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

Ask David, Rhonda and Matt Assertiveness, Suppressing your Feelings, and the "Miracle Cure" question Questions for today’s Ask David podcast.

Chris asks if I have a book about assertiveness. Brian asks: Is there anything to the theory that "suppressing emotions" is harmful or is that just Freudian mumbo jumbo? Matt asks about the “Miracle Cure” question in the Assessment of Resistance portion of a TEAM therapy session.

Rhonda began with a lovely endorsement and a cool reminder of the classic book, Robinson Crusoe, who created cognitive therapy (the double column technique) when he was stranded on a deserted island! I believe I wrote about it in one of my books, possibly Feeling Good. It’s pretty cool! You will hear Matt playing the role of the “evil” thoughts, like, “I am stranded alone on a deserted island,” and Rhonda will play the role of the “good” thoughts, like, “Yes, but my life was spared, and all of my shipmates died.”

Here's what it looks like in the novel:

I know this novel is a couple hundred years old, so it certainly deserves nomination of the earliest cognitive therapy!

Now, for the answers to today’s Ask David questions. Keep in mind that these answers were written BEFORE today’s recording, so the actual live answers will differ in some regards from the written answers below.

Hi Dr. Burns,

I hope you're doing well. Do you have a book on assertiveness training?

I've used your books to help me with my hidden "should" statements, which has enabled me to be less angry or anxious whenever someone treats me less than satisfactorily.

While this has helped immensely, I realize it's still in my interest to reduce the behavior I disagree with. For example, my sibling scheduled an early morning shift after I had a long day of work. Because they can't drive, they expect me to take them to work, which means I'll only get about 5 hours of sleep; this in itself isn't a bad thing... except this is the 3rd time in a row they've done this.

After using your techniques, I'm less angry and anxious, but I still want to address the behavior to reduce the likelihood that they do something like this again, which is why I'm reaching out.

Thanks for your help.

Kind regards,

Chris

David’s Reply

Sure. I like my own book, Feeling Good Together, and have often recommended Manuel Smith’s When I Say NO I Feel Guilty.

There is a LOT to be said about assertiveness training, including the fact that it doesn’t always work! I can give a great personal account of that!

Sometimes, or always, skillful listening is also effective. Assertiveness without listening makes it sound like only your own feelings are important, which is obviously pretty self-centered.

One of the most helpful things to me is the difference between healthy and unhealthy anger, and how to express tough messages in a loving, respectful way.

Can discuss more on the show. For example, what are the problems with the assertiveness movement? And where can it be helpful?

And what mistakes do unassertive individuals make when trying to be more assertive? Do they sometimes overdo it?

Warmly, david

David’s reply.

Thanks, Brian. Great question!

You can listen to the podcasts on the Hidden Emotion Technique, or read about it in my book, When Panic Attacks.

Will make this an Ask David question if that’s okay!

Hi David,

I've noticed that when I ask the 'miracle cure' question or 'magic wand' question, I'll sometimes get a response that isn't all that useful and I might waste time trying to figure out what the person is really asking for.

An example might be, 'I want to be able to support and understand my husband, who is addicted to video games and spends a lot of our money on games'.

I've found it helpful, in such situations, to ask, 'let's imagine you could achieve that goal, you were perfectly understanding and supportive, at all times, of your husband, who is addicted to video games and spends a lot of your money on games...what would change, in your life, if all your dreams came true?'

I think this might help in a lot of cases where the agenda is a bit fuzzy and unclear.

Wishing you the best!

Matt

David’s response

Matt and I exchanged several emails we’ll discuss on the podcast. Essentially, I don’t think this woman is asking for understanding why her husband is addicted to video games and spends money on them. Instead, she is secretly blaming him and is probably angry with him for not spending time with her! She wants to change him.

Matt agreed with this and has proposed a new tool therapists can use when setting the agenda.

I, David, also raised the problem of “hearing the music” behind the patient’s words. This is incredibly important—but hard for therapists to learn—when using the Disarming Technique. They have a tendency to agree with the patient’s words in a literal way without “hearing” what the patient is really trying to say.

If you use any form of therapy literally, with really grasping the patient’s feelings, your treatment will not be effective or helpful. There is a human art to therapy, and following rigid formulas simply won’t come across as compassionate or genuine most of the time.

That’s why I am dubious about testing different therapies with outcome studies with human therapists. You are actually testing the impact of a miscellaneous group of therapists with potentially widely divergent skill sets. This is one of the many reasons why psychotherapy outcome studies for depression all come out about the same—somewhat better than placebos, but not much better.

And there’s been no one winner when using human therapists.

Dr. Paul Crits-Christoph from the University of Pennsylvania Department of Psychology once published a study showing that the differences between therapists within each arm of an outcome study were grater than the differences between the two schools of therapy!

That’s why I’ve been so excited about analyzing data from our beta tests with the Feeling Great App. Each “patient” gets the exact same shrink! This makes the “dose” of the TEAM done by the computer the same for each patient, much like an outcome study of a medication.

TEAM is a actually series of metaphors! If you don’t “get” the metaphors, and try to apply TEAM in an overly literal way, you’ll have a lot of trouble learning TEAM!

David

Matt’s Musings:

David is incredibly gifted when it comes to ‘hearing the music’ behind what folks are saying, verbally. I suspect this is partially an innate gift, like someone who’s a prodigy at math, only for emotional states and understanding people.

After years of practice, I’m not quite as good as David. However, I think there were specific forms of experience that helped me improve my skill ‘hearing the music’.

In addition to using measurement and processing feedback with my patients, one thing that helped me a lot was using a lot of ‘uncovering techniques’. These include the ‘What If’ technique, to expose hidden fears, the ‘Individual Downward Arrow’, to expose hidden insecurities, the ‘Interpersonal Downward Arrow’, to expose hidden assumptions about how we ‘should’ act in our relationships.

Seeing several thousand of these has helped me with ‘pattern recognition’, which I think is related to ‘hearing the music’. I’m proposing that beginning therapists might also benefit from an ‘Uncovering Technique’ for agenda-setting, following the ‘Miracle Cure Question’, which keeps asking, ok, let’s say you got that, what would you hope for, if you got absolutely everything you wanted? Ok, and let’s say you also got that, what would you hope for, in your wildest dreams?

This might expose hidden agendas which can be super important if we want to be able to anticipate resistance and identify the ‘cost of recovery’.

Thanks for listening today!

Rhonda, Matt, and David

Incredible Voices from the Past! Plus: David's Amazing Summer Intensive Returns August 8 - 11, 2024

Today, David and Rhonda are joined by Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mountain View, California, and two incredible voices from the past: Dr. Karen Radella, a clinical psychologist who volunteered to do personal work at the 2013 summer intensive at the South San Francisco Conference Center, and Jacqueline Ong, LCSW, who volunteered to do personal work at the 2019 summer intensive. That was the last summer intensive, due primarily to the Covid pandemic.

Karen Radella, PhD

But here’s some fantastic news. The intensive returns again this summer, from August 8 to 11, 2024, at the same location. And Karen and Jacqueline give testimonial today, along with Rhonda, to the magic of the intensive, by describing the phenomenal impact of the personal work they did years ago, and the tremendous impact that work has had on their personal and professional lives.

Both Karen and Jacqueline had been suffering from the devastating emotional impact of severe personal trauma for many years. Nine years earlier, when Karen’s daughter was 12, she asked Karen if she could go out to play after dinner. She’d done this for years, but Karen had the thought that it was late and cold outside, but gave in and let her daughter go out to play.

Minutes later, some neighborhood boys snuck up on her and shot her in the mouth with a high-powered pellet rifle that blew out one of her teeth and did considerable damage to her mouth which triggered PTSD and required many dental surgeries to correct. Both Karen and her daughter had been suffering emotionally for the nine years since that incident.

Karen was telling herself that she was a bad mom, that she “shouldn’t have” let her go out to play on that particular night, and that her daughter’s horrific trauma was her fault. She was also convinced that other people, including the 100+ in the audience that evening, would be judging her as harshly as she was judging herself, and her feelings of fear and despair were palpable at the start of her live work.

Karen described the techniques that were so helpful to her in her fantastic recovery that evening during her two hour session with Jill and David, including the Survey Technique, which she said was the “coolest experience of my entire life.” She was also helped by other techniques, including Explain the Distortions, the Double Standard Technique, and the Externalization of Voices.

Jacqueline had suffered a different but equally severe traumatic event of a personal nature, but also disclosed it and worked it through with great courage in front of an audience of the same size in 2019. Like Karen, she experienced a complete elimination of her symptoms in the 2 hour session with Jill and David. She describe the keys to her suffering and recovery involved perfectionism (the need to be flawless) and perceived perfectionism (a term David coined that refers to the belief that others expect us to be perfect in order to be loved and respected.)

Jacqueline emphasized that “failing as fast as you can” is one of the keys to the rapid recovery we so often see in TEAM. Instead of meeting once a week for an hour, which sets you up for very slow progress with relapses between sessions, you use technique after technique in one session until you find the one that works.

Of course, following “recovery,” your negative thoughts will return over and over throughout your life, because no one is entitled to be—or would even want to be—happy all the time. But once you’ve experienced your own enlightenment, you know the tools that work for you, so you get better and better at heading off the relapses at the pass.

Jacqueline and Karen both said they’d heard that the personal work at an intensive can be life-changing, but they “wouldn’t have believed it” until they experienced it. Rhonda said,

“I saw both live demonstrations. My first intensive was also the 2013 intensive when Karen did her personal work and saw Jackie's work at the 2019 intensive. I cried my eyes out with both of you at those intensives. After watching David and Jill's personal work with Karen at the 2013 intensive, I decided that TEAM was the therapeutic method I wanted to learn, and that’s why I’ve dedicated my life to learning, practicing and teaching TEAM.”

David, Jill and Rhonda hope YOU can attend the magical intensive this year. To learn more, you can just go to www.CBTintensive.com. This year you can attend in person OR online, since the program will be live-streamed.

In the past, David has done all the teaching, but this year, David and Jill will do their dynamic “tag team” teaching made famous by their weekly free training group at Stanford. It is now online and is free for therapists around the world. It is Tuesdays from 5 to 7 PM west coast time. If you are interested in joining, contact Ed Walton, edwalton100@gmail.com.

You could also join Rhonda’s Wednesday TEAM training group that meets over zoom from 9-11:00 am. The timing of this group is more convenient for therapists from many parts of the globe. If you are interested in the Wednesday group, please contact Ana Teresa Silva, ateresasilva6@gmail.com.

We hope to see you on August 8 at the South San Francisco Conference Center. But move fast if you want to attend in person, since seating will be strictly limited for those who wish to attend in person.

Best, rhonda, jill and david

Thanks for listening today!

Ask David, Rhonda and Matt More on Insomnia; Porn Addiction Guilt; Rage Questions for today

James asks for help with insomnia. Arjun Asks: How can I stop blaming myself for my porn addiction as a teen? Stephan asks: How do you treat feelings of rage? And what if you are simply very angry, but you don’t have any thoughts?

James asks for help with insomnia,

Hi Dr. Burns,

I enjoy your newsletter and have experienced moments of clarity with your book. However, my current struggle is that I have developed terrible sleep anxiety. I feel nervous tension in my stomach and trembling limbs as nighttime approaches. Some nights I can put these feelings aside and dose off and others I just cannot stop dwelling on the negative body sensations and it does not allow me to sleep. I wonder if you can offer some advice on how to get over this fear and accompanying sensations.

Best,

James

David’s reply

Thanks, James. Sorry you’re struggling with trouble sleeping.

Yes, a Daily Mood Log can help, to find out what you are telling yourself that makes you so anxious about not sleeping.

Also, the Hidden Emotion Technique may be important to find out if there’s a problem in your life that’s bugging you.

There are also the typical sleep hygiene tips that can be useful for some folks, too! You can find these with an internet search.

Can I use this as an Ask David question for a podcast, with your first name or a fake name?

Best, david

Arjun Asks: How can I stop blaming myself for my porn addiction as a teen?

Hi Rhonda,

I Really appreciate the work that you guys do and I listen to most of the feeling good podcasts. I'm 27 and have struggled with depression and anxiety since my teens. I'm currently in therapy with a TEAM certified professional from India, but I'm still grappling with feelings of being stuck in my past.

During my pre-teen years, I battled a porn addiction for about a year, which has left me with ongoing feelings of anxiety, guilt, and depression. Despite trying various therapies, I haven't found relief.

I keep fixating on the thought: "I shouldn't have indulged in porn addiction in the past. It's led me to develop anxiety and depression."

How do I debunk this thought, reduce its hold on me, and cope with the regret it brings? It feels like I'm trapped in my past. and constantly blaming myself for that one mistake. because that indulgence in porn really did change my life. I wasn't the same as before. and never could go back to being who I was.

How do I put the lie to this thought? Any methods you'd recommend putting in the recovery circle?

Your insights would be invaluable in helping me move forward.

Thank you,

Arjun

David’s reply: The key concept is that the problem is perfectionism, plus the beating up on yourself in the here and now, and not the behavior or misbehavior in your past. In the live podcast, we can discuss the importance of T = Testing (with DML), E = Empathy and A = Assessment of Resistance, and M = Methods, like explain the distortions, Perfectionism / Self-Blame CBA, D. Standard, EOR, EOV, etc. etc.

The issue, as I see it, is that you are looking for a technique to help you accept yourself, but in reality, it is a decision for you to make. The choice is to accept yourself with compassion or continue to beat up on yourself.

There are many really GOOD reasons to beat up on yourself, and we can perhaps outline some on the podcast. You would then have to explain why you’d really want to accept yourself, given all the good reasons to keep beating up on yourself, and given all the positive things your self-criticisms show about you.

Also, I will try to remember to tell one of my favorite Buddhist stories that relates to this problem.

Stephan asks: How do treat feelings of rage? And what if you are simply very angry, but you don’t have any thoughts?

Hello Mr. Burns, I hope this email finds you in good spirits.

I’ve just begun your book “Feeling Good” and I have just reached the point where you begin to speak about cognitive distortions and how to get over your thinking. I’ve been doing your exercise on the days that my thoughts are heavily saturated in my mind and I’ve realized something within doing this exercise.

A lot of my thoughts do focus on the cognitive distortions that you’ve outlined in your book, but the other 75% of my thoughts focus on pure trauma of past situations and experiences that channels pure hate, anger and rage that pours out of my thoughts about the past situations. For example, one situation was someone purely scamming and taking advantage of me for years. And while doing your exercise, my hate and rage for that situation really comes out to where I wrote down “F*** that stupid a** b***** I hope she continues through her life being scammed as the fraud she is”.

A lot of my thoughts surround things like this with situation that I’ve been in. Or another example “This stupid a** girl gonna be married and divorced five times before I get married once And I went the wrong path. Ha.” Most of my thoughts are like this surrounded past relationships, friendships, and coworkers. And honestly, I don’t think it has anything to do with the list of cognitive distortions that you’ve provided. Not saying that I don’t have those thoughts, but the majority of my thoughts surround different topics.

I would love your input in your thoughts on what is going on in my head, and possibly even the name to the type of cognitive distortion, that these thoughts could fall under, if any. In the meantime, I will continue reading your book. Hopefully the answer is in there, but if not, I graciously await your response and I also thank you for your time.

Best regards, Stephan

David’s reply

Hi Stephan,

Anger always results from thoughts, and those thoughts are often extremely distorted. This thought, for example, contains Labeling, and many other distortions: “F*** that stupid a** b*****

Sorry you’ve been taken advantage of by someone acting fraudulently and scamming you, as I understand from your note. Anger is totally understandable. The first treatment tool would be a paradoxical Cost-Benefit Analysis, which we could illustrate on a podcast, if you are interested. Your questions touch on many important topics!

Best, david

Matt’s Reply

Thanks for the question, Stephan, like David is saying, getting out of rage and into peace and harmony, which is part of ‘enlightenment’, requires identifying the motivational elements that are pushing you away from, as well as pulling you into, that emotion.

For example, David has identified, over 30 Good Reasons to Blame Others and has a handout on this.

Here's an example of a reason to keep rage: You’ll be protected, from being taken advantage of, again, if that person is labeled as ‘bad’. This keeps them, and others like them, at a distance.

Another motivator for rage is that revenge fantasies can be pleasant, feel powerful, just, and gives us a sense of moral superiority.

Also, sometimes we’re not quite ready to just ‘let go’ and ‘move on.’ There might be things we really liked about the relationship that we don’t want to lose and we might not want to grieve the loss of that person, or the loss of our own time. We want our time back and for them to change!

Lots of other good reasons, again there’s a list of 30 Good Reasons to Blame, created by David.

Please bear in mind that rage can get you into lots of trouble, so if you’re at risk of acting out your anger, it’s a good idea to get professional help, not something we can provide, here.

Thanks for listening today!

Rhonda, Matt, and David

Featured photo is Dr. Jacob Towery Report on the 2nd Annual Social Anxiety Marathon Finding Humans Less Scary 2.0 Led by Jacob Towery, MD  (above) and   Michael Luo, MD (below)

Today, Drs. Jacob Towery and Michael Luo report on the second annual “Finding Humans Less Scary” 2-day marathon in March of this year.

As you all know, I am partial to offering valuable experiences for therapists and the general public for free, and my website (feelinggood.com) and life are focused pretty strongly on this goal, although I realize it isn’t always possible since we all have to support ourselves and our families. That’s why Rhonda and I are so proud of our colleagues, Jacob and Michel, who have now completed their second annual social anxiety marathon, which was open to therapists and the general public alike—in fact anyone struggling with shyness, public speaking anxiety, and other forms of social anxiety.

And the total cost of admission both years had been a simple, $20 tax-deductible contribution to one of the charities listed on the FHLS website. That’s pretty darn cool, since the leaders are among the world’s top experts in the treatment of social anxiety, and there were, in addition, numerous highly trained TEAM therapists providing small group supervision and mentoring as well!

They described a number of highlights from the event, including group exercises, both within the auditorium and also outside, on the streets of Palo Alto, doing exercises designed to help participants overcome fears and build feelings of confidence and self-esteem, including, but not limited to:

And many more

Michael explained that the program was sold out, and that participants came from a wide variety of backgrounds, and many had life-change experiences. Many provided testimonials on what the experience meant to them, including:

“I grew as a person and experienced a dramatic increase in vulnerability and genuineness in my interactions with others.”

“My son attended Jacob Towery's two-day social anxiety workshop, Finding Humans Less Scary, and found it life changing. He asked me to come along for moral support, which meant I witnessed the transformation in real time. I have never seen anything like it in my life! Quite literally, one person went into the conference room that morning and a different person came out at the end of the day. He was elated. He met amazing people and had transformational conversations. He walked down the street hooting like a bird. He looked and acted like he had thrown off some old moldy coat.

“Day two seemed to deepen and solidify the gains. On our drive home he taught me what he had learned (I got some trickle down wisdom!) and he was able to trace how the roots of his social anxiety got started and grew. He reflected on the fact that some people in the room were nearly 70, and that he felt lucky to be learning this stuff at 23.

“I can highly recommend this experience to other people who are struggling with social anxiety and want to try a novel approach to breaking the pattern.”

I’m of the belief that, in a sense, we’re all one. That means that you can’t bring joy to another person without bringing joy to yourself. And Jacob and Michael both seemed to be on a high from their efforts to touch so many people.

If you’re also excited, make sure you register next year well ahead of time so you, too, can have this life-transforming experience, which is (almost) totally free!

Thank you for listening today!

Rhonda and David

393 Marina Dyck on TEAM for Insomnia

Today we feature Marina Dyck, a TEAM-Certified Clinical Counselor in private practices in Swift Current, Saskatchewan, Canada. She works with individuals and families struggling with trauma, anxiety, depression, and relationship issues. She combines the latest research in neuroscience, powered by TEAM-CBT, and what she calls the "whole person" approach.

Marina describes her innovative TEAM-CBT treatment for patients with trouble sleeping. Many of them toss and turn at night, unable to turn off their anxious and agitated brains, so they ruminate over and over about problems that are bugging them. Sound familiar?

Here’s David’s quick, step by step overview of Marina's treatment approach, which is based on the steps of TEAM and the Daily Mood Log.

Step 1. Let’s imagine you’re the patient (or the shrink), so you start with a brief description of the Upsetting Event at the top of the Daily Mood Log. It could be something as simple as ”Lying in bed for several hours, unable to get to sleep because I keep ruminating about a report I have not finished for work,” or some other problem.

Step 2. Identify your negative feelings and estimate how intense each one is on a scale from 0 (not at all) to 100 (the worst.) For example, you may be feeling:

Sad, down: 80% Anxious, panicky: 95% Guilty, ashamed: 70% Inadequate, incompetent, inferior: 90% Alone: 100% Discouraged: 80% Frustrated: 95% Angry, annoyed: 100%

Step 3: Record your negative thoughts and how strongly you believe each one from 0% to 100%. For example, you may be telling yourself:

I have to get to sleep! 100% If I don’t get to sleep, I’ll never be able to function tomorrow. 90% I should have completed my report for my boss today. 100% I should get out of bed and work on it. 90% There must be something wrong with me. 100% etc. etc.

Step 4. Identify the distortions in these thoughts, like All-or-Nothing Thinking, Fortune-Telling, Should Statements, Emotional Reasoning, Magnification, and more.

Now, if you’re a shrink, after you’ve empathized, do the A = Paradoxical Agenda Setting or Assessment of Resistance. If you’re a general citizen, you can do Positive Reframing. In other words, instead of trying to make your negative thoughts and feeling disappear entirely by pushing the Magic Button, you can ask two questions about each negative thought (NT) or feeling:

How might this NT or feeling be helping me? What does this NT or feeling show about me and my core values that’s positive and awesome?

Example. In the current example you are 95% anxious and panicky about your report for work as well as the fact that you can’t relax and fall asleep. Could there be some positives in your anxiety and panic? For example, these feelings might show

Your intense commitment to your work. They may be a reflection of your high standards. Your anxiety, while uncomfortable, has probably motivated you to work hard and achieve a great deal. Your anxiety may protect you from danger and keep you focused on what you have to do to succeed and survive. Your anxiety could be an expression of your respect for your boss and for the company you’re working for. Your desire to do a good job is probably a reflection of one of your core values as a human being.

You could make similar lists for other feelings as well, like feeling down, guilty, discouraged, angry, and so forth.

At that point, you can set your goals for every negative feeling.

For example, you might decide that 15% or 20% might be enough anxiety and panic, and that 15% shame would be enough, and so forth. You can record your goals for each negative feeling in the goal column of your Daily Mood Log.

This is much easier than if you try to reduce them all to zero by pressing the Magic Button. And even if you could, then all of the positives you listed would go down the drain, right along with your negative thoughts and feelings.

Instead, you can aim to reduce them to some lower level that would allow you to relax while still maintaining your core personal values.

Now we’re ready for the M = Methods portion of the TEAM session.

You will enjoy this portion of the podcast. Marina led Rhonda in three classic TEAM methods: The Paradoxical Double Standard Technique, the Externalization of Voices, and something Marina calls Distraction Training, which is actually a mix of Image Substitution, self-hypnosis, and relaxation training. Essentially, you focus on something positive and relaxing, as opposed to ruminating about all you have to do.

This approach will come to life when you listen to the podcast, and I think you will agree that it IS innovative and significantly different and from 99% of what is currently sold as “insomnia treatment!”

Marina emphasizes that you, the client, will have to agree to spend 15 to 20 minutes per day doing written work with the Daily Mood Log, or all bets are off.

In addition, I would like to add that you and your shrink (or you and your patient) will have to find effective ways to combat each patient’s ruminations and negative thoughts, because we’re all quite different and our problems will usually be unique. In fact, that’s why I (David) have created way more than 100 methods for challenging distorted thoughts.

But here’s the basic idea: When you learn to CHANGE the way you THINK, you can CHANGE the way you FEEL as well as the way you SLEEP!

Thanks so much for listening today, and happy dreams!

Marina, Rhonda and David

392 The Empty Nest Cure Featuring Jill Levitt, PhD

Today we are proud to feature our beloved Dr. Jill Levitt. Jill is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California, and co-leader of my Tuesday evening psychotherapy training group at Stanford. She is a dear friend, and one of the world’s top psychotherapists and psychotherapy teachers.

Today, Jill joins us to discuss the so-called “Empty Nest” syndrome. According to Wikipedia, this is the “feeling of grief and loneliness parents may feel when their children move out of the family home, such as to live on their own or to pursue a higher education.“

Jill emailed Rhonda and me to explain why she thought a podcast on this topic might be of some value. She wrote,

Recently, I was working with two different women around the same age who were having similar feelings of guilt and shame about the choices they made around parenting versus working.

Jane is a 60 year old high level executive with two boys who was super successful and is now retired. She is telling herself, “

Stephanie, in contrast, is a 60 year old stay-at-home mom of four adult kids, and now that her last kid has left for college, she is telling herself:

Jane and Stephanie both struggled with feelings of guilt, shame, sadness and inferiority, and they were both telling themselves that they should have made different choices.

I’m sure your life is very different from their lives, but you may have also looked in to the past and beaten up on yourself for what you should or shouldn’t have done. Or, you may be beating up on yourself right now with shoulds, telling yourself that you should be better, or smarter or more successful or popular than you are.

In fact, according to the late Dr. Albert Ellis, these “Should Statements” are responsible for most of the suffering in the world, and there are several different types, including:

I’m sure you can see that both women were struggling with Self-Directed Shoulds. What can you do about these shoulds and the unhappiness they trigger?

Jill explains how both women experienced rapid recovery when she used simple TEAM methods systematically, including empathy and Positive Reframing as well as other basic techniques like the Double Standard Technique and the Externalization of Voices, and more.

I, David, then described a woman he treated who fell into a depression when her two daughters went off to college. And she was perplexed, because she’d always had a super loving relationship with them, just as she’d had with her own mother when she was growing up.

When I explored this with her, a Hidden Emotion suddenly emerged, as you’ll hear on the podcast, and that also led to a complete recovery in just two sessions.

Then Jill had a sudden “eureka” moment and realized that the Hidden emotion phenomenon was also central to the anxiety that one of her two patients was experiencing.

One of the neat things I (David) really like about TEAM is that we don’t treat people with formulas for “disorders” or “syndromes.” These three woman all had the same “Empty Nest Syndrome,” but the causes and the cures for all of them were unique, as you’ll understand when you listen to this podcast.

Our 400th podcast is coming up soon, and we want to thank all of you in advance for your support and encouragement over the past several years, which we all DEEPLY appreciate! We’ll be joined by a number of our podcast stars from the past 100 shows, as well as our beloved founder, Dr. Fabrice Nye!

And we have one VERY special event coming up this summer that might interest you if you’re a shrink. I (David) have done very few workshops over the past five years because of the pandemic as well as the intensive demands of developing our Feeling Great App which will be available soon.

The most fantastic work of the year was always the summer intensive at the South San Francisco Conference Center. Well, guess what! We’re bringing it back this year. The dates will be August DATES, and it will have the same magic it has always had, but with some cool innovations.

It will be Thursday to Sunday noon, 3 ½ days instead of four, but it will include two fantastic evening sessions, so you will get a MASSIVE amount of teaching. It will be sponsored by the Feeling Good Institute in Mountain View for the first time, Jill and I will teach together, just as we do in the Tuesday group. Of course, Rhonda will be hosting the event as well! There will be many expert helpers from the FGI to assist you in the small group exercises throughout, so you will LEARN from actual practice with immediate expert mentoring and feedback. There will be a live demonstration with an audience volunteer, as in earlier years, plus your chance to do live work in small groups on the evening of the third day. This is always the top rated event during the intensive. You can attend in person if you move fast (seating will be limited to around 100 or so) or online (for half price or so.) That will give people from around the world the chance to attend without the extra cost and time to come in person. The online people will have leaders guiding you in the same exercises we will do with the in-person group. You’ll get intensive TEAM training in the high-speed treatment of depression and anxiety, so you can really “get it” all at once and see how all the pieces of this amazing approach fit together. You’ll also have the chance to do your own personal work and healing, which is arguably the most important dimension of professional training. There’s a whole lot more but I’m running out of steam.

Here are the details:

 Rhonda, Jill, and I hope to see you there!

And thanks for listening today!

Evolution of TEAM from CBT Porn Compulsive Liars Angry Patients Who Resist Where's the App? and More!

Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda, Matt and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers!

Today's live discussion was especially fun and lively, so make sure you listen to the actual live podcast.

Questions for this Ask David Podcast

Stan asks if any of my early methods have been abandoned by newer and more effective methods as CBT evolved into TEAM. Stan asks if mild porn is harmful or helpful. Rima ask how you can deal with compulsive liars. Pretika asks what to do with patients who angrily resist positive reframing. Anonymous asks several questions about the Feeling Great App.

Hi David.

I read in the eBook (I think it was) that you have radically changed your approach and have many new methods for Habits and Addictions.

I actually have many of your books such as:

I wonder if you could please tell us in one of your Ask David podcasts which methods described in your earlier books you no longer recommend, because they have been superseded by more effective ones described in Feeling Great for example. I am sure there must be a lot of material that is still valid in those earlier books and which is not mentioned in Feeling Great. It would be great to know which ones you no longer recommend for the general public.

I also want to ask you about Porn Addiction. Do you think occasional mild porn use is harmful or beneficial?

I read in a BBC article that porn probably isn’t harmful for most men, and can even be positive for couples. For example, some couples start to engage in oral sex after seeing it on the internet. Porn seems a bit like alcohol, if you abuse it it will be bad for your health but if you don’t go for the strong stuff and don’t over use it, it could be OK. I think some people might misinterpret your references to porn addiction as being any kind and intensity of porn use.  Maybe these people feel anxious and shameful for using it as a result. I would welcome your clarification on this issue.

Finally, even though I know you have heard it thousands, or hundreds of thousands of times, your work is having a really positive effect on my life. I am truly grateful for all that you do.

Thank you, David.

Warm regards

Stan

David’s Reply

Hi Stan, I can turn this into a couple Ask David questions for the podcast if you like.

There have been many upgrades of the therapy ideas and techniques over the years, as we develop greater understanding of how people change, and what works and what tends not to work. In addition, I would say that we develop new methods and ideas on a weekly basis. The TEAM models lends itself very nicely to evolution, perhaps one of the strong points.

I can speak in more detail on the podcast, but here are two ideas. First, I have come to appreciate more and more that all change in emotions comes from a reduction in belief in the negative thoughts that trigger negative feelings with few, if any, exceptions. In addition, any reduction in belief in negative thoughts will case an immediate reduction in the negative feelings that thought causes.

This insight angers many people who don’t really “get” it, so I don’t push it. I find that people sometimes do not take kindly to statements that challenge their sacred beliefs. A simple example would be jogging, or aerobic exercise. Some people believe on faith or personal experience that exercise has a mood elevating effect due to release of endogenous “endorphins” in the brain, and many even claim that exercise is the most effective antidepressant known.

While some people do experience a mood lift after strenuous exercise, I believe this is due to the change in their thoughts, telling themselves and believing that this is going to be good for the health and outlook. So that thought can have potent effects on mood. I can describe some experiments on exercise and mood.

Second, I have tilted much further in the direction of appreciating the existence and power of resistance in all emotional and behavioral problems, and the often magical power of the new resistance-melting techniques I’ve developed in opening the door to the possibility of rapid and dramatic change.

I’m also very aware of the therapy wars, predicated on the belief that our group as THE answer and your group consists of fools! And typically, one or both of those who are arguing have never measured anything in their patients on a session by session basis to see if things are working or not.

This is just the tip of the iceberg, however!

You can find a free offer of two free chapters on Habits and Addictions on every page of my website in the right-hand panel. You will find a strong emphasis on powerful new techniques that focus on motivation, such as the Triple Paradox, the Decision-Making Tool, the Devil’s Advocate Technique, and more.

Most of the techniques I developed in the early days of CBT still have a lot of power and I use almost all of them, sometimes with various modifications and upgrades. For example, I have added the CAT to the Acceptance Paradox and Self-Defense Paradigm in the Externalization of Voices (EOV), and now there are two versions of the CAT, one of them created just last week!

On the porno question, I am not an expert in sociology research, so I don’t know, and I try to avoid giving expert answers on things I don’t have expertise in. My goal is not to proclaim what people should or shouldn’t do, but rather to help people who come to me asking for help. It is tempting to assume your own views are straight from God, but I find that my own narcissism just gets me into trouble most of the time!

I do like your thinking, though, that much of the time there are no absolute answers, rather personal preferences, and the impact will often depend on how things are used. As you say, a glass of wine could add to your meal. A bottle of wine daily might get you into trouble with your health and habits!

Warmly, david

How do you deal with people who are compulsive liars? I found that even when using the five secrets, they either get really angry and start on the offensive or completely deny no matter what you say. If you have a client or someone in your personal life that you have deal with that lies a lot even when faced with facts and proof, what is the best way to handle it?

On another point, I know that we all tell lies to a certain extent but I’m wondering whether you can impart some wisdom on why some people are compulsive liars.

David response: I have a policy of NEVER answering general questions. If you want help with a relationship problem, please fill out the first four steps of a Relationship Journal. That way, we can see what the other person said, and what you said next.

Otherwise, you might frame it as wanting help figuring out how to “handle” this other person who is “to blame,” or behaving badly, and so forth, without pinpointing your own role in the problem, which is the whole key to interpersonal therapy.

Then we will have some dynamite to play with, as opposed to bullshit which tends to be too gooey in my experience! Certainly, people who lie compulsively can be challenging and irritating for sure, but let’s take a look at the whole picture so we can also answer this question: Are you responding in a way that reduces the likelihood that they’ll be honest?

I’d LOVE to answer this question again once you send an RJ partially filled out.

Thanks!

My client was offended by the positive reframe questions (any benefits and values for anxiety). She was unable to 'see' any benefits to her anxiety despite 'priming the pump' and gathered evidence from friends to emphasize her point.

She ultimately dropped out of therapy.

I'm wondering if we can move forward without positive reframing and circle back later, or is an open hands with empathy the best option when a client refuses to reframe and is actually offended by the suggestion?

David’s Take

Sometimes you can do effective work without the A = Paradoxical Agenda Setting step in a highly motivated patient. However, I suspect a more fundamental problem is occurring here.

Whenever you’re stuck with an angry patient, immediately go to E = Empathy, and don’t use any methods until you get an A, and have really re-established a warm, trusting relationship with the patient.

I have emphasized the importance of using the BMS and EOTS with every patient at every session. Have you been doing this, and have you been getting a perfect score on the Empathy and Helpfulness Scales? This seems unlikely to me.

Often anxious patients feel shame, especially if they have social anxiety, but this is also common with panic attacks and some other forms of anxiety. If she’s ashamed of her anxiety, it would make sense that he might get defensive when asked to positively reframe it.

At this point, I can only speculate, since I don’t know the details of this case. Sometimes, it makes sense to pay a colleague for a couple consultation sessions to get “unstuck.” These are always extremely productive learning sessions.

Positive Reframing, or Assessment of Resistance, is an art form, and sometimes you just can’t “see” the reasons for the resistance at first. You might recall, or want to listen to, our live session with Sunny, who developed a sudden relapse of intense anxiety when he decided to change his approach to work, or non-work. (see podcast # X).

The traditional positive reframing was not effective, but then when we started on methods, I suddenly “saw” something none of us had seen before during the session. His “anxiety” was actually a sign that something wonderful was happening!

You can always start with M = Methods, and then when you run into resistance, you can revisit resistance with a Paradoxical CBA, or Externalization of Resistance, or some other approach.

But the crucial thing is to get on the same page, and stay on the same page, with your patient.

David

I have a question,

David’s take: Eventually we hope to include that dimension in our Feeling Great App.

David’s take: Yes, we use these role-playing techniques in the Feeling Great App.

David’s take: First quarter of 2024.

Thank you !

Thanks for listening today!

Self-Acceptance, People who Resist, Secrets of Dynamic Job Interviews, Five Secrets with your Boss, Do Cognitive Distortions Cause Transgenderism?

Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers!

Rizwan suggests a new method for self-acceptance. Anonymous asks how to convince someone that depression is NOT due to a chemical imbalance in the brain. My father does not believe that you can change the way you FEEL by changing the way you THINK! Marc asks about tips for job interviews, as well as how to respond during periodic performance reviews at work. Brian asks if transgenderism could be the result of distorted thoughts.

1. Rizwan asks

I have a question about the Acceptance Paradox that came to my mind during our Tuesday training group on 19 Dec, 23.

As homework, will it be useful to ask clients to make a list of things which they have already accepted in life and made peace with?

At the next stage, in the session, would it be useful if the therapist asks them, "why did you accept and make peace with those things?

“Can you use the same criteria to accept other things in your lives which you are not accepting now?"

Sincerely, Rizwan

 David’s take

Yes, you can certainly try that and let us know how it works out? I do lots of spontaneous and “new” things in almost every therapy session. Some things work out, and others do not. That way, I learn from my clinical work.

One thing to be aware of is that your proposed approach might overlap with “helping,” when a paradoxical approach might have more “punch” / impact, After all, the Acceptance Paradox is arguably more of a decision, than a skill.

But try, even with yourself if you like, and let us know what you discover. TEAM constantly evolves, and you can be an important part of that process!

Best, david

2. Anonymous asks how to convince someone that depression is not due to a chemical imbalance in the brain and that you can change the way you FEEL by changing the way you THINK?

Hi David

I love listening to your podcasts. And now I am seeing differences in my life but not my father who has been depressed for around 40 years. He is on medicines and has an extreme belief that it's on the basis of chemical imbalance. He is a pharmacist by profession, and loves to learn about how chemical changes mood swings.

I am not able to convince him to read your books. He just take sleeping pills every single and sleeps all day. He is learning something about neuroplasticity which is actually the case that happens in cbt.

But he think it's some kind of thought changing therapy which cannot change the chemical in our brain. Please help David. I would love you to answer this.

Regards,

Anonymous

David’s Response

Hi, I once gave the keynote address at a research conference at the Harvard Medical School. When the department chairman introduced me, he something like, “Dr. David Burns is going to show us how you can change brain chemistry with CBT, and without drugs!” It was pretty cool!

That’s one dimension. And we could add more evidence and research findings to support our side of the argument.

But on another level, we see the underlying issue of trying to convince someone who is taking an adversarial position and content with their own thinking and beliefs, and determined to argue no matter what evidence you present.

In my experience, spending time trying to convince them is almost always a losing cause. All you do is engage in a frustrating philosophical debate, at least that’s my thinking!

The podcasts on the theme of “How to Help and How NOT to Help” might be useful, in case you are looking for help with your relationship with your father. Your love and concern for him is huge and very touching!

Okay to use in an Ask David? I will not use your first name!

Best, david

3. Marc asks for tips on job interviewing.

Hi David, I hope you are keeping well.

I am wondering if you have any tips / strategies/resources that you recommend for an upcoming job interview?

Also, you once told a story of someone who worked in the tech industry that you counselled, and you recommended some questions for him to ask in periodic performance reviews. Does this ring a bell at all? I've had trouble remembering/locating this Podcast.

Stay well,

Marc

David replies

Hi Marc, Yes, we can discuss the secrets of successful job interview  on a podcast. I have LOTS of tips, actually, and we can perhaps do a podcast on this.

We could also focus on how to respond to your supervisor during performance reviews, and I DO have an amazing story about that as well; it was the fellow who had been fired six times in two years.

Thanks for reminding me. I might have given him the name of Rameesh, but not sure!

Best, David

 4. Brian asks: Could transgenderism result from distorted thoughts?

Hi David,

Happy New Year, and thank you for your amazing Monday podcasts.

I just started listening to yours today about transgenderism. Could transgenderism be the result of distorted thoughts?

I know it's a very sensitive subject like anti-depressants.

Thanks,

Brian

David’s Reply

Hi Brian,

Thanks for the question. Copying Robin, as she’s the expert.

But to my way of thinking, the answer is no. I believe, though I’m no expert, that gender identity as well as sexual preferences are primarily biological in origin, although there are obviously strong cultural influences and biases.

For example, ice cream preferences are kind of inherent to people, and mysterious, and cannot be changed by changing our thinking! I love blueberry pie, and many others don’t care for it. Just a preference!

Saying that gender results from distorted thoughts might also be hurtful, as if our identities might be somehow “wrong” or “defective.”

Might use as an Ask David question if you and Robin have no objection.

Best, david

Thanks for listening today!

Featured Photo is Dr. Amy Huberman The Amy Story, Part 2: The Joys of Doing the Laundry!

Amy and her exuberant son, Sasha, and wife, Alena

Last week you heard Part 1 of the Amy session, which included T = Testing, E = Empathy, and A = Assessment of Resistance. Today, you will hear Part 2 of Amy's exciting journey from perfectionism to JOY.

We used a variety of Methods to help Amy challenge her negative thoughts, starting with the first, “I’m failing my patients.” We started with Identify and Explain the Distortions, then went to the Double Standard Technique, and ended up with the Externalization of Voices.

As a reminder, you can see Amy's  Daily Mood Log at the start of her session here..

As an exercise, see how many distortions, or thinking errors, you can find in her first Negative Thought, “I’m failing my patients,“ using the list of cognitive distortions on the bottom of her Daily Mood Log. You’ll find the list of the ten cognitive distortions if you click here.  After you’ve identified each distortion, see if you can explain two things about it:

Why is this distortion in Amy’s thought unrealistic and misleading? Why might it be incredibly unfair and hurtful?

You’ll find my list of the distortions in this thought at the end of the show notes. But don’t look until you’ve made your list!

These techniques we used were effective , as you’ll hear on the podcast, especially the Externalization of Voices. You’ll hear us doing role-reversals with Amy, and the method that “won the day” was the CAT, or Counter-Attack Technique, combined with the Acceptance Paradox. The Acceptance Paradox involves finding truth in a negative thought with a sense of peace or even humor. The CAT involves confronting the hostile voice in your head and tell it to go fly a kite, or other gentle but firm message

You’ll enjoy seeing some striking changes in Amy, as her tears and feelings of intense self-doubt are suddenly transformed into joy and laughter.

Those changes created strong feelings of joy for Jill and me as well. We both have incredibly fondness and admiration for Amy, and feel great joy as well when she feels joy.

Here are Amy’s final scores at the end of the session.

The Joyous Dr. Amy!

Sudden and dramatic change is pretty trippy, but it isn’t much good if it doesn’t last. And it won’t! Negative thoughts and feelings will always return, because no one can be happy all the time. That’s why some relapse prevention training and ongoing practice and refinement of what you’ve learned can be vitally important.

In our follow-up session with Amy one week later she said she’d felt way better during the week, but did, in fact, have some relapses and had to challenge her negative thoughts again. She’d been helped a lot by the idea that it was okay to fail, to seek consultation, and learn, and that failing with patients gave us endless opportunities to learn and grow as therapists. And it was also okay not to have to listen so intently to the attempts of the negative self to put her down.

In fact, our misery almost never results from our failures, but from telling ourselves that we “shouldn’t” ever fail, and from punishing ourselves mercilessly when we do.

One of her most exciting statements in our follow-up session was that she discovered that even something as humble as putting the dirty clothes into the washing machine could be a joyous experience without that negative voice in her brain constantly hollering at her that she wasn’t good enough!

Teaching points

It was hard, at first, for Amy to “see” how distorted and unfair her negative thoughts were. She is an extremely intelligent, accomplished, and beloved colleague, and yet most of us cannot “see” or really “grasp” that we can be pretty mean to when we’re feeling down and anxious.

I have often said that feeling anxious and depressed is a lot like being in a deep hypnotic trance, telling yourself and believing things that just aren’t true. For example, Amy is doing beautiful work with the great majority of her patients, and is doing the exact same thing with the patients who are responding beautifully as she is with the two who are stuck. So, when she tells herself she’s a failure, she’s clearly involved in All-or-Nothing Thinking. In other words, she’s thinking that if she’s not perfect, she’s a complete failure and a fraud.

She also seems to have many Hidden Shoulds (e.g. I SHOULD be able to help every single patient quickly) and Mental Filtering (focusing only on the negatives) and Discounting the Positive (ignoring the positives, as if they didn’t count.)

The techniques that were the most helpful for Amy were

So, instead of labelling yourself as “a failure” and “a fraud,” which are just mean, vague words, you can tell yourself that you have a specific problem—in Amy’s case, getting stuck with two very anxious patients. Then you can focus on getting some help in solving that specific problem—for example, by seeking consultation from a colleague.

Jill said that’s what she does when she gets stuck. I used to do that every week, especially when I was first learning cognitive therapy. Getting stuck, then, can simply be an opportunity for growth and learning cool new tools.

If we never got stuck, we’d never learn anything new!

The very moment Amy stopped believing her negative thoughts, her feelings instantly and dramatically changed. That change happened suddenly, over the course of about 30 seconds, and you can SEE it in her face and hear it in her voice. But it won’t last forever! Jill pointed out that the belief at the root of Amy’s problem was Perfectionism, and the idea that “I should know exactly what to do with all of my patients.” That may be a pleasant fantasy, and it might even motivate us to work hard and achieve, but it’s also a recipe for misery!

Follow-up

Rapid recovery is great, but will it stick? You will hear excerpts from our brief follow-up session one week later for Relapse Prevention Training. The idea is that none of us can feel happy forever, and negative thoughts will creep back into our minds sooner or later.

However, you can anticipate this and prepare for it by challenging your negative thoughts with the same techniques that helped you the first time you improved. That’s because the details will usually be different every time you’re upset, but the pattern of self-critical negative thoughts will usually be the same.

And this DID happen to Amy, just as it will happen to you. But this was an opportunity for her to deepen her understanding of perfectionism and to refine and enhance her ability to respond to her negative thoughts.

During the weeks following the recording of this podcast, Amy found that she experienced some resistance to using the counterattack technique. She began to feel like she was relating to her perfectionism as an enemy and attacking it—and in doing so, was discounting all the good in it, including the values that came shining through during the Positive Reframing. She found that a better fit for her, instead of the counterattack, was to disarm her perfectionistic thoughts by seeing the truth in them. In fact, you could view this as yet another form of acceptance. When she did this, the perfectionistic voice in her head naturally backed down and gave her the space to do what matters to her unencumbered by self-criticism.

I thought it was cool when she described experiencing waves of joy while doing the laundry—an activity that had always felt like a chore to her before, when it was accompanied by thoughts like “I should have finished this laundry days ago.”   She discovered that without beating up on herself, something as humble as doing the laundry could be incredibly rewarding!

After our follow-up meeting, I got a lovely email from Amy about the joys of giving up the need for perfection, and sent this follow-up reply to Amy:

Thank you, Amy, you are the BEST!

I did a four-day intensive in San Antonio years ago with a small group of about 25 therapists. As you know, I always BS and say “As the Buddha so often said . . . “ followed by something goofy or quasi-mystical or whatever, and most people seem to kind of like that and see it as fun or humorous or whatever.

Well, I was doing that at the workshop, and at one of the breaks a woman approached me and said she was interested in my Buddhist remarks because she had been raised as a Buddhist in an Asian country where Buddhism is prominent. I panicked and thought I’d been found out and exposed as a fraud.

She went on to say that their family gave up Buddhism, however, and she was sad. I asked why they gave up Buddhism, and she explained that her mother suffered from severe depression, and the Buddhists taught that’s because you think you “need” things, and if you’re a good Buddhist you won’t think that way and you won’t ever suffer. Since she suffered, she felt like a failure as a Buddhist, so the family gave up Buddhism.

I told her that she might not be aware that there are actually two schools of Buddhism. There’s low-level Buddhism and high-level Buddhism. In low-level Buddhism, you’re not allowed to want or need anything, and you’re not allowed to suffer. That’s sounds like that was the school of Buddhism your family was raised in.

But there’s another type of high-level Buddhism. In high level Buddhism you’re allowed to suffer and struggle, and screw up, and fail, and all sorts of stuff.

She got animated and said, “I didn’t know that. Thank you so much. You’ve restored my faith in Buddhism, and I can’t wait to tell my mother!”

Aside from my being elderly and half-demented, I hope that makes some sense in light of our work together with Jill!

So, if you need any translation or explanation, Amy, I’m inviting you to join the high-level Buddhist therapist group where you’re allowed to screw up with some of your patients, or even many!

Warmly, david

Subsequent Follow-Up

I forgot to tell you what happened to Amy’s two “stuck patients.” Well, she got some consultation about why these patients might be stuck, which is nearly always an Agenda Setting problem—the therapist is working harder than the patient due to the need to “help,” and this plays into the patient’s ambivalence.

This struck a chord, and Amy was very excited to see her patients again, and both suddenly got “unstuck,” although in somewhat different ways. And that is why I call it the Acceptance Paradox. The moment YOU change, and accept yourself, your world will also change!

Or, to put it differently. We often see the world as “different” or as “other,” thinking we are separated. The Buddhists see the world as “one,” and that is certainly true in therapy as well.

Answers to the Quiz Question

David’s list of Distortions in Amy’s Negative Thought:

“I’m failing my patients.”

Thanks for listening today!

Rhonda, Amy, and David

Featured Photo is Dr. Amy Huberman The Amy Story Part 1: True Confessions of a “Fraud” and a “Failure” Part 2: The Joys of Doing the Laundry

Amy and her exuberant son, Sasha, and husband, Poppy

Today’s podcast, and next week’s podcast, include a single, two-hour session with Amy Huberman, MD. Amy is a psychiatrist in private practice in Baltimore, MD. She also serves on the volunteer faculty at the Johns Hopkins University School of Medicine.

Amy specializes in brief, intensive psychotherapy to help people overcome struggles with anxiety, OCD, and trauma, but today comes to us to get some help with her own anxiety. Often doing our own work can be a vitally important part of our training and growth as mental health professionals.

Amy has been upset because she is stuck with two of her patients, and she’s telling herself that she’s a “fraud” and a “failure.” Although her life is undoubtedly very different from yours, the root cause of her problem might be very similar to the source of your unhappiness, especially if you sometimes get down in the dumps and tell yourself that you’re just not good enough.

My co-therapist for this session is Jill Levitt, Ph.D. co-founder and Director of Clinical Training at the Feeling Good Institute in Mt. View California. Jill also serves on the Adjunct Faculty at the Stanford Medical School and is co-leader of my weekly TEAM Therapy training group at Stanford, Tuesdays from 5-7:00 pm pst.  If you are interested in joining David and Jill's Tuesday group, please contact Ed Walton, edwalton100@gmail.com.

That group is now virtual and therapists from the Bay Area and around the world are welcome to attend. It is free of charge. Rhonda Barovsky also runs a free weekly training group with Richard Lam, on Wednesdays, from 9-11:00 am pst, which is also free of charge. If you are interested in joining the Wednesday group, please contact Ana Teresa Silva, ateresasilva6@gmail.com.  Because the groups are virtual, they are open to therapists from around the world.

Amy has been a member of our Tuesday training group, and is a highly skilled, certified TEAM therapist. Like nearly all the mental health professionals who come for training every Tuesday, Amy has incredibly high standards and is sometimes harshly self-critical when she feels she is not living up to them.

At the same time, those high standards can be strongly motivating, and this can create strong feelings of ambivalence when it’s time to change.

Sound familiar? If you’re struggling with perfectionism, you might want to check out these two podcasts!

Amy opened by saying she was anxious and telling herself:

I’m about to reveal my weaknesses and my inner self—This is something I’ve never done before in such a public setting. . . I also have to confess that I’m struggling with social anxiety right now. I’m afraid that my patients might see this and think, “I don’t want to work with her! I want to work with a competent psychiatrist.”

I Included that because I am hoping you will appreciate Amy’s incredible courage and gift of sharing her true inner self today!

Amy described the problem that’s been bothering her for several weeks. Although she specializes in the short-term treatment of anxiety, she has been struggling with two patients with OCD symptoms who have been stuck and not making significant progress for a long time.

This has triggered feelings of shame and intense anxiety which have invaded Amy’s every moment when she’s NOT seeing patients, and has even prevented her from getting restful sleep at night. She keeps ruminating and beating up on herself.

You can see Amy's  Daily Mood Log Amy here.. As you can see, she was feeling intensely sad, panicky and ashamed, and rated these three feelings as 80% on a scale from 0 (not at all) to 100 (the most severe). She was also feeling worthless and defective which she rated at 100%, as well as hopeless (90%) and stuck (80%).

As you know, feelings do not result from the events in our lives (in Amy’s case, the fact that two of her patients were stuck), but rather from her thoughts, or interpretations, of those events. You can see on her Daily Mood Log that she was being intensely self-critical, telling herself that she was failing her patients, that she should refund their money, that she was not competent to practice psychotherapy and should find a new career, that she “should” know how to get them unstuck, and more, and finally that she was a fraud and a failure.

Her belief in all of these thoughts was super high, ranging from 80% to 100%. And if you’ve ever felt down or inadequate, I’m sure you recognize the same types of thoughts in your own thinking, telling yourself that you’re a failure, or not good enough, and so forth.

During the session, Jill and David went through the TEAM acronym:

We measured her negative feelings at the start of the session so we could measure them again at the end to see how we did.

We listened and supported Amy without trying to “help” or “save” her. The goal was to understand her thoughts and feelings accurately, while providing a sense of compassion, warmth, and acceptance.

This phase of the two-hour session lasted about 30 minutes, and Amy told us how she constantly ruminated about those two patients, asking herself “What am I doing wrong, what am I missing, what should I be doing differently?” She described these thoughts as a relentless “broken record in my brain.”

She confessed that her deepest fear was, “What if they kill themselves and I was responsible for their deaths?” She said this fear was almost unbearable!”

I pointed out that was also my deepest fear when I was in private practice—I was never upset by treating large numbers of severely depressed patients in back-to-back sessions, and it always made me happy, since I felt I had something to offer. But if I said something that hurt someone’s feelings, I found that pain almost unbearable until I saw the patient again the next week, and could talk things over and get back on a positive track.

Jill pointed out that Amy’s ruminations showed that she was a highly responsible psychiatrist who cared deeply about her patients! And while that is certainly a positive thing, the intensity of her fears had invaded every minute of her life, making her life miserable, even when she was with her family.

Amy said her fears have intensified since 2020, when she transitioned away from a traditional psychiatric practice involving long-term weekly psychotherapy and med-management, to focusing on short-term intensive psychotherapy using the TEAM model.

Then we asked her to grade us at the end, thinking about three categories of Empathy:

Did we understand how she was thinking? Did we understand how she was feeling? Did she feel cared about and accepted?

She gave us an A, which triggered our move to the next phase of our work with Amy.

In this phase of the session, we pinpointed Amy’s goals for our session and  melted away her potential resistance to her stated goal of learning to give up that self-critical voice in her brain. We asked her to imagine we had a Magic Button, and if she pushed it, all of her negative thoughts and feelings would instantly disappear, with no effort on her part, and she’d feel jubilant and happy.

She said she wasn’t so sure she’d do that. Most patients say YES, but Amy is familiar with the TEAM approach and knows that negative thoughts and feelings often result from some of our positive qualities.

Our strategy at this phase of the session was paradoxical: Instead of trying to help, save, or rescue Amy, and instead of trying to persuade her to change, we took the role of her subconscious resistance to change. With her help, we listed some of the many positives in her negative thoughts and feelings by asking these two questions.

What does this negative thought or feeling show about you and your core values that’s positive and awesome? How might this this negative thought or feeling be helping you and your patients?

Here are just a few of the positives we found in her negative thoughts and feelings:

The Positives in Amy’s Negative Feelings

You can do the same kind of Positive Reframing with all Amy’s negative thoughts and feelings, as well as your own. The list of positives would be long and impressive!

After listing these positives, we asked Amy these three questions:

Are these positives real? Are they important? Are they powerful?

How would YOU answer these questions if you were Amy?

She gave a strong yes to all three questions.

At the end we pointed out that it might not be such a great idea to push the Magic Button to eliminate the negative voice in her brain, because then all these positives would also disappear.

Instead, she decided to use the Magic Dial to reduce her negative feelings to some lower level where she could keep all the positives but suffer much less. Here you can see her goals for how she wanted to feel at the end of her session.

As you can see, she decided to aim for fairly large reductions in all six of her negative feelings.

These goals are not guarantees she will be able to reduce her feelings. In addition, the goals are not rigid, since she may be able to reduce them even further once she begins to challenge her negative thoughts.

Our real aim at this phase of our work was to reduce her feelings of shame and failure so she could see that her “symptoms” were NOT the expression of what was WRONG with her, but the expression of what was RIGHT with her. Paradoxically, this often reduces the resistance to change and vastly enhances the possibility of rapid and dramatic change during the final, M = Methods portion of the session that you’ll hear next week, along with some follow-up information.

The important thing we’ve hopefully accomplished is reducing Amy’s resistance so she can learn how to challenge and defeat the relentless and hostile voice in her brain that constantly puts her down whenever she fails to live up to her extremely high, and arguably perfectionistic, standards.

Rhonda, Amy, Jill, and David

Why Do We Resist Accepting Ourselves Other People, and the World? The Five Most Common Reasons!

Rhonda and David are joined in today’s podcast by Dr. Matt May, a super popular and loved guest on our show, to discuss the resistance findings in David's recent survey on acceptance and resistance. The following is a summary of some of the statistical findings, but the actual podcast dialogue was wide ranging and tremendously engaging, and won't require a lot of statistical smarts!

We also discussed the vitally important difference between healthy and unhealthy acceptance.

The group brought the five most common reasons to life with engaging stories.

Why should you accept yourself? We are not saying that you "should," and it's really a decision. However, the statistical models the I (David) developed indicated that healthy acceptance can trigger a 49% reduction in negative feelings and a 39% boost in positive feelings, which is tremendous.

Matt told an inspiring story about two strategy for training the dolphins at SeaWorld. One strategy involved trying to shape the behavior of the dolphins with little shocks, in much the same way that some people train horses. Sadly, the dolphins went to the bottom of the pool and appeared depressed, not moving much. It was a complete failure.

Then they tried a radically different strategy--they gave a new group of dolphins fish to reward them for doing the things the trainers wanted them to do. This strategy was tremendously successful.

So, the question is whether you want to shape your own life with frequent shoulds and self-criticisms, which can have the effect of electric shocks every time you fail or screw up or fall short of your goals, or whether you want to shape your life with love and rewards. Some of us have discovered that acceptance is way more fun and vastly more effective!

The typical survey respondent endorsed 1/3 of the 12 Resistance Scale items, and seemed to believed that Acceptance would be foolish and lead to a life of misery and mediocrity. The actual causal impact of the Non-Acceptance and Resistance scales on positive and negative feelings was massive and appeared to be in the exact opposite direction.

The respondents in the Resistance survey endorsed an average of 33.8%. (+/- 0.1%) of the items, ranging from 0 to all 12. The most commonly endorsed was, “Acceptance is easy for rich and famous, but hard if you’re struggling just to pay the bills.” 47% (+/- 2%) endorsed this item.

The least endorsed was, “If I beat up on myself, people will love me more,” although 25% (+/- 1%) of the people endorsed this item, so it was fairly popular. The high scores on the resistance scale items is also pretty consistent with my experiences over the years—the people in the study, and the people I’ve worked with, have expressed MANY reasons to beat up on themselves.

You can see the list of the 12 Resistance Scale items below. I have bolded the five most often endorsed. As you can see, many people surveyed believed that acceptance is fine for people who are rich and famous, but terribly painful and foolish for people who struggle with real problems. Many respondents were convinced that acceptance leads to pain, robs you of motivation and does not make sense in a the world that’s falling apart.

If I accept my flaws and shortcomings, I'll end up with a second-rate life. If I accept my flaws and shortcomings, I’ll lose all my motivation to learn If I beat up on myself and work my ass off, people will love and admire me. It would be tremendously painful to accept my flaws and shortcomings. That would be like giving up and having to live with a heavy load of inadequacies. Life has many real disappointments and losses. I don't want to feel happy and chipper by “accepting” all those negatives when the world is falling apart all around me. That just doesn’t make sense! I haven’t achieved many of my goals in life. I think it would be kind of pathetic to suddenly accept myself and feel enormous joy that I haven’t really earned or deserved. I’ve often fallen short, and I’ve made a lot of mistakes in my life. Are you saying that I should be happy about that? Hell NO! I am never going to accept myself as just another average or below-average person. That would be awful! If I accept my flaws, failures, and shortcomings, I’ll just be like everyone else. I won’t be special, and I won’t have the chance to become special. If I admit that I often fail and screw up, people will think less of me. If I’ve done things that have hurt others or if I’ve violated my moral values, then I deserve to suffer. Acceptance is fine and easy for people who’ve enjoyed tremendous success, but it’s really hard if you’re struggling to pay the bills, or if you feel like you haven’t succeeded at much.

What did the analyses show about the impact of resistance and non-acceptance on how we feel?

Accept this Sh__? Hell No!

Rhonda and David  are joined in today’s podcast by two dear friends, Dr. Matt May, a popular regular on our show, and Matt Pierce, a co-founder of the soon-to-be-released Feeling Great App

Brief bio sketch of Matt Pierce goes here, should you wish to include it in the show notes. Matt,. A pic would also be great, but not required. People get tired of the same pics each week, so a fresh face to illustrate this episode would be cool!

You’ve probably heard about acceptance. It’s a popular buzzword in the mental health space these days. In fact, some experts claim that it’s THE key to happiness and enlightenment.

It’s NOT, but it can be incredibly helpful.

I wanted to learn more about Acceptance and put some numbers on it’s effectiveness, or lack of effectiveness, so I recently sent an invitation to the 45,000 people on my mailing lists to complete a new survey on acceptance and resistance. More than 1,000 quickly responded, which was great. I hoped the data could provide some answers questions like these:

Thanks for listening, David, Rhonda and Matt

Do we have a "Self"? Or "Personality"? What's the best way to combat Should Statements?  Is TEAM effective without a therapist?  What's the Difference between Positive Reframing and Positive Thoughts? 

Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda, Matt and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers!

Questions for today’s Ask David Podcast:

Stefan asks if we have a “self” or a “personality.” Slash wants to know how to combat a “Should Statement.” Magellan asks about the effectiveness of TEAM without the guidance of a therapist. Werner asks about the differences between Positive Reframing and the Positive Thoughts you record on the Daily Mood Log.

Hi David,

I really love your work, both the books and the podcast you’ve created. Lots of great tools there. I think your down-to-earth approach is effective and great in de-mythologizing mental health care.

Still, one thing has been bugging me about your approach: the fact that you quite casually seem to discount the existence of the self. As a theologian I understand this position. In discounting the self as a construct, you’ll open the way to less resistance and more acceptance. I studied both Christianity and some Buddhism, and in that tradition the self is essentially something to let go of as an illusion. I think you called this the death of the ego, and it’s common in many mystical currents both within and without the major religious traditions.

However, by embracing this tradition in a therapeutic setting, I think there’s a great risk to gloss over long-held implicit beliefs or patterns in the construction of a personality that might hold people back from reaching their full potential. More specifically, I’m talking about schemas or Lifetraps (in the terminology of Jeffrey E. Young and Janet S. Klosko). I know Aaron Beck supports their work to address these “chronic self-defeating personality patterns” that are usually considered the be part of the self. What’s your take on their work?

Kind regards, Stefan

David’s reply

Hi Stefan,

Personality, like "self" is not a "thing," but just the observations that different people have different behavioral patterns. So, some are more outgoing, for example, while others are more introverted and shy and insecure.

The only meaning of "self" is the context in which the word appears. So, "behave yourself" simply means that you are misbehaving and need to stop!

Can you come to the Sunday hike is a question. It does not need the add on, "and do you plan to bring you 'self.'"

The only meaning of any word is the context, and many uses in the English language, or any language. Nouns do not always refer to "things." Words are just sounds that come out of our mouths.

I don't go into this much because few people "get it."

Thanks so much, Stefan.

Warmly, david

PS The above is my take on Wittgenstein's Philosophical investigations, published after he died in 1950. .

Second PS I had a random and fairly weak thought, but here it is. When doing my daily “slogging” a while back, I was going through a pleasant and familiar path and noticing how beautiful everything was, and had the thought, “This land is so valuable and expensive, and I’m SO GLAD I don’t have to own it. It would involve a nightmare of paper work, taxes and all kinds of worries. But I can just enjoy it without any of those burdens of ownership.

Then I thought of the “self,” and what a heavy burden it is to “have one,” and worry about whether or not it is “good enough,” or “inferior,” and so forth. Selves tend to be a bit overweight, and heavy to carry around. And how much more fun, beautiful, and rewarding life is without having to have a “self” to worry about.

Rhonda found this helpful after a time feeling confused about the "self," and Matt added this: "Right, and if we own the 'land' one day, and it changes, the next moment, is it the same 'land'?  Do we still own it?"

Matt’s "Self" Thoughts

Wittgenstein is one of my favorite philosophers due to the elegance of his solution to philosophical problems, which is to recognize that they are not, in fact, ‘problems’.  Instead of trying to answer the question, ‘is there a self’, ‘do I have a self’, he would point out that these questions are meaningless and can’t be answered.

One way to bring these questions into a form that could be useful and answerable, is to define the terms.  What is the ‘self’, and what can it do?  How would I know, if I had a ‘self’?  If the definition was in the form of a testable hypothesis, we’d be a step closer to arriving at a meaningful answer.

In some cases, this answer is incredibly meaningful, in terms of our mental state and relationships.  Let’s try on a few possible definitions of ‘self’ and consider some experiments that could be done to test whether these hold water.

‘Self’:  (from Meriam Webster):  one’s essential being, which separates them from others.  (I don’t find this definition useful, because now I just have to define what is an ‘essential being’?  What are we talking about?

‘Self’:  The subject of our experience; the thing that is thinking our thoughts, and feeling our feelings.  (This is also problematic for many reasons.  First, it’s based on an unproven assumption that experience requires an experiencer.  Descartes believed this but Nietsche retorted that this logic was highly flawed as it smuggles the ‘self’ into the equation without any justification.  Further, there are many ‘nondualistic’ philosophies that challenge the ‘separateness’ of ‘self’ and experience.  Meaning, the presence of thought doesn’t mean anything other than the presence of thought.  We ought to be skeptical of introducing additional complexity into the situation according to the principle of ‘Occam’s Razor’, that the simplest hypothesis that explains all the observations is more likely to be correct).

‘Self’:  The ‘CEO’ of your mind, the aspec of yourself that is directing your body, attention and decision-making.  (This is problematic in many of the same ways as the above definition.  It’s also the most readily falsifiable definition.  We can experiment with our ability to control our decision-making in a variety of ways, one of which is to see if you can ‘choose’, with your ‘self’ not to understand the words on this page.  Or to sit quietly and not think.  If our ‘self’ can’t use its ‘free will’ to control the brain’s activities in such simple ways, why would we imagine that we have a self, controlling our brain, at all?

In fact, most of us believe in a ‘self’, which, if we attempt to define it carefully, it can be proven NOT to exist.  However, this is an unacceptable conclusion for many people, even though it results in a form of enlightenment.  This form of enlightenement is slightly different from ‘self acceptance’.  It’s more like ‘waking up from a dream of a self’ than ‘acceping a flawed self’.

All that said, yes, it’s often incredibly useful to inspect our assumptions about our ‘self’, in terms of our ‘roles’ and ‘rules’ in our relationships.  David offers the ‘Interpersonal Downward Arrow’ to do this in a single session.  There, we might discover we are stuck in a belief system that is counterproductive, like, ‘we must be perfect’, ‘we should never have conflict’, etc.  There are countless ways people think about their ‘self’ which can be productive or a ‘trap’.  Obviously, if we had no sense of our identity, purpose, role, etc., it would be hard to know what to do with our ‘selves' on a day-to-day basis!

Hi David

I did some exercises and found I a believe that I should play guitar effortlessly or else I should enjoy the process of learning. My disadvantages are greater in CBA. Now what thought should I replace with so that I could have the advantages too.

Slash

David’s reply

Thanks, Slash!

It is a should statement.

Essentially, your “should” doesn’t make sense since there is no rule that says you should, must, or ought to enjoy something you don’t enjoy right now, so you are just putting pressure on yourself unnecessarily.

I once had a patient who had previously been treated briefly by Dr. Albert Ellis when he was in New York. He was on vacation, and was feeling depressed and telling himself that he SHOULDN’T be unhappy since he was on vacation. He thought he SHOULD be enjoying himself.

He said that the thing that helped the most was when Dr. Ellis said, “Where the F__K is it written that you are obligated to enjoy being on vacation?” (Ellis used that word a lot!)

He said he immediately gave himself permission to feel miserable on vacation, and instantly felt better! This is an example of what I call the Acceptance Paradox. When he accepted his unhappiness, instead of struggling in shame to make it go away, it disappeared.

I have a similar story. I used to have a keen interest in collecting coins from around the world, and when I was an intern at Highland Hospital in Oakland, I used to enjoy going to the local coin stores to see if I could find some interesting foreign coin to purchase for a few dollars. This was always exciting, but one day I was in the S & D Coin store just a few miles from our apartment, realized I was totally bored and had lost my interest in collecting foreign coins.

I told the friendly dealer, and he said, “Oh, don’t worry about it. Just do something else in your free time for a few weeks and your interest in collecting will probably come back.”

So, I did that, and that’s just what happened. Essentially, he was also giving me “permission” to feel the way I was feeling, and not the way I thought I “should” feel! And when I accepted my negative feelings, they ran their course and disappeared.

That worked for me, but there are a lot of methods in TEAM, and you sometimes have to try quite a few before you find the one that works for you, since we’re all different.

The “go to” method for Should Statements is called the Semantic Technique. Using this method, you could tell yourself, “Right now I seem to have lost interest in music. It would be great if it comes back again, and probably will. But it’s natural not to feel excited about music all the time.”

Notice that I used “it would be great if” in place of the “Shoulds.”

As an aside, we just completed a new class for the Feeling Great App entitled “Your PhD in Shoulds.” You might want to check it out.

There’s also a lesson on perfectionism at the end of the class.

Best, david

Cost-Benefit Analysis

Dear David,

Could you tell us about studies of the effectiveness of any written TEAM or other therapy materials offered without therapist guidance (for example when people are on a waitlist to see a therapist)?

I think I heard of one done with Feeling Good. I wonder if one may be done with Feeling Great.

Thanks,

Magellan

David’s response: We have impressive results with our app, which I can describe. It is completely automated without therapist guidance. It is kind of like my first book, Feeling Good, on steroids!

I also have precise data on waiting list controls. The waiting list do not improve until they start the Feeling Great App and then they experience rapid and dramatic changes with a couple days.

There's no doubt about the effectiveness of the app. Also, there's extensive research proving the effectiveness' o my first book, Feeling Good. There's no question about the effectiveness of these self-help tools. I have many questions about the effectiveness of human shrinks, however!

4. From Werner Spitzfaden: Positive Reframing vs Positive Thoughts

I periodically come across clients who get confused by the concept of the Positive Reframing vs Positive Thoughts on the DML.

The question they pose is if the Positive Reframe is similar to the Positive Thoughts on the DML?

After some explanation I focus on Positive Reframing as a way of seeing that even the most difficult and painful thoughts and feelings reveal something powerful and awesome about us and then ask if that's true about them. This focuses on Outcome Resistance.

The positive thoughts on the DML focus on defeating their negative thinking with 2 conditions needing to be present: their new positive thought needs to be believable and it has to drastically reduce the distress resulting from your negative thought.

This focuses on the early stages of Methods coming after looking at Distortions followed by the Straight Forward Technique. I would love to hear David's take on this.

David’s Response

Yes, Werner, you are right! The goal of Positive Reframing is not to “Cheerlead” or to persuade the patient that their negative thoughts are not correct, but rather to help them see why they may fight to hang on to their negative thoughts and feelings, because they are beneficial and helpful in many ways.

This is the latest list of questions you can ask when doing PR with a negative thought. Most will also apply to a negative feeling.

What is the truth in this negative thought? (This is essentially the Disarming Technique applied to your own self-criticism) Why might this negative thought or feeling be healthy and appropriate, given my circumstances. Why might this negative thought or feeling be helpful to me? What does it show about me and my core values that’s positive and awesome? What might be some negative consequences of giving up this negative thought or feeling?

You were spot on about Positive Thoughts. To be helpful, they must fulfill two conditions.

They must be 100% true. Half-truths and rationalizations are rarely or never helpful/ They must drastically reduce your belief in the distorted negative thought.

Hey, Werner, we miss you like crazy in the Tuesday group and in our (now small and humble) Sunday hikes. Hope you’re doing well.

Can You Treat ADHD with TEAM? Does Humor Play a Role in Therapy? What's the Difference between Rejection Practice and Shame-Attacking Exercises? Featuring Dr. Matthew May

Note: Not all of the information covered here is in the podcast, and much of what we discuss in the podcast is not covered here.

Questions for the next two Ask David Podcasts:

Rich asks how you treat ADHD in TEAM. Hwa-Chi Qiu Alvarez asks about the use of humor in therapy. Rima asks about the differences between Rejection Practice and Shame-Attacking Exercises.

Rich asks: How do you treat ADHD?

From Richard: How about a podcast concerning ADHD? I feel that applying TEAM would work. No? I mean “disorders” arise from distortions…so what does a distraction “disorder” arise from?

Thanks for all you do David,

Rich

Hi Rich,

I don’t treat “disorders,” I treat individuals at specific moments when they’re struggling and wanting help! Hope that helps.

As an aside, if you or a friend, colleague, or patient have ADHD and you can describe a specific moment when that person was struggling, I would love to hear about it! Then you’ll see how TEAM works it’s magic by focusing on individuals, and not “problems” or “disorders,” etc.

TEAM is a “fractal psychotherapy.” I will explain!

Warmly, david

Matt’s Take: Thanks for the question, Rich! I love what David is saying, about treating the individual, not the diagnosis.

There are a lot of things that can interfere with focus and attention, such as. medical problems, sleep difficulties, toxin exposure, substance misuse, and relationship problems. In addition, depression and anxiety can interfere with concentration and contribute to ADHD symptoms.

Below, I’ve listed many of the distracting thoughts that my clients have had. Along with a list of some good things about being Distracted.

Hope you enjoy!

I don’t feel like doing this This is boring and no fun I never get to do what I want It’s not fair I’ll do it later There’s plenty of time Best not to rush things I might be missing out on something interesting or important I’ll check my phone one more time, real quick, and then get right back to work This time will be different. Seriously. I mean it. Actually, I’m feeling too tired to concentrate I’ll just take a quick, 5-minute nap I’ll get to work when I feel more rested and motivated I’ve had a hard day and deserve a little break and some fun Tomorrow’s going to be really hard, so I need to rest up I just *can’t* concentrate, at all There’s something seriously wrong with me I lack willpower / I have no ambition I shouldn’t have to do this There’s no point doing this I’ll never be able to do this I need to be doing important, interesting things It would be really exciting and fun to … x, y, z, instead I need to tidy up a bit before starting this big project I don’t know where to get started / don’t want to mess up I’ll be too distracted if I don’t take care of this one thing, first

I can be spontaneous, have fun and be present, in-the-moment I won’t miss out on something interesting and important I won’t waste my life doing boring stuff that leads nowhere I’ll focus on what makes me happy I won’t let other people control me or make my decisions for me I like to feel powerful and in-charge; I call the shots This is my time, nobody controls me It’s calming to know that I’m in-control I want to treat myself with respect I want to be free, not shackled It’s important to take breaks I want to maintain a good work-life balance It’s fun and exciting to be a bit of a ‘rebel’ I’m my own unique person, doing things my way I just want to ‘go with the flow’, it’s easier I want to be safe, protected me from failure. I can’t really fail if I don’t give it my all I can get instant relief from the pressure anxiety when I outsource this task to ‘future me’ I deserve to do what I want, when I want to; I’m sticking up for me I can reject others’ advice and feel superior I don’t know where to start I can have more time to plan I’ll be less likely to mess up if I consider my approach carefully I don’t want to do an average job, this needs to be amazing I can prepare, talk, plan and complain; that’s more interesting and fun than doing I don’t have to face how dull and boring some parts of life can be I can daydream about a better life

On the live podcast, Matt and Rhonda gave examples of individuals diagnosed with “ADHD” who all needed completely different and highly individualized treatment, which is what TEAM is all about.

Matt described treating a boy with ADHD who would get anxious in class when he was called on to read out loud. He was afraid he’d get nervous and make mistakes, and the other students would judge him.

The technique that helped him was the Feared Fantasy.

Matt also described a fellow with ADHD who had trouble keeping appointments and getting places on time. He was helped by the technique I have called “Little Steps for Big Feats,” and the treatment was similar to the methods we used to treat procrastination.

Rhonda described someone with ADHD who felt anxious in social situations, and he was helped with the same types of techniques we would used to help anyone with social anxiety.

The bottom line: treat the person, not the so-called “disorder”!

Hwa-Chi Qiu Alvarez suggests: An episode focused on humor and its uses/impacts could be interesting, I didn't find any. What are some strategies for when humor backfires? How did you learn to appropriately use humor with patients?

First, time I “discovered” humor when teaching the psychiatric residents with Aaron Beck. How I think about my own use of humor: I just kind of blurt out things that are outrageous. Buddhists have concept of “Laughing Enlightenment,” which occurred during the Terri jumping jacks video. What laughing creates is the experience of not taking ourselves so The time I laughed with a patient during the entire session. When NOT to use humor, and what to do when it backfires.

During the live podcast, Matt, Rhonda and David talked about why and how humor can be helpful—in therapy, in teaching, during podcasts, and in life in general.

David talked about how he “discovered” humor when teaching a group of psychiatric residents at the University of Pennsylvania, and how he used a humorous Feared Fantasy to help a depressed FBI agent who was demoralized because he didn’t have a sense of humor. This was a problem because the men at work of joked around the water or coffee pot during breaks. When David modeled how to accept the fact that he had no sense of humor during the Feared Fantasy, it struck his funny bone, and he laughed so hard he fell out of his chair.

This was a paradox, since the very moment he accepted the fact, without shame, that he had no sense of humor, he suddenly discovered his awesome sense of humor! I, David, call that the Acceptance Paradox.

David also described how humor helped a woman who had struggled for ten years with terrifying panic attacks and extreme depression.

David also warned about the pitfalls of using humor with angry or severely depressed individuals who feel intense grief or extreme worthlessness and hopelessness.

I’ve noticed that if you’re ‘supposed’ to laugh, you won’t. But, if you’re not supposed to laugh, you probably won’t be able to stop laughing. Maybe that’s why, when we tried to talk about it, on the podcast, it was really dry and unfunny? Normally I’m hilarious.

Rima asks: I believe rejection practice is a fine art and I’m just trying to understand the specifics a little more, and how it differs from Shame Attacking Exercises.

David talks about some of his male patients doing rejection practice by asking as many women out as possible and collecting no’s from them. The way David explains it, it seems standard practice for the patients to self disclose to the women that they are doing the rejection practice and are collecting no’s. My question is, if you disclose this information, would that be considered a safety behaviour and maybe less powerful exposure than not disclosing what you are doing?

I’ll give you a personal example that hopefully will clarify more. I have been doing my own rejection practice to experience how it feels for myself. One of the things I set myself was to ask someone to sing a duet with me. I found that a little daunting so to make it easier for myself, I disclosed to a woman that I am doing shame attacking/rejection practice and thus would she help me and sing with me. I felt I was using a safety behaviour and protecting myself from certain judgements from her. Therefore, I’m wondering if the patient disclosing what they are doing would be as helpful exposure as not disclosing.

You are confusing Rejection Practice with Shame Attacking Exercises. They are actually very different.

You can do Rejection Practice with or without telling the person what you are doing.

Shame Attacking is just done without giving away what or why you’re doing it. For example, if you want to sing in public, you can just do that. Or you can approach a person or couple and offer to sing for them, and then when done hold out your hand as if asking for a tip.

There are certain general guidelines for Shame Attacking that we can mention, as they are very important.

You can also do with as a duet with someone you know, so you are doing Shame Attacking together. But in this case, you are definitely not confusing it with Rejection Practice.

During the live podcast, Matt discussed the pros and cons of two different styles of Rejection Practice, and David and Rhonda and Matt sharpened the contrast between Shame-Attacking Exercises and Rejection Practice, which are actually quite different, although there is clear some overlap.

Rhonda described a Shame-Attacking Exercise that David persuaded her to do after a Sunday hike, in a Chinese restaurant when everyone was ordering dim sum. Rhonda went to a nearby table and asked the people who were seated if she could taste their food!

This was almost impossibly anxiety provoking, but to Rhonda’s surprise, they let her tase one of their dim sum and she said it tasted great. They asked if she wanted more! It was a great exercise in overcoming social anxiety.

Matt described one of his outrageous Shame-Attacking Exercises in a grocery store, lying on his back making angels in the snow in the produce section, talking loudly about what an awesome grocery store it was.

He said that he was surprised and relieved to discover that no one seemed interested in what he was doing. He said that one of our illusions is that people are incredibly interested in us, whereas in reality, most people are mainly interested in themselves!

Quite a useful discovery.

Hi Rima, thanks for this nuanced question, I can tell you’ve been paying close attention!

As a little background, the fear of getting rejected can cause a lot of suffering and deprivation, both emotionally and in the form of loneliness, relationship problems and career development. Overcoming this fear can improve one’s social life, relationships and career. However, there’s a ‘necessary’ part of overcoming any fear, which people don’t want to do. It is to lower our defenses and face the fear directly. This is the only way to prove that we are, in fact, ‘safe’, for example, when we are rejected.

Rejection Collection (getting rejected frequently and regularly, and counting these as ‘wins’) is a powerful social exposure method that has helped many people, including myself, overcome the fear of getting rejected.  Huge thanks to David for helping me overcome my resistance to trying this (extremely challenging) exercise. Doing so has helped me overcome my fear and has radically improved many aspects of my life.

Exposure may not work, however, for a variety of reasons. A common one is motivational. For example, we may not want to feel ok, if we’re getting rejected. We might prefer to feel upset, perhaps as a motivator to improve.

Surprisingly, there are many good reasons to base some portion of our worth on the approval of others: Wanting to live up to their expectations, wanting to be open to feedback, wanting to avoid conflict, wanting to be maximally motivated to work hard, in our relationships, to be mature and responsible.

TEAM therapy stresses the importance of raising these motivational elements to the surface for discussion, in an admiring way, before deciding whether to change anything about a person.

If someone can still convince me that they want to overcome the fear of rejection and are willing to do the hard work, rejection collection is extremely effective and powerful. It’s good to know that one’s nerves won’t be the thing that gets in the way of developing a wonderful social life.

Rejection collection can still fail, however, for other reasons. For example, it’s common to focus too narrowly on only one method. There are many, many methods that can help, and may be necessary, to overcome a fear of rejection. Just in the category of ‘Social Exposure’ there are quite a few:

TEAM Therapy Social Exposure Methods:

You’re correct, too, Rima, about the problem of ‘safety behaviors’. Even if ‘rejection collection’ were the method that could lead to a cure, it still might fail if we are, in some way, ‘protecting’ ourselves, during the rejection collection exercise. The most common form of ‘safety behavior’ I’ve seen, when doing ‘rejection collection’, is to rush the process. Then, we can tell ourselves, ‘well, if I’d really tried and put in the time and all my effort, I wouldn’t have gotten rejected’. This defeats the most liberating experience of, ‘I got thoroughly rejected, despite my best effort, and it’s totally fine’.

You asked, is it would be a ‘safety behavior’. if you said this to a stranger: “Please reject me, to help me get over my fear of rejection.’,

I would not necessarily label it as a safety behavior, unless it was the only thing that was said. I would consider this to be ‘Self Disclosure’ (talking about oneself in a vulnerable way) combined with rejection collection. If this were the only thing you said to someone, then I’d agree that it’s a ‘safety behavior’, as there’s a rushed element to it, as opposed to a ‘best effort, still failed, it’s fine’ experience.

The liberation of a ‘real’ rejection is a glorious thing and is, in my experience, most often achieved by combining multiple of the above techniques, starting with, ‘smile and say hello’, ‘talk show host technique’, ‘flirting’, self-disclosure, survey technique and only then asking for a rejection. Practicing this for a bit using the ‘Rejection Feared Fantasy’ (a role-play/practice exercise with one’s therapist) is often great preparation for the real-life experience.

We thank Rhonda for recording for us today, when she is just starting to recover from COVID, and the day before a trip to visit her son, daughter in law, and two wonderful grandchildren.

We love you Rhonda, and wish you the best for a wonderful month!

Thanks for listening today, and thanks for submitting your excellent questions.

Stay tuned for more answers to your questions next week, including these:

Magellan asks about the effectiveness of TEAM without the guidance of a therapist. Werner asks about the differences between Positive Reframing and the Positive Thoughts you record on the Daily Mood Log. Anonymous asks several questions about the Feeling Great App.

Matt, Rhonda, and David

Transgender Issues Featuring Dr. Robin Mathy

Emily Dickinson, from Amherst, Massachusetts, was one of the greatest American 19th century poets, and after hearing one of our Amherst professors explain her life and work, I fell in love with her incredible poetry. When she attended Mt. Holyoke College as a freshman, she was obligated to sign up as a “Christian,” a “Non-Christian with hope,” or a “Non-Christian without hope.”

She was the only student who had ever signed up as a “Non-Christian without hope,” and she was given one semester to change her registration category. When she refused, she was asked to leave, and spent the rest of her life living in Amherst, baking cookies for children and writing her fabulous poems, which were sometimes included in her cookie packages.

Her poetry was all about loss, which was much the story of her life. However, she was not self-pitying, which is part of what makes her poetry so sad and magical.

Emily Dickinson always dreamed of visiting the west, but never got the chance to travel much beyond the outskirts of Amherst.

She once wrote,

To make a prairie,

It takes one clover,

and a bee.

One clover and a bee.

And reverie.

The reverie alone will do, if bees are few.

Tears come to my eyes every time I think about that poem! When I was a student at Amherst, we used to visit her grave, and I once actually knocked on the door of the house where she once lived. I explained I was a huge fan and actually got the chance to look around. I actually found a poem scribbled on a scrap of paper on a window ledge.

Today we interview Dr. Robin Mathy, who describes herself as “A human who hopes.” Robin is a well-published expert on LGBTQ issues, with a specialization in transgender research and political activism based on science to debunk hateful myths about sexuality.

She is also a new member of our Tuesday training group at Stanford!

In addition to studying to become a TEAM therapist, Robin is a Doctor of Social Work student at Tulane University.  She is a researcher and activist who has published four books and more than 50 peer-reviewed articles or book chapters.  She is a beloved member of David and Jill’s Tuesday TEAM CBT group.

Rhonda kicked off today’s podcast by reading two very moving endorsements from people who heard part 1 of the live work with Jessica, “Living with Regrets,” which we had published just prior to our interview with Robin.

Then Rhonda kicked off our dialogue with Robin by asking if there are any special treatment considerations when you are working with trans individuals.

Robin said that there really aren’t—TEAM-CBT is already highly personalized and individualized, so we let the patient set the agenda. Robin emphasized the importance, of course, of being warm, affirming, and supportive.

In addition, do not assume that the patient is there because of gender identity issues, or automatically refer them to a support group on that topic, because the patient’s issue may be radically different, and that would amount to stereotyping your patient.

I asked Robin for a simplified introduction to LGBTQ, including what these terms actually mean. That’s because I have to admit I never had any good sexual diversity training during my medical school or psychiatry residency, and I suspect that some of our podcast fans, perhaps many, would also appreciate a little enlightenment based on science.

Robin pointed out that transgender has to do with identity issues: what is your sense of self? Do you see yourself  more as a woman or a man? And sometimes, this will be quite different from the gender you were assigned at birth.

So, for example, you may be assigned as a boy at birth, but your sense of who you are may be a girl, when you are young, and a woman as you develop during puberty. In this case, you would be a trans-gender woman. To be respectful, you should refer to a transgender woman as she or her. And, of course, if you were assigned as a girl at birth, but your sense of who you are is a boy/man, you would be a transgender man, referred to as he / him.

Some transgender people are nonbinary, meaning they do not want to be referred to as either a man or a woman, and they do not want to be referred to with either binary pronoun. To be respectful and sensitive, you should always ask someone what pronouns they prefer.

In contrast, the terms, LGBQ, do not refer to gender identity, but rather to sexual attraction. So, a lesbian is a woman who is sexually or romantically attracted to women, and a gay man is attracted to men, and so forth.

The term, “cis,” refers to your gender that was assigned at birth. According to the National Center for Transgender Equality,

When a person begins to live according to their gender identity, rather than the gender they were thought to be when they were born, this time period is called gender transition. Deciding to transition can take a lot of reflection. . . . Possible steps in a gender transition may or may not include changing your clothing, appearance, name, or the pronoun people use to refer to you (like “she,” “he,” or “they”).

But it can be a bit more complex. Robin says:

A lot of people like me do not actually identify as transgender. I was assigned as a male at birth, but I have always felt like a girl / woman. I think of myself as gender-diverse, not as transgender. . .

I remember taking a bath with my sister when we were young, and I realized that I had something that didn’t belong on me. . . .

My parents raised me as a boy, but I was always effeminate. As I developed as a teenager, my transition was from being “me” to being “fully me” and completely embracing my identity as a woman. This was freeing to me.

We are taught to believe that there are two types of chromosomes that determine our gender: XX for female and XY for male. But this is misleading because there is actually a broad range of chromosomal makeups (sex), sexual attractions as well as gender identities, and gender identity and sexual attraction can be completely independent. For example, someone can be a transgender woman, and be attracted to either men or women or both.

Robin pointed out that some transgender women can look like glamorous women, and two transgender women have actually won national beauty contests. "It is cruel," Robin suggests," to insist that transgender women must use men’s bathrooms, just because they have the XY chromosome set."

She pointed out that gender identity usually develops by age 7, but in trans individuals the incongruity between their gender identity and sex assigned at birth crystallizes at around age 10 or 11, during puberty. Although many transgender people recall being gender nonconforming and/or identifying as another gender in early childhood, we now know this is not always the case.

We discussed the pain of discrimination trans individuals face, and Robin described her own suicide attempt in her early twenties, in part because her male sexual organs and secondary sex characteristics like facial hair “disgusted me.”  Fortunately, she was assigned a very understanding gay psychiatrist in the hospital, and he said that she could start transitional hormone therapy right away if she was interested, and this was a great help.

She said that she was a candidate for the Olympic wrestling team, and it was clear that she did not appear feminine to others because of her muscles, and she experienced a great deal of ridicule and rejection when began to transition. This negative bias included some medical professionals she consulted for help. Eventually she was able to obtain gender-affirming surgery. She said she came out as gender-diverse in March 2023 to be an advocate because 24 states in just the past three years have banned gender-affirming medical care for minors.

Robin also clarified the meaning of the term, queer, which used to be a pejorative term. Now it is embraced by the LGBTQ community as a term referring to all sexual and gender minorities.

Toward the end of our interview, Robin emphasized the importance of hope, and said she had a “glimmer” of hope, even in her darkest hours.

To learn more about Robin’s pioneering work, or if you are interested in the science and research regarding transgender issues, Robin warmly invites you to visit her YouTube channel, (27) Robin Mathy - YouTube. She says, “Please feel free to disseminate the information” and wants you to know that “I love comments (positive and negative).” So give her some feedback if you’re so inclined!

Thanks for listening today!

Robin, Rhonda and David

Overcoming Loneliness Part 2-- A Master Class on the Feared Fantasy Technique Featuring Dr. Orly Marmur

This is the second of a two-part series on loneliness, featuring the courageous personal work of Dr. Orly Marmur with Drs. David Burns and Jill Levitt as co-therapists.

After Orly shared her story, we worked on helping her learn to use the Five Secrets, especially the Disarming Technique and Inquiry, to develop closer relationships with others. Jill described the philosophy of this approach as learning to be ”interested” in others—encouraging them to talk about themselves—rather than trying to be “interesting" or "impressive," which is usually a losing battle.

We also worked with the Feared Fantasy technique to help Orly deal with her fear of rejection. Essentially, we explained that we would enter an Alice-in-Wonderland Nightmare World where there were two weird rules:.

If you think people are judging you or looking down on you, they really are! In this Nightmare World, people are not polite but get right in your face and tell you all the negative thoughts they’re having about you.

We asked Orly to describe the worst criticisms she thought her friends might have about her. Here’s the list:

We’re not really interested in you. You don’t really say or create anything interesting. You are by yourself. We have families. You’re not funny enough. You’re not fun enough. You’re too intellectual. You’re too political. You’re a liability.

Orly bravely took the role of herself to kick things off, and Jill and David played the role of the “friends from hell,” and verbalized these criticisms to Orly.

At first Orly struggled to respond effectively to the critical statements. She got stuck defending herself at times, and forgot to express interest in the critic and the specific criticisms.

David and Jill modeled more effective responses, using the Five Secrets of Effective Communication, including

Orly did a fantastic job, as you’ll hear on the podcast, and we did some role reversals to refine certain responses.

The goal of the Feared Fantasy is not so much to prepare for rejection in the real world, since very few people would ever say these things in such a harsh and open way. The Feared Fantasy “Monster” actually exists primarily in your own mind. But since most of us never think about the thing we fear, we don’t realize or discover that the monster has no teeth.

That is to say that by engaging with your greatest interpersonal fears, you discover that if someone were to attack you with over the top vague criticisms, you would survive, and it would reveal something terrible about the other person, not about you!

The Feared Fantasy Technique brings this to life in a dramatic, emotional, and vivid way.

At the end of the session there was a dramatic reduction in all of Orly's scores on the Emotions Table of her Dailly Mood log. Her

As you can see, there was a dramatic reduction in all of her scores.

We asked Orly what the most important healing elements during the session were. What techniques were that were most helpful.

Orly said that the empathy from Jill and David was really  important as she felt heard and accepted. The Feared Fantasy Technique also made a huge difference, as it taught her what she wanted, which was to feel intense feelings without doing anything about them. Orly felt that this is the continuation of earlier work that made her realize that she struggles with Emotophobia (which means “the fear of feeling your emotions), and she wanted to increase her capacity to simply feel.

Rhonda, Jill, and David want to give a shout out and virtual hug to Orly for a most fantastic session and learning opportunity for all of us.

Teaching Points

Here are a few teaching points for therapists as well as the general public.

The secret of meaningful relationships is to be interested in others instead of trying to be “interesting” or impressive. You do not need to add more accomplishments to the list in order to feel close and loved by others. The Disarming and Inquiry Techniques (which are parts of the Five Secrets of Effective Communication) are extremely important in calming troubled relationships, if used skillfully, because they open the door for the other person to be heard and validated, and hopefully interested in healing and repairing the relationship. When you use the Feared Fantasy Technique, you discover that the rejecting “monster” you feared has no teeth, and you may also discover that you are the one who created it. In other words, the “monster” you’ve feared was always just the projection of your own self-criticisms! The Feared Fantasy is an intense method that can be helpful when the patient feels “trapped” or intensely afraid of rejection. However, it requires a strong foundation of trust between the therapist and the patient, especially when you respond to the “monster’s” criticisms with acceptance and vulnerability. The more “over the top” the criticism is in the feared fantasy, usually, the more successful the method is, because you discover two things: 1) that the extremely harsh criticisms reveal something negative about the critic, rather than about you, and 2) specific criticisms (e.g., “you haven’t read enough books”) are very easy to agree with and disarm and do not have to hurt your ego! Rhonda pointed out that during the early empathy phase of the session, Jill and David did “very basic, simple empathy” without any attempt to cheerlead or “help.” Very few therapists can do this, and most therapists don’t even realize that their empathy / listening skills are poor. The use of David’s empathy scale at the end of every session with every patient can be extremely eye-opening for therapists who are brave, because you will see how your patient really sees you and rates your empathy skills. Effective therapy is highly individualized and rarely or never formulaic. Orly started out by asked for help with symptoms of PTSD that started the day of the horrendous slaughter of many Israeli citizens by the invading Hamas fighters. But the session evolved into something entirely personal involving Orly’s relationships with herself and with other people. In the end, Orly worked on accepting herself, connecting with others, and reducing her own perfectionism and perceived perfectionism, a therapeutic agenda that emerged as David and Jill empathized and collaborated with Orly. This led to Orly feeling less lonely, isolated, and numb, and more able to feel her feelings!

Follow-up (many weeks later)

Orly reported that she has felt “calm and quiet” since her session. She has definitely attempted to use the Disarming and Inquiry Techniques in several relationship situations, but said that the most important change has been her feelings of “inner calm and peace of mind.”

She said that she is no longer so invested in doing for others or attempting to show people that she is there for them. She simply lets things unfold naturally and is now able to let go and accept it when things she hoped for don’t happen.

This may be related to reducing her underlying beliefs around perfectionism and perceived perfectionism that were targeted in the feared fantasy work that she did during the session. Instead of thinking that she has to be impressive in order to be loved, she has learned to accept herself, which is arguably the greatest change a human can make!

For those who might be looking for a bottom line, I (David) might summarize Orly’s subtle but remarkable change as a boost in acceptance of self and the world—a result that is easy to explain, but difficult for most people to comprehend, and even harder implement in our own lives.

A big thanks to you, Orly, for teaching all of us through your own courageous personal work as the New Year unfolds and hopefully offers more world peace and increased love and connection.

Thanks for listening!

Warmly,

Rhonda, Jill, Orly, and David

Overcoming Loneliness Part 1-- How to Develop Loving Relationships Featuring Dr. Orly Marmur

This is the first of a two-part series on loneliness, featuring the courageous personal work of Dr. Orly Marmur with Drs. David Burns and Jill Levitt as co-therapists.

Orly is a clinical psychologist from Southern California and member of our Tuesday TEAM-CBT training group at Stanford. She loves to hike, and recently went on a 25 mile solo hike from the North to the South Rim of the Grand Canyon, an arduous hike that she planned for a long time  She happened to be hiking on October 7, 2023, the day of the Hamas invasion of Israel.

The hike was a huge victory for Orly, but when she arrived at the top of the South Rim, her cell phone was instantly bombarded with news and emails about the Hamas invasion and brutal murder, beheading, and rape of many innocent Israeli citizens.

For the next several days, Orly’s mind was flooded with flashbacks of her life, growing up in Israel when the country was still young, and living through four wars. Her father and brothers were in one war together, and her brother was wounded, but survived and recovered.

Orly felt guilt and shame because she was not there to help. She said that she wanted to go to Israel to help her brother with his farm, but was conflicted because she did not want to abandon her clinical practice in Southern California.

She explained:

I grew up with the people who started the State of Israel. Those were idealistic, heroic times. My grandmother left Europe when she was 17 and settled in Israel. The focus was on building. We learned to be heroic.

A few days later, in the Tuesday group, David noticed that I was feeling down and lonely unable to focus and “checked out.” I had  a hard time feeling my feelings. I had shut down.

I began being flooded with memories of sexual molestation at my grandparents’ house when I was a girl in Israel. I remember standing next to a tree, and feeling like I was “different” from the other kids,

I started feeling sad and guilty about losing so many relationships over the years. I’ve alienated so many people, and now I want to accept responsibility for that.

When my daughter was 1 year old, I became friends  with other parents at the day care center. We became like an extended family as our kids grew up, getting together on Fridays for dinner, celebrating holidays together and being there for each other.

However, during the pandemic, I began to feel rejected by them. And sometimes there were individual rejections. We had often camped out together over the years, but all of a sudden, I was not invited. I was the only single person. The rest of the group are couples. Over the years, I was told a few times that, at times, my presence makes things difficult.

Since then, I’ve been invited to some but not other functions of our group. I haven’t felt like people are interested in me, or like me.

I also want to feel my feelings and develop a sense of empathy for others and greater pride in myself—after all, I DID survive.

I became very politically active with others interested in supporting Israel after the October 7th invasion. I was hoping to feel close to people, but it didn’t work because I still felt alone. I had hoped they’d be impressed with my political activism, but it didn’t help.

My problem was not the war, but me.

I’m hoping today you can help me to feel my feelings again! I realize that I tend to jump to action rather than feel my feelings. I think that it has to do with my upbringing and the circumstances and culture that I came from. Next week you will hear the exciting conclusion to the work with Orly, and a follow-up several weeks later.

Thanks for listening today!

Rhonda, Jill, Orly, and David

The Anxious Child— Three Common Errors Parents Make, and How to Avoid Them!  Featuring Dr. Taylor Chesney

Today we interview Dr. Taylor Chesney who is the Director of the New York office of the Feeling Good Institute. She specializes in the treatment of children and teens, and today will tell us about the three biggest errors parents make in dealing with anxious kids.

Dr. Chesney has been a guest on several of our podcasts in the past (episodes 107 and 263, and Corona Casts 4 and 6) and is a terrific teacher and therapist. She recently taught a 12 week course for therapists working with teens and children (ages 6 to 18) and their parents and brings us some of the highlights today.

She always begins treatment by interviewing the child and the parents and pinpoints what they want help with. Then she assesses how hard they are willing to work to bring about that change. The goals may be quite different for the child and the parents. It’s crucial to develop a meaningful therapeutic contract with the children, as well as the parents, as opposed to thinking your role is to “fix” the child for the parents.

If the child is less than 11 years old, she meets with the parents first. If the child is 12 and up, she meets with the child first. Either way, she empathizes with the child and encourage them to tell their side of the problem.

During or after empathizing, she does Positive Reframing, to show the child what their negative feelings, like depression and anxiety, show about them that’s positive and awesome. For example, if you’re sad about not being invited to a birthday party, it shows that you value friendships, and that you care a lot about other people.

If the child is anxious, she will teach them how their anxiety can be helpful. For example, if the child is a good athlete or student, anxiety can be an important motivating force in their success.

But sometimes we might get too anxious and feel intensely anxious about something that is not actually dangerous. Then you might experience your anxiety as trouble eating, a belly ache, trouble sleeping, or some other symptom that gets in the way of your optimal functioning.

The most important question with parents and children is usually: “Do you want to learn some tools and skills to help you change the way you feel?”

She also teaches children and teens what different kinds of emotions are, and the kinds of thoughts that trigger them. For example, if you feel anxious, you’re probably telling yourself that you’re in danger and that something bad is about to happen. If you feel guilty, you’re probably telling yourself that you’ve done something bad, or that you hurt someone you love; and if you’re feeling angry you may be telling yourself that someone is trying to hurt you or take advantage of you.

Taylor brings the core cognitive therapy ideas to life with examples that children can understand.  Here’s how she explains the idea, taught by Epictetus nearly 2,000 years ago, that our feelings do not result from what happens to us, but from our thoughts about what’s happening. Let’s say that you got a 90 on a test. How would you feel? You might feel overjoyed if you studied hard and felt like you did a good job and got a wonderful grade.

However, if you felt like you had to get a 95 to raise your semester grade in the class to an A, and you even skipped going to the prom to study extra hard, you might feel sad, ashamed, frustrated, angry, and disappointed, telling yourself that you “failed.”

Same grade, but two radically different emotional reactions, depending on how you think about your grade. Conclusion: it’s not what happens, but what you tell yourself, that triggers all of your positive and negative feelings.

Taylor said that anxiety is incredibly common in her clinic population and that surveys indicate that a whopping 25% of children have an anxiety disorder. She teaches her patients that anxiety in children, teens, and adults results from giving in to the urge to escape from a frightening or uncomfortable situation instead of facing your fears and discovering that the monster has no teeth.

For example, Taylor was in the ocean with her 9 year old son, and there were jellyfish in the ocean. Her son was terrified and wanted to get out of the water and back to the shore.

Taylor asked him what he was telling himself, and he said he was thinking that the jellyfish were bad. She also told him, “It’s okay to be afraid and to be careful and avoid the jelly fish, but you can also choose to stay in the ocean. Then we can have some fun together playing in the water.” He decided to stay and have fun and felt proud of himself!

She described Three Common Mistakes parents make in dealing with an anxious child.

She explained that we love our children, and don’t want them to suffer, so we may give them an easy way out. For example, if your child is afraid to go to the party when you are dropping them off, you might say, “If you don’t want to go to the party, we can go home.”

This seems like a kind and loving thing to do, protecting your child. However, you’re teaching the child that he or she can escape from anxiety through avoidance, so the child’s fear of social interactions actually increases. It also teaches the child that you don’t think they can handle the situation.

An alternate response would be to say, “Let’s go in and sit down together!”

She advised against cheerleading or trying to convince your child that they have nothing to be afraid of (e.g. “it’s not that scary” “there’s nothing to be afraid of.”) Instead, you can tell them that it’s okay to feel the fear but do it anyway, and you can often model that together with them.

In this trap, you let your fearful and avoidant child become more and more anxious and demanding, until they freak out and throw a temper tantrum, and then you give in to them. This, again, provides immediate relief, but in the long run you are training them to escalate and throw a tantrum to escape from having to face their fears, and on a broader scale, any time they want to get what they want.

Mental Filtering is one of the ten original cognitive distortions, and it means focusing on the negatives in any situation and ignoring, or discounting the positives. It’s a common cause of depression, but can also be a communication error if you focus excessively on what your child is doing wrong.

Instead of pointing out your child’s errors, you might say, “Johnny, I love how you stayed calm when X happened. You’re really getting good at that.” In other words, you can comment on what they are doing right.

She said that showing kids how to be successful is more effective than berating them for what they’re doing wrong. This is an effective and low-stress way of reshaping their self-defeating behaviors.

David mentioned that this positive style of communicating can also be highly effective in a work environment, and that he uses it a great deal in his interactions with colleagues on the app team. If done in a genuine way, it can quickly reduce conflict and enhance morale and mutual respect.

David asked Taylor if many parents resist implementing these kinds of changes. Taylor said that if she calmly and clearly teaches the parents what they’re doing that isn’t working, using the Five Secrets of Effective Communication, most parents quickly become motivated to grasp their mistakes and change their strategies in dealing with their children.

Taylor also “Sits with Open Hands” when making suggestions to parents. She explains it like this:

This means that if what the parents are doing works for them, and they aren’t willing to work hard to make changes, I accept this. But if they’re willing to work hard and change, we can work together to help them implement more effective parenting strategies.

Getting parents to work together as a team can be very important, but some parents may fight over the best way to discipline and raise their kids. These conflicts between mom and dad are one of the major causes of the unhappiness in the kids and get in the way of change.

Taylor emphasizes “Little Steps for Big Feets,” and might set small attainable goals for the parents who are at odds. For example, can they just sit next to each other and perhaps even “fake” a unified front for one conversation? Parents do not have to commit to making these changes “for the rest of their lives,” but make experimental small changes instead, for a small discrete period of time, and then check in and see if the change makes a difference. If it does, they may be motivated to continue to try to implement more changes.

Taylor typically works with children and their parents for 12 to 16 sessions and gives them a tool set to change some specific problem they came to therapy to solve. She has worked virtually for the most part since the start of the pandemic, but is now starting to see some people in person again.

She offers classes for mental health professionals and also runs a monthly case consultation group on the last Wednesday of every month from 12:30 – 2 pm EST. For more information, you can reach Dr. Chesney at Taylor@FeelingGoodInstitute.com.

Every fall, Taylor teaches a 12-week training course for therapists on TEAM-CBT for children and adolescents. You can also check the www.FeelingGoodInstitute.com website for more information on TEAM-CBT training for children and adults.

Thanks for listening today!

Rhonda, Taylor, and David

Personal Work with Dr. Tom Gedman-- Overcoming Performance Anxiety The Triumphant Conclusion

Last week you heard Part 2 of our personal work with Dr. Tom Gedman, which included T = Testing and E = Empathy. This week you will hear the dramatic and inspiring conclusion of the session, including A = Assessment of Resistance and M = Methods.

We began with the Invitation Step, asking Dr. Gedman what he hoped to accomplish in today’s session. His list included:

Develop some clarity on the direction of my business. Become more authentic in my video recordings promoting my clinical work. Increase in self-confidence. Feel accepted by David and Rhonda. My ability to push ahead during recordings instead of stopping and backing down because it isn’t “good enough.”

Dr. Gedman said that he’d gladly push the Magic Button to make his negative thoughts and feelings instantly disappear, but agreed to look at some of the positives in them first by asking these types of questions of each negative thought or feeling.

Is there some truth in this negative thought? Could this negative thought or feeling be appropriate or even healthy, given my circumstances? How might this negative thought or feeling be helping me? What does this negative thought or feeling show about me and my core values that’s positive and awesome? Could there be some negative consequences of giving up this negative thought or feeling?

Negative thought: “I can’t be authentic on videos. I look like such s smug phony.”

I want to be other-centered, and focused on how I might be able to relieve the emotional struggles and health problems of my patients. I value being authentic and genuine. I want to help people who resonate with my message. I don’t want to hide. I want to be open with my flaws. I value honesty and integrity. I value humility. I value compassion.

Negative feeling: sadness

I care a great deal about my dream. I don’t want to fail and let my family down.

Negative feeling: shame

Motivates me to work harder Shows my love for my family. I’m aware that I’m letting down the very people I want to help.

Negative feeling: inferior, inadequate

Show that I respect and admire the many people who have superior skills at talking live in front of a camera. Shows that I’m aware of what others have accomplished. Shows I don’t feel superior to others.

The idea behind the Positive Reframing is to help the patients see that their negative thoughts and feelings are not the expression of what’s “wrong” with them, but what’s right with them. This paradoxically reduces the resistance to change and opens the door to the possibility of rapid recovery.

You can see Dr. Gedman’s goals for each of the negative feelings on his Daily Mood Log if you click here. As you can see, instead of trying to eliminate his negative thoughts and feelings by pushing the Magic Button, he has decided to dial them down to lower levels with the Magic Dial.

Of course, these are only goals. We will need methods to challenge and smash his negative thoughts so we can reduce his negative feelings.

Rhonda, Tom, and David used a variety of methods to work on several negative thoughts Tom wanted to work on first, including numbers 1, 2, and 4 from Tom’s Daily Mood Log..

I can’t be authentic. I look like a smug phony. 100% I waste so much time on my videos. I should be quicker. This should be easier. 100% David and Rhonda will judge me for what I’m doing. 80%

We used several methods including Explain the Distortions, Survey Technique, Externalization of Voices (with Self-Defense, Acceptance Paradox, Counter-Attack Technique,) and more

You can see Dr. Gedman’s end-of-session scores on his nine negative feelings on his Daily Mood Log if you click here. As you can see, eight of the feelings fell all the way to zero, and his feelings of inadequacy fell from 100 all the way to 5.

Toward the end of the session, we discussed Tom’s medical and psychological philosophy, which might appeal to some of our podcast fans, especially if you live in England. First, he uses TEAM-CBT in individual two-hour sessions to help help people who are struggling with feelings of depression and anxiety. He finds this work thrilling because you can often see amazing changes within a single session, just like we saw in Tom’s work today.

Dr. Gedman also hopes to develop TEAM-CBT groups as well. This can be difficult because you need many referrals, but in my experience, TEAM groups can be incredibly effective, and cost-effective as well.

In addition, Tom also has a Functional Medical Practice which focuses on developing healthy nutritional and eating habits, consistent exercise, limiting the intake of toxins, developing loving relationships via the Five Secrets of Effective Communication, and enhancing spirituality.

If you would like to contact Dr. Gedman and learn more about his clinical practice, he can be reached at www.DrTomGedman.com.

Toward the beginning of these show notes, I reminded everyone of how anxious and insecure our beloved Rhonda felt at the start of our work together, when she took over for Fabrice. And now, she seems to be the poster child for charm, warmth, humor, and charisma.

That doesn’t usually happen automatically. Rhonda, like Tom, did her hard personal work, using the Daily Mood Log and several TEAM-CBT methods. But one thing that has been especially helpful to her, after initially “beating” her insecurity, has been the constant exposure work, with hours of weekly podcast recordings.

I, too, have had the chance to do constant, ongoing exposure for my own extreme feelings of inadequacy in front of live audiences or cameras, since I teach every week at my Stanford psychotherapy training class, as well as frequent  workshops, In addition, I have recorded almost daily for the Feeling Great App, which should be released in the first quarter of 2024. This exposure work has helped me cement and extend my gains in overcoming my own performance anxiety.

I plan to contact Tom to recommend the same. Perhaps in England they have program similar to Toastmasters, where you can have the chance to speak in public frequently and get valuable feedback from peers and colleagues.

I want to give a big hug and thanks to you, Tom, for sharing your intensely personal and real personal work with all of us today, and thanks, too, for reminding us of our own humanity and the magic of humility and the “Great Death” of the “Self.”

Thanks for listening today!

Tom, Rhonda, and David

Personal Work with Dr. Tom Gedman-- Overcoming Performance Anxiety

Have you ever struggled with Performance Anxiety? That can include public speaking anxiety, as well as anxiety when having to perform in an athletic or musical event, or speak on the radio, TV, or internet , etc. This is one of the most common forms of anxiety that we see in mental health professionals, as well, of course, in general citizens, including children, teens and adults.

Today you will hear Part 1 of the live work with Dr. Tom Gedman, a British physician struggling with intense performance anxiety, including the initial T = Testing and E = Empathy. Next week, you’ll hear Part 2 of the session as David and Rhonda do the A = Assessment of Resistance and M = Methods portions of the work with Dr. Gedman.

You may recall Dr. Gedman from our previous podcast (# 348). Recently, Dr. Gedman has wanted to promote his new programs on health and mental health in brief videos he plans to publish on social media sites, but finds himself crippled by negative thoughts that make him freeze up in front of the camera, like these:

I’m not good at this. 100% I can’t be authentic. 100$ I’ll look like a robot! 100%

Tom practices in England as a family practice doctor, but has decided to work part time for the national health service while he establishes his clinical practice because he is only permitted to spend 10 minutes with each patient. He has developed a love affair and expertise with TEAM-CBT, and wants the freedom to practices in the way he wants, offering two-hour individual and group sessions, where he emphasizes the integration of physical with mental health.

But this means having to advertise his clinical practice to solicit patients, and this is a bit of a treadmill because of the rapid changes he sees in so many of his patients. Hence, his urgent need to overcome his public speaking / performance anxiety.

I have a soft spot in my heart for anyone who’s struggle with these types of anxious thoughts and feelings, because I have encountered them on many occasions in my professional career when I had to present my work in conferences, or even when attending receptions that included other mental health professionals.

In fact, I am the “voice” on the Feeling Great App that I’ve been developing over the past several years, and it took me some time to get comfortable with the recordings, since I told myself that I “had to sound natural, spontaneous, and inspiring.” Of course those internal and external demands caused the exact opposite—feelings of tension, insecurity, pressure, and intense self-doubt, resulting in “robotness” as opposed to spontaneity!

Yikes! It was a dreadful battle for a while! So, I KNOW how Tom has been feeling.

And our beloved Rhonda has been there, too, especially when she took over from Dr. Fabrice Nye as host of the Feeling Good Podcast that you’re listening to right now. If you recall, she was feeling pretty darn insecure! (See Podcasts # 142 and 143.)

Perhaps you’ve also struggled with social or public speaking anxiety, and felt insecure, panicky, frustrated, or ashamed? Have you? Even in our weekly training group at Stanford for mental health professionals, these feelings are rampant and nearly universal.

Tom brought a partially completed Daily Mood Log to today’s session. You can review it if you CLICK HERE. As you can see, he was feeling nine different categories of negative feelings, all intensely, with estimates ranging from 70 to 100.

This is why T = Testing is necessary for all mental health professionals, regardless of your so-called “school” of therapy. People, like Tom, may look attractive and filled with enthusiasm and joy on the outside, and still be experiencing EXTREME levels of distress inside.

The T = Testing vasty improves your accuracy in understanding how your patients are feeling. It also makes you accountable, which can be sobering, because we will again ask Tom how he’s feeling at the end of the session. The improvement, or lack of improvement, will tell us EXACTLY how effective, or ineffective, we were today in our work with Tom.

This is a great bonus for therapists who are courageous enough to use my Brief Mood Survey at the stat and end of every session, with every patient, because your patients become your best teachers, by far. But it’s also a threat, because the numbers don’t lie, and you’ll also be confronted by your ineffectiveness with many of your patients / clients.

Sadly, a great many therapists would prefer not knowing the truth!

Although Tom had previously defeated these anxiety-provoking thoughts and reached a state of relative enlightenment and joy, the thoughts have come creeping back into his psyche. That’s one of the things about anxiety. Once you’ve beaten it, you have to keep up the assault with frequent, ongoing exposure, or the anxiety will once again invade your brain and body.

But the good news is that the methods that helped you initially are very likely to help you again, and if you continue using exposure after your first recovery, you can greatly reduce the probability of relapse.

These are the methods that helped Tom in the past:

Tom said,

Those techniques worked like magic when David and Mike Christensen did a live demonstration with me several months ago at a TEAM-CBT conference in England. I opened up about how I was feeling inside, and sobbed for several minutes during the session. Then I developed amazing relationships with colleagues at that conference. I was on a high for several months.

The TEAM-CBT session was life-changing. It gave me my life back. But now I’ve lost my way again.

Can those methods help Tom again today? You will get the chance to look behind closed doors as Rhonda and David do some personal TEAM-CBT work with Tom.

Tom continued to explain his situation as Rhonda and David empathized.

I’m very passionate about the work I want to do, but when I try to convey my message, I tighten up. . . I did 18 takes on a brief message to promote my new practice, but I just wasn’t authentic. I felt enormous pressure to entertain.

If I don’t get over this, people will think I’m a quack. I’ll get criticized. The work I do with patients behind closed doors has been amazing.  personal  The last couple patients I saw got their mood scores down all the way to zero.

Those sessions were intensely exciting! But how can I get the word out to the many people who need help with feelings of depression and anxiety, as well as poor habits of exercise and eating?

I’m just not earning much money now. My wife is working long hours to support our family while I’m trying to guild up my clinical practice. I feel so guilty. I take care of our three-year old son. On Monday, I felt so frustrated and discouraged that I felt like I was on the verge of a breakdown.

I feel sad and worried that things won’t pan out. It’s high stakes. . . I’ve always been a perfectionist. It’s helped me, but it’s also held me back.

I’m just angry at myself for not getting myself out of this desperate situation.

Rhonda and David paraphrased Tom’s words and acknowledged his intensely negative feelings as he spoke, without trying to be helpful, and without making interpretations or trying to cheer him up. Then we asked Tom to give us a grade on empathy, thinking of these three aspects of effective:

How well did we understand how Tom was thinking? How well did we understand how he was feeling inside? Did we create a sense of warmth, connection and acceptance?

Tom gave us an A. Next week, you’ll hear the dramatic conclusion of our session with Tom, including the A = Assessment of Resistance and the M = Methods, and, of course, the final T = Testing to find out if the session was helpful!

Thanks for listening today!

Tom, Rhonda, and David

Rhonda Describes the GRIP Program and Interviews GRIP Graduate, Shakur Ross

The Guiding Rage Into Power (GRIP) Training Institute serves incarcerated men and women in California.  Their mission is to create personal and systemic change to turn violence and suffering into opportunities for learning and healing.

I (Rhonda) was introduced to the GRIP program when two of my dearest friends, Steve Zimmerman and Vicki Peet, invited me to a yearly celebration of the GRIP Training institute.  I was blown away by who I met and what I learned that I wanted to share it with the Feeling Good Podcast listeners.  Thank you, David, for letting me deviate from our typical subjects.

The GRIP program is a different subject for the Feeling Good Podcast, because it is not about TEAM-CBT.  What the GRIP Program and TEAM-CBT have in common is that they are both evidence-based programs that incorporate CBT theory and methods into their treatment methodology.  But the main thing they have in common is that people who engage in these two therapies experience profound, enlightening changes in their lives.

From their program:

“The GRIP program is an evidence-based methodology developed over 25 years of work with 1000’s of incarcerated people and many victim/survivors. Rooted in Restorative Justice principles, the program’s trauma informed model integrates cutting-edge neuroscience research.  Students engage in a yearlong, in-depth journey to comprehend the origins of their violence and develop skills to track and manage strong impulses rather than acting out in harmful ways.  They transform destructive beliefs and behaviors into an attitude of emotional intelligence that prevents revictimization.”

The GRIP Training Institute was started in 2011.  As of October 2020, nine years after running its first group, 915 students have graduated.  Of the 915 graduates, 369 were released from prison.  Only 1 graduate in nine years returned to prison, which is a recidivism rate of 0.3%, which is very impressive considering the recidivism rate for California is between 44-46%.  Many, if not all of the graduates, say that GRIP saved their lives.  Something many people who have benefitted from TEAM-CBT echo.

At the GRIP celebration, I was standing in line waiting for the buffet.  A man got in line behind me.  It was confusing where the line ended, which was not directly behind me.

In another circumstance I might have mentioned to him that the line ended somewhere else, but he was kind of scary looking, big, buff with obvious prison tattoos on his neck so I didn’t say anything.  But the line moved slowly and I was curious so I asked him what his connection to GRIP was.  He told me he was a graduate of the program and then politely asked me the same question.

It has been my experience that often people love to talk about themselves more than they are interested in other people so I was immediately impressed that he was as interested in me as I was in him.  When I told him I was a therapist, he asked me what kind of therapy I practiced.  I explained TEAM-CBT, and he was super interested!

He told me he loved CBT, and had learned a lot about himself through that kind of therapy because GRIP incorporated it in their program.  I asked him about his experience in GRIP and his tough exterior transformed right in front of me as he talked about how GRIP saved his life.

I talked to several other men (so far only men have graduated from the GRIP program because the services have only recently been brought to a women’s prison), and had the same experience.  I met our guest on this podcast, Shakur Ross, who kindly agreed to share his journey of transformation with us.

GRIP graduates continue to do the work and live as Peacemakers.  Shakur works for GRIP and returns to San Quentin and other prisons to provide the same lessons that he received.

The podcast starts with an interview with Kim Moore, the Executive Director of the GRIP Training Institute, who explains some of the key concepts of the program.

Thanks for listening today!

Rhonda

Jessica Malvicino Live Work With Jessica-- Living with Regrets

Rhonda and I recently did live work at a TEAM-CBT intensive in Mexico City. Our “patient” was a 40 year old mental health professional named Jessica with many years of unhappiness because of a decision she made when she was just 17. Perhaps you’ve also looked back on your life and thought, “If only I would have . . . “ done something I didn’t do,” as well as, “I wish I hadn’t done X, when I was young.”

Last week you heard the initial Testing and Empathy portions of the session with Jessica. Today you'll hear the Assessment of Resistance, Methods, and final Testing..

Jessica said her goal for the session was learning to accept life and move on, and not have such constant feelings of emptiness, with so many “I should have” thoughts running through her brain.

Although Jessica, like most people, said she’d press the Magic Button to make all of her negative thoughts and feelings disappear, we decided to do some Positive Reframing first, to see if there were some positives hiding in her negative feelings. We asked the following questions about a number of her negative feelings and thoughts:

Why might this thought or feeling be appropriate and healthy? Why might this thought or feeling be helpful to you? Why does this thought or feeling show about you and your core values that’s positive and awesome. ?

As you probably know, the goal of there are two goals for this paradoxical exercise: First, we want to bring the patient’s subconscious resistance to conscious awareness. Second, we want her to see that her struggling and suffering is NOT the result of what’s WRONG with her, but rather, what’s RIGHT with her.

The moment that people really “see” and “get” this, there’s often a sharp and sudden reduction in feelings of shame, and a strong burst of motivation to crush the negative thoughts at the heart of her misery.

Here are some of the Positives we listed:

My sadness shows my passion and love of dancing.

It shows my dedication to the idea of having a fulfilling career.

It shows that I’m a very loving person.

ANXIETY, WORRY, NERVOUSNESS

These feelings

After listing these and other positives, Jessica decided to use the Magic Dial to reduce her negative feelings to lower levels, but not necessarily all the way to zero, as you can see in the goal column on her emotions table:

Then we went on to

These were some of the negative thoughts that Jessica wanted to challenge, along with the percent she initially believed each of them:

I’m a failure. 90% My mom is to blame for not understanding the career path that I wanted. 90% I was an idiot for not following my dreams. 100% Nothing will truly fulfill my professional career. 100% I have to “settle” for my professional career now.100%

She had many others ad well.

We used a variety of techniques to challenge and crush these thoughts, including the Externalization of Voices with Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique), and used frequent role reversals to help Jessica get to “huge” wins when she was in the role of her positive thoughts.

Here you can see Jessica’s scores in the “% After” column. As you can see, her scores were extraordinarily low, which is terrific.

Typically, such drastic and sudden reductions in negative feelings not only indicate “recovery,” but the experience of feelings of joy and enlightenment.

At the end we asked Jessica two questions:

Are the scores valid, or is she just trying to please us? If they are valid, what were the most healing and helpful aspects of the session?

As you listen to the end of the live session, you’ll find out what she said!

Rhonda and I hope you enjoyed the session with Jessica. We believe that live work with real people, and not role players who are pretending to be in therapy, is invaluable, and one of the best—and only—ways to learn many of the subtleties of rapid and effective treatment. And if you are a general citizen, and not a therapist, I hope your found our work with the brave and wonderful Jessica to be inspirational and educational, especially if you have also sometimes felt depressed, anxious, or ashamed, and if you have found that regrets about the past can put a real damper on your capacity to live and enjoy your precious present moments!

Our best teaching is usually through live work, and so we give you, Jessica, a warm thanks and salute for the great teaching YOU have done today!

Thanks for listening, everybody!

Jessica, Rhonda and David

Live Work With Jessica-- Living with Regrets

Rhonda and I recently did live work at a TEAM-CBT intensive in Mexico City. Our “patient” was a 40 year old mental health professional named Jessica with many years of unhappiness because of a decision she made when she was just 17. Perhaps you’ve also looked back on your life and thought, “If only I would have . . . “ done something I didn’t do,” as well as, “I wish I hadn’t done X, when I was young.”

Today you'll hear the initial Testing and Empathy portions of the session, and next week you'll hear the Assessment of Resistance, Methods, and final Testing..

DAVID WILL SUMMARIZE SCORES ON BMS AND DML

You can also see her scores on the emotions table of her Daily Mood Log here.

As you can see, these negative feelings were all incredibly intense.

Jessica, who grew up in Florida, explained that she started ballet dancing at the age of 3, and when she was 17, she won a prestigious full scholarship to study and have the chance to join a world renowned ballet company. Jessica was incredibly excited, but her mom did not see ballet as a “true career.” In addition, her mother was quite protective, which was not uncommon in the Cuban community, and told Jessica she could only accept the scholarship if she agreed to live with her grandparents in New York.

Jessica angrily rebelled and turned down the offer. Although she continued to dance professionally until her first daughter was born 14 years ago, she battled with feelings of anger and regret the entire time, while also blaming her mother for her. unhappiness.

She eventually got a bachelor’s degree in journalism, and worked in television for a period of time. Then she got a master’s degree in counseling, and found that she loves clinical work and helping people. However, she continued to live with feelings of regret and anger directed at her mom from age 17 to her current age of 40, for a total of 23 years, and explained that she frequently “takes it out” on her mom during periods of irritability.

She also has feelings of grief about what she’s lost when she see her young niece dancing ballet beautifully now. This statement brought tears to her eyes.

Jessica described all the sacrifices she’d made when growing up in order to become a top dancer, including periods of bulimia to maintain the thinness that her teachers always stressed. She explained that “everyone did it—they weighted us frequently and would grill us if we were even a little bit overweight. . .” and this was all in order to fulfill her ultimate dream of becoming a world class ballerina, a dream that vanished.

Jessica gave Rhonda and David an A on Empathy, and said that the self-disclosure felt uncomfortable, but helpful. Next week, you'll hear the inspiring conclusion of the work with Jessica!

Today's special guest, Brittany. Podcast 375. I'm Struggling! Ask David Live: a New Podcast Twist

We start today’s podcast with a visit from Dr. Jacob Towery. You might recall that one year ago he offered an amazing and (almost) totally free two-day workshop for shrinks and the general public on overcoming social anxiety. Roughly 90 people attended, and it was a huge success. The only “cost” was a $20 contribution to a charity of your choice, including Doctors Without Borders and several others.

This year, Dr. Towery will be repeating this incredible program on March 16 and 17, 2024, which will be on a Saturday and Sunday, in Palo Alto. Once again, the title will be “Finding Humans Less Scary.” Jacob and Michael Luo will lead the program and will be assisted by 10 - 20 expert therapists who will lead the break-out groups.

Last year, people described the program as “transformative” and “life-changing.” Social anxiety can have a significant impact on your life, so you owe it to yourself to attend if you or a loved one has struggled with any of the five common forms of social anxiety:Shy Bladder Syndrome

You’ll learn and practice tons of awesome anxiety-busting techniques, including Smile and Hello Practice, Flirting Training, Rejection Practice, Talk Show Host, Shame-Attacking Exercises, and much more.

Social anxiety rarely exists alone, but is nearly always associated with other mood problems, such as loneliness, shame, depression, and substance misuse with alcohol and benzodiazepine pills to try to combat the symptoms, to name just a few.

How do you sign up? It’s easy! Just go to

FindingHumansLessScary.com

If you attend, let us know how it worked out for you, what you learned, and how you grew. Thanks so much, Jacob, for making this kind of world-class experience available to everyone who’s looking for some help, and some wild, life-changing and zany fun in March!

Brittany, an enthusiastic podcast fan, asked for help with a conflict with her husband. She wrote:

Hi Dr. Burns,

I’m struggling a bit. My husband reads a ton of articles and feels that the media has been portraying a lot of the current events incorrectly, especially the horrifying Israel/Palestine conflict. He is extremely frustrated by this and has become depressed because none of his friends or family seems to want to talk about it. He says he feels alone & isolated. I have never been much into politics, abd I don’t know enough to have a real opinion on things to say who is right.

I try to be a good listener to whatever he says. For example, I may say “yeah, that sounds really frustrating,” and then I agree with what he says. But I’m obviously doing a bad job at the empathy because he says the support he gets from me is not satisfactory at all. Sometimes I feel like a parrot, just repeating back what he says.

I think you had an example before on an Ask David where you showed how to empathize with someone who says how awful everyone is and how awful all the liberals are. Something like that. But I can’t find it.

When I empathize my husband says I just don’t get it and nobody is doing anything to help these innocent people who are being attacked, and he says that I am not doing anything either.

I’m at a loss on how to reply? Maybe you could do an example on an Ask David. Sorry for the long message.

- Brittany

Hi Brittany,

Sorry you’re struggling, this is a common but important problem.

Yes, we can and will do that. Can you give me an example of something he says to you, and exactly what you say next? You can use the attached Relationship Journal I you like.

Try to complete steps 1 and 2 at least, and mail back to me ASAP. Lots of people with this problem these days, so could be great ASK D question.

Weren't you on the show live once a few years back? I know you’ve sent us some great questions. I'm thinking MAYBE you could join and practice with us, using your example.

Do you have / have you read my book, Feeling Good Together?

Best, david

It turned out that Brittany was eager and willing to join us live on today’s podcast . This is kind of an experimental podcast where we not only respond to a great question by one of our fans, but actually invite that person to get our “expert” help in real time and live on a podcast.

You can let us know if you like this format.

To get us started, Brittany sent us an example of a Relationship Journal she had prepared. I thought this was really well done, and gave her revised version a grade of A-, which is way better than most people can do. I sent her an email saying that she could probably add more acknowledgement of his feelings and her feelings, like feeling alone and hurt and a bit lonely, and also a bit more Stroking, like "I want you to know how much I love you, and how special you are to me. And that's why it's so had for me to realize that I've really been letting you down."

We practiced with Brittany using my Intimacy Drill, which you'll hear on the podcast. Essentially, one of us would play the role of Brittany's husband, and we would say something she wanted help responding to, and she used the Five Secrets to respond. Then Rhonda, Matt and David gave her an overall grade (from A to F), along with fine tuning suggestions, emphasizing what she did that was especially effective and if there were any changes that might make her excellent responses even better. Then we did role reversals so we could demonstrate ow we might respond, followed by additional role plays until she was satisfied with her response.

Five Secrets of Effective Communication

This approach is called "Deliberate Practice" and it is by FAR the best way to master the Five Secrets so you can use them successfully in real time.

We also discussed her concern that at home she'd been feeling like "a parrot" when she tried the Five Secrets. That is always caused by the absence of "I Feel" Statements in your statements, and we modelled how to correct this error.

One of the biggest problems in the way people communicate during a conflict or argument is defensiveness, and given in the urge to argue and defend your territory, so to speak. Matt explained that this nearly always results from thinking you have a "self" that you have to defend.

Another common Five Secrets error is the failure to acknowledge the other person's anger. Therapists and the general public nearly always make this error, because of a mindset I call "anger phobia" or "conflict phobia." However, Brittany did really beautiful work during the podcast exercises, as you'll see when you listen.

We (the so-called "experts") also practiced what we preached and took turns responding to criticisms, which is always fun and challenging, and often humbling when we goof up!

Let us know what you think about this new format of having someone who asks a question actually appear live on the podcast so you can actually learn through practice while we answer your question.

Thanks for listening today, and thank you Brittany for blazing new trails on our podcasting adventure!

Brittany, Rhonda, Matt, and David

Featured photo is Mina as a child (more pics below!) 374 Anger, Part 2 You Have Always Hated Me!

In the Anger Part 1 podcast (371 on November 20), Rhonda, Matt and David discussed the fact that when you’re feeling angry, there’s always an inner dialogue—this is what you’re saying to yourself, the way you’re thinking about the situation—and an outer dialogue—this is what you’re saying to the other person.

In Part 1, we focused on the inner dialogue and described the cognitive distortions that nearly always fill your mind with anger-provoking inner chatter about the ‘awfulness” of the person you’re mad at. Those distortions include All-or-Nothing Thinking, Overgeneralization, Labeling, Mental Filtering, Discounting the Positive, Mind-Reading, Fortune Telling, Emotional Reasoning, Other-Directed Should Statements, and Other-Blame.

That’s a lot—in fact, all but Self-Blame. And sometimes, when you’re ticked off, you might also be blaming yourself, and feel mad at yourself at the same time.

Matt suggested I add these comments on Self-Blame or it's absence::

Another possible addition would be when you identify the absence of Self Blame when we’re angry. For me, it’s been easier to think of that as a positive distortion, because you are blind to, or ignoring, your own role in the problem. In other words, when I’m blaming someone else, it’s me thinking my poop smells great and tit's all the other person's fault..

I’ve wondered if we fool ourselves like this because of the desire to have a special and perfect “self,” which we then defend. Because nobody’s perfect, our "ideal self," as opposed to our "real self," is just a pleasant, but potentially destructive, fantasy.

Still, we try to preserve and project the fantasy that we are free of blame and the innocent victim of the other person's "badness," , and we imagine there we have a perfect “self” to defend. Or, as you’ve said, at times, David, “anger is often just a protective shell to hide and protect our more tender and genuine feelings.”

We also discussed the addictive aspect of anger, since you probably feel morally superior to the “bad” person you’re ticked off at when you’re mad, and this makes it fairly unappealing to change the way you’re thinking and feeling. Your anger also protects you from the risk of being vulnerable and open and genuine.

Today we discuss the Outer Dialogue, and how to express angry feelings to another person, as well as how to respond to their expressions of anger. The main concept is that you can express anger in a healthy way, by sharing your anger respectfully, or you can act out your anger aggressively, by attacking the other person. That’s a critically important decision!

Toward the start of today’s podcast, Rhonda, Matt and David listed some of the distinctions between healthy and unhealthy anger. The following is just a partial list of some of the differences:

To bring some dynamics and personality to today’s podcast, Mina, who’s made a number of noteworthy appearances on the podcast, agreed to describe what she learned on a recent Sunday hike. (I’ve started up my Sunday hikes again, but in a small way now that the pandemic has subsided, at least for the time being. I’m struggling with low back pain when walking and that severely limits how far I can go.)

Mina began by explaining that when she was talking to her mom on the phone. Her mom described a conflict with woman friend who seemed angry with Mina’s mom. Mina said, “I can see why that woman got angry with you.“

Mina explained that her mother, who is “conflict phobic,” paradoxically ends up with conflicts with a lot of people. However, Mina’s mother sounded hurt by Mina’s comment, and said, “You’ve always hated me since you were a little girl! You always looked at me hatefully!”

Here are some of Mina’s "angry" childhood photos:

Mina explained how she felt when her mom said, "You’ve always hated me.”

My jaw dropped when she said that! It was such a shock. I’ve always felt like she was my best friend! . . .

I hate feeling angry. It makes me every bit as uncomfortable as anxiety. If I express my anger, it goes away, and I feel better. But I don’t usually express it, and then it comes back disguised as weird neurologic symptoms.

And that, of course, is the Hidden Emotion phenomenon that is so common in people who struggle with anxiety. When you try to squash or hide negative feelings your think you’re not “supposed’ to have, they often resurface in disguised form, as phobias, panic, OCD symptoms, chronic worrying, or any type of anxiety, including, as in Mina’s case Health Anxiety—that’s where you become convinced you have some serious neurologic or medical problem, like Multiple Sclerosis.

Matt suggested that I might remind folks of my concept that “anger allays get expressed, one way or the other.” He’s found this idea to be both true and incredibly helpful for “us nice folks who think we can get away without expressing our anger, thinking we can avoid conflicts, entirely. This always backfires, in my experience!”

On the recent Sunday hike, Mina practiced how to talk with her mom, using the Five Secrets of Effective Communication. After that, she used what she’d practiced on the hike to talk to her mom about their relationship, and then got an “I love you” message from her mom the next morning.

This made Mina very happy, but because she had a full day of back to back appointments, Mina decided to spend time crafting a thoughtful reply at the end of the day, when she had a little free time. But when she went back to her computer at the end of the day to send a message to her mom, she discovered that her mother had deleted the loving message she sent early in the day, and Mina felt hurt.

When Mina asked her mom about it, her mom said that deleting the message was just an error due to ‘old age.” However, Mina did not really buy this, and thought her mom probably felt hurt and angry because Mina had not responded sooner.

In the podcast, we practiced responding to mom using the role-play exercise I developed years ago. Essentially, one person plays the role of Mina’s mom, and says something challenging or critical.

Mina plays herself and responds as skillfully as possible with the Five Secrets, acknowledging the other person’s anger and expressing her own feelings as well.

We practiced responding to mom’s statement, “You’ve always hated me.” Matt played the role of mom and Mina gave a beautiful Five Secrets response. You’ll enjoy hearing her response, and Matt’s and Rhonda’s helpful feedback, when you listen to the podcast.

Then Mina asked for help responding to another statement from her mom, who had also said:

All of the kids your age are angry, because you were neglected a lot of the time because of the war in Iran, and your dad and I were busy doing what we had to do to survive and avoid being arrested. All of my Iranian friends with children your age are experiencing the same thing.

Matt and Rhonda did more role plays with Mina, followed by excellent feedback on Mina’s Five Secrets response. Again, I think you’ll enjoy the role-playing and fine tuning when you listen to the podcast.

One of the obvious take-home messages from today’s podcast is to use the Five Secrets of Effective Communication when you’re feeling angry and talking to someone who’s angry with you as week, As a reminder, these are the Five Secrets.

LINK TO 5 SECRETS

And to make it simple, you can think of talking with your EAR:

E = Empathy (listening with the Disarming Technique, Thought and Feeling Empathy, and Inquiry)

A = Assertiveness (sharing your feelings openly with “I Feel” Statements)

R = Respect (showing warmth and caring with Stroking)

However, here’s the rub: People who are angry will usually NOT want to do this! When you’re ticked of, you will almost always have a huge preference for expressing yourself with the Unhealthy Anger described above.

Matt urged me to publish my list of 36 reasons why this intense resistance to healthy communication. LINK HERE for the LIST

So, as you can see, there’s a lot more to skillful communication of anger than just learning the Five Secrets of Effective Communication, although that definitely requires tremendous dedication and practice. But motivation is the most important key to success or failure.

When you’re upset with someone, you can ask yourself, “Do I want to communicate in a loving, or in a hostile way?”

The reward of love are enormous, but the seduction of hostility and lashing out is at least as powerful! This battle between the light and the dark is not new, but has been blazing for tens of thousands of years.

And, of course, the decision will be yours.

Thanks for listening today,

Mina, Rhonda, Matt, and David

Why Therapy Fails

One of the most common reasons patients contact me is to find out why the therapy isn't working. They may be TEAM-CBT patients or patients of therapists using other approaches. Therapists also ask for consultations on the same problem--why am I stuck with this or that patient who isn't making progress?

In the Feeling Good App, my colleagues and I have been looking into this as well. Most app users report excellent and often rapid results, but some get stuck, in just the same way they might get stuck in treatment with a therapist. I have tried to organize my thinking on this topic, because if you can diagnose the cause of therapeutic failure, you can nearly always find a solution. Of course, the app is not a treatment device, but a wellness device, but the same principles apply.

So today, Rhonda, Matt and I discuss a couple reasons why therapists and patients alike sometimes get stuck. Matt described a patient who was misdiagnosed with a psychotic disorder who turned out to have sleep apnea. When the proposer diagnosis was made and treated, the patent suddenly recovered.

Rhonda described a patient who jumped from topic to topic and always brought up a new problem before completing work on the previous problem. This problem was solved when Rhonda explained the importance of sticking to one problem for several sessions, until the problem was resolved. The patient then began to make progress.

David described a depressed woman from Florida who was stuck in treatment, and not making progress, and then the therapist said "I just can't help you," This hurt and confused the patient who wrote to me. There were essentially two problems--the patients depression what brought her to therapy in the first place, and her unresolved hurt feelings when the therapist "gave up" on her. This problem reflected many failed relationships is the patient's life. This was resolved when the patient took the initiative to schedule a session to talk about the conflict more openly with excellent results.

In addition, the patient had heard that she "should" accept herself, but didn't know how to accept her constant self-critical troughs and intensely negative feelings. I suggested she make a list of the benefits of her negative thoughts and feelings, as well as the many positive things they showed about her and her core values as a human being.

She came up with an extremely impressive and long list! For example, her criticisms showed her high standards, her humility, her dedication to her work, her accountability, and much more. In addition, she'd achieved a great deal because of her relentless self-criticisms.

I asked her why in the world she'd want to accept herself, given all those positive characteristics

She decided NOT to accept herself, and was delighted with her decision. She said she felt profound relief!

An unusual, but awesome, path to acceptance! In other words, she ACCEPTED her "non-acceptance."

I hope you find today's podcast interesting and helpful. Of course, ultimately therapy is part science and part human relationship art. That's why Rhonda and I offer free weekly training groups for therapists who wish to develop their therapeutic skills. The groups are on zoom so therapists from around the world are welcome. Matt offers a consultation group (free to Stanford psychiatric residents) every other Tuesday for therapists who want help with difficult, challenging cases. To learn more, you'll find details and contact information at the end of the show notes.

Here’s are some of the most common reasons why therapy might fail or appear to be stuck / without progress. Some of them will be of interest primarily to clinicians, while others will be of interest to clinicians and patients alike. And many of these reasons will also apply to individuals using the Feeling Good App who are stuck in their attempts to change the way they think and feel.

But what does “stuck” actually mean? The definition, of course, is subjective. I believe that a substantial or complete elimination of depression and anxiety can typically be achieved in five sessions with a skilled TEAM therapist. I use two-hour sessions, and can usually see dramatic change in a single session, although follow-ups may be needed for Relapse Prevention Training or other problems the patients might want help with.

In my experience, the treatment of relationship problems and habits and addictions usually takes much longer than the treatment of anxiety or depression. The techniques to treat relationship problems and habits and addictions actually work just as fast as the techniques to treat depression and anxiety, but the resistance can be far more intense. For example, someone may be ambivalent about leaving a troubled relationship or giving up a favored habit for many months or years before making a decision to move in a new direction.

And, of course, the treatment of biological problems like schizophrenia and bipolar I disorder will nearly always require a long term therapeutic relationship, often requiring medications in addition to therapy.

The problems and errors I’ve listed below are mostly correctable. And although there are many traps that therapists and patients fall into, the vast majority of therapeutic failure the patient's hidden 'resistance' to change and the therapist's lack of skill addressing it. This is true in clinical practice and in psychotherapy outcome studies, as well.

On the one hand, a great many patients will feel ambivalent about change. For example, a patient with low self-esteem may not want to stop being self-critical and accept themselves, as-is, but to have a better version of themselves, first. Or they may want to overcome their fears without facing them. Or they might want a better relationship but would want the other person to do the changing.

Unfortunately, most therapists lack the skills to address resistance and, in fact, often make it worse by trying to motivate the patient to change, rather than understand their hesitation to change and discuss it with them. This is one area where TEAM training has a great deal to offer, including over 30 skills therapists can learn to address motivation and resistance.

The following list of 37 reasons why therapy fails follows the structure of T, E, A, M.

Errors at or before the initial evaluation

Patient is just window shopping Patient does not buy into the cognitive model Incorrect conceptualization of type of problem, so you end up using the wrong techniques. To simplify things, I think of four conceptualizations:
Individual mood problem (depression or anxiety) Relationship Problem Habit / Addictions “Non-problem”: healthy negative feelings such as the grief you might feel when a love one dies
Patient is not in treatment out of choice. For example, a teenager might be brought in by parents to be “fixed,” like bringing in your car to the local garage for a tune up, and you don’t have an agenda with your patient. Or a parent might be court-ordered to go to therapy if he wants to have custody of his children. Failure to ask patients to complete the Concept of Self-Help Memo, the How to Make Therapy Rewarding and Successful memo, and the Administrative Memo prior to the start of therapy. These memos fix a great many therapeutic problems that are likely to emerge later on, like homework non-compliance, premature termination, and policies about confidentiality, last minute cancelling of sessions, conflicts of interest (eg patient is seeking disability) and more. Most therapists ignore the use of these memos, only to pay a steep price later on. Failure to mention the requirement for homework and similar issues the at initial contact with the patient. Failure to explore the patient’s motivation for treatment.

T = Testing

Diagnostic errors: not recognizing additional problems which patient may have in addition to the initial complaint, such as drug or substance abuse, psychosis, intense social anxiety, past trauma or abuse, or hidden problems the patient is ashamed to disclose. This is easily solvable by the use of my EASY Diagnostic System prior to your initial evaluation. It screens for 50 of the most common DSM “diagnoses” and only takes ten minutes or so out of a therapy session to review and assign the “Symptom Cluster Diagnoses.” Failure to use Brief Mood Survey before and after each session. This error makes the therapist blind to the severity or nature and severity of the patient’s feelings, which cannot be accurately identified by a patient interview or therapy session. As a result, the therapist’s understanding will not be accurate, and the therapist will not be to pinpoint the degree of change (or failure to change) during and between therapy sessions.

E = Empathy

Failure to ask patients to complete the Evaluation of Therapy Session after each session. As a result, it will not be possible for therapists to understand their level of empathy, helpfulness, and several other relationship dimensions critical to good therapy. Failure to use the “What’s My Grade” technique while empathizing with the patient. Failure to receive training in the Five Secrets of Effective Communication and the three advanced communication techniques. These techniques are difficult to learn, requiring lots of practice and commitment, but can be invaluable in therapy and in the therapist’s personal life.

A = Assessment of Resistance (also called Paradoxical Agenda Setting)

Failure to recognize and deal with Outcome Resistance: There are four distinct types, corresponding to depression, anxiety, relationship problems, and habits and addictions. Failure to recognize and with Process Resistance: There are four distinct types, corresponding to depression, anxiety, relationship problems, and habits and addictions. The “because” factor: I won’t let go of my depression until “I’ve lost weight,” or “I’ve found a loving partner,” or “I’ve achieved something special,” or “I’ve found a better job / career,” or “I’ve achieved my goals at X.” This is another type of Outcome Resistance.

M = Methods--errors using the Daily Mood Log

Patient “cannot” identify any Negative Thoughts The way you worded your Negative Thought. The common errors include thoughts describing events or feelings, rhetorical questions, long rambling thoughts, or thoughts consisting of a few words or phrases, like “worthless.” No Recovery Circle / many need many techniques combined with the philosophy of “failing as fast as you can.” This allows you to individualize the treatment for each patient. It is simply not true that there is one school of therapy or method (like meditation, mindfulness or daily exercise, etc.) that will be helpful, much less “the answer,” for all patients! The way you did the technique / incorrect use of technique. Many of the most powerful techniques, like Interpersonal Exposure, Externalization of Voices, Paradoxical Double Standard, Feared Fantasy, and many more require considerable sophistication and training. They can be fantastic when used skillfully, but they aren’t easy to learn! Trying to challenge your negative thoughts in your head / vs on paper or computer. This is associated with Process Resistance for depression—refusing to do the written homework, and it is exceptionally common. Trying to challenge the negative thoughts of someone else or encouraging them to think more positively: won’t work! In my first book, Feeling Good, I spelled out the warning that cognitive techniques are for you, and NOT for you to use on other people, including friends, family, and so forth. It is my impression that many people ignore this warning. When they discover that the person they are trying to “help” does take kindly to identify the cognitive distortions in their thoughts, both end up frustrated. Failure to “get” the Acceptance Paradox / using too much self-defense in your positive thoughts, especially Technique when doing Externalization of Voices Using the Acceptance Paradox in a defeatist, self-effacing way Failure to include the Counter-Attack Technique when doing Externalization of Voices. This techniques is not always necessary, but can sometimes be the knock out blow for the patient’s endless inner criticisms. Not understanding the necessary and sufficient conditions for emotional change when challenging distorted thoughts. Too much focus on cognitive / rational techniques when far more dynamic techniques are needed, such as the Experimental Technique (e.g. exposure) in treating anxiety or the Externalization of Voices or Hidden Emotion Techniques Not recognizing that the patient’s negative thoughts might be valid (I think that my partner is cheating on me) and trying to get your patient to challenge the “distortions” in the thoughts

Other therapist errors

Codependency: addiction to trying to “help” / cheer up the patient / solve some problem the patient has Need to be “nice” and refusal to hold patients accountable Narcissism: unwilling to be criticized, unwilling to fail, needing to stay in the expert role Difficulties “getting” the patient’s inner feelings, due to lack of skill with Five Secrets and the failure to use Empathy Scale Difficulties forming a warm and vibrant therapeutic relationship, which can sometimes result from strong (and nearly always unexpressed) dislike of the patient Commitment to a favored “school” of therapy / thinking you are superior to colleagues and have the one “correct” approach Failure to use assessment tools with every patient at every session Failure to make patients accountable for homework Four types of reverse hypnosis: this is where the patient hypnotizes the therapist into believing things that simply aren’t true.
Depression: the patient may really be hopeless or worthless Anxiety: the patient is too fragile for exposure Relationship problems: the patient is too fragile for / not yet ready for exposure Habits / addictions: not making the patient accountable or assuming patient isn’t yet “ready” to give up the addiction, or the patient needs to have emotional / relationship problems fixed first
Unrecognize, unaddressed conflicts with therapist that need to be addressed with Changing the Focus. This error often results from the therapist’s fear of conflict or patient anger, and is usually accompanied by a failure to use the Evaluation of Therapy Session, which would send a loud signal to the therapist that something is wrong. Failure to do Relapse Prevention Training prior to discharge. Conceptualization errors. Failure to use or select the most effective therapeutic approach and techniques for the patient’s problem. For example, the Daily Mood Log and Recovery Circle are great for depression and anxiety, although there will be some important differences in the choice of methods for depression vs. anxiety. For example, Exposure and the Hidden Emotion Technique are great for anxiety, but rarely useful for depression. The DML has only a secondary role in the treatment of relationship problems (the Relationship Journal is more direct and useful) or habits and addictions (the Triple Paradox and Habit and Addiction Log (HAL) are far more useful. The therapist may be committed to a school of therapy, like Rogerian listening, without addressing resistance or using methods. Or therapist may believe that psychodynamic or psychoanalytic therapy, or ACT, or traditional Beckian cognitive therapy, will be the “answer” for everybody. The schools of therapy function much like cults, causing feelings of competitiveness (our guru is better than your guru) and sharply limiting the critical thinking and narrowing the consciousness of the faithful “followers.” Conflicts of interest. The therapist may subconsciously want to keep the patient in a long-term “talking” relationship due to emotional or financial needs. The therapist may have been taught that therapeutic change is inherently slow, requiring many years or more. This belief will always function as a self-fulfilling prophecy.

Thanks for listening!

Matt, Rhonda, and David

At Last! An Outcome Study! 

One of the wonderful things about TEAM-CBT is the dramatic and rapid changes we see in so many of our patients. But we've had a huge problem-no published outcome studies. And that has definitely limited the general acceptance and recognition of TEAM-CBT.

Today, that era has come to an end, thanks to Dr. Elise Munoz, who joins our beloved Feeling Good Podcast to discuss a remarkable outcome study conducted at her Feeling Good Psychotherapy clinic in New York City. She wanted to evaluate the effectiveness of TEAM-CBT with teens and young adults.

Dr. Munoz is the Founder and Lead Therapist at Feeling Good Psychotherapy and Adjunct Assistant Professor at New York University. She is also a Level 4 Certified TEAM-CBT Therapist & Trainer, and specializes in the treatment of anxiety, depression and life transitions.

Elise conducted a “naturalistic” study of data from 116 teenagers and young adults aged 13 -24 years of age who were treated by 15 therapists between 2017 and 2022. In a “naturalistic” study, you simply analyze all the data from your patients to evaluate the effectiveness of  the treatment. This is in contrast to a “controlled outcome study” where patients are randomly assigned to two treatments to see which treatment delivers the best results. Elise conducted the research study as part of her work for a Doctorate in Clinical Social Work at the University of Pennsylvania in Philadelphia.

"The results," she says, "were encouraging." That's perhaps a humble description of her findings. David and Rhonda might say that the results were pretty awesome!

Elise told us that although the average number of treatment sessions was 27, most of the patients made maximal gains after just 10 weeks (2.5 months) of treatment, and many achieved maximal improvement by the 5th session.  Specifically, by the tenth session. 80% of the patients scored in the "subclinical" range on the depression scale of my Brief Mood Survey (with scores of 0 to 4) and 87% scored in the subclinical range on the anxiety scale (scores from 0 to 4) . These scales range from 0 (no symptoms) to 20 (extremely severe.) Prior to the study, only 30% were in the subclinical range.

According to Elise, the rapid improvement suggested that most patients will not need long-term treatment, although some will need more time to incorporate their gains following their initial improvement, and many will want to remain in treatment to deal with other problems, such as relationship issues that are so important in this (or any) age range.

Prior to the study, Elise trained the therapists in a weekend TEAM-CBT "boot camp," along with two hours per week of group training and 1 hour per week of individual consultation/supervision. My own view (David) is that learning TEAM-CBT is very challenging, requiring a minimum of one to two years of intensive training. However, the fact that therapists can get excellent results with a relatively small amount of training is encouraging.

One of the key components of TEAM is T = Testing. We test every patient at the start and end of every therapy session, asking, "How are you feeling right now?" This provides the therapist with a kind of emotional X-ray machine that allows you to see the precise degree of improvement, or lack of improvement, at every session in multiple dimensions. Therapists can use the information to fine-tune the treatment on an ongoing basis. Many other research studies have demonstrated that session by session monitoring of symptoms, consisting of measurement and feedback, significantly improves outcomes in mental health treatment. (please contact Elise for a list of research studies you can look up online).

Research indicates that roughly half of adolescents and young adults will suffer from some mental health problem. Therefore, it is essential to provide accessible, effective treatments to prevent the development of long-term mental health problems.

We salute Elise for going the extra mile to evaluate the effectiveness of the treatment and to identify the therapists who get the best results. This requires courage and also allows our field to move forward based on real data rather than subjective impressions.

Dr. Munoz’s fascinating work adds to the body of evidence supporting the effectiveness of TEAM-CBT. and also sets a commendable example of dedication to improving mental health outcomes through research and ongoing professional development in a private practice environment. The famous and idealistic “Boulder Model” of the “scientist / practitioner” is highly touted in graduate school graining programs for mental health practitioners, but is rarely practiced in real life. Dr. Munoz shows that the integration of science with clinical treatment in community settings is not only possible, but extremely important.

Dr. Munoz’s research also indicates that the TEAM model offers an exciting path to improved mental health for teens and young adults!

Anger, Part 1 You suck! Screw you! 

 Jay asks: Are you EVER going to do a podcast on anger?

Dr. Burns,

Also are you EVER going to do a podcast on Anger with Rhonda and Matt? You have done many podcasts on depression, anxiety, interpersonal relationships YET there is not one podcast addressing anger.

Given the world we live in right now maybe it's time to address Anger from a TEAM-CBT perspective and give it the attention you have given anxiety and depression.

All the Best,

Jay

In today’s podcast, Rhonda and David address this important but neglected topic that is perhaps more important than ever in today’s angry and violent world.

David began by pointing out that in the feeling Good App, anger improved as much as six other negative feeling clusters, with fairly dramatic reductions in just a few days. This was completely unexpected and exciting, and has been replicated in numerous beta tests.

Maybe there IS a small glimmer of hope in this troubled, angry world!

David pointed out that anger is addictive

Any group that is at war tends to feel morally superior and sees the “other” as scum, the enemy, and these distortions give you justification for hurting and killing them and feeling good about what you are doing.

What makes the treatment of anger fairly challenging is that most angry people are not looking for help.

How do you treat a patient who is angry?

You always start with T = Testing. David’s research on therapist accuracy indicates that therapist accuracy is recognizing anger in their patients is incredibly poor. If you want to assess and deal with patient anger,  the Brief Mood Survey at the start and end of every session can be invaluable, and the Evaluation of Therapy session at the end can also help.

E = Empathy comes next. However, empathizing with someone who is angry can be challenging because they are often provocative, or want the therapist to align with them in their belief that the person they are angry with is to blame. We want the client to feel accepted, and have a warm relationship with their therapist so the therapist can easily get sucked into the patient’s blaming mind-set.

David calls this “reverse hypnosis,” and this can sabotage the chance for effective treatment.

Empathy can be challenging if the anger is directed at the therapist, or if the client is saying they are so angry they want to hurt someone. That can be ethically challenging because of the Tarasoff duties to warn the victim and notify the police. That is tough because the client can get upset with the therapist.

A = Assessment of Resistance comes next, starting with the Straightforward or Paradoxical Invitation. With someone who is angry, we nearly always use the Paradoxical Invitation. Here’s an example:

You have been talking about person X, and I can see you are pretty fed up with her. You said, you’ve tried everything and nothing works, and she won’t change.

I have a lot of tools that could be very helpful if you want to do work on the relationship and turn it around. But I did not hear you saying that, and I am assuming that is NOT what you want.

Don’t get me wrong, if you want to work on this relationship, I’d love to do that so you can develop a closer relationship, but at the same time, there’s no law that says you have to get along or like everyone.

I’m assuming you DON’T want to work on your relationship with X, but want to make sure I’m understanding you. Am I reading your right?

M = Methods

Two invaluable tools are the Straightforward or Paradoxical Cost-Benefit Analysis for anger, blame, or for the relationship.

What are the Advantages and Disadvantages of feeling intense anger at the other person.

What are the Advantages and Disadvantages of blaming the other person for the problem.

What are the advantages and disadvantages of having a relationship with this person?

David provided this example of a Paradoxical Anger CBA. A man was hospitalized involuntarily in Philadelphia who was brought in by the police. He was working at Savings and Loan company with disgruntled customers. A customer came in who was whining and complaining. The patient was a large and powerful man, and he got so angry at the whining customer that he picked him up and threw him against the wall. They called the police who arrested the man, but he seemed psychotic, or in a manic state, so they brought him, instead, to the hospital.

He was sent to Dr. Burns’ cognitive therapy group shortly after he was admitted to the locked unit, and defiantly stated at the start of the group that he was sent here for “anger management!”

Dr. Burns said he never tried to “manage” anger, and instead suggested that they could list some of the advantages and benefits of his anger with the help of the group, and also list what his outburst showed about him that was positive and awesome.

Together, the man and the group listed more than a dozen positives on the white board, including:

At the end of the group, Dr. Burns reviewed all the really good reasons for his angry outburst, and said he did not see any reason for him to change or to give up his anger.

The patient said he totally agreed.

At the start of the group, the man’s anger had been 100 on a scale from 0 to 100.

Dr. Burns asked him how angry he was now, and the patient said zero!

The dramatic change came about because of the Paradoxical Cost-Benefit Analysis.

That strategy can be tremendously helpful when you are working with an angry patient. You won’t get any buy-in by trying to convince the patient to manage their anger. David was actually siding with the patient’s resistance, and the patient could sense that David actually liked and admired him. This can form the basis of a trusting and productive therapeutic relationship.

But many therapists are afraid of this type of paradoxical strategy and reluctant to let go of their addictions to “helping,” in spite of the high failure rate with that approach.

You and your patient have to be on the same team if you want to use tools for effective change.

If the patient is motivated and wants help, you can work on the inner dialogue or the outer dialogue, or both. The inner dialogue is the way you are thinking about the situation, and the outer dialogue is the way you are communicating with the other person.

Anger always results from your inner dialogue—your thoughts about the other person, and those thoughts will nearly always be distorted. The Daily Mood Log can be very helpful at eliciting and challenging those distortions.

The focus with the DML is on the inner dialogue, which will nearly always include a rich mix of positive and negative distortions including

Once you’ve identified the distortions in a thought, you can use any of the more than 100 M = Methods I’ve developed to challenge it, such as

If our listeners (meaning you) want a Part 2 podcast on anger, we can describe helping the patient with the Outer dialogue, which is how you actually communicate with the person you’re feeling angry with. This was not discussed in great detail on today’s podcast, but we just touched on a couple points.

The first topic is the difference between Attacking with your anger vs Sharing your anger. It’s not bad to be angry, but it is how you share and express your anger that’s most important. There’s a huge difference between healthy and unhealthy anger.

If your goal is to hurt and demean the other person, it’s unhealthy, destructive anger. You may want to get back at the other person, hurt them, or put them down.

Healthy anger is very different. Martin Buber, a 20th Century Jewish theologian, distinguished an “I-It” vis and “I-thou” relationship. Buddhist philosophy is similar. They say that the cause of all evil is the belief that you are separate from an external reality, so you see other person or group you’re angry with as the “enemy” or the “it,” that is separate from you, and “different,” as opposed to the “thou.” Then you can rationalizing using, hurting, or even killing them in order to advance your own interests, or so you think!

Sharing your anger involves letting the person know directly and openly and respectfully that you are angry with them because of something they DID, and not because of something they ARE. The goal of healthy anger is to develop a deeper and more loving (or satisfying) relationship with the other person.

Healthy anger is the decision you make to share your anger, rather than to attack with your anger out of vengeance, frustration or rage. Healthy anger is not the choice that most people seem to make, since unhealthy anger gives feelings of vengeance and moral superiority.

A Part 2 podcast on anger might include

Forced Empathy

Relationship Journal (RJ

What did the other person say? What did you say next? EAR Checklist / Bad Communication Checklist Consequences Five Secrets of Effective Communication List of 12 GOOD Reasons NOT to

The RJ Requires insight, communication skill, and the painful death of the “self”

Examples:

Thanks for listening!

Rhonda, and David

Ask David The fear of ghosts; the truth about nutritional supplements; the fear of fear; how does anxiety treatment work? And more. 

Today, David and Rhonda answer six cool questions submitted by podcast listeners like you!

Joseph asks: How would you use exposure to confront your fear of ghosts? Salim asks: What herbs and supplements will help me become more zen and relaxed? Peter asks: How do you stop fearing the fear and discomfort of anxiety? Jillian asks: How does cognitive therapy work to help reduce anxiety? Sanjay asks: How do you give up wants, needs, and desires? Dana asks for help with the Disarming Technique.

In the following, David’s reply was David’s email response to the person prior to the podcast, just suggesting some directions we might take on the podcast.

The Rhonda comments were based on notes she took during the live podcast.

For the full answers, make sure you listen to the podcast!

Joseph asks: How would you use exposure to confront your fear of ghosts?

Hi David and Rhonda,

Thank you again for your wonderful replies and the amazing podcast.

If you would humor me, I have another question -- I know David talked about exposure therapy in overcoming fears, but I wonder how this could apply to some fears like the fear of ghosts where it is caused by an over-active imagination (in which case, what should one be exposed to?)

Regards

Joseph

 David’s reply

Cognitive flooding would be one approach.

Will give details on podcast. Thanks!

David

 Rhonda’s notes

Find out what is happening in the person’s life, and treat that specific problem.

Maybe someone developed a fear of ghosts after the death of a loved one, so the idea of being around death or dead things may also cause intense anxiety. Going to a cemetery may be part of their exposure.

Other examples of exposure for overcoming the fear of ghosts could be:

Fear of darkness may accompany fear of ghosts so staying in the dark may be part of your exposure.

Fear of sleeping alone may also accompany fear of ghosts so sleeping alone in your home may be part of your exposure.

Salim asks: What herbs and supplements will help me become more zen and relaxed?

Hello Mr. David D Burns,

I want to tell you that i loved "Feeling Good", your book helped me a lot in improving my life, I have a question, can you recommend herbs or supplements that help me be more Zen and more relaxed? I would be eternally grateful. 🙏.

Thank you so much.

Salim

David’s reply.

Hi Salim, I don’t believe in the efficacy of herbs etc. except for their placebo effect. However, the written exercises in the book, like writing down your negative thoughts, can help a lot. You’ll find lots of free resources on my website.

At the same time, the use of herbs and supplements is kind of a “cult” thing, and as you know, cult followers don’t like to have their views challenged!

And our field of mental health is, to my way of thinking, a mine field of cults!

Thanks!

David Burns, MD

Peter asks: How do you stop fearing the fear and discomfort of anxiety?

David’s Reply

Exposure!

However, I don’t “throw” methods at symptoms, but rather work systematically with the TEAM approach, and always incorporate four models in my work with every anxious patient: The cognitive, motivational, exposure, and hidden emotion models.

You can learn more about this in the free anxiety class on my website! You’ll find it right on the homepage for www.feelinggood.com.

Thanks, David

Rhonda added

You don’t stop fearing the fear and discomfort of anxiety before doing an exposure. You do all of the work necessary using the three other models of treating anxiety (see the anxiety question directly below this one) and then you dive into the exposure, embracing the discomfort until it’s reduced or gone.

Jillian asks: How does cognitive therapy work to help reduce anxiety?

Hi David,

I have questions about how using your methods helps people. I’m someone that uses an acceptance method for my anxiety with success and throughout this journey I’ve really been able to catch my mind trying to focus on the negative and trying to spiral into ruminating.

With negative thoughts, how do your methods actually help, does it start to change the way you think or make you automatically think in more of a positive way (eventually without having to “challenge” each thought?) Do you have to believe the challenges to your negative thoughts in order for it to work? What if you believe the original negative thoughts more? Do you actually start viewing things in a more positive light?

Kinds regards,

Jillian

David’s Reply

Hi Jillian,

I can make this an Ask David question for my weekly podcast if you like. You can find the answers, too, in the free anxiety class on my website and in my book, When Panic Attacks. Thanks1

Essentially, and I’ve covered this in detail in a podcast, cognitive techniques can be very helpful in reducing anxiety, but they are only one strategy among many. I actually use four models in treating anxiety: the Motivational Model, the Cognitive Model, the Behavioral (Exposure) Model, and the Hidden Emotion Model. You can learn more about them in Podcasts #22-28. You can find links here: https://feelinggood.com/list-of-feeling-good-podcasts/

I use all four models with every anxious individual I treat.

The Acceptance Paradox is a small but important part of the Cognitive Model.

Positive Thoughts have to be 100% true to be effective, but that does not mean they will be effective. They also have to radically reduce your belief in the negative thoughts triggering your anxiety.

If you still believe your negative thoughts, you need to try a different method to challenge them. I have developed 125 or more methods for challenging negative thoughts, since each person is a bit different!

Thanks!

D

Rhonda’s comments

We do not treat a diagnosis with a formulaic process. We treat a human being, one specific event at a time. Empathy is absolutely necessary for the treatment.

Here are David’s Four Models for treating anxiety:

Motivational Model. You need to address the Outcome & Process Resistance with every anxious patient before trying any other methods.

Exposure. No one wants to do exposure. You may also have to feel feelings that you do not want to feel. Feel intense emotions instead of binging, for example.

Cognitive Model. Pick a specific moment you were anxious about a thought. Go through the DML, what is going on with your patient? The positive thought needs to be 100% true, and it must drastically lower the belief in the NT to be effective. Exposure and Response Prevention Model. Exposure is necessary and often helpful, both gradual exposure and flooding. Hidden Emotion Model. Nearly all anxious patients tend to be exceptionally nice people because people who are prone to anxiety tend to avoid conflicts and negative feelings. (Wanting something you are not supposed to want, or feeling anger). These feelings are swept under the rug, and they come out indirectly, as some type of anxiety.

Sanjay asks: How do you give up wants, needs, and desires?

Hello David, Rhonda, and Fabrice,

It was really nice to meet Fabrice after a long gap. The topic Fabrice has started is very special of Should , Want and Need. I have heard about this topic in bits and pieces by you in many podcasts and also in your set of 4 podcast of self-deaths.

I kept thinking a lot about this beautiful concept of Want versus Need. And if we are able to learn technique to balance between Want & Need ,our lives will become happier and more stress-free.

Buddhist teachings say that Desire is the cause of suffering, so they want us to achieve a state with zero desires, which is Nirvana.

Also, the Holy book of Hinduism Geeta says further that if the purpose of our desires are to fulfill a duty or to help someone, only in these two cases will desires be good and bring happiness to the person. So, desire to eat a Mango will not fall in any of the two😄

But the penultimate question is that if we don’t have desires, life will be very dull and boring. As you had mentioned in podcast number 348 with Dr. Tom Gedman that unless one is in a very very positive state (which is rare like Buddha himself was) then only you can remain in a state of zero feeling otherwise you are bound to fall down and will lead to a very fast relapse . I also agree that zero feelings or Zero desires state will ultimately lead people into depression therefore I feel the best way is to do positive-reframing of Need and dial it down to Want. So that we get the advantages of desires and leave the disadvantages of it .

As you have mentioned a number of times that FEELING GOOD APP is a very high priority for you but you try to keep it as your “want” and try not to enter this desire in the NEED zone.

Balancing desires on the border between Need and Want is quite challenging I request that please do a podcast for discussing as how to keep desires in check till want and if possible please develop a self-assessment questionnaire in a podcast with Matt May and Rhonda ,sounds i feel this is a valuable topic for exploration. It can provide listeners with tools and insights to strike a balance between fulfilling their desires for happiness and well-being without becoming enslaved by them.

I hope my message is clear and I am eagerly looking forward to the discussions amongst yourself.

Warm regards, Sanjay

New Delhi , India

David’s Reply. We can discuss this on a podcast, and I can tell you the story of a woman who attended a workshop I gave in San Antonio. She was raised as a Buddhist, but her family gave up Buddhism because her mother felt she’d “failed” at giving up wants and needs and desires.

Rhonda added these definitions:

Wants are personal preferences for things or experiences. Needs are essential requirements for survival and well-being. Desires are strong longings or aspirations that go beyond basic needs and contribute to a person's happiness and fulfillment. Shoulds are when we scold ourselves because we did or did not do something.

Dana asks for help with the Disarming Technique.

Dear David,

I would like to request that you, Rhonda, and Matt show your listeners how disarming practice would sound with the following statements.

I feel like when my flight response is in mode I cannot think of how to respond to targeted questions especially. I feel so inferior. Please think of any others you can and add to these to help.

Thank you so much!!!!

Dana

 David’s reply.

Thanks, Dana, We might include these on an Ask David.

It might help, too, if you could provide a brief context for these statements, and what, exactly, you typically say next.

That way, we might be able to point out your errors as well, if you are interested in learning how you might trigger these statements.

Of course, most folks don't want that, preferring to blame. But it can be empowering, at least for the brave!

David

Rhonda described one of the responses we modeled on the podcast.

David’s A+++ reply (according to Rhonda)

Ouch, I’m feeling zapped right now, and you’re right. I am starting up on something that’s been very annoying to you. I think it was aggressive on my part. I have to plead guilty as accused.

I love you to death. When we go round and round it is painful for me, too. Clearly, I am to blame for that right now. I am ready to listen.

Maybe you can tell me what it is like for you when I start preaching again and we go round and round. It is clearly disrespectful.

I want to listen. You may be angry, frustrated, and pissed off. Can you tell me what this has been like for you and how you’re feeling right now?

At the end of our answer on the podcast, David added:

Dana, will you please take one of the examples you sent us, give us a context or a few details, and we will illustrate better disarming responses on a future podcast.

Will you also please use the Relationship Journal, and make your own attempt at a 5-Secrets response that we could evaluate and make suggestions on a future podcast?

Thanks for listening!

Rhonda, and David

369 The Invisible Racism We All Deny, Featuring Drs. Manuel Sierra and Matthew May

Today we’re joined by Drs. Manuel Sierra and Matthew May on the sensitive topic of racism.

Manuel Sierra MD is a child and adolescent psychiatrist practicing in Idaho, one of the places where he grew up (he also spent time in Oregon). He was a classmate of Matt May during his residency training days at Stanford, and they remain close friends today.

Rhonda begins today’s podcast with this mail we received from Guillermo, one of our favorite podcast fans:

Guillermo asks: How do you respond to family or friends who make racist comments?

Hello, Dr Burns

Not sure if you have addressed this in any of the podcasts (I don’t recall it being a topic) but:

I was recently in a group chat with some cousins, and I read some really disappointing racist comments about a particular group. Many people ignored it (as I did) and a couple AGREED with the comments.

How can we balance not judging not just any people but our longtime friends and family about overtly racist actions/comments and the thinking that it is not the event but our thoughts that create our emotions?

I don’t care about “judging them” (in the sense that I don’t think it is my place to “change” their views) but just hearing/reading comments like this bothers me when they come from people close to me.

When I see it on tv or the internet, I don’t get affected because I feel it is beyond my control.

I don’t believe they will change their views so do I just remove them from my life? I apologize, the topic is too wide, but I’ve been thinking about this.

Sincerely grateful for all you do,

Guillermo

Manuel kicked off our answer to Guillermo by saying that he has been personally familiar with racism within families and communities, and says that he and Matt have talked about this topic “a lot.” He explained that:

Although I am proud of my Mexican-American heritage, I was born and grew up in Oregon and Idaho, where I’m currently practicing. I encountered considerable racial bias when I was a kid, and later in life as well. I clearly cannot speak for all Mexican-American people, I can only speak for myself and what I’ve personally experienced, and I am extremely aware of how difficult the current times are.

My grandparents didn’t teach my mom Spanish. She was a single mom, and we lived in a small town in Idaho. I also have family through marriage who live on Native American lands.

In grade school I began hearing jokes about Mexican Americans, and this was very awkward, painful, for me. I also got ridiculed for not speaking Spanish.  Even my grandfather asked me, “why aren’t you speaking Spanish?” There were also gangs where the racial bias got worse and frequently turned violent.

After learning more about Manuel’s experiences, we modeled various ways of talking to a friend or family member who has made hurtful racist comments. Manuel cautioned that it might be best to do provide the feedback individually, and not in public, so as not to shame the person. In addition, this can reduce the chance for social posturing and responding in an adversarial way.

Matt agreed and emphasized the importance of combining your “I Feel” Statement with Stroking. For example, you might say something like this, assuming the racial slur comment came from a relative or person you like,

Jim, as you know, you’re one of my favorite people, but I want you to know that when you said X, Y and Z, it really upset me, because it sounded like a put down to people who are (Mexican, Jewish, Moslem, gay, or whatever).

I (David) like this approach because it sounds respectful and direct, but not judgmental or condemning. Rhonda modeled an excellent alternative response which included this type of add-on: “And I’m going to request that you not say that again in my presence. “

I (David) would prefer not to add the directive statement at the end, which could, in theory, rankle some individuals with coercion sensitivity, because it might sound scolding. However, that’s just my take on it, and it’s not some kind of gospel truth. If you want to push your assertiveness and stick up for yourself, it might be effective, and was effective recently for Rhonda because the relative she said this to stopped making similar racial comments in her presence.

I would suggest ending any kind of response to the person who made a racial slur with Inquiry, asking them about their racial feelings as well as the fact that you are criticizing them. Do they feel hurt, angry, anxious, or put down? You might also ask something along these lines--Have they always had negative feelings about this or that racial or religious group?

Manuel described an experience in medical school when an attending doctor was supervising a group of medical students in how to do a particular medical procedure quickly, and said this to him, “You can be like a Mexican jumping bean!”

Then Manuel asked himself, “Should I say something?” Which of course incurs the risk of retaliation from an authority figure in a position of power.

Manuel mentioned that just because you’re working in a prestigious medical setting, this does not protect you from racial slurs. He described hearing people comment on how he and several Mexican-American classmates probably got into medical school because of their ethnicity, implying they weren’t sufficiently intelligent or on par  with their classmates.

He also mentioned an incident during his internship when he checked in on a patient wearing his white lab coat with stethoscope around his neck, and the patient asked him if he was there to pick up the trash and could he please get the doctor.  Manuel humbly replied that he could pick up the trash, and he was the doctor.

I asked Manuel how he felt when hearing these types of belittling and patronizing racist comments. He said that he felt annoyed, embarrassed, angry, put down, anxious, and alone.

He described one of his best friends growing up who was white. However, this fellow grew up poor as well, so they easily formed bond because they’d had similar class-based experiences. His friend sometimes lived in all-black neighborhoods and had also felt out of place at times, not accepted, and targeted.

I asked Manuel how he felt describing these intensely personal experiences on the podcast today, knowing so many people would be listening. He said, “It’s anxiety-provoking. My mouth is dry, my heart is racing, and I’m afraid I’ll sound like an idiot!”

We discussed the differences between being unintentionally or intentionally offensive with racist comments, and also mentioned the related topic of bullying which, of course, is intentionally hurtful. Manuel said that an example might be calling me names or saying terrible things about my mother, or making threats to hurt your family, or your mom. Often the bully is trying to get you to fight, so you’d be beaten up. The bully’s goal is to humiliate you in front of others and make you feel bad about yourself.

Manuel introduced us to some of the approaches he uses when working with kids who are bullied. I’d like to hear more on this topic but we were running out of time. We could address bullying on a future podcast with the same crew, since Manuel and Matt both have a lot to offer on that sensitive and exceptionally challenging topic. Let us know if you’re interested in hearing more.

The response to bullying has to have two dimensions. First, your thoughts, and not the bully’s statements, create all of your moods. So, you can use the Daily Mood Log to record and modify your inner dialogue. The goal would be to support yourself and not buy into the notion that you are somehow “less than” or a loser or coward just because someone is trying to bully and exploit you in a sadistic fashion.

The cognitive work is based on the idea that ultimately, only you can bully yourself. The words of the bully cannot affect you unless you buy into them. But then it’s your own beliefs that are the source of your emotional misery.

Second, your verbal response to the bully can also be helpful to you, or it can serve to make the situation worse. But these techniques, based in part of the Five Secrets of Effective Communication, can be challenging to learn, especially during the heat of battle, so considerable practice is vitally important.

The goal of changing your thoughts as well as the way you respond is not to blame you for the problem, but to give you some reasonably effective coping skills, perhaps similar to the verbal karate I mentioned in my first book, Feeling Good.

At the end of the podcast, we did a survey among the four of us on whether meanness and aggression and exploitation is one of the inherent and genetically based drives in human nature, along with our more loving impulses and drives, or whether humans are basically good and all the hostility and killing is the result of adverse influences along the way. There was a sharp difference of opinion, and you can listen to the podcast to find out what everyone thought!

We were, of course, just speculating, as this question is partly scientific and partly philosophical.

I asked Manuel how he felt at the end of the podcast, and he said he was feeling a lot better. He was powerful and informative, and I was grateful he could appear with our team and teach us from the heart today! I hope you enjoyed today’s program as well.

Thanks for listening!

Manuel, Matt, Rhonda, and David

A Strange Paradox-- The Incredible Impact of Compassion + Accountability Featuring Adam Holman, LCSW

We want to remind our listeners about the upcoming Mexico City TEAM intensive from November 6 – 9, 2023, organized by Level 5 TEAM therapist, Victoria Chicural, and Level 4 TEAM therapist Silvina Bucci. The Intensive will be held in a beautiful part of Mexico City (Sante Fe) at the Hotel Camino Real. There will be lots of opportunities to practice every aspect of TEAM-CBT along with many excellent, internationally renown TEAM-CBT trainers.

I (David) will do a keynote address on Day 1,  On Day 2 Rhonda and I will do a live TEAM demonstration with a volunteer attending the conference. On Day 3 everyone will have the opportunity to practice the TEAM model from start to finish.  And on Day 4 Leigh Harrington and I will answer questions about the TEAM treatment model.

This promises to be an Intensive not to be missed!  To learn more and register, please visit their website: https://teamcbt.mx,

Today we are joined by Adam Holman, LCSW, whose podcast 288 on April 22, 2022 was a big hit. He shared his strategies for working with kids with video game addictions, and his no-nonsense, patient-focused approach made good sense and resonated with many of our podcast fans.

Today, he talks about what he calls a “Strange Paradox,” which is:

If you treat people like they’re fragile, they act and behave like someone who’s fragile. If, in contrast, you hold them accountable, with compassion, they will discover their strengths.

He began by commenting on hearing David talk about how therapists often get hypnotized by our clients without realizing it. When that happens, we buy into the clients’ beliefs that they’re helpless and hopeless. And, I (David) might add, worthless.

When that happens, we start to treat them as if the beliefs are true, further proving to them that they’re helpless, hopeless, and worthless. This became incredibly evident after Adam had a unusual encounter with a child  while on a hike with his partner near Prescott, Arizona.

The child was shrieking in terror at the top of his lungs. As they got approached the child, they saw that he was paralyzed by fear of a swarm of flies near his head. They also realized that his family had already walked past, and were about 45-seconds down the trail, hoping that he would become brave and walk through the flies and catch up with them.  But that clearly wasn’t happening.

Adam walked past the flies and stood next to him before saying, “I know you’re scared, that’s okay. I just walked past the flies and it’s safe. You can walk through.” Then, the boy immediately stopped crying and walked past the flies on his own.

The boy willingly chose to walk past them the moment that his suffering was acknowledged. He heard the message that there was nothing wrong with him or the fear that he was feeling.

In other words, the acknowledgement of his fear send the message: “It IS scary, and you can do it. You’re capable of doing scary things.”

And he immediately found his courage and became capable.

Adam continued:

My partner and I began thinking about the suffering that the boy had experienced in that moment, and how little he needed in order to become strong and courageous. We felt close to the boy, and talked about our own suffering, and our parents’ suffering that was passed on to us.

We cried for three hours that day and began to think about all the suffering in the world. It felt incredibly relieving, I felt so connected to all of the people in my life, and naturally began thinking more about the suffering experienced by my clients.

I realized that with many of them, I’ve just given in to listening without holding them accountable. I had been standing next to them, but I was treating them as if they could not walk past the flies.  . . . I loved your podcast on stories from the 60’s, especially your experience when you were crying for hours when driving through the Nevada desert.

All the same kinds of feelings bubbled up in me. I saw that his parents were just doing what they’d learned to do; to try to discourage the uncomfortable feelings by walking away from them. Unknowingly, this was sending the message that he isn’t strong enough and that he is weak for feeling so fearful.

Like many of us, they had learned that it’s not okay to suffer, that experiencing feelings like fear is not acceptable. This, ironically triggers more suffering because you learn to avoid and fear your negative feelings, and you don’t gain the courage to sit with your painful feelings and the feelings of others You can say (to the little boy), it’s okay that you’re suffering and afraid, and that’s not a problem.

I related to that boy. My dad was very critical, and would berate me for feeling anything other than happiness. Feelings like fear or sadness were signs of weakness, and eventually I stopped realizing that I was even feeling them.

Then my feelings came out in the form of a lot of anxiety that I was avoiding, and the avoidance of that anxiety didn’t allow me the opportunity to see that I had strengths.

Rhonda, Adam and David discussed the role of tears in healing. Rhonda mentioned the immense value of exposure in recovery from anxiety, as opposed to avoidance, and the importance of making her patients accountable.

David mentioned that our field is based on the idea that your negative feelings, like depression, or fear, show that there’s something “wrong” with you, like a “mental disorder,” so you need to be fixed, by some pill, or some new school of psychotherapy. But if you’re trying to “fix” someone, you’re giving them the message that they’re “broken.”

TEAM, in contrast, is based on the opposite idea, that our negative thoughts and feelings will always be the expression of what’s right with us, and not what’s wrong with us. “Getting this,” which may not be easy at first, can paradoxically open the door to rapid change, just as we saw with the frightened boy that Adam encountered on the hike.

Finally, Adam discussed how he ended up applying what he realized to a client he had been working with. The client was diagnosed with “Treatment-Resistant OCD,” and had years of therapy and medication that had not brought him to much relief. Adam had been working with him for a few months and they were able to recognize some outcome resistance.

Outcome resistance is when the client has one or many good reasons not to give up their symptoms. Specifically, this client had an intense fear of rejection, and was making sure that his appearance was absolutely perfect in order to prevent rejection.

Adam discusses sadness and frustration over the term “Treatment Resistant”, noting that it often keeps people feeling more stuck. Once the client saw this, he decided that they wanted to go forward and let go of his compulsions and agreed to include exposure in his treatment. This would mean that he would have to let his appearance be imperfect, and allow himself to feel anxious. Thinking back on the treatment, Adam realized that he had been providing listening and support without making the patient accountable and insisting on exposure.

The next session, Adam recognized that just like the boy, he needed to treat his client with compassion and accountability. Adam re-invited the client to address the OCD and offered the gentle ultimatum, reminding the client that in order to go forward, we’re going to have to do exposure.

The client agreed, then started to hesitate as a result of his fear when he realized that the exposure would be taking place right at that moment. Adam messed up his own hair and invited the client to do it along with him.

Adam reiterated that getting over it requires the use of exposure. The client then messed up his hair, and expressed feeling anxious for a few minutes before erupting into laughter. Then the client proceeded with his day without fixing his hair. He also decided to do more exposure on his own after session without giving into the anxiety.

When he returned for the next session, he explained that his compulsions were gone for the first time in his life. The moment he was treated with compassion and accountability, he also found the strength to recover.

So, what’s the bottom line? When working with your own fears, or the fears of your clients or friends, two things are required. First, respect and compassion can help you accept your fear without feeling broken, or ashamed, or less than. And second accountability can give you the courage to confront your fears for the first time, and make the magical discovery that the monster really had no teeth!

This is one form of enlightenment, going back 2500 years to the teachings of the Buddha on the “Great Death” of the “Self.”

Thanks for listening today!

Adam, Rhonda, and David

TEAM for Troubled Couples A New Twist!

Today we are joined by a favorite guest, the brilliant Thai-An Truong. Thai-An is a Licensed Professional Counselor (LPC) and Alcohol and Drug Counselor (LADC). She is the first Certified TEAM-CBT Therapist and Trainer in Oklahoma. She has found TEAM-CBT to be life-changing professionally and personally and is passionate about training other therapists in this “awesome approach.”

In her private practice, Thai-An specializes in the treatment of trauma and OCD. To learn more about her TEAM-CBT Trainings, visit www.teamcbttraining.com

Thai-An has been featured on many Feeling Good Podcasts focusing on

Now Thai-An adds an important dimension to the TEAM Interpersonal Model—working with trouble couples, as opposed to working with individuals with troubled relationships. She also describes a new way to use Positive Reframing to reduce patient resistance to giving up David’s famous list of “Common Communication Errors,” and she adds five new errors to the list.

At the start of the podcast, Thai-An described a woman who complained that her husband often “shuts down” when they are communicating about a sensitive topic, and she wondered why. Thai-An decided to invite him to join the session so his wife could find out why.

This really opened things up, and the wife discovered that her husband shut down because he was feeling inadequate when she pointed out all the things that were wrong with the house, and he was taking her comments as criticism. However, the more he shut down, the more she complained, and this pushed him away even further since her criticisms intensified his feelings of inadequacy.

Thai-An then used Positive Reframing to help her see why he shut down.

One of Thai-An’s new ideas was to use Positive Reframing to cast our list of “errors” on the “Bad Communication Checklist” in a positive light, just as we do with the negative thoughts and feelings of people who are using the Daily Mood Log. By siding with the patient’s resistance and listing all the good reasons NOT to change, nearly all patients paradoxically let down their guard and powerful urges to oppose change. Instead, they open up and become receptive to the many methods for challenging distorted thoughts.

Thai-An has observed the same phenomena with troubled couples. When they see the GOOD reasons to why they or their partners use dysfunctional ways of communicating, they paradoxically let down their guard and become more willing to use the Five Secrets of Effective Communication.

She says:

Positive reframing started to open them up to each other, and helped them see each other in a more positive light. At the same time, they discovered that they shared the same values.

Voicing the good reasons to maintain the communication errors as well as the cost of change (e.g., it’ll be hard work, I’ll have to focus on changing myself, it’ll be vulnerable) allowed each partner to melt away their resistance to change.

David comment: This is an excellent example of a “double paradox.” Once again, instead of trying to “help,” which often triggers intense resistance, the therapist sides with the resistance, and this paradoxically triggers strong motivation to change!

Thai-An reminded us that it’s important to go through the TEAM structure before moving forward with tools to help the couple change. For testing, she asks both partners to complete the version of David’s Brief Mood Survey that includes the Relationship Satisfaction Scale, and asks both to complete the Evaluation of Therapy Session at the end. She makes sure both partners rate her empathy toward them at 20/20 (perfect scores) before proceeding to the next steps.

During the Assessment of Resistance, she begins to work with David’s Relationship Journal to get a specific moment in time of conflict. Then when they do Steps 3 and 4, where they identify their own communication errors and their impact on their partners, she does positive reframing of the bad communication errors, which you can see here, along with five new errors that Thai-An has listed below.

The Bad Communication Checklist*

* Copyright ã 1991 by David D. Burns, MD. Revised 2001.

Thai-An Truong’s 5 Additional Communication Errors:

Shut down—You shut down and ignore the other person or give them the silent treatment. Avoidance—You hide your feelings and avoid talking about hard topics, or disconnect through some form of escape. Rejection—You make threats to leave – “I’m done with you,” or “I can’t deal with this anymore,” or “I want a divorce.” Control—You insist that the other person “needs” to behave or communicate differently, or “should” or “shouldn’t” behave the way they do. Invalidation—You tell the other person they shouldn’t feel the way they feel.

Here’s how Thai-An did the Positive Reframing with this couple. First she asked the wife, “Why might your partner suddenly want to “shut down” and stop communicating during a conflicted exchange?” She also asked, “What does this do for the person who is shutting down?”

This is the list of positives they came up with. Shutting down . . .

Keeps me safe and protects me from more criticism Protects my partner from hurtful comments I might make. Shows that I value our marriage and my partner’s feelings. Shows my love for my partner, and for myself. It shows that I’m feeling hurt and want to be appreciated. Guarantees that I won’t make things worse. Shows that I want to protect myself from becoming overly vulnerable and getting invalidated again. Shutting down feels less risky than sharing my feelings.

Once she saw why he shut down, she realized the negative impact of her complaints, and began to provide more genuine words of appreciation to him. He said that this meant so much to him and made all the hard work worth it.

Her common communication errors included “truth” and “making complaints.” He realized, again through positive reframing, that she also wanted validation, that raising children can be hard, and that she ALSO wanted appreciation for how well she was keeping up with the home and the care of their children.

So, when she wasn’t getting validation and appreciation from him, she was even more likely to complain to try to voice her perspective. Once he was able to stop shutting down, and instead began to make more disarming statements, use feeling empathy, and stroking, she was much less likely to complain. They also realized they had the same values of wanting healthier communication and to provide a safe and happy home for their children.

Was this effective? Both went from 10/30 and 11/30 on the relationship satisfaction scale (shockingly poor scores) to 26/30 by the end of the relationship work together (extremely high scores indicating outstanding scores on my Relationship Satisfaction Scale.)

Thai-An provided us with a cool Positive Reframing document for all of the communication errors. You can check it out if you CLICK HERE.

I (David) pointed out that Positive Reframing can also be used in conjunction with the Relationship Journal in another way. In step one of the RJ, you write down one thing the other person said, and you circle all the many feelings they were probably having, like hurt, alone, anxious, angry, sad, unloved, and many more. In step two you write down exactly what you said next, and circle all the feelings you were having.

This would be an ideal time to do Positive Reframing of your partner’s negative feelings, so as to shift you perception that the other person is “bad” or “to blame” or some negative interpretations that you may be making. This reframing might be helpful in the same sense that my technique, Forced Empathy, can sometimes cause a radical shift in how you see the person you’re at odds with.

Announcements

On January 4, 2024, Thai-An Truong will be offering a 14-week training program in TEAM couples therapy for mental health professionals. The class will meet weekly from 11:30 to 1:30 East Coast time. To learn more, please go to Courses.teamcbttraining.com/relationships

There will be a 4-day TEAM-CBT Intensive November 6-9, 2023, in Mexico City, at the Hotel Camino Real.  To learn more, please go to:  https://teamcbt.mx/welcome

Thanks for listening today! Let us know what you thought about our show!

Thai-An, Rhonda, and David

AI and Psychotherapy— Doomsday or Revolution?

Featuring Drs. Jason Pyle and Matthew May

Today we feature Jason Pyle, MD, PhD and our beloved Matthew May, MD on a controversial, exciting and possibly anxiety-provoking podcast on the future of AI in psychotherapy and mental health. Will AI shrinks replace humans in a doomsday scenario for shrinks? Or will AI serve shrinks and patients in a revolutionary way that sees the dawning of a new age of psychotherapy?

You are all familiar with Matt, due to his frequent and highly praised appearances on our Ask David segments, but Jason Pyle, MD, PhD, will probably be new to you. Jason joined the Evolve Foundation as Managing Director in 2022 to focus his work on the mass mental health crisis and the rampant diseases of despair, which afflict tens of millions of Americans. The Evolve Foundation is a private foundation dedicated to the advancement of human consciousness. Evolve is active in philanthropy and venture investments in the mental health fields.

Jason is an accomplished biotechnology executive with over twenty years of executive management and technology development experience. He is committed to developing healthcare technologies and bringing science-backed healing to the most important problems of our generation.

Jason is a veteran who served as a US Ranger, and earned an Engineering degree from the University of Arizona. He received both his MD and PhD in Neurosciences from the Stanford University School of Medicine, where he met Matt May and they became close friends. At the start of today’s podcast, Matt and Jason reflected on their long friendship, starting as classmates at the Stanford Medical School 20 years ago.

The following questions were submitted by Jason, Matt, and David prior to the start of today’s podcast.

Jason’s Questions:

How important is the role of therapist rapport with patients? If it is important, how might AI accomplish or fail to accomplish this? Given the limitations of AI, what parts or pieces of the therapeutic process might it best serve? One of AI's potentially best features is that it can interact with a person anytime/anyplace, how could this be useful to augment the current therapeutic paradigm? We talk a lot about patients using AI, but how could therapists use it to better serve their needs?

Matt’s Questions about AI:

What is AI? How does it work? If therapists strengths tend to be their weaknesses and vice-versa, what might we expect to be the strengths and weaknesses of an AI therapist? How do these expectations match up with what David is seeing in the data? Is AI safe? Can it be made to be safe? What would be the best case scenario for AI, in therapy?

David’s question about AI:

Will AI replace human therapists?

Jason kicked off the discussion with a brief description of AI and machine learning, and outlined four potential roles for AI in psychiatry and psychology:

An AI therapist full replaces the human therapist An AI helper augments human therapist, acting as a 24 / 7 therapist helper in a myriad of ways involving ongoing support for patients between therapy sessions and support for patients during crises. AI helps the therapist with rudimentary tasks like record-keeping, recording, and summarizing sessions. AI can study transcripts of therapy sessions for research purposes, rating what procedures were done as well as degree of adherence to the therapeutic methods, and the skill of the therapist.

The ensuing dialogue was illuminating and exciting. In fact, I got so engrossed that I stopped taking notes, so you’ll have to give it a listen to find out. However, one thing that was interesting and unexpected was highlighting the strengths and weaknesses of AI. For example, a patient with social anxiety might benefit greatly from armchair work, focusing on ways to combat distorted negative thoughts, but will still have to interact strangers in social situations to conquer this type of fear.

David and Matt nearly always go with the patient out into the world for interpersonal exposure exercises, and find that the presence and trust and “push” from the human therapist can be invaluable and necessary. It is not at all clear that an AI therapist working via a smart phone could have the same effect, but that might require an experiment to find out.

Jumping to conclusions without data is rarely safe or accurate! Maybe an AI “helper” could be very helpful to individuals with social anxiety!

Jason raised the question of whether AI could replicate the trust and warmth and rapport of a human therapist, and whether the warmth and rapport of the therapeutic relationship was necessary to a good therapeutic outcome. I (David) summarized some of the findings with our Feeling Good App showing that app users actually rated the “Digital David” in the app substantially higher on warmth and understanding that the people in their lives. And now that we are incorporating AI into the Feeling Good App, the quality of the empathy / rapport from our app may be even higher than in our prior beta tests.

We have not done a direct comparison between the rapport of human therapists and the rapport experienced by our Feeling Good App users. Many people might jump to the conclusion that human shrinks have better rapport than would be possible from a cell phone app, but this might be the opposite of the truth! In my research (David), I’ve seen that most human shrinks believe their empathy and rapport skills are high, when in fact their patients do not agree!

In my research on the causal effects of empathy on recovery from depression in hundreds of patients at my clinical in Philadelphia, and also in more than 1300 patients treated at the Feeling Good Institute in Mountain View, California, it did not appear that therapist empathy had substantial causal effects on changes in depression.

The late and famous Karl Rogers believed that therapist empathy is the “necessary and sufficient” condition for personality change, but most subsequent research has failed to support this popular belief.

I (David) believe that AI therapists are likely to outperform human shrinks in rapport, warmth, trust, and understanding, but it remains to be seen whether this will be sufficient to make much of a dent in the patient’s symptoms of depression, anxiety, marital conflict, or habits and addictions. Other techniques are likely to be required.

However, we may have new data on this question shortly, as we will be directly studying the effectiveness of AI empathy on the reduction in negative feelings. We might be surprised, as our research nearly always gives us some unexpected results!

Rhonda gave a strong and appreciated pitch for the idea that there is something about a person to person interaction, like a hug, that will never be duplicated by an app. If this is true, or even believed to be true, then there will likely never be a complete replacement of human shrinks by AI apps.

But once again, you can believe this on a religious, or a priori, basis, or you can take it as a hypothesis that can easily be tested in an experiment. We do have very sensitive and accurate tests of therapists’ warmth and empathy, so “rapport” can now be measured with short, reliable scales, making head to head comparisons of apps and humans possible for the first time. At one time, it was thought that AI would never be able to beat human chess champions, but that belief turned out to be false.

The podcast group also discussed some of the potential shortcomings of an AI shrink. For example, the AI does not yet have the insight of how to “see through” what patients are saying, and takes the patient’s words at face value. But a human therapist might often be thinking on multiple levels, asking what’s “really” going on with the patient, including things that the patient might be intentionally or unintentionally hiding, like feelings of anger, or antisocial behaviors.

At the end, all four participants gave their vision, or dream, for what a positive impact of AI might have on the world of mental illness / mental health. Rhonda had tears in her eyes, I think, over the suggestion that an effective and totally automated AI therapist would be scalable and might have the potential to bring ultra low-cost relief of suffering to millions or even hundreds of millions of people around the world who do not currently have access to effective mental health care.

And I would add the individuals who now have access to mental health care, often cannot find effective treatment due to severe limitations in therapists as well as all current schools of therapy.

Jason described his vision for an AI shrink as the helper of human therapists, extending their impact and enhancing their effectiveness. Jason is super-smart and wise, and I found his vision very inspiring! I have trained over 50,000 therapists who have attended my training programs over the past 35 years, and one thing I have learned is that most shrinks, including David, have tons of room for improvement.

And if a brilliant and compassionate AI helper can enhance our impact? Hey, I’m all for that!

Thanks for listening today! Let us know what you thought about our show!

Jason, Matt, Rhonda, and David

Where Do Feelings Come From? Getting Unstuck from Apathy Ancient Stoic Philosophers--and More! Ask David Questions for Today

Bystad: Why is it so helpful to write down your negative thoughts when you’re upset?

Anyinio: Do we have to have a thought every time we have an emotion? What if I see a car coming fast and about to hit me? Would I have to have a fast automatic thought?

Raghav: How can I get unstuck from apathy?

Anita: What are the necessary and sufficient conditions for emotional distress as well as escape from emotional distress?

Louisa: Can you tell us some more about the ancient and modern Stoic philosophers who influenced the development of CBT and TEM-CBT?

Answers to today’s questions. The following answers were written before the podcast. The information on the podcast may be quite different in some cases, and will typically provide much more information than the brief answers below. David

Bystad asks: Why is it so helpful to write down your negative thoughts when you’re upset?

Dear David!

I have practiced the paradoxical approach where I just write down my thougts / worries without challenging them.

I think I learned that approach from your great book «When Panic Attacks».

This is something that really works for me, especially for worries. It is almost like I «get the worries out of my head».

Can you talk about this approach in your lovely podcast, why is it so effective for some people??

Best regards from Martin

David’s reply

Great question. Will address it the next time we record an Ask David podcast!

Anyinio asks: Do you ALWAYS have a thought before you can experience an emotion / feeling?

David’s response

The word “thought” is just a form of shorthand for perception. Perception can take many forms. When you see a car about to hit you, you already HAVE a negative and alarming thought!

If you like, you can check out the railroad track story in my Feeling Good Handbook. It is a story about a man who became euphoric after his car was hit by a train going 60 MPH because of his thoughts about it!

When a deer spots a pack of howling wolves, it runs in terror. It does not have a “thought” in English, but it DOES have the perception of being in imminent danger, and it DOES experience intense, sudden fear. However, the deer did NOT feel fear / anxiety until s/he SAW and correctly interpreted the pack of wolves.

Thanks, best, david

Raghav asks: How can I get unstuck from apathy?

Hi Dr. Burns,

I hope you’re doing well and thank you so much for all of your incredible work! It has really helped me pull myself out of some of the deepest depressions and anxieties I’ve had.

I wanted to ask for your help with a problem I’ve been facing recently:

I seem to get stuck in depressive cycles at times where I don’t want to do a DML even though I know it will make me feel better. When I start doing the positive reframing, it helps melt away this resistance, but I still mope around for a while before I start the positive reframing. My thoughts during this time are generally “There’s no point to getting better,” “Doing a DML is like forcing myself to cheer up,” “I should care about getting better more than I do right now,” and “There’s no meaning to life.” How would you recommend I go about dealing with this apathetic state?

I would greatly appreciate any help in this matter!

Thanks,

Raghav

David’s reply:

You could perhaps list:

All the really GOOD reasons NOT to do a DML. What the procrastination / avoidance shows about you and your core values that positive and awesome. How the avoidance helps you.

Something along those lines.

I might make this an Ask David question if that’s okay with you. Could use your first name only, or a fake name if you prefer.

Thanks! Good question, as so many can relate to it!

Best, david

Raghav’s response to David

Here’s the answers I came up with:

Good Reasons NOT to do a DML

Doing a DML might be difficult and take a long time. I might not be able to answer some of my thoughts. Even if I do a DML, I might not be able to change my mood. Even if I change my mood, there’s no point in being happy. There’s no sense of meaning in doing a DML. It feels inauthentic to try to change my mood. Even if I do a DML now, I will return to this state again. Doing a DML is like forcing myself to cheer up and I don’t want to be forced to do anything. I want to be able to get better without doing a DML. I might have to confront really negative and distressing thoughts.

Core Values it shows about me

I care about doing things successfully — I don’t want to half-ass it. I want to put my best foot forward when doing tasks — i.e. not do them when I’m tired. I want to be self-reliant and be able to solve all my problems myself. I care about being able to change my mood. I care about having meaning in life. I care about being authentic to my emotional states — I can honor my apathetic/bored side. I can sit with my sadness and apathy rather than trying to escape it. I care about having lasting solutions rather than short-term fixes. I’m my own man — I’m not going to be forced to do something I don’t want to do. I care about being able to deal with my emotional problems without “crutches.”

How the Avoidance Helps Me

It means that I don’t have to do the hard work of doing a DML. I don’t have to engage in the ups and downs of life if I’m apathetic/avoidant. I can keep engaging in avoidance and distracting myself. It feels like there are no consequences to my actions so I feel more free. I don’t have to do the hard work required to build meaning into my life. I can fully engage and honor my apathy and boredom. I’ll push myself to search for lasting solutions to my problems. It pushes me to improve my mental capabilities of solving my problems. It helps me avoid the pain and anguish of actually addressing really negative thoughts. It pushes me to find more interesting things to fill my life with.

Raghav

David’s reply

Great work, thanks! So now my question is this: Given all these positives, it is not clear to me why you’d want to do a DML. What’s your thinking about this?

Best, david

 Anita asks about the necessary and sufficient conditions for emotional distress as well as escape from emotional distress?

Dear David

While revisiting Feeling Great I was thinking further about the interplay of necessary and sufficient conditions that are correlated to emotional distress.

Necessary condition: You must have a negative thought

Sufficient condition: You must believe in the negative thought

I was thinking of another sufficient condition that may account for the behavioural component of emotional distress:

Sufficient condition: You must act in way that reinforces your negative thought.

For me this additional sufficient condition unlocks another philosophical underpinning why exposure is a key to overcoming anxiety.

For example, if I have a negative thought I’m going to screw up in a presentation and then I believe it 100%. I can still summon up the courage to go ahead and do the presentation. Thus, I’m behaving in a way that doesn’t fulfil the second sufficient condition, and therefore another way to reduce emotional distress. More often than not, the presentation is not as calamitous as I anticipated anyways.

Thanks for reading.

Warm Regards

Anita

David’s reply

Hi Anita,

Great question, thanks. I greatly appreciate folks who think more deeply about these things.

Exposure is a desirable tool in the treatment of anxiety, for sure, but if you point is “necessary and sufficient” for emotional distress, then the action thing is an unnecessary and erroneous, to my way of thinking, add-on. For example, many people who are severely depressed and believe themselves to be worthless do very little, and others do a great deal, but both feel the same severity of distress.

Could we use this for an Ask David, with or without your first name? If so, we could also discuss the “necessary and sufficient” for emotional change. Here the sufficient condition is that you no longer believe  the negative thought, or your belief has gone down significantly.

You can respond, too, if you like to my comments.

Warmly, david

Anita’s Response to David

Thanks David, sure I’d be pleased if you find any of what I wrote useful for your listeners. Feel free to use my first name. I’m also curious to know more about the depth of belief in a negative thought as a sufficient condition for emotional distress. Is there a particular intensity or tipping point that might lead to the emotional distress?

David’s Response: The greater you belief in a negative thought, the greater the emotional impact. There’s no “tipping point.”

I loved the premise of your book: “When you change the way you think, you can change the way you feel” It got me pondering about the possibility other things such as some behaviours in addition to thoughts that could be associated with emotional distress.

David’s Response: Your own or someone else’s behaviour won’t have any effect on you until you have a thought, or interpretation, of what’s happening. This is the basic premise of CBT, going back 3500 years or more.

An example I’m thinking of is workplace procrastination. Let’s say I have been given two weeks to tackle a laborious project. I might initially have thoughts there is plenty of time and I can procrastinate for the first week doing things I find more satisfying at work.

Towards the end of the second week, panic sets in as I rush through the project so I can still meet the deadline.

After the event, I start ruminating and believing self-critical thoughts such as “I shouldn’t have been so lazy” and “I’m never able to handle projects well.”

Is it to say, the behaviours before the event has little to no bearing on the negative thoughts or belief after the event? And if so why is it really the case that the negative thinking comes into play after the event happens?

David’s Response: Negative thinking can happen before, during, or after an event.

I really have gained much from many of your books. I’m inquiring to deepen and refine my own thought processes.

Thankyou

Warm Regards

Anita

David’s Response

Thanks so much for you kind and thoughtful comments.

Louisa asks: I’d like learn more about the ancient and modern Stoic philosophers who influenced the development of CBT and TEM-CBT.

Hello Rhonda and David,

I am a Belgium based listener thoroughly enjoying the podcast and sharing it far and wide! I love the TEAM CBT structured approach.

I find in particular that many of the methods are (relatively) easy to remember and administering self-help feels much easier than I ever imagined.

Well-done, David!

I wonder if David could talk one time about the different influences various figures in the development of CBT right from its inception with (it seems to me) the Roman Stoics until this century.

Some names that come to mind are Seneca, Epictetus, Marcus Aurelius, to Albert Ellis, Aaron Beck & William Glasser (these last three all since passed away.)

Are they any particular names that stick out as having been particularly useful in the development of TEAM CBT and why or how? Do the Roman Stoics still have anything to offer us?

Thanks for the great show!

Louisa

David’s Response

Hi Louisa,

Thanks, will include in the list of questions for the next Ask David, depending on time constraints.  Best, david

PS Albert Ellis documents much of the history in his book, Reason and Emotion in Psychotherapy. I believe that Karen Horney, the feminist psychiatrist of the first part of the 20 th century, discuss lots of the current ideas as well, especial the “need” for love, success, etc. and the idea that we have an “ideal” self and a “real” self. We get upset when we realize that the two don’t match!

David and Rhonda are grateful that Matt can join us often on the podcast.

Self-Esteem, Self-Confidence, and Self-Acceptance What's the Difference? What's More Important?

Questions for today’s Ask David podcast

David asks: What’s the difference between self-confidence, self-esteem, and self-acceptance?

Guillermo asks: How do you help people who are not asking for help or don’t even know they need help with depression?

The answers to today’s questions in these show notes were written before the podcast. The information on the podcast may be quite different and will typically provide much more information than the brief answers below. David

David asks: What’s the difference between self-confidence, self-esteem, and self-acceptance?

Hello David,

The mental health world seems to like or argue about the meaning of terms like self-confidence, self-esteem, and self-acceptance? What’s the difference between them, and which one is the best thing to have?

David’s response: Great question, David. I think of self-confidence as the conviction that you’re probably going to win because you’re very good at something. Self-esteem, in contrast, is the decision to love yourself whether you win or lose. Between those two, I’d say that self-confidence is more fun, but self-esteem is more important.

But where does self-acceptance fit in? That’s the big buzz word these days, although the concept has been around for ages. We’ll have to ask the experts today to find out where it fits in! I’m a bit confused at the moment!

 Guillermo asks: How do you help people who don’t know that they need help with depression?

Hello, Dr Burns

I was curious as to how you would help someone who isn’t aware (or capable to know--but not in a medical sense) that they need help. You've said before that the worst thing you can do is try to help (especially when no one asked for help), but how have you handled in the past cases when someone isn’t aware that they need help for depression?

Seems like it would be very tough without the person being motivated.

As always, thank you for all you do,

Guillermo Campos

Rhonda, Matt, and David will reply on the podcast.

361: Cultivating Delight Today we feature Dr. Angela Krumm, Clinical Director at the Feeling Good Institute (FGI) in Mountain View, Ca, and Zane Pierce, LMFT, a Level 3 TEAM therapist at FGI, on a novel and arguably controversial tool which is not aimed at reducing negative feelings, but rather boosting positive feelings. 

Are the "physical" symptoms of depression specific or non-specific? How do you treat schizophrenia with TEAM? Why don’t more shrinks help themselves? Healthy vs unhealthy negative feelings-- what's the difference? Questions answered in this podcast: 1. Laura asks: Why don’t you include the physical symptoms of depression in your assessment tests? 2. Fred asks: How would you use TEAM-CBT to treat individuals with schizophrenia? 3. Author not known: Why don’t the therapists you treat with TEAM treat themselves using self-help techniques? 4. Zach: How does David understand the difference between healthy and unhealthy emotions? Is there any overlap between EFT (Emotionally Focused Therapy) and David’s TEAM-CBT?   The following are David’s written responses to these questions. However, in the podcast, Rhonda and David discuss them, and their answers together may differ or enlarge on the material below. Also, in some cases, the written answers contain additional information not included in the live podcast. 1. Laura asks: Why don’t you include the physical symptoms of depression in your assessment tests? Author: Laura asks a question about post #248: “David and Rhonda Answer Your Questions about Exercise, Empathy, Euphoria, Exposure, Psychodynamic Therapy, and more!” Comment: Fabulous, David. Bless you. Have you done a show on assessments? I'll be honest about my confusion. Some of the measures that you have developed almost seem too simple to be accurate. For example, the depression test isn't sensitive to any of the physical manifestations of the illness. Anyway, I was just curious about that. David's Reply Thanks, Laura! Good questions! First, the so-called physical symptoms of depression are non-specific and not uniquely associated with depression. Only the core emotional symptoms are good indicators of depression: feeling down, hopeless, worthless, unmotivated, and not enjoying life. If you want to measure physical symptoms, they won’t give you much information about depression, but at least they need to be worded correctly, which they aren’t in most assessment tols. For example, you can measure weight gain, OR weight loss, in single and separate items, but not in the same item. But if you go to a mall and ask how many people have had weight gain, you’ll probably find that more than 50% report weight gain, but this is rarely due to depression, rather it is due to overeating! Similarly, a significant fraction will say yes to a question about weight loss, and in the vast majority of cases this will be due to dieting, not depression. Similarly with the other poorly thought out physical symptoms, like trouble sleeping. The reliability of my depression measures has typically been .95 or better, as compared with measures like the Beck or PHQ9 that have only .78 to .80 reliability coefficients (called “coefficient alpha.”) I have observed a phenomenal lack of critical thinking behind most current psychological tests for depression, anxiety, and other variables of interest to clinicians and researchers. You also asked about apps for anxiety, like OCD, as opposed to depression. The Feeling Good App causes rapid and significant reductions in, not one, but seven categories of negative feelings, including feelings of depression, anxiety, guilty/shame, inadequacy, loneliness, hopelessness and anger. Thanks so much! Finally, I have to confess my bias toward trying hard to make things simple, so we can all understand what we’re talking about! When things are overly complicated or hard to “get,” I usually feel fairly suspicious about the person who is trying to “teach.” In college I always had the policy that if I can’t understand what the teacher is trying to say, the teacher has a problem! My thinking today is pretty similar! I’ve always appreciated teachers who keep things simple for us mere mortals who appreciate having things explained clearly and in everyday words. Best, david 2. Fred asks: How would you use TEAM-CBT to treat individuals with schizophrenia? Hi David, Do you have any schizophrenia thought experiments? Most of my clients struggle with voices. I tell them there is always a good voice, which I believe is the Holy Spirit woven into every person at birth. I also tell them to welcome the voices and listen for what they need, because the voices need to be welcomed back into the body - the "family" - of the person, according to Internal Family Systems. I welcome your thoughts. I am not a therapist so anything I say or do needs to fit my role as a recovery coach. Fred South Bend, Indiana David’s Reply. Thanks, Fred, great question. I have treated many individuals with schizophrenia, but they have rarely or never asked for help with the voices they hear. I like to set the agenda for each patient, finding out what they specifically want help with. And individuals with schizophrenia respond very well to TEM-CBT, both the individual treatment model for depression and anxiety, as well as the interpersonal model for relationship problems. An experience early in my career highlighted the folly of trying to challenge the delusions of individuals with schizophrenia. A young man, a new patient, seemed uncomfortable and when I inquired, he explained that the receptionist, Lucretia, was listening in because she could “hear” our thoughts and our conversation. I explained that Lucretia did not have much money, and that if he wanted we could do an experiment to test his belief. I put a $20 bill on the desk and said that if Lucretia knocked and came into the office, she could have the money. So I did that and Lucretia did not knock on the door or appear in the office. I asked the young man what he concluded from our “experiment.” He said that she “knew” it was an experiment since she could “hear” our thoughts, and didn’t come in because she didn’t want us to know she was “listening in” on our dialogue! That’s an excellent example of what happens when the shrink tries to set the agenda, as opposed to helping patients with what THEY want help with! In my experience, you can help individuals with schizophrenia with self-esteem, anxiety, and relationship problems with psychotherapy, and they do feel and function somewhat better, but they still, sadly, have schizophrenia. This is my thinking only, and others may differ. I know that Aaron Beck and many of his followers have done research studies claiming they can help schizophrenia with traditional CBT. I am skeptical, but have not read those studies or evaluated the data with a critical eye! So who knows? Maybe they have some decent results. Best, david 3. Author not known asks: Why don’t the therapists you treat with TEAM treat themselves using self-help techniques? Why can't the TEAM-CBT therapists who have done personal work with you on the podcasts do that work themselves in self-help mode?" They know all the techniques and have all the tools. With no qualifications, I have my own theory on that, which is actually based on TEAM. I don't know how to give myself the level of E=empathy required to move on to the next stage. So I guess my question could be reworded as "Is it possible to give yourself sufficient empathy in self-help mode?" or "Are there techniques or tools you can use to give yourself empathy in self-help mode?" David’s Response Thanks, cool question!

When a client is grieving, David encourages the tears to flow and notes it’s an expression of how much the client valued something. David also demonstrates what EFT would call protective anger, when using the counterattack method, “I’m tired of listening to your BS.” And lastly David demonstrates what EFT labels self-compassion while using the acceptance paradox and 5 secrets responses to critical thoughts.

Podcast 357: Stories from the 60s, Part 1 Today’s podcast will be a little different. I had the good fortune to be alive in Palo Alto, California during the late 1960s. For me, it was a magical era of happenings, the Haight-Ashbury District in San Francisco, psychedelics, war protests, civil rights activity, cool music, learning about life, and cutting an awful lot of medical school classes! But what I learned on the streets was far more valuable in my later career as a psychiatrist, working with real people with real problems, than anything I learned in medical school. It was an era of magic, to be honest. In fact, to me, California has always had the feel of magic. And that magic is still alive and well, happening every day, at least in my life. Let me know if you like these stories. I shared them at my weekly Stanford training group, and publish the recording of that evening’s training session here, with trepidation. Some of the stories are pretty far out. If you like them, and want more, I have a lot more, which I’ve listed below. Just let me know, and I’ll gladly start babbling again. . .  IF I haven’t been arrested! If you’d like to see one of the R-rated but gorgeous Larry Keenan photos taken at my “Uptightness” happening, you can see it at this link: Look for the photo called “The Kiss.” https://www.larrykeenan.com/prints Larry Keenan, a brilliant young commercial photographer at the time, attended my “uptightness” happening and took many fantastic photos that day. Larry became a famed photographer of many of the greats of the “Hippy Era,” like Bob Dylan, Neil Cassady, Lawrence Ferlinghetti, and a host of others. Sadly, Larry passed away several years ago, but I will always be grateful to him for the gorgeous and now-famous photos he created that day in the infamous but glorious 60’s! Warmly, david Part 1 (in this podcast) Psychodrama / encounter

David gets put down: Rob Krist’s encounter group The return of tears: My first psychodrama marathon The pompous professor: False front / tragic surprise

Desert experience: Sadness as celebration

Having fun and making a movie: "Uptightness”

Husain Chung and the crazy teen from LA: When a stallion wants to run A frightening encounter with Vic Lovell: And a mentor’s advice Threats from unwanted guests: Fighting back with paradox Bar next to the Free University Coffee House: Outrageous works, even with Hell’s Angels Inside the Free University Coffee House: How I met my wife The day we bombed Cambodia: Triggering a riot at Stanford, beaten by police, motorcycle smashed to bits, handcuffed, arrest announced on the campus radio station, escaped The bearded man on the quad near the Stanford student union—Telling me to “sit with open hands” Ken Kesey and his merry pranksters in the Stanford student union—they were dressed in pajamas or clown outfits and Neil Cassady was juggling hammers) The tape recorder experiment: Bizarre week, unexpected conclusion

Stanford medical school interview: Unexpected outcome The day that Gene Altman and I attended class: Totally weird Broken jaw: Anger, fear, and intense pain that suddenly vanished Getting kicked out of neuropathology class Encounter at the Medical School: Psychiatry and Psychotherapy—Are they Relevant or Obsolete? Featuring Hussain Chung Missing graduation ceremony: Didn’t pick up my diploma until years later Homeless in Carmel Valley: Saved by Ramadan, Subud Re-entry: The Highland Hospital Emergency Room

Hidden emotion 1: One of Stanford’s first coronary artery bypass patients Hidden emotion 2: Doc, what happened? I’m not dizzy anymore! Hidden emotion 3: Help! I need emergency surgery NOW!

Ask David: Burn Out; When Challenging Thoughts Doesn't Work; and more! Featuring Dr. Matthew May In today’s podcast, Matt, Rhonda and David discuss four challenging questions from podcast fans like you: 1. Joseph asks if it’s okay to take a break when you get “burned out.” Below, David expands on this and describes the difference between “healthy” and “unhealthy burnout.” 2. Joseph also asks why your feelings might not change when you challenge your negative thought with a positive thought that’s 100% true. 3. Dan asks about Step 4 of the Relationship Journal, which is the most difficult and important step in the TEAM interpersonal model—see exactly how you’re forcefully causing and reinforcing the very relationship problem you’re complaining about. For example, if the person doesn’t “listen,” you’ll see that you’re forcing them not to listen. If she or he doesn’t open up and express feelings, you’ll see that you prevent them from opening up. And if you think your partner doesn’t treat you in a loving and respectful way, you’ll suddenly see exactly why this is happening—if you have the courage to take look and see: But if fact, this is one of the “Great Deaths” of the “self” in TEAM-CBT, and very few folks are willing to “die” in this way. 4. Finally, Clay asks about EMDR. He’s been treated with it without success. David and Matt weigh in with their thoughts about EMDR. This question was not addressed on the podcast, since some practitioners of EMDR might be offended by David and Matt’s thinking, but they did describe their thoughts in the show notes below. If you are an EMDR enthusiast, you might prefer NOT to read our comments. Joseph writes: Thanks, David, for sharing so much on the podcasts! I have a couple questions. Personally, I find that when I'm burnt out, I get a lot more anxious automatic thoughts. While it's definitely good to combat these distorted thoughts by replacing them with realistic ones, my takeaway is that it's also sometimes wise to change our lives / circumstances (e.g. to take a break). By the way, I also wanted to ask if you've ever faced a situation where you are convinced that a thought is distorted and irrational (and you know what the realistic thought is), but you still can't shake it off? I sometimes get stuck when I already know the "right answer" (ie. what the realistic thoughts are based on the methods you've taught), but I just can't seem to get my brain to fully believe it. For example, I was recently on vacation and a small blip made me think "my vacation is ruined!". I immediately identified it as all-or-nothing thinking, and replaced it with "my vacation is still going very well even if it's not perfect" (and I'm convinced this thought is true), but somehow my mind kept going back to the automatic thought again and again. Curious if you've ever experienced this. Thanks again so much for your time and your teaching; just wanted to say I really appreciate it! :) Regards Joseph David’s Reply to Joseph. Thanks for the great questions. We address both of them on an upcoming podcast. Here’s the quick response. Yes, it is okay to take a break when you feel “burned out.” However, you can get “burned out” in a healthy or unhealthy way. For example, after I edit for two or three hours, which I love, my brain gets “burned out.” So I take a break and come back later, maybe even a day later, and I feel refreshed and filled with enthusiasm about writing and editing some more, because I love these activities. When I was in private practice in Philadelphia, I saw 17 patients back to back on Wednesdays. That way, I could have a three day weekend. Actually, I loved it and as the day went on, I got higher and higher. At the end I was exhausted, but exhilarated. I was never “burned out” because I loved what I was doing, and the clinical work was SO rewarding! However, sometimes I made a mistake and a patient would get very upset, sometimes angry with me, or felt hurt. THAT was when I got suddenly burned out and exhausted. But it wasn’t because of my work, or the conflict, but rather my thoughts about it, which generally involved a combination of self criticism and frustration with the patient, both the result of distorted thoughts, generally Self-Directed and Other-Directed Should Statements. And THAT kind of “burned out” won’t improve with a break. The answer is challenging and changing your own inner dialogue, as well as your dialogue with the other person, using the “failure” in the relationship as an opportunity to listen and support and create a deeper and more meaningful relationship. With regard to your second excellent question, we explored that in depth in the podcast, and also made it a problem for our listeners to think about. So tune in for the answers! This is a popular question I’ve been answering for more than 40 years, and the answers tell us a great deal about how cognitive therapy actually works. Thanks so much, Joseph!  Subject: Relationship Journal Gem I Found Dan (a former participant in David and Jill’s Tuesday training group at Stanford) writes: Hello to the Dynamic Duo (David and Jill), I came across this doc for Step 4 of the Relationship Journal, but I don’t really understand it and I don't remember the context. I know it was from the Tuesday Group years ago. It says it's about conceptualizing the problem, just not sure how to utilize this in step 4. Thanks. (You will find this document in the show notes below.) ~Dan (Daniel C. Linehan, MSW, LCSW) David’s Reply Hi Dan, Great question. In this document, I am trying to make it a bit easier for folks to see how they are triggering the very problem they are complaining about. So, I have listed three categories of common complaints. For example, an Empathy complaint would be that “My partner doesn’t listen,” or “always has to be right.” Then you ask, “If I wanted to force my partner to behave like this, how could I so?” Well, one good way would be to interrupt when your partner is trying to talk, or argue and insist your partner is wrong when they’re trying to make a point, and so forth. This would force your partner to argue and insist that they are right! It is pretty basic and obvious. But most human beings don’t “get it,” and in part that’s because a great many don’t want to. Blaming the other person seems way more popular than looking at your own role in the problem these days. Good to hear from you on this important topic! People can usually “see” how step 3 of the Relationship Journal works—you simply examine what you wrote down in Step 2, and you can almost always see no E (Empathy), no A (assertively sharing your feelings with “I Feel” Statements, and no R (conveying respect or liking to the other person, even when you’re angry.) But most people don’t seem to have the natural mental aptitude or the stomach for Step 4, where you go beyond Step 3 and explain EXACTLY how you FORCE the other person to behave in the exact way you’re complaining about. The document in the link is an attempt to help people with Step 4—IF you are willing to examine your own role in the problem. In Step 4, you ask yourself what category you see the other person in, and there are three choices to make it fairly simple. You might feel that they don’t listen or try to see your point of view. This would be an E = no Empathy complaint. Or you might feel like they can’t, or won’t, share their feelings. Instead, they might just keep arguing, or they might refuse to open up. This would be an A = no Assertiveness complaint. Or, you might complaint that they don’t treat you with warmth, love, or respect. That would be an R = no Respect complaint. This makes it much easier to “see” how your response to the other person in Step 2 actually causes and reinforces the exact behavior you’re complaining about. Lots of people get defensive or annoyed at this step of the RJ, and refuse to continue! That’s because Step 4 is all about the third “Great Death” of the “self,” or “ego,” in TEAM-CBT. Most of us don’t want to “die” in this way. It can feel humiliating, or shameful, to pinpoint your own role in the problem. But, there’s usually a big reward—you’re suddenly “reborn” into a far more loving and satisfying relationship. In the podcast, brave and wonderful Rhonda provided David and Matt with an example when she was visiting her son and daughter in law in Germany last month to help out with their twin baby girls. This example really brings this “Great Death” to life, and we are grateful to Rhonda for helping us in this very vulnerable and real way! Feel free to ask again if I have not made it clear. To me, this phenomenon of causing the very problems we are complaining about in our relationships with others is incredibly fascinating. However, change involves the “death of the self,” which is painful, because you have to see, usually for the first time, your own role in the problem you’re complaining about. It is based on the Buddhist idea that we create our own interpersonal reality at every moment of every day. In other words, we CREATE our enemies, and then whine and complaint about it! Most people don’t want to see this! They want the therapist (or friend they’re confiding to) to agree that the other person REALLY IS a jerk, or to blame, or whatever. They just want to complain and blame and feel superior! In my book, Feeling Good Together, I think I said something to the effect that we “want to do our dirty work in the dark.” In other words, we don’t want to turn the lights on so we can “see” how we’re actually causing the conflict. The person asking for help can nearly always be shown to be the 100% cause of the conflict. This technique is one I recommend when working with an individual, and not a couple. Other less confrontational techniques are probably more effective when you are working with both partners at the same time. Warmly, david (David D. Burns, MD) Here’s the document: Conceptualizing the Patient’s Complaint in Step 4 of the Relationship Journal (RJ) By David D. Burns, MD* Problem Area Specific Complaint—S/he Complaints about the other person’s lack of E = Empathy

355: Relationship Problems: Be Gone! Featuring Dr. Matthew May In today’s podcast, Matt, Rhonda and David discuss relationship problems, and how to overcome them. We also give instructions on the Paradoxical Invitation, one of the most important and difficult techniques for TEAM-CBT therapists to learn. We started today’s podcast interviewing Tania Ahern and Andy Persson who give a plug for the upcoming TEAM-CBT intensive from August 14 to 17, 2023 in Bristol, and incredible British city with an outstanding TEAM-CBT training program in store for you. Many notable TEAM experts will be presenting, including Drs. Leigh Harrington, Heather Clague, Marius Wirga, Stirling Moorey, Mike Christensen and many other notable teachers.  Special thanks to Peter Spurrier for being a fantastic TEAM therapist and organizer! I will also be there virtually doing a keynote address, a Q and A session, and a live TEAM-CBT demo with a workshop volunteer. The amazing Mike Christensen will be my co-therapist. Hope to see you there! Go to TEAMCBT.UK for registration and more information. Today we focus on relationship problems, starting with a real example, which often makes for the best teaching. Rhonda recently spent time with her son and daughter-in-law to help with their new twin babies. Rhonda’s daughter-in-law had a very difficult delivery, and was in the hospital for several weeks following the birth of the babies. Rhonda worked relentlessly cooking and cleaning for them, feeding the babies, changing their diapers, and comforting them, and providing help for the new mom, who was overwhelmed and fearful of bathing the babies, thinking she might hurt them when attempting to bathe them. As so often happens in real life, Rhonda ran into a severe conflict with her daughter-in-law and responded with anger, and we all so often do. She reveals how terrible she and her daughter-in-law felt, and how she saved the day after deciding to have a “redo” of the interaction, using the Five Secrets of Effective Communication. Rhonda, Matt and David described one of the most difficult therapy tools in TEAM-CBT, the Paradoxical Invitation Step, and contrasted it with the Straightforward Invitation. Rhonda also mentioned some podcasts for further information on the Relationship Journal and the Interpersonal Model in TEAM-CBT. There are even more, but here are some that might interest you. My book, Feeling Good Together, is also a must-read for anyone wanting to make profound changes in the way you connect with the people you love, as well as your patients if you’re a shrink! # Podcast Title Min 054 Interpersonal Model (Part 1) — “And It’s All Your Fault!” Healing Troubled Relationships 54 055 Interpersonal Model (Part 2) — “And It’s All Your Fault!” Three Basic Assumptions 27 056 Interpersonal Model (Part 3) — “And It’s All Your Fault!” Interpersonal Decision-Making and Blame Cost-Benefit Analysis 46 057 Interpersonal Model (Part 4) — “And It’s All Your Fault!” The Relationship Journal 44 226 The “Great Death” in a Corporate / Institutional Setting 56 227 Echoes of Enlightenment 43

Grass Roots TEAM-CBT Completely FREE Practice / Training Groups Today we interview four courageous pioneers of free and low-cost TEAM-CBT for the masses, featuring Brandon Vance, MD, Patricia O’Neil, Ana Teresa Silva, DVM and Nicholas Santascoy, PhD. Many of you are already familiar with Brandon Vance and Heather Clague’s awesome online Feeling Great Book Clubs which will start again, running from September 13, 2023, through December 6, 2023. The book clubs are popular and have gotten wonderful reviews.  They are a fun and engaging way to structure your reading, discuss the book, see demonstrations, practice tools, ask experts questions and connect with others around the world who are working on Feeling Great – and no one is turned away for lack of funds. Sound interesting? You can learn more and join here. But you may not be aware of a growing number of fantastic totally free self-help groups springing up for people around the world. These groups offer training in different aspects of TEAM-CBT. For example, Patricia offers DAILY (!) practice sessions that focus on the use of the Daily Mood Journal. You can also join

353: The Inner Scoop on “No" Practice! The “Inner” and “Outer” Dialogues— The “Inner” and “Outer” Solutions As you know, I have created many powerful communication techniques, including the Five Secrets of Effective Communication and more. One of the additional techniques is called “No” Practice, and it’s designed for people who have trouble saying “no,” or setting limits with other people. Essentially, you do a role-play with a colleague or therapist who keeps pestering you with pushy demands, and you have to practice saying “No” in a polite but firm and assertive way. Sounds simple, right? But it’s not! People have many reasons for not wanting to say “No.” For example, you may be afraid of hurting the other person’s feelings, or letting them down, or running the risk that they may get mad at you if you don’t say, “Yes.” In addition, you may feel like you’ll miss out on some special activity if you say no, so you end up way over-committed. In this session, you will meet an exceptionally compassionate and highly trained young psychiatrist named Lee, who asked for help with a problem relating to some of his patients. My co-therapist is Dr. Jill Levitt, who is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California. Lee explained how he struggles with saying “no” when patients make inappropriate requests, like pushing for a medication they’re addicted to, and wanting premature discharge from the inpatient unit when they have unrecognized safety issues. Instead, he seems to get drawn into long explanations of his thinking and why he’s declining the other person’s requests, sometimes for half an hour, and ends up frustrated when the other person still doesn’t “get it” and with himself for spending the time. People often think that therapy is easy, and that people just need encouragement, advice, or behavioral practice to change the way we interact with others. But as you will vividly see in this session, that is often not the case, and things that may seem simple or obvious can seem almost impossibly difficult to learn. Why does this happen? Why is it so difficult for people to learn new and seemingly simple verbal skills? Well, to find the answer, we have to go back to the teachings of the Buddha and Epictetus, who taught us that our negative feelings do NOT result from what’s happening, but from our thoughts. What does this mean? Well, Lee is an incredibly intelligent and compassionate young psychiatrist, and he’s clearly highly motivated, and yet he seems very slow in learning how to say “no.” Can his thoughts illuminate his apparent resistance to learning a new approach? During the session, Dr. Levitt reminded us of the fact that whenever you are involved in a conflict with someone, or any interaction for that matter, there are always two dialogues going on: the Inner and Outer Dialogues, and if you ignore either one of them, you may have difficulties triggering change. The Outer Dialogue involves what you say to the other person, and what they say next, and how you respond. For example, Patient says: “Doctor, I want to get discharged from the hospital.” Lee says: “No, I can’t do that because you’d be in danger and without a place to live. You’d be living on the streets, and it wouldn’t be safe for you.” Patient (who is in a state of psychosis) responds: “No doctor, I’ll be okay, because I’m living with Michael Jackson.” Then Lee tries to explain his thinking again, and then the patient asks to be discharged from the hospital again. And this cycle repeats itself many times, over and over, for as much as an hour. And they both end up frustrated and a bit miffed. Why is it so hard for Lee to say no in a kindly way and then move on to some other activity? That’s where the Inner Dialogue can be so important. It appears that Lee has two types of distortions that interfere with his ability / willingness to say “no.”

Featuring Dr. Matthew May In today’s podcast, Matt, Rhonda and David discuss four challenging questions from podcast fans like you: 1. what do you do with patients who use marijuana excessively but have no interest in changing or reducing their use? 2. How do you help clients control their anger? 3. How can you use TEAM if you are only allowed to see clients for 15 to 20 minutes? 4. If David never went into the medical / mental health field, what career path do you think you would have chosen? The answers on the show are live and will differ considerably from the information below, which is primarily to document the full questions that the fans submitted.

A Second Visit to David and Jill's Tuesday TEAM Training Group at Stanford Last week, you “sat in” on our Tuesday training group at Stanford and learned about two of the four most important techniques in the treatment of perfectionism, or any other Self-Defeating Belief. (For a list of 23 common Self-Defeating Beliefs, click here.)

Tuesday TEAM Training Group at Stanford In 1980 I published an article entitled "The Perfectionist's Script for Self-Defeat" in Psychology Today Magazine, in an attempt to get some publicity for my (then) new book, Feeling Good. At the time, it was the cover feature and became the most popular article in the history of that magazine. Perfectionism is definitely one of the most common themes I have confronted in my clinical work and teaching over the past many decades. If you would like to take a look, you can check it out at this link. They had fantastic colorful illustrations, including a bleeding dart board wtih a dart in the bullseye, and sadly you'll only get the text in black an white at the link. It seems that almost everyone succumbs to this mindset from time to time, and it can cause many negative moods. But at the same time, the attempt to be perfect brings many benefits at the same time. This can be a dilemma. The next several podcasts will be based on a two-week perfectionism class I developed for the weekly Stanford TEAM-CBT training group that I direct along with my esteemed colleague, Dr. Jill Levitt. This podcast class is suitable for therapists and non-therapists alike. These podcasts will give you the opportunity to “attend” the group and witness the procedures we use to train therapists. You will have the opportunity to practice the same techniques the students will practice when we break into small groups. I would encourage you to turn off your podcast temporarily so you can practice the exact same techniques on your own when we break into small groups for practice. For example, in the first class you are about to hear, we will spend 20 minutes doing a Cost-Benefit Analysis for perfectionism. You will find a blank CBA if you click HERE. I would encourage you to practice the same thing for 20 minutes during each practice group. During the first breakout group, you can spend 20 minutes listing the advantages and disadvantages or perfectionism. Ask yourself, “how might this mindset help me? And how might it hurt me?” You can use this blank CBA. After listing the advantages and disadvantages, weigh them against each other on a 100-point scale, and put two numbers adding up to 100 in the two circles at the bottom. For example, if the advantages are greater, you might put 75 and 25 in the two circles. If they are about equal, you can put 50 and 50. And if the disadvantages are somewhat stronger, you might put 40 and 60 in the circles. Remember, it’s not the number of items in the columns, but how you feel about them overall. Sometimes, one powerful advantage might feel much more important than the five disadvantages, and sometimes one powerful disadvantage might feel more important than numerous advantages. Part of the fun (hopefully) of this podcast is that you’ll get to hear the questions and suggestions of many of the 45 or so students in the class that night. As you will hear, we have a multi-cultural rainbow group with therapists from around the world. We started Part 1 of the Perfectionism Master Class with these important two questions:

If you want to join David and Jill's Tuesday group, that meets from 5:00-7:00 pm PST, please contact Ed Walton: edwalton100@gmail.com

If you want to join Rhonda and Richard Lam's Wednesday group, that meets from 9:00-11:00 am PST, please contact Ana Teresa Sliva: ateresasilva6@gmail.com

Thank you for listening,

David, Jill and Rhonda

Live Therapy with Veena: Part 3 of 3 Relapse Prevention Training In the last two weeks, you heard Parts 1 and 2 of our live work with Veena, a young woman who felt devastated for fear she would be unable to conceive. One week after the work with Veena, I received a request from colleagues to have a Tuesday evening session at Stanford on Relapse Prevention Training (RPT). Jill and I decided to demonstrate the RPT techniques with Veena so we could demonstrate this technique in real time with a real situation. Prior to the role play demonstrations that you will hear, I presented the highlights of RPT with four PowerPoint slides. Here are the guidelines when working with a patient who is depressed: 1. Do RPT immediately when the patient has recovered, and before you discharge the patient. This means that the patient’s scores on the Brief Mood Survey will be low and the patient is feeling terrific. If the patient’s scores are still elevated, they have still not recovered completely, and need more therapy work. 2, Inform the patient that the likelihood of relapse is 100%. Relapse is defined as one minute or more of feeling upset. By that definition, most of us relapse frequently, perhaps every day. However, these relapses do not have to be a problem if you anticipate them and know how to deal with them. 3. When they relapse, they will typically experience two kinds of negative thoughts. First, the negative thoughts that had previously will return. So, in Veena’s case, she will again be probably telling herself that “I cannot be happy without a kid,” “my in-laws will judge me and sideline me,” and so forth. Veena imagined having a relapse and prepared a Daily Mood Log prior to the training group. If you would like, you can review it here. 4. In addition, nearly everyone who relapses will have thoughts like these:

Live Therapy with Veena: Part 2 of 3 Last week you heard the first half of the session with Veena, a young woman who was devastated by a medical problem that may make it difficult or impossible to conceive the child she is dreaming of. Today, you will hear the inspiring and dramatic conclusion of her story, along with the feedback comments from the individuals in David and Jill's Tuesday training group who witnessed the live work. A = Assessment of Resistance Jill asked if she felt ready to roll up her sleeves and get to work on some aspect of what she’d been telling us, and she was. Jill then asked what she was hoping to get from tonight’s session. If we could offer a “Miracle Cure,” what would that look like? She said, “I’d feel a lot less guilty and responsible, so I would no longer feel like the problem was my fault. I’d know that I did my best and that I can be okay even if people don’t like me or judge me. Jill asked the Magic Button question, and she said that she love to see her guilt go all the way to zero, but not her many other negative feelings, like depression, anxiety, inadequacy, self-consciousness, hopelessness, upset, insecurity and self-doubt. With Positive Reframing in mind, we listed many of the positives in these negative feelings, including:

Veena with her in-laws

Live Therapy with Veena “It's all my fault!” The star of today’s 2-part podcast is Veena Mulchandani, a 28-year old certified Indian TEAM therapist who has just learned that her difficulties becoming pregnant result from an infection in one of her fallopian tubes. Veen feels devastated and fears that she might never be able to have a child. She also fears that her husband and extended family will judge and reject her, since there is so much pressure in Indian culture for women to have babies. And although she has many medical options, including IVF, she is intensely fearful that they might not be successful. My beloved colleague, Dr. Jill Levitt, will be my co-therapist for today’s session. Jill is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California (www.feelinggoodinstittute.com). Today you will hear part 1 (T = Testing and E = Empathy), and next week you will hear the exciting conclusion (A = Assessment of Resistance and M = Methods), along with some follow-up. Part 3 will be the Relapse Prevention Training we did one week after treating Veena. Jill and I treated Veena in our Tuesday evening training group at Stanford. We feel that personal work is an essential part of the training of any therapist.

Veena with her two very beloved nephews who she considers being a mother to

Veena with parents

Sexual Abuse / Emotional Eating Personal Work with Orly, Part 2 of 2 Last week, you heard the first half of our live session on Emotional Eating, featuring Orly. Today, you will hear the second half and exciting conclusion and follow-up on that therapy session. A = Assessment of Resistance (previously called Paradoxical Agenda Setting) Orly did want help, but there were a number of directions / conceptualizations we could have pursued, including:

Working on the distorted negative thoughts that were triggering intense negative feelings and robbing Orly of self-esteem. This would involve the use of the Daily Mood Log. Working on relationship conflicts with the Relationship Journal. Working on the addiction to binging, using the Habit and Addiction Log and the Triple Paradox if you click HERE. Exposure work to help Orly overcome her Emotophobia. That’s a term I coined that means “fear of strong emotions.”

I need to take care of myself because in truth I really am unlovable. I’m not entitled to feel traumatized because he did not hurt me. If I get excited or upset, and I don’t eat, I might go crazy. If I feel strong emotions, I’ll end up rejected and alone.

Absolutely superb training! Thank you, Orly for the gift of your amazing personal work. And, thank you David and Jill for another magnificent teaching and healing session. I love the interplay between David and Jill. I loved Jill's empathy. I was so happy to get to know Orly better, and felt so close to her after the session. I was touched by her candor and disclosing about her abuse and life experiences. Unbelievable session, more like a miracle. A lifelong deep emotional issue to flow towards resolution in a couple of hours happens only in TEAM therapy. This was so very real; Orly was so open and insightful and vulnerable. Jill's identification of the choice point as to what to work on, and specifically, the option to focus on emotophobia--the anxiety around feeling intense emotions--and hence, exposure/flooding as treatment, struck me as so great, so much deeper than I'd initially expected. Jill's explanation that she focusses on the thoughts that drive the behavior in the HAL encapsulates it well.

Sexual Abuse / Emotional Eating Personal Work with Orly, Part 1 of 2 In today’s podcast, you will hear the first of a two part series on Emotional Eating, featuring Orly, an Israeli psychologist who experienced sexual abuse at age 6 when she was a “skinny little girl.” After that, she began devouring her grandmother’s delicious cookies, and suddenly gained a great deal of weight. She continued binging for more than 50 years whenever she was excited or upset. This led to a pattern of dramatic swings in weight of 100 pounds or more over and over again. And now, Orly has decided she wants to end this pattern. My dear colleague, Dr. Jill Levitt, will be my co-therapist in this single, 2 hour-session that was conducted in front of my TEAM-CBT Tuesday training group at Stanford. Part of therapist training involves doing your own personal work, although this is not a requirement, it is recommended. That’s because the patient experience gives you a much deeper appreciation for how the therapy works. Rhonda, Jill and I want to thank Orly for permission to publish her highly personal work, and hope you find it immensely educational—so you can see exactly how TEAM-CBT works in real time with real people—and inspirational as well. Nearly all of us are pretty flawed in one way or another or many, and learning how to accept our flawed selves and celebrate is one of the deeper goals of the therapy. Today, we will cover the T = Testing and E = Empathy phases of the treatment. Next week, you will hear the exciting conclusion of our work with Orly, as well as the follow-up. Will she really be able to resolve a severe problem that has defied a solution for more than 50 years in a single TEAM therapy session? Let’s check it out! Part 1 of the personal work with Orly T = Testing At the start of the session, we reviewed Orly’s scores on the Brief Mood Survey that she completed just prior to her session. She scored only 3 out of 20 on the depression test (minimal), zero on suicidal thoughts and urges, 5 out of 20 on anxiety (mild), and 2 out of 20 on anger (minimal.) Her happiness score was 16 out of 20 (very happy with a little room for improvement), and her relationship score with her daughter was 18 out of 30, indicating lots of room for improvement. She indicated she'd done a great deal of homework in preparation for the session. You can also see her scores on nine mood dimensions if you take a look at her molestation Daily Mood Log. As you can see, her scores were quite high, and you can also review many of her negative thoughts when she was growing up. For example, at age 8 she told herself, “I am the fattest kid here. I will never be beautiful or desirable.” You can also see her Habit and Addiction Log (HAL) just prior to binging after a backpacking trip if you look HERE. Once again, you can see that all of her negative feelings were intense, and rated in the range of 90 to 100. You can also see her tempting thoughts, like “I can afford it since I spent so many calories during the hike.” E = Empathy David and Jill empathized while Orly told her graphic story of sexual abuse from a young man while growing up on a farm in Israel around the time of the “Six Day War” in 1967. She explained that he had been like an “older brother,” and she didn’t quite understand what had happened, since there was no Hebrew word for sexual abuse, and the subject was never discussed in public or with children. As she grew up, she learned to be independent, and felt like she was “different” and never really fit in. She developed a strong connection with nature and with spiritual values, and served as a park ranger during her military service in Israel. After her military service and an undergraduate degree from the Hebrew University, she set out to backpack in South America for a year and then settled in Los Angeles. She was married, and had a daughter who she considers her most important relationship, However, it was a troubled marriage and Orly and her husband were divorced when her daughter was 6. For quite a while, her daughter “blamed me for the divorce and for many  other things.” Eventually, she settled down in the United States and decided to become a psychologist after going to therapy, which was “the only diet I had never tried.” In 2020 she got some medical help from her doctor and started hiking extreme distances and heights, and lost a tremendous amount of weight. Nonetheless, she still finds herself “eating her feelings” and engaged in binge eating every once in a while. She also joined our Tuesday training group at Stanford, and said that it made an enormous impact on her life and on her clinical practice, and began at times to think, “Maybe there’s NOT something wrong with me.” She said the group made her an effective therapist and “I got to liking myself just a little bit!” She said the group also helped her tremendously with relationships. I believe she was referring to the five Secrets of Effective Communication that we have demonstrated so often in our podcasts as well as other tools such as the Relationship Journal She shared she was feeling terrified and had a number of negative thoughts during our session, since she was really hopeful that she could finally end her Emotional Eating. Her thoughts included:

I don’t belong. 70% Something is wrong with me. 70% What I do is not good enough. 60% Now that I’m more than 60 years old, most of my life is over. 60% If I don’t get over my emotional eating, I’ll never feel normal. If I fail to solve my addiction, I’ll fail in my most important existential tasks. That would mean I’m a failure. That would mean that didn’t make a positive impact on the world.

Good Grief—Featuring Mike Christensen     Mikes' beloved friend, Kris Yip, word-ranked bicyclist who suddenly and tragically died. Mikes' beloved dog and best friend, Josie, who died the day before the podcast was recorded In today’s podcast we feature one of our favorite people, Mike Christensen. Mike is a Certified Level 5 Master TEAM CBT Therapist and Trainer, and is the Director Feeling Good Institute, Canada. Mike is a Registered Clinical Counsellor with the British Columbia Association of Clinical Counsellors and holds a Master of Arts in Counselling Psychology degree. His diverse background in business, community organizations, and family support roles has provided Mike with a wide array of experience in leadership, administration, parenting training, and team building. He provides advanced level online training with the Feeling Good Institute for therapists around the world and is currently co-authoring a book with Maor Katz on Deliberate Practice of TEAM-CBT. Mike specializes in treating depression and anxiety, with experience and training in addictions, PTSD, and relationship challenges. Today, Mike comes to us today with a personal issue, grief and loss. The day before the recording Mike’s beloved dog, Josie, died, and this came on the heels of the death of one his best friends, Kris Yip, a month earlier. Kris had died suddenly and unexpectedly at the age of 47. Kris was 7 or 8 years younger than Mike, and appeared to be the perfect example of health and fitness, so his loss was an unexpected and devastating punch in the gut. Mike explained that Kris was a celebrity in the bicycling community. He was the Canadian national champion and war ranked 59th in the world. However, he was humble and never promoted himself. Instead, he always focused on others, encouraging even those who were just beginners. Mike has also been a competitive bicyclist, and Kris had invited Mike to join an online racing team consisting of four friends who got together daily on stationary bikes linked by videos on the internet so they could talk while biking. In January of 2023, while riding, Kris’s heart suddenly stopped. A friend of Kris called Mike to say, “Kris is gone!” This was devastating to Mike, who said: “He was the fittest of our group. The impact was profound.” He had trouble sleeping and was in disbelief. He said, “It felt surreal. It felt like something is wrong. He told himself, “I should be able to keep it together without falling apart.” Mike also told himself that Kris, was too young to go, and missed him tremendously. Mike thought of Kris’s mom, and how much she was suffering, so he spent a week with Kris’ family and friends in Prince George. Which was where Mike was born, and his brother and his other biking buddies live.  He said, “We cried together and were together.” He explained, “Whenever I got on my bike to ride, Kris was always there. He’d always say, ‘Let’s ride.’ I miss his voice.” He also said that during his rides, you could see Kris’ face on the video feed, and he was always struggling, digging deep, suffering, but loving it! Mike said that all of his losses, including his sister, his son, and Kris,  were actually double losses, because “I lost not only what had been, but what was to come in the future, and didn’t.” Mike said, “Kris was so humble, so I want to brag for him. He always cared and made all of us feel so encourage and inspired!” Mike mentioned some of the positives he saw in the pain of grief:

Amy and her "fab fiancé," Randy Kolin! Secrets of Flirting, Sex Appeal and True Love! Today Rhonda and David interview Amy Berner, who has fallen in love and has quite a story to tell! Today is Valentine’s Day (we recorded this on February 14, 2023), so we thought a love story would be a ray of joy for all of you, whether you are in a loving relationship or still looking for one! But first, Rhonda and David briefly interview Jeremy Karmel, the co-CEO of David’s Feeling Good App. Jeremy tells his dramatic personal story that led to the creation of the app, and solicits for people who might want to join us for beta testing, which has gotten very busy of late. David also present some amazing data from a small, four-week beta test in December involving around 45 beta testers. The findings appeared to indicate that beta users experience far greater warmth and understanding from the app than from the people in their lives, which is on the sad side, since at the time users applied for the app, they only estimated 55% (on a scale from 0 to 100) warmth and understanding from the people in their lives, and roughly 85% from the digital “David” they interacted with in the app. We’ll see if those amazing findings hold up in two larger replication studies now in progress. If you think you might be interested in being a beta tester, please sign up at www.feelinggood.com/app. Rhonda also gave an endorsement for the upcoming second World Congress on TEAM-CBT in Warsaw, Poland this year, March 30-April 2, 2023. It sounds exciting. I will be there is a variety of capacities including conducting a personal session with Jill Levitt, PhD. Please check it out! And, as usual, she read a compelling comment from one of our regulars, Irish Brain, who wrote: “Another amazing podcast for the collection!” Amy Berner is a licensed marriage and family therapist who works with adults and teens online in California. She loves helping her clients heal from heartache, depression, and anxiety. You can find her at the FeelingGreatTherapyCenter.com. Amy’s love story started at a women’s group that Rhonda was also in more than a year ago. It turns out that Rhonda is quite the match-maker, and has arranged dates for large numbers of her friends and colleagues, including Amy. However, Amy was feeling insecure, as so many of us might, before this date. To help her, Rhonda suggested the Feared Fantasy Exercise, and asked Amy to list some of the things she was afraid her blind date might be thinking, but not saying, when they met. When you do the FF, one person plays the role of the “Date from Hell” who not only thinks these awful things about you, but gets right up in your face and says them. This list of awful things the Date from Hell might say included:

Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 2

Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 1

What's the Antidepressant Myth? Have We Been Scammed?

Integrating TEAM-CBT with Martial Arts Training! Podcast Episode 330, Featuring Dor Star Our guest today is Dor Star. Dor is an educational counselor (MA) and a level 2 TEAM practitioner who works with children in Israel who have emotional and interpersonal problem. He works with children as young as four years old, but most of his work is with children ages seven to twelve years old. The children he works with experience various challenges and difficulties such as: Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), learning disabilities, tantrums, outbursts of anger, all kinds of anxieties, social difficulty, bullying and much more. His work is unique because he works mainly in small groups (4-6 participants) using martial arts and sports as therapeutic tools. In his work Dor uses the TEAM model with some adaptation, because of the children’s ages and sports methods, with great success! In fact, one can say that he discovered for himself, and for his patients, a new way to use the TEAM model. He also teaches sports and martial arts trainers who are interested in entering the field of child therapy. Dor describes his first encounter with TEAM-CBT, which blew him away, but he was initially frustrated because he was thinking of his conventional ways of dealing with kids VS TEAM. But after a few weeks he discovered that he could use the TEAM structure to improve his approach, and wow, did he ever start to shine, as did his results with TEAM. Today’s podcast was really a breath of fresh air! Dor began with T = Testing, and describes how he developed simple assessment tools to rate how his children (aged 4 to 11) were feeling at the start and end of his classes, but also how they felt about him. He uses simple questions like “Did I understand you today? How well did I listen?” He also asks them, “How much fun was the session,” and “How did you grade yourself?” Then they grade him on a scale from 0 (the worst) to 10 (the best.) So, it’s quick, easy, and . . . shocking. Dor says: “I found out that I wasn’t nearly as effective as I thought. Sometimes the kids thought the class was fun, but I got really low grades on Empathy, as well as how depressed, anxious and angry they were feeling at the start and end of each group session. Essentially, I discovered that I wasn’t achieving almost any of my goals for my kids. This was disturbing at first, and I had to let my ego die. But I decided to try to view it as valuable information that I might be able to use to learn and grow.” For example, I had one of the most amazing sessions with an 11 year who was smiling the entire time. I was absolutely certain it was one of my best sessions ever. But when I asked him for my grade, he gave me a 3 out of 10! When I asked why, he explained that at the start I didn’t introduce myself or ask him about himself! So, in this simple but compelling way, Dor has used the T = Testing to transform the entire way he works with kids! I believe he’s had the same experiences I’ve had with the T = Testing component of TEAM. Dor has made his patients his teachers, and this has led to some amazing and revolutionary developments in his approach. Dor emphasizes the importance of E = Empathy, and says that “the Five Secrets of Effective Communication” are incredible! For example, if they’re having a rage attack, or a temper tantrum, you can tell them they are absolutely right in the way they’re thinking and feeling.” He also uses what he calls the Five Ways of Love.

Verbally expressing respect and liking Giving service: tying a child’s shoes, giving them some water during the training. These small acts can create feelings of trust and connection. Spending time with them, paying attention to them. This is especially important because so many are angry and try to push others away. They are good at getting other people to reject them and not want to spend time with them. Giving gifts, something they can take home and show to their parents. Making physical contact with them during the martial arts training, playing with them, having fun.

Ask David: Featuring Matt May, MD 329: How can you deal with a “narcissist?” In today’s Ask David, we respond to a listener who requested a podcast on the topic of narcissism, including how to deal with them, so we will focus on these topics. The following show notes were prepared prior to the actual podcast to provide a structure. For more great information, listen to the podcast, as much more was covered! David

What is the definition of “narcissistic personality disorder”?

How do you treat narcissistic patient?

How can you deal with narcissistic individuals in the real world?

What are the causes of narcissism? 

What you have to let go of to relate to someone who is narcissistic?

What is “Malignant Narcissism?”

What does it mean when someone is “manipulative?”

Live Therapy with Cody, Part 2 of 2 Last week we presented the first of our session with Cody, a young man wanting help with his fairly severe social anxiety since childhood. My co-therapist for this session was Dr. Rhonda Barovsky, the Feeling Good Podcast co-host, and Director, Feeling Great Therapy Center. Today, you will hear the exciting conclusion of his session, and the follow-up as well! Part 2 M = Methods We focused on cognitive work and interpersonal exposure techniques as well. I will leave it to you to listen to the podcast, as I became so engrossed in what we were doing that I stopped taking notes. However, we used a number of tools within the group, including:

Do at least three Rejection Practices in the mall and notify the training group members via email within 24 hours that he had completed this assignment. Complete the Positive Thoughts column of your Daily Mood Log.

Featured pic of Cody in one of the small group practice sessions in David's virtual Tuesday training group. Live Therapy with Cody, Part 1 of 2 I recently treated Cody, a young man wanting help with his fairly severe social anxiety since childhood, during one of our Tuesday evening Stanford training groups. My co-therapist for this session was Rhonda Barovsky, PsyD, the Feeling Good podcast co-host. The full session will be broadcasted in two parts, starting today and finishing next week. Part 1 T = Testing At the start of the session, Cody’s depression score was only 6 out of 20, indicating minimal to mild depression, but his score on the loss of self-esteem was “a lot.” His anxiety score was 11 out of 20, indicating moderate anxiety, and his anger score was only 2, minimal. However his score on the Happiness test was only 11 out of 20, which is only moderately happy, indicating a lot of room for improvement. If you like, you can review his Brief Mood Survey at this LINK. We’ll of course ask him to take this test at the end of today’s session so we can see what, if impact, we made on his feelings. E = Empathy Cody described his shyness like this: “I’ve been shy for as long as I can remember and feel introverted. It started in middle school. I felt like I never fit in or connected with people very deeply. In middle school, you really want to fit in. “I wanted my friends to like me, and one day they all started to torment me. Our seats in school were assigned, so I couldn’t get away from them. I cried at recess every day for months. Then, one day, they suddenly went back to being my friends again, and I never understood why. “When they were tormenting me was the most painful moment of my life. I felt like they were judging me. “I’ve worked on my own and I’ve gotten over 90% of my social anxiety. At first, I was afraid of answering the phone or even ordering a pizza, so I got a job where I was required to answer the phone and got over it. “Now I’d like to date, but this has been a problem for me. Also, when I’m treating someone, and this topic of social anxiety comes up, I get uncomfortable. I think if I could overcome the rest of my shyness, it would boost my confidence. “The podcast you and Rhonda did with Cai on Rejection Practice (LINK) inspired me tremendously, and I managed to do one Rejection Practice. By now I’m chickening out again. I go to the mall determined to do it, but I just keep putting it off. Asking women to reject me seems incredibly frightening, and I’m afraid people will judge me or see me as a predator. I love in a small town, and most people know each other. “When I was thinking about the session all day today, I felt nervous and my stomach tightened up. Cody brought a partially completed Daily Mood Log to the session, which you can review at this LINK. As you can see, the Upsetting Event was thoughts of approaching someone at the mall for Rejection Practice. His negative feelings included the entire anxiety cluster, shame, the entire inadequacy cluster, unwanted, humiliated, embarrassed, the entire hopelessness cluster, frustrated, annoyed, and anger with himself. These feelings ranged from a low of 35% for shame to a high of 100% for foolish and humiliated and 90% for the hopelessness cluster. And as you can see, many of his negative thoughts focused on the theme of being judged by others who might see him and think he was strange, or a disrespectful jerk, and so on. He was also convinced that women would be annoyed by him, and that the word would spread so that he’d lose the respect of people he cared about. A = Assessment of Resistance Cody’s goal for the session was to feel motivated to do the Rejection Practice he’d been avoiding, and to get rid of the negative thoughts that were holding him back. He said he’d be reluctant, though, to press the Magic Button and make all of his negative thoughts and feelings disappear, so we listed what his fears might actually say about him and his core values that was positive and awesome. Here’s the list we came up with: Positives My anxiety

My anxiety shows that I care about peoples’ comfort. My anxiety protects me from rejection or doing something foolish. My fears of being seen as a predator show that I want to fit in with the social norms and not be weird or threatening to women. My fears show that I want to be respectful towards women. My fears of being judged show that I care about friends and family. My anxiety shows that I care about my reputation. My feelings of inadequacy show that I’m aware that I have things I want to work on. Those feelings also show that I’m humble. My feelings show that I really care about connecting with others, which is one of the most important things in life! My negative thoughts and feelings motivate me to work hard on changing. They also show that I have high standards. My hopelessness shows that I’ve tried to do Rejection Practice six times and have always chickened out. So I’m being realistic. My hopelessness also protects me from getting my hopes up and then being disappointed. My unhappiness gives me greater compassion for my clients. My anger energizes me and motivates to do something new.

David and Rhonda

Curing YOUR Social Anxiety— The Ridiculously Cheap and Awesome Shame-Attacking Marathon Jacob Towery, MD Michael Luo

Maybe I’ll make a mistake. I might be wasting Jacob’s time. Then he might not want to mentor me.

Secrets of Overcoming Romantic Rejection Part 2 of 2 In last week's podcast we interviewed Dr. Kyle Jones on the topic of how to overcome romantic rejection, and answered five of your questions. Today we publish Part 2 of that interview. Rhonda, Kyle and David will tell you how to stop obsessing about someone who has rejected you, and whether you can "heal completely,"and how you can get your confidence back, and more! 6. Do you have any tips for moving on and realizing that maybe your ex isn’t as great as you think they are? David 20 qualities I’m looking for in an ideal mate. Rhonda Time, patience, space away from each other. Make lists of qualities you liked about your ex and qualities you wish were different.  Fill out the form: “20 Qualities in An Ideal Mate” and review how many of these qualities your ex had. 7. Since cheating is something that happens so often in relationships, what would you recommend (techniques wise) for someone who’s been cheated on in trying to get their confidence back? David YOU CAN USE THE DAILY MOOD LOG, DOUBLE STANDARD, ETC. OVERCOME FEAR OF BEING ALONE. ETC. Examine the Evidence; Worst, Best, Average. Kyle Cheating can be really devastating if you and your significant other were in a monogamous relationship. What are the negative thoughts you have about yourself after you’ve been cheated on? Practice talking back to those. 8. How can we boost our confidence back up after a breakup in general even if we haven’t been cheated on? David SAME ANSWER. Rhonda Do things you love to do with people who love you:  go dancing, go to the beach, go hear music, read, etc. Daily Mood Log on the thoughts that lead to your lack of confidence. 9. Do you guys believe in the notion that you are capable of “healing completely from your ex (aka completely being over them and all the pain the breakup brought you)” or do you believe that it’s not possible. David I MEASURE THINGS. YOU CAN DO WAY BETTER AS YOU GROW. IS THERE A CLAIM THAT THERE IS NOW AN INVISIBLE BARRIER ON YOUR SCORE ON THE BMS. THIS IS SUCH, EXCUSE MY CRUDITY, HOGWASH! HOPEFULLY, YOU’LL NEVER AGAIN FIND SOMEONE JUST LIKE THE PERSON WHO REJECTED YOU! Rhonda You may never be exactly the same, why would you want to be?  Every experience in life gives you the opportunity to grow (as cliche and kind of yucky as that sounds). Maybe you need to acknowledge and examine your role in the breakup, come to a place of humility or maybe even compassion, but definitely understanding. Interpersonal Downward Arrow to look at the Roles and Rules in your past relationships.  Relationship Journal to see how you have contributed to the relationship problems.  Maybe do Reattribution to see what you contributed to the relationship problems and what they did. 10. What are some realistic expectations to have coming out of a breakup, recovery wise, and what are some unrealistic expectations? David I DON’T IMPOSE MY STANDARDS AND AGENDAS ON OTHERS! THAT’S LIKE MISSIONARY WORK, TRYING TO GET SOMEONE TO ADOPT YOUR STANDARDS. I TRY TO LISTEN (EMPATHY) AND THEN SET THE AGENDA WITH THE PATIENT, AND THE NEGOTIATION STEP IS SOMETIMES IMPORTANT. I ALSO USE STORY TELLING TO ILLUSTRATE A RADICALLY DIFFERENT REALITY FROM WHAT THE PATIENT “SEES.” Rhonda I can’t add anything to that, except, after examining your role in the relationship, you may see the expectations you want to eliminate and the ones you want to maintain. 11. Do you guys feel that you shouldn’t date for a while after getting your heart broken? David THIS CAN BE A GREAT IDEA. I ALWAYS INSIST, AS PART OF NEGOTIATION PHASE OF AGENDA SETTING, THAT THE PERSON OVERCOME THE FEAR OF BEING ALONE BEFORE DATING, WHETHER OR NOT A REJECTION HAPPENED. Rhonda This is a very personal decision.  Have you had time to heal before getting into a new relationship?  Have you had time to examine your role so you can make changes if you choose, so you won’t repeat the same mistakes in the next relationship? 12. Do you have to move on from your ex to go back out into the dating world again and to possibly be in a relationship again? Do you guys feel that “jumping” from relationship to relationship can be a bad thing? Why or why not? David THESE THINGS ARE ALWAYS ON AN INDIVIDUAL BASIS. I THINK IT CAN BE HEALTHY TO DATE A VARIETY OF PEOPLE AND NOT GLOM ONTO THE FIRST PERSON WHO EXPRESSES AN INTEREST IN YOU. THAT WAY, YOU CAN COMPARE A VARIETY OF RELATIONSHIPS AND IN ADDITION, YOUR DATING SKILLS WILL IMPROVE. THE “20 THINGS I’M LOOKING FOR IN AN IDEAL MATE” CAN BE VALUABLE. Rhonda “Jumping from relationship to relationship” sounds so judgmental.  Are you finding yourself in relationships where you have similar complaints from your last relationship, repeating patterns that you dislike?  Then I would pause and take time to heal and learn before starting another one. Kyle What does be “moved on” really mean here? Would you have to never have a thought about your ex again before dating? That might be impossible! I don’t think there’s anything wrong with dating multiple people or starting and stopping relationships with some frequency – especially if you’re looking for a good fit and it’s not working out with someone. 13. How do you overcome your trust issues when getting into another relationship after your heartbreak? David PATIENT WOULD HAVE TO GIVE ME A SPECIFIC EXAMPLE, AND NOT DEAL WITH THIS OR ANYTHING “ABSTRACTLY.” Rhonda Daily Mood Log work, starting with a specific event that led to the lack of trust. Let us know if you would like a third podcast on how to deal with romantic rejection at some point, since we have a number of remaining questions. Thanks! My book, Intimate Connections, will help you with dating and rejection issues!

Secrets of Overcoming Romantic Rejection Part 1 of 2 In today’s podcast we are proud to interview Dr. Kyle Jones from the Feeling Good Institute in Mountain View, California. Kyle Jones, PhD is a clinical psychology postdoctoral fellow affiliated with Feeling Good Institute in Mountain View, California where he provides individual psychotherapy in a private practice. He co-leads a monthly consultation group with Maggie Holtam, PhD where therapists can get help with exposure methods for anxiety. He has recently become an Adjunct Professor of Psychology at Palo Alto University - teaching Clinical Interviewing in the clinical psychology PhD program. Kyle wrote: “Here are some questions from patients of mine for our podcast today - we don't have to go through all of these bust just some talking points!" We will publish part of the questions in today's podcast, and several more next week. There are even more questions, so let us know if you would want a Part 3 on this topic at some time in the future. Below you will find the list of questions with some responses by David and Rhonda BEFORE the podcast. To get the true scoop, listen to the podcast, as most of the comments below were simply ideas that popped into our heads prior to the podcast. Although we focus on romantic rejection in these two podcasts, the idea really pertain to rejection in all segments of our lives. 1. Why do you think it’s so hard for us humans to handle rejection/why do you think we are so afraid of it? David THE LOVE ADDICTION SDB. LOOKING TO EXTERNAL SOURCES FOR FEELINGS OF SELF-WORTH AND HAPPINESS. THE CBA IS CRUCIAL, SINCE PEOPLE MAY NOT WANT TO STOP LINKING SELF WORTH WITH LOVE. Rhonda Plus, it hurts.  And our brain is wired to experience pain when rejected.  We are wired that way. Evolutionary psychologists believe it all started when we were hunter gatherers who lived in clans. Since we could not survive alone, being ostracized from our clan was basically a death sentence. As a result, we developed an early warning system to alert us when we were at risk of being rejected by our tribemates. People who experienced rejection as more painful were more likely to change their behavior, remain in the clan, and pass along their genes. Kyle Getting dumped sucks! We aren’t really taught how to handle rejection very well in our culture. 2. Are we capable of overcoming the fear of rejection and how do we accomplish that?  David You can face your fear with REJECTION PRACTICE. The FIRST SECTION OF INTIMATE CONNECTIONS IS ON OVERCOMING THE FEAR OF BEING ALONE. Rhonda Is part of the fear of rejection also a fear of being alone?  You can use the “What If” technique to uncover more about those fears.  Then put the thoughts in a Daily Mood Log, and challenge them with a variety of techniques you can select for a Recovery Circle. You can also face your fears with Rejection Practice and/or Exposure. 3. When it comes to getting dumped do you guys believe there is a good way to approach it communicating wise? David YOU CAN USE FIVE SECRETS TO FIND OUT WHY THE OTHER PERSON IS REJECTING YOU. OR, PERHAPS BETTER, YOU CAN TURN THE TABLES ON THE REJECTOR, SINCE IT IS PART OF A CHASE GAME. Rhonda If you want to know more about why you were “dumped,” will you trust the other person to be honest with you?  Will you believe them when they respond?  You might want to do a Cost Benefit Analysis to decide whether or not you even want to ask them to explain why you were “dumped.” Kyle It depends on the situation. If you have gone through a divorce and have children, you may still need to talk with you ex-partner. Generally, I don’t think it’s a good idea to stay in touch and keep chatting with an ex who dumped you! 4. If we are caught off guard with the breakup and don’t see it coming and all of a sudden one day our partner decides to end the relationship, how do we not let our emotions get the best of us in that moment in that very moment? David WHEN YOU SAY, “GET THE BEST OF US” IT SOUNDS LIKE YOU’RE NOT ACCEPTING YOUR FEELINGS. IS IT OKAY TO FEEL FEELINGS? THIS QUESTION SOUNDS LIKE EMOTOPHOBIA. Rhonda It’s perfectly reasonable to be sad, to cry, to be shocked and angry.  Why not have those feelings?  You also don’t have to expect to respond with a “perfect 5-Secrets.”  Maybe you need to take a break from each other, breathe, walk, calm down, and then meet again to talk talk, if that is what you want to do. Kyle If you get blindsided by a breakup it can really be shocking and overwhelming. It’s okay to feel how you feel in that moment I would think. 5. When it comes to recovery after being broken up with, how do you fight the urge to go back to your ex? David THIS URGE IS DUE TO THE BURNS RULE: WE ONLY WHAT WE CAN’T GET, AND NEVER WANT WHAT WE CAN GET. ALSO, CAN DO A CBA ON CHASING. Rhonda Also, look at the thoughts that are leading you to want to get back together.  What do they say about you that is awesome?  Then examine them for Cognitive Distortions, and talk back to them with Dbl Standard or Ext of Voices. Do a “Time Projection,” see yourself in 5 years, in 10 years, in 20 years.  Have a conversation with your future selves to talk about what you want, what kind of person you want to be with, how you want to be treated in the future. Practice “Distraction,” when you start thinking about your “ex” distract yourself by concentrating intensely on something else, music, work, friends, cooking, another hobby. Kyle Come back to reality and remember all the crummy ways an ex may have been treating you, instead of letting your mind ruminate on how great things were during the first few weeks of dating. Come up with all the good reasons to continue wishing/hoping you and your ex will get back together and talk back to those. My book, Intimate Connections, will help you with dating and rejection issues!

How Skillful is your Shrink! Now you can find out! The Exciting Recovery Coefficient-- and the FEAR the grips the hearts of the therapists who are afraid to use it! People often wonder how skillful or effective their therapist is, but until now, there was no very valid or precise way to know. But now there is, and it has fantastic implications for psychotherapy. Today, we feature an interview with Kevin Cornelius, a therapist at the Feeling Good Institute in Mountain View, California.  Kevin Cornelius is a Licensed Marriage and Family Therapist in private practice at Feeling Good Institute, with in-person counseling for teens .Kevin is a Certified Level 4 Advanced TEAM-CBT Therapist and Trainer. I asked Kevin to write a brief description of his evolution from a career in acting to his career as a shrink. Here’s what he wrote: After many years of working as an actor I was ready for a change. After some painful personal events, I saw a therapist who was quite helpful to me. She helped me see that changing to a career as a therapist could be a great thing for me. I went to school and got my Master's in Marriage and Family Therapy. Just before I began applying for internships to complete licensure, I learned that the children's theatre group I had grown up in was looking for a new supervisor to lead the group following the death of its beloved founder and leader. This was a wonderful opportunity for me to use my theatre skills and my desire to help young people in their growth and development. I was very fortunate to be hired and worked as the director of the children's theatre group for 19 years. Towards the end of my years with the children's theatre, I was ready for a change and thought it might be time for me to finish getting my therapy license. It had been 15 years since I had worked with a patient in a therapy session, so I had a lot to learn! I was so lucky to discover David Burns and his amazing TEAM-CBT. The testing element of TEAM enabled me to see right away where I needed to improve so I could focus my efforts on improving specific skills. Being able to study with David in his Tuesday group at Stanford was a golden opportunity. Here was a framework designed to make therapy as effective as possible being taught (for free!) by one of the world's greatest therapists. I'm so happy I followed David's advice to get involved at Feeling Good Institute while I was still pre-licensed. Learning TEAM while I was completing the process to earn my license as a therapist enabled me to start my career in private practice with confidence and a stable foundation. Now, I get to continue learning from mentors at Feeling Good Institute, from the wonderful Feeling Good Podcast, and the valuable lessons I get from my patients. I'll sum up my good fortune with a theatre reference and quote the Gershwins: "Who could ask for anything more?" Kevin recently made the courageous decision to find out exactly how he was doing as a therapist. And the results surprised him tremendously. Background Information for today’s podcast Outcome studies with competing schools of psychotherapy in the treatment of depression have been disappointing. They all seem to come out about the same, slightly better than placebos, but not much. For example, in the British CoBalT study of 469 depressed patients treated with antidepressants vs antidepressants plus CBT, only 44% of the patients treated with antidepressants plus CBT experienced a 50% improvement in depression after six months of treatment, and the multi-year follow-up results weren’t any better. This was better than the patients treated with antidepressants alone, (only 22% experienced a 50% improvement), but still—to my way of thinking—very poor. We see more improvement than that in just one day in patients using the Feeling Good App. Here are just two of many online references to that landmark study: https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00495-2/fulltext https://www.thelancet.com/pdfs/journals/lanpsy/PIIS2215-0366(15)00495-2.pdf Because of the disappointing results of research on the so-called "schools" of psychotherapy, the focus is switching, to some extent, to the effects of individual therapists, since even within a school of therapy, there can be huge differences in therapists’ effectiveness. Some therapists seem to have the proverbial “green thumb,” with many patients improving rapidly, while others seem much less effective. Is there a way to measure this? Now there is! And do patients have a right to know how effective their shrinks are? That’s what I’m proposing! For at least twenty years or more, I’ve been trying to sell therapists on my Brief Mood Survey with every patient at every session. That’s because you can see exactly and immediately how depressed, anxious, or angry, etc. your patient was at the start and end of today’s session. This allows therapists to see, for the first time, exactly how much the patient improved in various dimensions within the session, as well as how much the patient relapsed or continued to improve between sessions. Here’s a simple example. To make things really clear, let’s imagine that your depression test goes from 0 (not at all depressed) to 100 (the worst depression imaginable, and your patient has an 80 at the start of today’s session. That would indicate a horrendously severe depression, similar to patients hospitalized with depression. And yet, your patient might be functioning effectively, and might appear reasonably happy. So, bonus #1, you can see exactly how your patient was feeling at the start of the session. You might think of the BMS as an “emotional X-ray machine.” Now, let’s assume you have an excellent session, and feel like you’re clicking with the patient, and the patient scores 40 on the end-of-session BMS. That would be a phenomenal 50% improvement. Of course, a score of 40 means that the patient is still moderately depressed, and has a way to go, still the goal is a score of 0 on the depression test and a huge boost in the patient’s score on the happiness test on the BMS. Keep in mind that in the dozens of psychotherapy outcome studies that have been published worldwide, the very highest levels of improvement in months and months of therapy are  never higher than this. So, I call this the Recovery Coefficient (RC), and it is a very precise measure of any therapist’s effectiveness in treating anything you can measure accurately. In an informal study of de-identified data of more than 10,000 therapy sessions at a local treatment center about two years ago. I discovered that the RC the first time therapists met with their patients predicted the improvement over the entire course of therapy. In addition, different therapists had vastly different initial RC scores, which can range from -100% in a single session (meaning a complete elimination of symptoms)  to +100% in a single session (meaning severe worsening.) Sadly, because all patient or therapist identifying information was removed to protect identities, I had no way of letting the therapists know their skill levels! But today, we are joined by a therapist who had the guts to calculate his RC in ten patients to see how he was doing. He was initial incredibly demoralize with his percent reductions (RC) of 45% for depression and 47% for anxiety in 50 minute sessions,  He reasoned that a 44% in a class would be a failing grade, but I pointed out that this isn’t the right comparison. After all, if you had a contract to build the Brooklyn Bridge, and could complete nearly half of it in 50 minutes, you’d be doing something incredibly amazing. Kevin's Depression and Anxiety Recovery Coefficient Calculations     Depression Anxiety Empathy 1 Before 6 14 20 After 3 1   % Change -50.00% -92.86%       Depression Anxiety Empathy 2 Before 5 6 20 After 1 3   % Change -80.00% -50.00%       Depression Anxiety Empathy 3 Before 12 10 20 After 9 9   % Change -25.00% -10.00%       Depression Anxiety Empathy 4 Before 10 5 20 After 5 3   % Change -50.00% -40.00%       Depression Anxiety Empathy 5 Before 5 9 18 After 3 5   % Change -40.00% -44.44%       Depression Anxiety Empathy 6 Before 18 15 20 After 10 9   % Change -44.44% -40.00%       Depression Anxiety Empathy 7 Before 14 12 20 After 10 6   % Change -28.57% -50.00%       Depression Anxiety Empathy 8 Before 2 9 18 After 4 5   % Change 50.00% -44.44%       Depression Anxiety Empathy 9 Before 2 1 20 After 0 1   % Change -100.00% 0.00%       Depression Anxiety Empathy 10 Before 6 5 20 After 1 0   % Change -83.33% -100.00%       Depression Anxiety Empathy Recovery Coefficient   -45.13% -47.17% 19.6                     And indeed, Kevin’s scores actually showed he was outperforming all the published outcome studies on depression by a factor of several hundred. Which was, I think, a well-deserved pleasant shock to his system! I’ve always had tremendous admiration and respect for Keven because of his obvious great skill and intelligence combined with world-class compassion and humility. In addition, patients complete the Evaluation of Therapy Session (ETS) immediately after the session, and rate the therapist on Empathy, Helpfulness, and other crucially important dimensions. Kevin’s Empathy score was 19.6 (96.5%), indicating near perfect empathy ratings from his patients. This is extremely impressive, since most therapists get failing Empathy scores from nearly all of their patients when they start using the ETS scales. However, what was really cool is that Kevin brought the Daily Mood Log he prepared prior to the podcast. As you can see if you check the link, recording his intense negative feelings and self-critical thoughts when he initially completed his calculations. This helps to explain the fear that so many therapists—nearly all—feel when it comes to being accountable for the first time in the history of psychotherapy. Here's what he was telling himself:

I’m not doing well enough. I’m fooling myself. I’m letting my patients down. I’m a fraud. I should be better. I should charge less. I suck!

Yikes! Do I REALLY have to share my feelings?  Last week, we featured Part 1 of a live therapy session with Keren Shemesh, PhD,  a licensed clinical psychologist who began having intense panic attacks when her mother and father visited from Israel.  Today, we feature the exciting conclusion of that session, with follow-up. If you are interested, you can listen to the follow-up with Keren and Jill who joined us st the end of today's podcast. They comment on the session as well as the details of what happened following the session. I (David) raised the question of why so many of us have trouble being honest and open with our feelings, especially anger. Jill suggested that it might be due to the false dichotomy people see, contrasting aggression with love. But you can be honest and loving at the same time, including when you express feelings of anger. Of course, we make the Five Secrets of Effective Communication sound easy, but these powerful tools actually require an enormous level of skill as well as commitment. Part 2 of the Keren session: M = Methods We began the Methods part of the session with a bit more Paradoxical Agenda Setting, and listed some really GOOD reasons NOT to open up more to her mother.

I want to protect her because it may be hard and upsetting to her. I’m not used to being vulnerable with my parents. I don’t want to rock the boat or change the status quo. I’m not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won’t want to get “close.” Jill tried to finesse around this by suggesting Keren might aim for a more “honest” relationship instead of a “closer” relationship. There are things about me that they’ve rejected, like the fact that I don’t really want children. And I’m not so sure I want to make myself vulnerable and get rejected again! I’m afraid I’ll get swallowed up and enmeshed.

My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach. I am scared for her future, since she is not in good health and she’s not taking care of herself. I have feelings of anger and resentment about the fact that I’m not the kind of daughter they wanted. I’m sad about her health and seeing her struggle. I feel hurt when I think how I have failed them and let them down. I sometimes feel like I don’t really belong.

When the Hidden Emotion isn't Hidden! Today’s podcast will feature a live therapy session on September 13, 2022 with Keren Shemesh, PhD,  a licensed clinical psychologist and certified TEAM-CBT therapist. The entire session was recorded and will be presented in two consecutive podcasts. The two co-therapists are Jill Levitt, PhD, a clinical psychologist, and Director of Clinical Training at the FeelingGoodInsititute.com. Part 1 of the Keren session I will summarize the work that Dr. Jill Levitt and I did with Keren according to the familiar sequence of a TEAM-CBT Session: T = Testing, E = Empathy, A = Assessment of Resistance (formerly Paradoxical Agenda Setting), and M = Methods, with a final round of T = end-of-session Testing. In today’s podcast, we will include the T, E, and A. In Part 2, we will include M = Methods and the final T = Testing. T = Testing Just before the start of the session, Keren completed the Brief Mood Survey (BMS) which you can review at this link: Keren's Pre-Session BMS As you can see, her depression score was only 3 out of 20, indicating minimal to mild depression. There were no suicidal thoughts, and her anxiety score was 10 out of 20, indicating moderate anxiety. She was also moderately angry (7 out of 20) and her happiness score was 10 out of 20, indicating very little happiness. Her relationship satisfaction level with her mother was 19 out of 30, indicating lots of room for improvement. However, she rated “degree of affection and caring” at 6 for “very satisfied,” which is the highest rating on this important item. We will ask her to take the BMS again at the end of the session, along with the Evaluation of Therapy Session, so we can see what the impact of the session was on her symptoms, as well as how empathic and helpful we were during the session. These ratings will be important, because the perceptions of therapists can be way off base, but the perceptions of our patients will nearly always be spot-on. Keren also brought a partially completed Daily Mood Log, which you can see at this link: Keren's Daily Mood Log (DML) at the start of the session As you can see, the upsetting event was her mother’s visit from Israel. She had moderately to severely elevated negative feelings in nine categories, along with 17 negative thoughts, along with her rather strong beliefs in all of them. Most of her thoughts were of a self-critical nature, with lots of Hidden Should Statements as well. E = Empathy At the start of our session, which took place in front of our Tuesday evening training group at Stanford, Keren described her struggles like this: On Wednesday I woke up at 3 AM with panic attacks, one after another, and no way of getting back to sleep. I get somatic symptoms, I felt weak, nauseated, with no strength, almost paralyzed, and emotionally unstable. This was four days after my mother arrived form Israel. In the last 20 years, she and my dad visited me only once, on my graduation. I always had to visit them in Israel every year and was frustrated they none came to visit me in the Bat Area. On my last visit in May, I expressed my frustration about them not visiting me. They took it to heart and made plans to come for the Jewish high Holidays. My mom arrived first a few days ago and It’s my first time alone with her. She’s a Jewish mom and she stresses me out. Of course, I was really excited when she first arrived, but after four days I feel overwhelmed. This is SO MUCH WORK! I feel sad. I’m afraid I won’t be able to function. I just cannot seem to enjoy my time with her. I feel fragile, but I’m hiding it. She’s 73, and the signs of aging are obvious now. She needs more care, and it’s tough to see her aging. Dad has always been super athletic, and he’s in great shape, but she doesn’t exercise or take care of herself. She’s frustrated about aging and is angry with us for not accepting her as she is. I don’t want to seem unhappy. I’m overwhelmed and just feel bad! David and Jill empathized, and Jill emphasized how much her parents must love her, coming from such a great distance to be with her, but also acknowledged how hard it must be for them and for Keren to be living at such a great distance. Jill pointed out that one of the issues Keren may be struggling with is the belief that their time together should be fun and conflict-free, since the time is so precious. Keren continued: My biggest problem is that I feel I cannot be me when I’m around them . . . . They want me to be a different version of myself. . . . They want me to be a mother, and they want grandchildren. But I’m in the 5% of women who don’t have any interest in having children. I’m 46 years old now, and I guess I could see myself adopting, but having a family is a big job, and I’ve never had the passion. So, I feel like I’m a disappointment to them. But we never talk about it. I sometimes feel invisible and unseen when I’m around them. They’d be so much prouder of me if I had children they could brag about. Keren also shared her frustration and anger with her mom for not taking better care of her health. Since her mom has been in town, Keren has arranged all kinds of fun activities for them to do together, but Keren’s joy is dampened by the many unspoken feelings she is constantly trying to hide, for fear of conflict and upsetting her parents. A = Assessment of Resistance Keren gave us an A+ in Empathy, so we went on to the Assessment of Resistance phase of the session, where we set the Agenda. Keren’s goal was to get over her panic attacks, and we discussed three possible treatment strategies with Keren:

The Hidden Emotion Technique: This technique would be based on our hunch that Keren’s panic attacks are the direct result of the many feelings she is consciously, and subconscious trying to hide and sweep under the rug. Dealing with the self-critical thoughts on the Daily Mood Log she provided at the start of the session. LINK Using Forced Empathy to help her see the world through her mother’s eyes, as we did in a fairly recent podcast with Zeina, another member of our Tuesday training group who was in conflict with her mother.

I want to protect her because it may be hard and upsetting to her. I’m not used to being vulnerable with my parents. I don’t want to rock the boat or change the status quo. I’m not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won’t want to get “close.” Jill tried to finesse around this by suggesting Keren might aim for a more “honest” relationship instead of a “closer” relationship. There are things about me that they’ve rejected, like the fact that I don’t really want children. And I’m not so sure I want to make myself vulnerable and get rejected again! I’m afraid I’ll get swallowed up and enmeshed.

My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach. I am scared for her future, since she is not in good health and she’s not taking care of herself. I have feelings of anger and resentment about the fact that I’m not the kind of daughter they wanted. I’m sad about her health and seeing her struggle. I feel hurt when I think how I have failed them and let them down. I sometimes feel like I don’t really belong.

Ask David: Featuring Matt May, MD Can hypnosis be used for evil? Can you fall out of love? Why does cheerleading fail? In today’s podcast, we discuss three intriguing questions from listeners like you:

Can hypnosis be used for evil? Matt says no, David mainly agrees, but isn’t entirely convinced. Is it possible to fall out of love? This can and will happen. What can we do about it? Empathy vs. Cheerleading: What’s the difference between cheerleading and genuine empathy with someone who’s upset?

Horrific World Events: Can TEAM-CBT Help Us? Featuring Live work with Meina Today, we see lots of horrific events, and violence and hatred seem to be on the upswing. There are the repeated and horrible mass shootings in the US, the horrific war in the Ukraine, and the extensive protests that are rocking Iran. Those problems are real, and terrible in reality. So, maybe the TEAM-CBT model, with its emphasis on our interpretations of reality, and our relationships with others, might seem like irrelevant and useless tools. Or are they? Let’s check it out. Sometimes, as you’ll see, things can a take sudden and unexpected change in direction in TEAM-CBT if you follow the energy. There is no “formula” for treating anything. We treat humans, not diagnoses or problems. But we do go through the T, E, A, M model in a systematic way so we can find out what, if anything, each patient wants help with, and then design an individualized plan to make that happen, if possible. Part 1 T = Testing Today’s guest, whom we’ll call Meina for protection, migrated to the United States from her mother country, Iran, as a young woman, and she’s definitely upset. In fact, her mood scores are among the most severe that I’ve seen recently. Her depression score of 15 out of 20 indicates severe depression, and her anxiety and anger scores of 19 and 20 out of 20 indicates extreme anxiety and anger. You can see Meina’s Daily Mood Log at the start of the session as well, with nine categories—depression, anxiety, guilt, loneliness, humiliation, hopelessness, frustration and hatred all estimated between 90 and 100 out of 100, again confirming the most extreme upset a human being can experience. As you might expect, her happiness score was 0 out of 20, indicating no happiness at all, and her Relationship Satisfaction Scale score, thinking of her husband, was only 19 out of 30, indicating considerable marital distress. What’s causing those feelings? Well, let’s take a look at her negative thoughts and how strongly she believes them:

I’ll always suffer because of being born in Iran: 90% My heart will stop from feeling so much hatred. 80% There’s nothing I can do to help (the women who are protesting.) 100% It is pathetic that I can’t stop feeling so angry. 90% I’m going to get sick because of these feelings. 90% Many young women will be tortured and killed. 100% I’m going to lose all my friends because I’m so angry. 70% My marriage will also be negatively impacted. 100%

Audrey Kodye

Systemic racism: the Five Secrets of Effective Communication can be helpful. For example, it is important to acknowledge the anger your patients may feel because of the injustices they experience. Micro-aggression: These are subtle put-downs that may sound like compliments, and might even be intended as such, but are really hurtful. For example, when learning that Sunny is gay, someone may say, “Well, Sunny, you certainly don’t act gay!” This statement, which might sound innocent, actually implies that you’re “less than” or “less of a man” if you’re gay! Internalized oppression: This is when the person who is being targeted turns against himself or herself, and internalizes the message that “I’m not good enough,” or “I’m defective.”

I get to abuse you, physically, psychologically, sexually, or financially for my please. We have to keep it secret. If you ever tell on me, or even imply that I’m doing something wrong, I’ll REALLY hurt you. It’s all your fault. You’re the dirty bad one, and you deserve what I’m doing to you. I’m a god who is superior and without fault.

Ask David: Featuring Matt May, MD 1. Roy asks: How can I challenge my core belief that there is something wrong with me? 2. Lynn asks: Do you have any recommendations for someone with health anxiety? Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. 1. Roy asks: How can I challenge my core belief that there is something wrong with me? Hello Dr .Burns, Regarding podcast 294, I had a few quick questions/suggestions on acceptance. Is it possible to do a podcast with you and Matt and Rhonda on one specific core belief? The belief: There is Something Wrong With Me Let me explain. I have dated and had relationships with some very physically attractive women in the past. In the last year I have not been able to duplicate these past successes and I suspect it's because I am at least 10 years or more older than these women ( 23-28). Let's say I NEVER EVER date or have a relationship with my specific type EVER again? This has caused a ton of frustration and some depression ( low) but has been a bit to my self image and self esteem Thoughts? Thanks Dr. Burns Roy David: At my request, Roy provides more information on his Core Belief: There is something wrong with me. Why believe it? 1. My parent said "What's wrong with you?" whenever I got in trouble in school ( infers there IS something wrong with me) 2. It feels like there is something wrong with me 3. I make mistakes and am not perfect so there MUST be something wrong with me I believe this Core Belief to be 100 % True David: I asked Roy to provide a Daily Mood Log. DML Activating Event: 3 specific events A) My ex girlfriend dumped me and ended our relationship B) A woman I suspect is a super model said No to my request to go out on a date C) I have recently struck out with the last 5 women I REALLY want to date. They ALL rejected me Feelings: Depressed/Down/Unhappy (70%) Worthless/Inadequate/Defective (80%) Unloved/Rejected (95%) Hopeless/Discouraged (99%) Frustrated/Defeated (99%) Resentful/Irritated/Upset (99%) Negative Thoughts 1.There is something wrong with me (100%) 2. I must get this specific woman's love and approval to feel good about myself (80%) 3. If I am a sexy charming guy then this woman would find me attractive. I must not be very attractive (100%) 4. If I played in the NBA or NFL then this woman would be attracted to me (100%) 5. The sex would be amazing if I were to be intimate with this woman (100%) 6. I would be so much happier if I was to have a relationship with this woman (100%) 7. Women like her with incredibly sexy attractive bodies only go for high status millionaires. I am not a millionaire. It's awful I am not a millionaire (100%) 8. I am 10 years older than these women and therefore my age turns them off (100%) David wrote back, suggesting that Roy list the benefits of his belief that “there’s something wrong with me.” Positives of believing There is Something Wrong With Me

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

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

Check it Out!  The September, 2022 Podcast Survey  Dear Podcast fans. Thank you for your responses to our podcast survey yesterday, asking about your likes and dislikes, as well as your suggestions for the future of our podcast. The following report is based on 355 responses we received the first day of the survey. A link to the survey report will be included in spots so you can examine it for more information! LINK TO SURVEY RESULTS Thanks So much! Rhonda and David PS Rhonda is now our official Host and Producer! Demographics Gender: 58 / 42 = female / male Age: 21 to >70. None under 21. Education

David and Rhonda

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

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

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

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

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

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

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

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

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

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

Podcast #300: Celebrating Five Million Plus

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

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

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

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

Many, many Ask David episodes,

#265, Exposure to Leeches with Danielle Kamis

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

#146, When Helping Doesn’t Help

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

Lorraine Wong (#155-treating emotional eating &

#257 Intensives),

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

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

Brandon Vance-

#160 Listening to the Music of TEAM

#161, Music under what someone is saying

#249, Report on Feeling Great Book Clubs

#260, TEAM games (with Amy Spector)

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

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

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

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

#167, TEAM and the Brain,

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

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

#218, Postpartum Depression,

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

#283, The “O” of OCD

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

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

Rose Markotic, #252 & 253, Sadness as Celebration

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

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

Sunny Choi, #214 & 215, The Approval Addiction

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

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

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

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

Hi David,

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

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

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

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

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

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

-Matt

Fabrice replied to Matt:

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

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

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

Warmly, Fabrice, Rhonda, Matt and David