in relationship satisfaction in men or women since the pandemic. This is encouraging, and means that although men and women are more distressed now, feelings of intimacy and closeness to others have not diminished. In other words, social distancing has not led to feelings of isolation or emotional distancing in our population.

How Are Therapists Feeling Now?

Do you think that the therapists who completed the survey will have significantly different scores than non-therapists on the negative and positive mood variables? And if so, do you think the mean therapist scores will be higher or lower?

Here are the findings:

  1. Therapists scored 9.85 points higher on happiness as well as relationship satisfaction than non-therapists at both time points. This was highly significant. For example, non-therapists scored 50.2 on happiness and relationship satisfaction at time 1 (moderately happy and moderate relationship satisfaction), while therapists scored 60.1 on happiness and relationship satisfaction. Of course, there's a lot of room for improvement in both groups, since these variables range from 0 to 100.
  2. Therapists also scored better than non-therapists on the negative variables at time 1, and the magnitude of the difference was 7.7. So for example, on depression, the non-therapist mean at time one was 21.2 (approaching mildly depressed), while the therapist mean was only 13.5. However, at the current time, things have changed. Now the therapists scores on depression, anxiety, anger and hopelessness are no different, on average, from the scores

    Open-Ended Questions: The People Behind the Numbers

    Dr. Diane Schiano led the charge in the discussion of several open-ended questions in our survey. The results can be summarized like this:

    • People are feeling concerned about getting sick, dying or something bad happening to a loved one.
    • People are coping by connecting with friends and loved ones and trying to keep up physical and mental health.
    • People think digital therapy is a good idea, even if it’s not ideal

    For example, one respondent wrote:

    "I remember hearing about the [the corona virus] when [the pandemic] first started in China, but I wasn't overly concerned. I felt like it was a bad flu and would likely blow over. Then I watched the news unfold, particularly in Italy, and realized how serious this is. Once they started shutdowns in California, I realized how serious and close to home this is."

    Rhonda pointed out the discrepancy between our findings and a recent UN reports of increases in domestic violence since the start of the pandemic. While our survey of podcast fans did document increases in anger in men and women since the outbreak, satisfaction in personal relationships was absolutely unchanged in men and women, and was identical in men and women. At the same time, the mean relationship satisfaction level in our group was only "moderate," which is not especially high.

    There are a few disclaimers. First, the findings in this survey probably do reflect the people who receive my Word Press blogs, but may not reflect the US population as a whole. The individuals who receive my blogs or listen to my podcasts are therapists, patients, and general citizens with a fairly strong interest in mental health topics as well as self-help, so the feelings in our group might easily be skewed in a somewhat more negative direction.

    Second, we are measuring peoples' perceptions of their feelings prior to learning of the pandemic. We did not actually measure their feelings prior to the corona epidemic.

    Thanks for tuning in, and please let us know what you thoughts about today’s program! If you'd like me to publish more polls, suggest some interesting poll questions, if any come to mind.

    Rhonda, Jeremy, Diane, Alex, and David

Apr 16 2020

1hr 2mins

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185: More Great Questions from Listeners Like You!

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Rhonda and David address five fascinating questions in today’s podcast, including these:

  1. “I’m incredibly shy. How do you talk to girls?”
  2. How did you get over your fear of vomiting?
  3. Do you still use behavioral techniques like Exposure?
  4. Should I try to include the E and A of TEAM when trying to crush my negative thoughts on my daily mood log? And how would I do this?
  5. Please give us a podcast on how to express anger.

Nandini writes:

I have zero experience dating and talking to girls. I don't know how to even make girl as friend.

Whenever I talk to a girl, the next day I think “How should I talk to her?”

Should I go to her because now she wants me to talk to her?

Which makes me very nervous.

And also. if am talking to a girl I think about when I will have to go to her next time. When I’m doing my work, I think should I go to her, because she works in our office.

Means I don't know how to do that! Can you help?

Rhonda and David respond with some simple advice, but encourage all listeners to use the search function on his website to get lots of great links to helpful material on just about any mental health topic, including flirting, dating, shyness, or just about anything.

In additon, my book, Intimate Connections, could be really helpful to Nandini, as well as my books, When Panic Attacks and The Feeling Good Handbook, that all have extensive sections on anxiety. You can find all of them at my books page (https://feelinggood.com/books/).

In addition, we’ve recently featured several podcasts on shyness and social anxiety, including:

128: Intense Social Anxiety–I’m Losing Control! What Can I Do?

134: Smashing Shyness: Part 1

135: Smashing Shyness: Part 2

169: More on Social Anxiety–the Case for Vulnerability

142: Performance Anxiety: The Story of Rhonda, Part 1

143: Performance Anxiety: The Conclusion

088: Role-Play Techniques —Feared Fantasy Revisited

  1. How did you get over your fear of vomiting?

DB,

I know you probably don't remember me because it's been years since we emailed, but you helped me via your Ask The Guru section of your old website years ago and we occasionally emailed back and forth after that. Which reminds me to once again thank you for your books and how you've dedicated your life to your work. It has made a difference in my life and I would imagine literally millions of others. What a wonderful thing.

I stumbled upon an article about you in the Stanford Magazine from 2013 and learned something I didn't know -- you suffered at one time from a fear of vomiting. I've dealt with that since I was a kid. It's not as severe now as it once was, but I'm wondering what CBT methods might be useful for that particular issue. (No chance I'm taking ipecac syrup!).

I know you're busy so I understand if you can't answer, but wanted to reach out anyway.

Thanks in advance,

Steve 

  1. Do you still use behavioral techniques?

Dear Dr Burns,

I really appreciate your efforts in this area cognitive behavioral therapy, but your efforts and techniques are so powerful and you use them so efficiently that almost no time you have to use the behavioral part of it as patients seem to be relieved enough with cognitive work.

One thing I am curious about is that if you can't get enough response with cognitive work, and if you have to use the exposure model, and the patient is afraid of exposure because he or she goes into a severe state of anxiety, depersonalization or derealization symptoms and feels like gonna go crazy and lose control, would you still push him or her to the cognitive exposure and are there any risks of it?

Thank you very much.

Jordan 

  1. Should I try to include the E and A of TEAM when trying to crush my negative thoughts on my daily mood log? And how would I do this?

Dr. Burns,

It would be impossible for me to heap sufficient praise over you and your podcasts because I've really gained an intangible amount of benefits and continue to learn something actionable from both on a weekly basis. I'm currently finishing Feeling Good Together and am finding the experience transformative.

I wanted to see if I could ask you a question regarding the Daily Mood Log and crushing negative thoughts. I'm completely on board with the notion of fractal psychotherapy and the idea that all of our negative emotions will be captured in a single negative thought and by crushing it, we will feel substantial relief and even euphoria.

I've been using the Daily Mood Log to inconsistent effect. I write down my negative thoughts, identify the distortions and then identify statements to attack that thought that are 100% true. Perhaps I am rushing through the exercise too quickly, as I try to make it a daily habit. But is it possible I'm missing an element?

I've noticed in your live therapy that you allocate a sizable chunk of time to Empathy and Agenda Setting. Is it possible that the E and A in TEAM's absence in my Daily Mood Log is stunting my progress? Is there a way and should I be implementing both into the exercise?

I would appreciate any input you have on this question and I look forward to continuing to listen to the podcast as new episodes come out, along with your new book and App!

Best regards,

Tommy

Dr. Burns,

Thank you! I’d be happy for you to use my first name. I’ll look out for it in the upcoming podcasts. Have a great rest of the week.

Tommy

  1. Please give us a podcast on how to express anger!

Hey Dr. Burns, I’m loving the podcast, and my favorite podcasts are the Ask David and Live Treatment ones! Also, I can’t wait for the new app and book!

I did have a question, which I can go into more detail if need be. Specifically, what podcasts and book would you recommend for anger? I’m unsure how to express anger in a productive way (in my relationship), and would love more guidance and practice prior to trying to use the 5 secrets “live”. Thanks in advance!

Thanks for listening today, and thanks for all the kind comments and totally awesome questions!

David and Rhonda

Apr 13 2020

47mins

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Corona Cast 4: I Might Lose My Husband!

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David and Rhonda are joined in today’s podcast by Dr. Taylor Chesney, a former student of David’s who is now the head of the Feeling Good Institute of New York City. She is a prominent TEAM-CBT therapist and trainer, and specializes in the treatment of children and teenagers.

Taylor kindly agreed to do some live work today on her panic and despair because of the impact of the pandemic on her family. Her situation is especially challenging and poignant because her husband, Gregg, is a highly esteemed Emergency Room / Intensive Care physician in New York, and he is constantly working to save the lives of Covid-19 victims. Ten days ago he moved to a separate apartment several blocks away so he will not put his wife and children in harm’s way in case he contracts the Covid-19 virus.

But will he, himself, be struck down by this vicious virus? He told Taylor that he recently had to intubate several of his colleagues, which is horrifying. Taylor fears that  she may lose her beloved husband, and that her three children may have to grow up without a father. She also feels overwhelmed because she’s supporting many people now.

David begins with a brief overview of the cognitive model, including several key points:

  1. All negative feelings result from thoughts, and not from what’s actually happening. So even in a crisis that is as real and devastating as the Covid-19 pandemic, all of our emotions will still result from the way we think about it. Remember the teachings of Epictetus 2,000 years ago, when he wrote: “People are disturbed, not by things, but by the views we take of them.”

This is potentially empowering, because we usually cannot change the fact—the pandemic is real and we are powerless to make it disappear—but we may be able to change our perceptions (eg thoughts, or “cognitions”) about what’s happening.

There’s a healthy and an unhealthy version of every kind of negative feeling. For example, healthy fear is not the same as unhealthy anxiety; healthy sadness and grief are not the same as clinical depression; healthy remorse is not the same as neurotic guilt. And so forth. Our goal is not teaching you how to be happy all the time no matter what—that would be absurd—but simply to reduce or eliminate unhealthy negative feelings.

  1. Healthy negative feelings result from valid negative thoughts, and do not have to be “treated.” Unhealthy negative feelings, in contrast, result from negative thoughts that are distorted and illogical. David reminds us that even in a crisis, depression and anxiety are still the world’s oldest cons, and that you CAN change the way you feel.

But is this possible? It just doesn’t sound right! Can Taylor really change the way she thinks and feels when the crisis is so overwhelming and so real? And can you?

As the session unfolds, Taylor tearfully describes her intense fears for her husband, who she loves so greatly, as well as their three young children. She says that 75% of the time, she’s “okay,” when she’s awake and involved with caring for her kids, but 25% of the time—especially late at night when she’s alone with the kids—things get pretty desperate, and sobs for 30 minutes or more while experiencing “sheer terror.”

What’s making the situation more painful is that Gregg is temporarily living six blocks away in order to protect his family in the event he does contract the potentially deadly virus. Taylor says that “it feels like we’re kicking him out. He’s at war. He’s fighting, struggling, suffering.” She says he’s passionate about his work, but she wishes he’d quit!

Take a look at Taylor's  Daily Mood Log at the start of the session. As you can see, she is focusing on how she is feeling every night before going to sleep. She circled seven different categories of negative feelings, and all are intense, including the depression, anxiety and frustration clusters (all are 100%), the lonely and hopeless categories (both 90%), as well as feeling “bad” (50%.)

You can also see the negative thoughts she recorded. She is telling herself that:

Negative Thoughts % Now 1.      I shouldn’t have to do this alone. 90 2.      I can’t handle parenting alone. 70 3.      I shouldn’t burden Gregg with my feelings. 70 4.      I should share my feelings. 50 5.      I should be strong and tough. 80 6.      I’ll let my patients down if I don’t have enough time for them. 50 7.      I’ll lose Gregg. 50 - 100 8.      I shouldn’t have to do this. 100 9.      I should be able to work and support my family while Gregg stays at           home safely. 50

You can also see that her belief in these thoughts varied from 50% to 100%.

After empathizing for 30 minutes, Rhonda and David asked about her goals for the session, which would be to turn down the intensity of her negative feelings. Together, Rhonda, Taylor and David do Positive Reframing, asking two questions about each negative thought and feeling:

  1. What does this negative thought or feeling show about Taylor that’s positive and awesome?
  2. What are some benefits, or advantages, of this negative thought or feeling?

Together, they generate an impressive list of Positives. Then Taylor decides she can use the Magic Dial and reduce her negative feelings, while not eliminating them completely, as you can see at this link.

Then they use a variety of techniques to challenge each negative thought, staring with #4, “I shouldn’t share my feelings.” Taylor identifies many distortions in this thought, including Should Statement, Emotional Reasoning, Mind-Reading, Self-Blame, and Mental Filter.

Taylor decides to think about it like this instead:

“It’s okay to share my feelings. It could bring us closer together. It’s human to be struggling, given the circumstances. My feelings matter to Gregg.”

She believes this Positive Thought 100%, and her belief in the Negative Thought fell to 5%, which was enough, since there was a little truth in the thought. You might have to be thoughtful about the timing of self-disclosure.

Rhonda and David continue to challenge the rest of Taylor’s Negative Thoughts, using a variety of techniques such as the Externalization of Voices, Acceptance Paradox, Paradoxical Double Standard Technique, and more. The most challenging Negative Thought was #7—her fear that Gregg might die.

At the end of the session Taylor recorded a substantial reduction in her negative feelings.

Thanks for tuning in, and please let us know what you thought about today’s program!

Rhonda, Taylor, and David

Apr 09 2020

1hr 36mins

Play

Corona Cast 3: Quieting Conflict / Boosting Love

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My mother won't follow my advice!

David and Rhonda are joined in today’s podcast by Alex Clarke, MD, a former student of David’s who is practicing TEAM therapy at the Feeling Good Institute in Mountain View, California, and by Zeina Halim, a TEAM therapist and student in David’s Tuesday Stanford psychotherapy training group.

In our last two podcasts (Corona Cast 1 and 2) (links) we focused on the impact of the corona crisis on internal feelings like depression, anxiety, panic, hopelessness, and so forth. In this week's Corona Cast 3, we will switch our focus to the impact of the pandemic on personal relationships, using a real example. Zeina was concerned that her mother, aged 72, was not being sufficiently careful about social distancing. Zeina felt panicky because she feared her mother might get the virus and die.

However, Zeina’s mother is very self-reliant and independent, and didn’t take kindly to Zeina’s frequent reminders to do this or do that so as to be safe. They ended up arguing and feeling frustrated with each other.

Perhaps you’ve also run into problems with friends and loved ones because of the corona crisis. When people get confined into close quarters, under conditions of intense stress and uncertainty, clashes are almost inevitable.

When you’re angry with someone , you’ll nearly always be viewing the other person in a distorted way. For example, you may be telling yourself that s/he “should” not think, feel or behave the way he or she is thinking, feeling, or behaving. Of course, this is a classic other-directed “should statement.”

Or you may be telling yourself that the other person is being “stubborn” or “unreasonable” (Labeling; Mind-Reading). Or you may tell yourself that you’re right and the other person is wrong (All-or-Nothing Thinking; Blame). And in most cases, you’ll be telling yourself that the conflict is the other person’s fault and that you’re the innocent victim of his or her bad behavior (Blame.)

These are just a few of the cognitive distortions (link) that fuel conflict. But it’s these distorted thoughts, and NOT what the other person is thinking, feeling, or saying, that actually causes your negative feelings. You are making yourself angry--the other person is NOT causing your anger or frustration! You are creating these feelings. And the thoughts that trigger these feeling are wrong thoughts.

This can be a VERY hard pill to swallow. You, and not the person you're mad at, are triggering your feelings of frustration and anger. In addition, the thoughts that upset you are not valid. They’re distorted, and just plain WRONG.

If you don’t like this message, you might want to stop reading! I get it! It is SO MUCH more rewarding to blame the other person!

In today’s podcast, we discuss and illustrate a sophisticated TEAM-CBT technique called "Forced Empathy" (link). Forced Empathy forces you see things from the perspective of someone you’re at odds with. It will ONLY be effective if you want a closer relationship with the person you’re at odds with. If you want to remain in battle--as most people do--then you're welcome to do that. Go for it.

If, in contrast, you do want to feel closer and more loving, Forced Empathy can lead to a helpful shift in how you think about the person you’re angry with. When you suddenly see things through the eyes of the person you're angry with, you may suddenly discover that your thoughts about the other person’s motives were not correct.

Alex and David describe how the technique works in a step-by-step way, and then illustrate it with a role-play between Zeina and her mother. This is a recreation of the technique they used live in the Stanford Tuesday group a couple weeks before the recording.

Forced Empathy proved to be extraordinarily helpful to Zeina, and brought tears to her eyes. Once she saw things from her mother’s perspective, the tone of their interactions suddenly softened, and the tension was replaced by feelings of love and acceptance.

Zeina was surprised to discover that, among other things, her mother, while not wanting to die, had no fear of death, but didn’t appreciate being constantly told what to do, or what not to do, and that she loved and admired Zeina tremendously.

Zeina also discovered that in the highly unlikely event that her mother did die, she would want to spend her last days or weeks with her Zeina, feeling close, and loving one another, instead of arguing.

Is this relevant to you and your friends and loved ones? In today’s podcast, we talk about how you can improve your relationships with friends and loved ones during these challenging times using the Five Secrets of Effective Communication.

We emphasized one of the important take home messages in podcast 164 on "How to Help, and How NOT to Help." Sometimes, people just want someone to care about them and listen, without having someone trying to help them or give them advice. Learning to do this can be incredibly freeing, but it’s not easy, because so many of us are addicted to “helping.”

If you want some additional help, check out David’s book, Feeling Good Together.

Thanks for tuning in, and let us know what you thought about today’s program!

Until next time,

Rhonda, Alex, Zeina, and David

Apr 06 2020

48mins

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Corona Cast 2: Is this the "New Normal?"

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With the "Shelter in Place" orders in California, we are recording these podcasts from our homes instead of from the Murietta Studios.  The sound quality may not be as high as usual while we are learning to use the new technology. (I apologize for the echo in this week's podcast. It won't be there again-Rhonda) Let us know what you think!  Thank you, David & Rhonda

David and Rhonda are joined again in today’s podcast by Jeremy Karmel, who is working with David on the new Feeling Great app. In our first Corona Cast, we promised to present an example of how TEAM-CBT can be helpful for individuals who feel depressed and anxious about the personal impact of the pandemic.

Rhonda kick starts today’s session by describing her treatment with a patient we're calling Alice just a few days ago. Alice woke up feeling stressed and having trouble settling in and getting to work. If you click here, you can see how she filled out the first few steps of the Daily Mood Log just before the start of her session with Rhonda.

The Upsetting Event was simply waking up and feeling out of sorts. She circled and rated her negative emotions, which were fairly intense, especially the feelings of depression, anxiety, inadequacy, despair, frustration. Her anxiety was only minimal, but she was also feeling tremendously "jittery."

Why was Alice feeling so upset? Her feelings didn't result from the corona virus epidemic, but from her thoughts about it. As you can see, she was telling herself:

1.      This could be the new normal. 2.      My life is going to waste. 3.      I should be handling this better. 4.      I could catch the virus and die. 5.      No one is in charge.

She strongly believed all of these thoughts except #4, which she only believed 40%. You may recall that in order to feel upset, two things must be true:

  1. You must have one or more negative thoughts on your mind.
  2. You must strongly believe these thoughts.

How are we going to help Alice? In the old days, I would have jumped right in to help Alice challenge her Negative Thoughts, but now we have a far more powerful and systematic approach called TEAM-CBT, as most podcast fans probably already know!

These are the four steps of TEAM-CBT:

T = Testing. Rhonda tested how Alice was feeling at the start and end of the session.

E = Empathy. Rhonda provided warmth and support without trying to "help" or "cheer-lead."

A = Assessment of Resistance. This is one of the unique aspects of TEAM-CBT, and it's the secret of ultra-rapid recovery. Rhonda used the Miracle Cure Question, Magic Button, Positive Reframing, and Magic Dial to bring Alice's "resistance" to change to conscious awareness, then quickly reduced it before trying to "help."

M = Methods. Rhonda helped Alice identify the many cognitive distortions in her thoughts. For example, her first Negative Thought, "This could be the new normal," was an example of All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Fortune Telling, and Emotional Reasoning.

The goal of the M = Methods phase is to crush the Negative Thoughts that  are upsetting you. Do you know how to do this? You have to come up with a Positive Thought that has two characteristics:

  1. It must be 100% true. Positive affirmations and rationalizations and half truths are worthless. Cognitive therapy is based on the Biblical idea the "The truth shall set you free."
  2. The Positive Thought must drastically reduce your belief in the Negative Thought you've recorded on your Daily Mood Log, and ideally your belief in it will go all the way to zero.

In fact, the very instant you stop believing the Negative Thought, your feelings will change, and often quite dramatically.

Rhonda helped Alice challenge her Negative thoughts with a powerful technique called the Externalization of Voices. For example, Alice was telling herself that "I should be handling this better" because she'd been having trouble adjusting to the home isolation and had been procrastinating instead of focusing on her writing, and she was also telling herself that "My life is going to waste," thinking she'd be procrastinating and feeling miserable forever: "The new normal."

The Positive Thought that crushed it was, "I have a lot of experience as a self-starter, and I've got eight weeks of free time now to write, which is pretty awesome. In addition, I can give myself a break, instead of putting myself down, and give myself a little to regroup!"

After all, there are hundreds of millions of people around the world who are feeling isolated and in distress, and probably most of them aren't being nearly as productive as they usually are, but clearly, that isn't going to go on forever! Instead of putting yourself down, you can give yourself some support and encouragement, in exactly the same way you might talk to a dear friend.

Once Alice crushed her Negative Thoughts with strong Positive Thoughts, her feelings suddenly changed. Although the session was only one hour long, Alice experienced incredible improvements in how she felt, thanks to Rhonda's compassion and skillful guidance. Alice's depression went from 95 to 5, and her anxiety dropped from 95 all the way to zero. The rest of her negative feelings dropped to very low levels or zero as well.

Did it last? Long-term follow-up isn't possible for such a recent session, but she did call Rhonda the next morning to say that she woke up Feeling Great . . . which is the name of my new book, due for release in September. You can see the cover below! If you want, pre-ordering on Amazon may be available by the time you hear this podcast.

In next week's Corona Cast 3, we will switch our focus to the impact of the pandemic on personal relationships, using a real example of a young woman named Zeina who felt her mother, aged 72, was not being sufficiently careful about social distancing. Zeina felt panicky because she feared her mother would get the virus and die.

They ended up arguing and feeling frustrated with each other. We will illustrate a sophisticated TEAM-CBT technique called "Forced Empathy" that brought tears to Zeina's eyes, and we'll also talk to you about how you can improve your relationships with friends and loved ones as well during these challenging times.

Thanks for tuning in, and let us know what you thought about today’s program!

Until next time,

Rhonda, Jeremy, and David

Mar 30 2020

48mins

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Thank you

By jessicabarrett - Apr 23 2020
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This podcast has helped me so much with my anxiety and depression.

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 🙏!