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

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

David Burns, MD
Bildung, Gesundheit

This podcast features David D. Burns MD, author of "Feeling Good, The New Mood Therapy," describing powerful new techniques to overcome depression and anxiety and develop greater joy and self-esteem. For therapists and the general public alike!

497 - 423: The Feared Fantasy Festival
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  • 497 - 423: The Feared Fantasy Festival

    The Feared Fantasy Festival! Featuring Jill Levitt, PhD

    Rhonda asked about the differences between the four Feared Fantasy Techniques and what each one is used for. So we're dedicating today's podcast to answering that question and bringing them all to life. We are honored to be joined by our beloved and brilliant Dr. Jill Levitt, the Director of Clinician Training at the Feeling Good Institute in Mountain View, California.

    Below I have listed the four Feared Fantasy Techniques. As you can see, each one targets a different Self-Defeating Belief.

    Approval Addiction: I need everyone's approval to feel happy and worthwhile. Perceived Perfectionism: I must impress others to be love and respected. People will not love or accept me if they see my flaws and shortcomings. Achievement Addiction: My capacity for happiness and my worthwhileness as a human being depend on my achievements, intelligence, success, and productivity. Love Addiction: I need to be loved to feel happy and worthwhile. Submissiveness: I must make others happy, even at the expense of my own needs and feelings.

    Here are the Feared Fantasy Techniques used for each SDB:

    Approval Addiction / Perceived Perfectionism: “I judge you.” Achievement Addiction: “High School Reunion.” Love Addiction: Rejection Feared Fantasy Submissiveness: No Practice

    During the live podcast, we did a deep dive on each of the four Feared Fantasy techniques, and emphasized that the goal is actually enlightenment, and it's based on the teachings Tibetan Book of the Dead that when you finally challenge and confront the monster you've feared and run away from in all of your previous reincarnations, you will discover the the monster has no teeth, and that your fears throughout all of those reincarnations were based on a cosmic joke. This can create something called "laughing enlightenment," so you no longer have to go through the life death cycle, but can go instead to Nirvana--or something along those lines!

    You really must listen to the podcast to "get" the impact of these Feared Fantasy role plays, and role-reversals, to see how simple, easy, and obvious self-acceptance, and enlightenment really are, and you will see and hear how we fight to protect and defend ourselves from attack, and end up feeling trapped yet again in our needs to be "special" or "worthwhile." David pointed out that when you let go of the idea that you have a "self," your suffering can disappear because you will no longer have to wonder whether your "self" is good enough, or worthwhile enough.

    Jill complemented this line of thinking by pointing out that the technique, Be Specific, is one important key in most of these techniques. We can be flawed in all kinds of specifics, but that will never hurt unless you generalize to your "self." No self, no problem, as some mystics have said. And that is SO TRUE!

    David also discussed throwing away the idea that you are worthwhile, or that you need to be more worthwhile, and described how he and his wife saved a mouse that had somehow gotten into their house, but the poor thing was terrified and heroically tried to survive, hiding out in their kitchen. Instead of trying to kill it, they fed it nuts and grapes. Eventually, they caught it in a safe trap, and set it free, and left a last meal for it outside, which it found and happily ate.

    It was a deep dive on Feared Fantasy and lots of spiritual and philosophical topics, and we hope you enjoyed it!

    Although we did not cover this topic in the podcast, there are quite a number of additional role play techniques in TEAM-CBT, too, as you know, including:

    to help with Self-Critical Thoughts:

    Paradoxical and Straightforward Double Standard Externalization of Voices

    to help with Uncovering Techniques, like the Individual Downward Arrow

    Man from Mars

    To help with Tempting Thoughts

    Devil’s Advocate Technique Tic-Tok Technique

    to help with Resistance

    Externalization of Resistance How Many Minutes?

    to help with the Five Secrets / Relationship Conflict

    Intimacy Exercise One Minute-Drill

    Perhaps you can think of more, too! The generous use of role-playing techniques is one of the unique features of TEAM, but for whatever reason it seems like few therapists use them. This is perhaps unfortunate because they tend to be more potent, emotional, and fast acting than many if not most other techniques.

    Warmly,

    david

    Mon, 18 Nov 2024 - 1h 31min
  • 496 - 422: Ask David: Getting off Benzos; Music and Emotions; Negative Thoughts about the World; and more

    Ask David: Getting Off Benzos How Does Music Stir Our Emotions? Combatting Negative Thoughts about the World Treating Schizophrenia with TEAM The Four Feared Fantasy Techniques and more!

    Questions for today:

      Mamunur asks: What’s the best way to withdraw from benzodiazepines? Gray asks: How does music evoke such powerful emotional reactions? Josh thanks David for techniques that have helped in his personal and professional life. Harold asks: How do you respond to negative thoughts about the world, as opposed to self-criticisms? For example, “The world is filled with so little joy and so much suffering.” Moritz asks: How do you help people with bipolar, schizophrenia, etc.? John expresses gratitude for our answer to his question on Positive Reframing, which triggered an “ah ha moment.” Rhonda asks: What are the four Feared Fantasy Techniques?

    The answers below were written prior to the podcast. Listen to the podcast for the dialogue among Rhonda, Matt, and David, as much more emerges from the discussions!

      Mamunur asks: What’s the best way to withdraw from benzodiazepines?

    Ask David, Bangladesh question

    Dear Sir,

    I am writing to you from Bangladesh. Your book Feeling Good is a phenomenal work, and it has greatly helped in promoting the development of a healthy mind through logic and reason.

    Sir, I have a question regarding benzodiazepine withdrawal, which is often prescribed for mental health disorders. Is there a specific CBT (Cognitive Behavioral Therapy) approach that can help in withdrawing from benzodiazepines? Your guidance on this would be invaluable, as many people have been taking it for years, either knowingly or unknowingly, without being fully aware of its severe withdrawal effects.

    Thank you, sir, for your kind contributions to humanity.

    Sincerely,

    Mamunur Rahman Senior Lecturer

    David’s reply

    Dear Mamunur,

    Thank you for your important question! I am so glad you like my book, Feeling Good, and appreciate your kind comments!

    As a general rule, slow taper off of benzodiazepines is recommended. This might involve slowly decreasing the dose over a period of several weeks.

    When I was younger I used to take 0.25 mg of Xanax for sleep, because it was initially promoted as being non-addictive, which was wrong. It is highly addictive. The dose I used was the smallest dose.

    When I realized that I was “hooked,” I tapered off of it over about a week, and simply put up with the side effects of withdrawal, primarily an increase of anxiety and difficulty sleeping. These disappeared after several weeks.

    Abrupt withdrawal from high doses of any benzodiazepine can trigger seizures, as I’m sure you know. That is the biggest danger, perhaps.

    I do recall a published study from years ago conducted at Harvard, I believe at McClean Hospital. The divided two groups of people hooked on Xanax into two groups. Both groups were switched to Klonopin which has a longer “half-life” in the blood and is supposedly a bit easier to withdraw from than Xanax, which goes out of the blood rapidly, causing more sudden and intense withdrawal effects.

    After this initial phase, both groups continued with slowly tapering off the Klonopin under the guidance of medical experts. However, one of the groups also attended weekly cognitive therapy groups, learning about how to combat the distorted thoughts that trigger negative feelings like anxiety and depression.

    My memory of the study is that the group receiving cognitive therapy plus drug management did much better. As I recall, 80% of them were able to withdraw successfully. However, the group receiving drug management alone did poorly, with only about 20% achieving withdrawal.

    My memory of the details may be somewhat faulty, but the main conclusion was clear that the support of the group cognitive therapy greatly enhanced the success of withdrawal from benzodiazepines.

    I decided early in my career not to prescribe benzodiazepines like Ativan, Valium, Librium, Xanax, and Klonopin for depression or anxiety, because the drug-free methods I and others have developed are very powerful, and the use of benzos can actually make the outcomes worse.

    Years back, a research colleague from Canada, Henny Westra, PhD, reviewed the world literature on treatment of anxiety with CBT plus benzos and concluded that the benzos did not enhance outcomes. Here is the link: https://pubmed.ncbi.nlm.nih.gov/12214810/.

    I hope this information is useful and I will include this in a future Feeling Good Podcast.

     

      Gray asks: How does music evoke such powerful emotional reactions?

    Subject: Re: Podcast question: love songs

    Hi David,

    That's a really tough question. Music has a unique way of cutting straight to emotions for me, and it makes it especially hard to identify the thoughts behind them. My best way of explaining is with these two thoughts, which have to be viewed as a pair to get that emotional reaction:

      My life would be perfect if I had that I'm so far away from that

    These thoughts don't resonate quite right for me, but it's something like that, going from imagining bliss to crashing to hopelessness within the space of a moment.

    Thank you so much for your response.

    Gray

    David’s reply

    You’re right. Music can be so beautiful, especially of course, the songs we love, that it is magical and emotional to listen to! It seems more like a sensory experience, than something mediated by thoughts, but we certainly have perceptions of beauty, etc.

    Similar with some incredibly delicious food. Creates incredible delight and satisfaction, and no words are necessary other than “delicious!”

    Sorry I can’t give you a better answer to your outstanding question!

    Best, david

     

      Josh thanks David for techniques that have helped in his personal and professional life.

    Dear Dr. Burns,

    I am sure you are swamped with substantive emails and fan mail, but I just wanted to express appreciation to you for all I have gained from your publicly available content. I have learned so much that I have applied in my personal life. I have also benefited tremendously in my work with clients.

    So much of what you say about anxiety, and especially the hidden emotion technique, has allowed clients to have in almost every session an aha moment. I have not yet been able to see a complete removal of symptoms in one session yet, but as a therapist, I too have many skills yet to improve and much work to do.

    So, in short, thank you so much for making your experience and wisdom available for free, and thank you for doing it in such an engaging manner.

    Sincerely,

    Josh Farkas

     

    David’s Reply

    Thanks, Josh. You are welcome to join our weekly virtual free training group I offer as part of my volunteer work for Stanford, if interested.

    For more complete change within sessions, a double session (two hours) in my experience is vastly more effective. Is it okay to read your kind note on a podcast?

    Warmly, david

     

      Harold asks: How do you respond to negative thoughts about the world, as opposed to self-criticisms? For example, “The world is filled with so little joy and so much suffering.”

    Dear Dr. Burns,

    First of all, I would like to thank you for all your work and your outreach. Your books have profoundly influenced my thinking and value system. I really admire how you exemplify both scientific rigor and human warmth. Finally, I want to thank you for promoting the idea of “Rejection Practice! I haven't had a breakthrough yet, but some unexpected, very encouraging experiences.

    I first came across Feeling Good 12 years ago when I developed moderate depression in the context of living with my ex-partner, who probably had borderline personality disorder. I tried the techniques in Feeling Good and also psychotherapy, but unfortunately without much success. I only started feeling a lot better when I began to rebuild my social life and leisure time activities (ballroom dancing, getting involved with a church, ...). Several months later, I also broke up with my ex-girlfriend. Since then, I've had ongoing mild depression.

    I recently tried the techniques in Feeling Great but wanted to ask you for your opinion on a couple of negative thoughts I'm particularly stuck with. My issue is that I'm normally not attacking myself, but life in general. I keep on telling myself things like "Life is just one crisis after the other," "Life is for the lucky ones," "Really good things just don't want to happen," "Life is so much suffering and so little joy," and the depression itself makes these statements all the more convincing. (Triggering events can be rainy holidays, romantic rejections, grant interview rejections, etc.)

    I think it could be helpful if in a podcast you could give more examples on resolving negative thoughts attacking life / the world rather than oneself. I also have many more questions for podcasts if you are interested.

    Thank you for reading this, and thank you so much again for all your work!

    With very best wishes,

    Harold

     

    David’s Reply

    Happy to address this on an Ask David, and it would help if you could let me know what negative feelings you have, and how strong they are. I will be answer in a general way, and not engaging you in therapy, which cannot be done in this context. Is that okay?

    I’m attaching a Daily Mood Log to help organize your thoughts and feelings. Send it back if you can with the Event, Negative Feelings and % Now columns filled out (0-100), and Negative thoughts and belief in each (0-100).

    You can also fill in the distortion column using abbreviations, like AON for All-or-Nothing, SH for Should Statement or Hidden Should, MF for Mental filtering, DP for Discounting the Positives, and so forth.

    Thanks!

    If you were in a session with me, or if we were just friends talking, I would reply to your complaints with the Disarming Technique, Thought and Feeling Empathy, “I Feel” Statements, Stroking, and Inquiry, like this:

    Harold: “Life is so much suffering and so little joy."

    David: “I’m sad to hear you say that, but you’re right. There’s an enormous amount of suffering in the world, like the horrible wars in Ukraine and in the Mid-East. (I feel; Disarming Technique) It makes sense that you’d be upset, and have all kinds of feelings, even anger since there’s so much cruelty, too. (Feeling Empathy)

    And even people who appear positive and joyful often have inner sadness and loneliness that they are hiding. (Disarming Technique) Your comment tells me a great deal about your core values on honesty and compassion for others. (Stroking) Can you tell me more about the suffering that you’ve seen that has saddened you the most, and how you feel inside? (Inquiry)

    But I’m mainly interested in you right now. Can you tell me more about YOUR suffering, and especially if there’s some problem you might want some help with? (Inquiry; Changing the Focus)

    I would continue this strategy until you gave me an A on Empathy, and then I would go on to the A of TEAM (Assessing Resistance), and ask what kind of help, if any, you’d be look for in today’s session. I might also use a paradox, like the Acid Test.

    If you wanted to reduce some of your negative feelings, I might try a variety of techniques, such as “How Many Minutes?”

    I’d also think about the Hidden Emotion Technique. Is there some problem in your life right now that you’re not dealing with, so you instead obsess about the problems in the world to distract yourself?

    I would continue this strategy until you gave me an A on Empathy, and then I would go on to the A of TEAM (Assessing Resistance), and ask what kind of help, if any, you’d be look for in today’s session. I might also use a paradox, like the Acid Test.

    If you wanted to reduce some of your negative feelings, I might try a variety of techniques, such as “How Many Minutes?”

    I’d also think about the Hidden Emotion Technique. Is there some problem in your life right now that you’re not dealing with, so you instead obsess about the problems in the world to distract yourself? I ask this because your negative thoughts are very general, but I always focus only on specifics, specific problems and moments. What’s has been going on with your parents or in the past or present that you are distressed about? I’ve found that when I (or my patients) solve one specific problem that’s bugging me, everything seems to suddenly brighten up.

    For example, you wrote : “I asked someone out I like; she surprisingly said yes. After 10 days of not hearing from her, I messaged her, . . . “ I wrote a book about dating, Intimate Connections, because I was a nurd and had a lot to learn about dating. One idea is that waiting 10 days might not be a good idea to arrange the specifics of the date, as that might make her feel uneasy. There’s a lot to learn about dating, for example.

    A tool like the Pleasure Predicting Sheet can sometimes help, too. And finally, a good therapist can also often speed things up. Sometimes two heads are better than one. You seem extremely smart and willing to work hard, so there’s all kinds of room for growth, learning, and greater joy.

    The Feeling Great App is NOT therapy, but the tools there might also be helpful, especially since you are willing to work hard a do a lot. That’s super important.

    Can I use this email in my reply in the show notes if we discuss your excellent questions? And should I change your name to Harold?

    Warmly, david

    Best, david

     

     

      Moritz asks: How do you help people with bipolar, schizophrenia, etc.?

    Hi David,

    You have mentioned a few times that there are only a handful of "real" psychological disorders with known causes, as opposed to just a collection of symptoms.

    Could you please tell a bit about how you would go about helping somebody with one of the "real" disorders (like Schizophrenia or Bipolar) using TEAM therapy?

    Most of the episodes with personal work seem to fall into the other category (anxiety, depression, compulsive behavior), so I'd be really curious about some examples.

    Best regards,

    Moritz Lenz

     

    David’s Reply

    Hi Moritz, Thanks! Good question, and happy to address this on an Ask David. Here's the answer in a nutshell. When working with someone with schizophrenia, the goal is to help them develop greater happiness and interpersonal functioning, exactly the same as with anyone else, using TEAM. The goal is not to cure schizophrenia, because we still do not know the cause and there is no cure. But we can help individuals with schizophrenia with problems that they are having.

    Bipolar: in the manic phase, usually strong meds are indicated, and often at least one hospitalization. For the rest of their lives, including depression, TEAM works great.

    Can add more in the podcast.

    Best, david

     

      John expresses gratitude for answer his question on Positive Reframing, which triggered an “ah ha moment.”

    Hi David and Rhonda!

    I have listened to Episode 415 and your response to my positive reframing question!

    I had a bit of a aha moment! I think I had been approaching it in the cheerleading sense and trying to encourage myself with these positive qualities rather than attaching the positives to the negative thoughts and feelings themselves!

    This has created a much stronger emotional response during the positive reframing section! The building up of the negative thoughts and feelings is a gamechanger! Thanks so much for the time and attention given to it during the podcast.

    Thanks so much again, I appreciate you folks way more than you could know!

    John

    David’s Reply

    Thanks, Rhonda and John. Yes, you’ve pointed out a huge error many people make when trying to grasp positive reframing. If it is okay, we can include your comment in a future podcast.

    Warmly, david

     

      Rhonda asks about the four Feared Fantasy Techniques:

    David’s Reply

    Here are the four Feared Fantasy Techniques

    Approval Addiction / Perceived Perfectionism: “I judge you.” Achievement Addiction: “High School Reunion.” Love Addiction: Rejection Feared Fantasy Submissiveness: No Practice

    There are quite a number of additional role plays, too, as you know. Maybe a question about all the role plays, bc we all have:

    Self-Critical Thoughts:

    Paradoxical and Straightforward Double Standard Externalization of Voices

    Uncovering Techniques

    Man from Mars

    Tempting Thoughts

    Devil’s Advocate Technique Tic-Tok Technique

    Resistance

    Externalization of Resistance How Many Minutes?

    Five Secrets / Relationship Conflict

    Intimacy Exercise One Minute-Drill

    I’ll bet you can think of more, too! This is one of the unique features of TEAM, but for whatever reason it seems like few therapists use them. As you know, on average they tend to be way more potent and emotional, and of course fast impact.

    Warmly, david

    Mon, 11 Nov 2024 - 1h 16min
  • 495 - 421: Enlightenment Month: Meet Tahn Palmetto!

    Meet Tahn Palmetto Theravada Buddhism--the Thai Forest Tradition

    Our dear colleague, Jason Meno, generously invited five high-profile Buddhist monks / teachers, to appear on our Feeling Good Podcast, hoping we could feature one every week during our "Enlightenment Month."  He included his dear friend and ordained Buddhist monk, Tahn Palmetto. Happily, Tahn accepted Jason’s invitation, and we are thrilled to chat with him today about his feelings of depression as a young man in the army to his search for happiness and peace through meditation.

    Tahn began his journey when we was young, 20 or 21 years old. After he enlisted in the army, he was lying on the floor, staring at the ceiling and realized he was depressed. He also realized that he didn’t actually want to go to war, and saw that the best of good intentions often lead to pretty terrible outcomes.

    Jason and David described the basis of cognitive therapy, confirmed in Jason’s recent research on meditation, that the degree of upset from any negative thought depends on how strongly you believe it to be true. Tahn said he also realized that his negative feelings did not depend so much on what he was doing, but how much he believed his thoughts.

    He got out of the army and searched for spiritual teachers, and eventually settled on Theravada Buddhism, also known as the Thai Forest Tradition. He said, “I found that you can have a lifestyle that triggers feelings of unhappiness, and committed my life to achieving happiness and peace.”

    He said that some people who come to the monastery discover that they don’t want to commit themselves to the monastic life, and some commit to it but do it poorly. He said that your commitment will depend on how strongly you want to feel happy and enlightened. Believing that this is possible requires a paradigm switch.

    It is possible to have a mind that is clear, but even on a clear day, there will be clouds. The clouds, however, are only temporary.

    Our suffering comes and goes. If you twist your knee, it may hurt for life. But if you have a cold, you can recover completely. Even in a monastery, people have their squabbles. Within the Buddhist practice, Than explained that it is important to try to identify the disease and only then prescribe the effective treatment.

    Jason mentioned that some people come to the monastery but leave feeling hopeless. Others stay and are successful. Tahn explained that in Asia it is common for someone to enter the monastic life for a brief period, for example when they are experiencing grief. He said that if you grieve over the loss of a loved one, time alone will heal your grief, and once the suffering is relieved, they leave the monastic life.

    Rhonda asked if mindfulness meditation could be harmful to some people.

    Tahn explained that mindfulness does not cause negative feelings, but often reveals the presence of negative feelings. If you have a condition that prevents you from experiencing enlightenment, the condition is getting in the way. Sometimes the practice will give you the stability and the peace of mind to deal with it.

    If you come to the practice of mindfulness or the study of Buddhism for the wrong reasons, you might stay for the right reasons. If it does not work or help, you can always seek some other type of treatment.

    Tahn explained that mindfulness or Buddhism addresses unhappiness caused by mental or physical pain, and that people are often surprised by how it helps them. He believes that mindfulness meditation is “the thing” that treats someone’s stress. It treats the “dukka,” which is a fundamental Buddhist teaching that refers to (according to the internet) the “suffering” or “unhappiness” of life. It is one of the first “noble truths” of Buddhism; namely, that suffering cannot be avoided.

    Apparently dukka comes in three flavors:

    Physical and emotional pain and discomfort Suffering from the inability to accept change The profound dissatisfaction of existence.

    Tahn said that you develop greater resources when you meditate. Then you may have extra resources to help others:

    You learn to deal with everybody’s stuff. You learn to be aware of your body. This is your perspective for everything you do. It makes me happy to think about my eyeballs. When I meditate on this, it becomes funny, and I laugh.

    Tahn suggested that when you meditate, you learn to be aware of your body, because that is the center point of your world. This is your perspective on everything that is going on in the world. When you become aware of your body and what it is doing, you know the context of everything in your life.

    What does his day look like? Tahn said:

    I answer emails, I troubleshoot problems. Lately we’ve had a problem with scorpions. But we don’t try to kill them.

    Tahn talked about how Buddhism defines Truth as reality, and that the definition of happiness is “non-suffering.”

    There are three patterns that lead to unhappiness:

      Attachment, which he defined as greed and desire, especially when you seek some external object(s). An extreme example would be disregarding the needs of others or even endangering others to get the object of your desires, or an attitude of only wanting or caring for things that you like or want. Aversion which refers to feelings of aggression, anger, and hatred. Aversion’s opposite is loving kindness. When we experience Aversion, we push away (usually aggressively) the things that we dislike. If we allow our ignorance to take over, we can conjure up hatred for the things that we dislike and the people we see as blocking our desires. We saw from the meditation experiment that Jason described last week, how meditating on loving kindness brought about a reduction in people’s negative thoughts. Ignorance refers to delusion, confusion and dullness. Ignorance defuses understanding serving to confuse you and prevent you from doing something functional. This can be experienced as an inability to see the truth or reality of ourselves or the world around us. Asking questions like “Am I real” is the basis of the first two in this list.

    Tahn also discussed how the mind precedes the thoughts.

    Then we talked about the concept of the Self, in that we think that we exist. However, there is no stable “I.” All we find are temporary phenomena. For example, you don’t need to have a “self” to drive to a picnic. All you need is a car and a tank of gas.

    The group discussed the Buddhist concept of “laughing enlightenment.”

    Thank you for listening today!

    Tahn, Jason, Rhonda, and David

    Mon, 04 Nov 2024 - 1h 33min
  • 494 - 420: The Mindfulness Mystery Tour! And Two HUGE Discoveries!

    The Mindfulness Mystery Tour! And Two Mind-Boggling Discoveries about Meditation! Featuring Jason Meno

    Today, Jason Meno, our beloved AI guy on the Feeling Great App team, shares some incredible and innovative research he recently did on the effect of meditation on how we think and feel. As you know, basic research is a high priority of our app team, and our major focus is to make basic discoveries in how people change, and especially on what triggers rapid and dramatic change. We use that information to develop and refine the app on an ongoing basis, and also to contribute to basic science.

    Jason recently created a “New Cool Tools Club” which has 160 members who Jason can notify whenever he has a cool new app tool that he wants to test. If you are interested in joining, you can find his contact information at the end of the show notes. There is no charge if you’d like to join this group!

    Jason had a strong background in Buddhism and has been working with our company for several years, focusing in the last year on the AI chat bot portion of the Feeling Great App. He has meditated for many years, and uses TEAM-CBT as well to deal with his personal moments of stress and unhappiness, something that most if not all of us experience at times!

    Introduction

    Jason was interested in evaluating the short-term impact of meditating, and did a literature review but found that most or all of the published studies had a focus on the effects of daily meditation over longer periods of time, like two months for example.

    He was also interested in how long and how often people should meditate, and what types of meditations, if any, were the most effective.

    So, he decided to test a one-hour meditation experience consisting of five ten-minute recorded meditations, including

      A body scan meditation, systematically relaxing various parts of your body, beginning with your feet and toes. A breathing and counting meditation, where you focus on your breathing and count the breaths going in and out. A loving kindness meditation, starting with sending feelings of love, happiness, and health first to someone you love, then to yourself, then to someone you aren’t especially close to, or don’t particularly like, and on and on until you are projecting love and kindness to the entire universe. A mindfulness exercise where you notice if you are thinking, hearing, watching, remembering, and so forth as various thoughts pass through your mind. A “Do Nothing” meditation where you are instructed to simply “do nothing” for ten minutes.

    Because previous research on meditation did not use scales that assessed specific kinds of negative feelings in the here-and-now, he decided to use the highly accurate 7-item negative feelings sliders as well as the 7-item positive feelings sliders prior to the start of the medicine, after each meditation, and at the end of the app.

    He also asked many questions about motivation and expectations prior to the start of the meditation experiences, all answered from 0 (not at all) to 100 (completely), including

      How familiar are you with David’s work? How familiar are you with meditation? How strongly do you believe that meditation will make you feel better? How strongly do you believe that meditation will be rewarding? How strongly do you believe that meditation will only have a small effect? How strongly do you believe that meditation will be a waste of time? How strongly do you believe that meditation will make you feel worse? How strongly do you believe that it will be painful or difficult?

    You can find these data at this link.

    He also asked every participant to generate an upsetting negative thought, like “I’m a loser,” and use 0 to 1000 sliders to indicate how strongly they believed that thought, and how upsetting it was.

    60 individuals started the experiment, and 35 completed it, with 25 dropping out prematurely before they completed some of the meditations.

    He presented the data as a two-group analysis, those who completed and those who failed to complete the hour of meditation. Here, are just a few of the preliminary findings, and more refined analyses are planned so we can look at causal effects.

      Both groups were moderately to very familiar with David’s work and with meditation. The completers had higher scores on the questions about positive expectations than the dropouts, although the differences were not great. The dropouts had substantially higher scores on four questions about negative expectations for the experience, like “it will be a waste of time” or “it will be painful or difficult.” The initial scores on the belief in the negative thought were similar in the two groups (76% and 74%, respectively), but the Upsettingness of the thought was a bit higher in the completers (83% and 79%. The mean of the initial scores on the 7 negative feelings sliders was significantly higher in the dropouts (37% and 46%, respectively), while the initial scores on the 7 positive feelings sliders was somewhat lower in the dropouts (49% and 45%, respectively). Both groups expected a modest reduction in negative feelings and a modest boost in positive feelings during the hour of meditation.

    Results on the 35 completers

      After the first ten-minute meditation, there were significant reductions in the negative feeling sliders (from 37% before to 25% after) and increases in the positive feeling sliders (from 45% before to 55% after). There did not appear to be any additional improvements in negative or positive feelings in the subsequent four meditations. There was a significant reduction in the belief in the negative thought after the first meditation, and the reduction continued throughout the next four meditations. (76% to 54%), for a reduction of 29%. There was a significant reduction in the upsetness caused by the negative thought after the first meditation, and the reduction continued throughout the next four meditations (79% to 47%) for a reduction of 40.5%.

    You can find the remarkable results if you click here!

    There are many fascinating results, but one of the most amazing--which we've replicated almost exactly in independent beta tests--is the remarkable similarity between the changes in negative and positive feelings the participants predicted, and the actual results. They are so close it looks like somebody faked the data, but that's not the case at all.

    We will have to do more analyses to figure out what this means, but in simple terms, this seems to be iron clad proof that our expectations of the mood changing results of any intervention can be tremendously powerful. In fact, you could argue--and it would need further statistical analyses to test--that the causal impact of the expectations eclipsed the causal impact of the actual intervention, which in this case was meditation.

    One of the cool things about quantitative research is that it nearly always shoots down our favorite hypotheses, and also gives us new and totally unexpected gifts to stimulate our thinking! In this instance, there were at least two mind-boggling and toally unexpected results:

      When people mediate, the improvement in negative feelings is accompanied by parallel reductions in participants belief in their negative thoughts. Participants predictions of the changes in seven negative and seven positive feelings by the end of the hour of meditation were spot on, and seemed almost impossibly accurate!

    Discussion

    The findings are exciting and specific, and suggest that the reduction in negative feelings during meditation may be, and is, mediated by the reduction in the users’ belief in their negative thoughts. We will attempt to look into this more deeply using non-recursive analytic methods with SEM (structural equation modeling).

    All samples are biased, and it can sometimes be extremely helpful to understand the bias in your sample when interpreting the results. The sample in this case included users favorably disposed to meditation, and responding to an email inviting them to participate in a meditation experiment. Only those who persisted the full hour were analyzed in the final outcome data, which could be another source of bias in the data. How much improvement would we have documented if we were analyzing completers (45) AND dropouts (35)?

    Actually, this type of analysis is possible using Direct FIML (Full-Information Maximum Likelihood) with SEM techniques. I will, in fact, do these analyses as soon as I get the data set from Jason. This will allow me to estimate the scores at the end for all participants, including those who dropped out. It seems mathematically impossible, but it actually can be done.

    If those who dropped out are systematically different from those who continued, it will “know” and correct for this. For example, if those who dropped out were, on average, doing more poorly, then the estimates based on those who persisted will be biased, and the degree of bias could potentially be infinite. The SEM analyses will also tell us if there are no significant differences in those who  persisted and those who dropped out.

    Finally, the data LOOKS like the meditation “caused” some fairly significant improvements, although the results were in some ways puzzling. Using SEM, I should be able to determine whether, and to what degree, the improvement was simply a “placebo” effect resulting from the participants expectations of improvement, as opposed to an actual result of the meditation.

    So, stay tuned for updates on this amazing and deeply appreciated research initiative by our beloved Jason Meno!

    Thanks for listening today.

    Rhonda, Jason, and David

    Mon, 28 Oct 2024 - 1h 26min
  • 493 - 419: Ask David: Changing an SDB; Intense Public Speaking Anxiety

    Ask David How Can I Change an SDB (Self-Defeating Belief)? How Can I Cope with Intense Public Speaking Anxiety? Featuring Rhonda Barovsky, Psy.D., Matthew May, MD, Jason Meno and David Burns, MD (Jason is an AI Scientist on our Feeling Great App Team)

      Anonymous asks: How can I change an SDB (Self-Defeating Belief)? Hiranmay asks: How can I deal with my intense anxiety before public speaking.
    Answers to Your Questions

    Note: These answers below were written BEFORE the podcast, and the live discussion always adds new and different angles.

    Today, Jason Meno, our beloved AI guy on our app team, also chimes in on the many super questions submitted by Andrew (#3 - #10.)

    1. Anonymous asks: How can I change an SDB?

    Dear Dr. Burns,

    I’m an avid listener of the Feeling Good podcast and for the past few weeks, an avid user of the Feeling Great app. Thank you for your incredible work and dedication to making people everywhere feel better about themselves.

    I have a question about self-defeating beliefs that I’m hoping you can address, either on the show or on your website. You have mentioned on several occasions that SDBs are the root cause of negative thoughts and consequently of negative feelings.

    Yet, to me it doesn’t feel like SDBs are really addressed enough on the podcast. There seem to only be a handful of episodes covering the topic. It also seems there is a very limited toolbox of methods to use on SDBs, almost like dealing with them is considered an afterthought. If SDBs really are the cause of it all, shouldn’t the primary focus be on defeating them first and only then, on defeating negative thoughts?

    I’m just a little bit lost when it comes to defeating SDBs, which seem to be way harder to deal with than negative thoughts. Any insights or thoughts on the subject will be greatly appreciated.

    Sincerely,

    Anonymous

    David’s reply

    Dear Anonymous,

    Will start a new Ask David with your excellent question. Thanks,

    david

    First, you can look up Self-Defeating Beliefs in the search function on my website, and you'll find many great examples. Here's what I got just from "Self-Defeating Belief." You could also search for a specific type, like Perfectionism, Perceived Perfectionism, Achievement Addiction, Love Addiction, Approval Addiction, Submissiveness, etc.

    In general, there are two approaches to any SDB. Four approaches can be used in this order:

        Do a Cost-Benefit Analysis of the SDB. If Disadvantages outweigh Advantages, use Semantic Technique to modify the SDB. Do an experiment to see if the SDB is actually valid. Use the Feared Fantasy Technique to put the lie to the SDB at the gut level.

    Here's our latest thinking, which is a step beyond the four steps above. Do a Daily Mood Log on one specific moment when you were struggling with your SDB. We will discuss these ideas in greater depth on the show, of course!

    You can also find a great deal on SDBs in my books, like Feeling Good, the Feeling Good Handbook, and more. But right now, I don't even know what SDB you might want help with / more information about.

    Also, in the Feeling Great App, there's a terrific class called "Your PhD in Shoulds." It includes a lesson on perfectionism.

    2. Hiranmay asks: How can I deal with my intense anxiety before public speaking without working on the negative thoughts I have afterwards, like

    “I am going to mess this up” “People are going to notice something obviously wrong in my presentation that I missed, and I will look like a fool.“ “This talk is important, it must go well!

    Here’s his email:

    Dear Dr. Burns,

    I love your books and the feeling good podcast. They have made such a huge difference in my life (in a good way of course).

    I have an “ask David” question on acute anxiety:

    If I have to play a badminton match or give a presentation, I usually get some or a lot of anxiety the day before the big event as well as the morning of. I then use all the methods you have taught, and the anxiety reduces. However, it usually comes back with a bang just before I give the talk or play a match. Cognitive techniques are not very helpful to me 30 minutes or 5 minutes before the presentation or match. I don’t have the time to sit down and write my thoughts or cannot focus at all on my thoughts. Are there any strategies to reduce this form of acute “relapse” or nerves.

    Here are some more details:

    Event: 30 minutes before my presentation. I just entered the seminar room, and the first speaker is about to start their talk. I am next. I can feel my heart starting to pound and I am getting the familiar sense of anxiety and nerves.

    Thoughts: “I am going to mess this up”. “People are going to notice something obviously wrong in my presentation that I missed, and I will look like a fool“. “This talk is important, it must go well”.

    Although to be honest, this is my analysis of what my thoughts were after the fact. 5-15 minutes before the presentation, I usually just notice my thoughts racing.

    To reiterate: I am not looking for help with working on these thoughts after the presentation. Any strategies to acutely deal with anxiety or rather relapse of anxiety when I don’t have time to use all the wonderful TEAM tools would be very helpful.

    Thanks so much.

    Best,

    Hiranmay (pronounced he-run-may) living in Basel, Switzerland.

    David’s Reply

    Sure, as a starting point I’d like to see your work with these thoughts on a Daily Mood Log. Do you have one that you could send me, with the percents filled in, etc.

    That will allow me to see what your strategies are on challenging these thoughts, and whether you can knock them out of the park, or only challenge them “somewhat.”

    Best, david

    You can see Hiranmay's excellent DML if you check here.

    David Continues

    Hi Hiranmay,

    It sounds like are not interested in help with the thoughts you recorded in your email below, since this, by definition, is “after the presentation.” If you like, you could perhaps “make up” some thoughts you might be having BEFORE you start to speak.

    As someone who has had, and recovered from crippling public speaking anxiety, I have tons of powerful techniques, but would need some help from you so I’ll have something to go on.

    By the way, I absolutely DO NOT BELIEVE you when you say those are not the thoughts you are having in the minutes before you begin to speak! So, your requirement that we are not allowed to work on them is a bit of a hindrance.

    As an aside, I will include this in an Ask David podcast, if that is okay!

    Sincerely, david

    I asked H to send me a copy of his Daily Mood Log, which was really well done, and responded with a few suggestions.

    Then I sent this note:

    David’s Subsequent Response

    One thing I noticed on your Daily Mood Log is your fear of making a mistake, or having a critical question from someone in the group, or not being able to impress your audience sufficiently. These fears are common in public speaking anxiety. We've all struggled with them at one time or another, I think!

     I have changed my focus from needing to impress the audience with myself or my talk, and instead I try to remember to try to impress them with themselves, and how awesome they are.

    Here's an example. I once gave a presentation on the serotonin theory of depression for about 1,000 psychiatrists at a prominent medical school in Texas. It was going well and suddenly a man at the rear stood up and started shouting something like this:

    “I’m so sick of all you establishment researchers thinking you know so much and ignoring my work. I have discovered the cause and cure for depression in my laboratory. (He claimed it was some kind of vitamin deficiency.) But everyone is ignoring my work (and more ranting and raving.)

    There was a chilled silence in the room. Here’s how I responded:

    “I appreciate was you’re saying, and I agree. I think our current focus on deficiencies in brain serotonin is extremely misguided, and predict, as you say, that research will show that the chemical imbalance theory of depression is not valid. And often, the most important breakthroughs come from laboratories like yours, where someone who is unknown discovers the actual cause of an illness after being ignored for years and years. I’d be honored if you’d approach me at the end of my talk so I can learn more about your pioneering research!”

    Notice I did not defend myself, but tried to make HIM feel good.

    At the end of my talk, about 20 or more people came crowding up to the podium with questions and such. I saw him at the back of the group, pushing his way to the front. I braced for another attack. He said,

    “Dr. Burns, that was the best presentation I’ve ever heard by far on the serotonin theory of depression. If you would give me permission, I would love to show your slides to my students and colleagues!”

    I have very little fear of being attacked by people in the audience, and I now speak all the time in front of groups. I used to have paralyzing public speaking anxiety. But the monsters I feared were all in my brain!

    Warmly, david

     

    Andrew asks 8 cool questions! (#3 - #10) which are listed below, along with my answers. Jason Meno also sent some awesome answers, which you'll find below as well, right after my answers to the 8 questions.

     

    Mon, 21 Oct 2024 - 1h 16min
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