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 The Disarming Technique (finding truth in the criticisms), Inquiry (ask for more information with a spirit of curiosity) Thought and Feeling Empathy (acknowledging how the critic was thinking and feeling) “I Feel” Statements (sharing feelings like sadness, shame, and loneliness in an open, respectful way) and Stroking (expressing positive regard for the critic, even in the heat of battle). 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 Unhappiness dropped from 40 to 0 Anxiety dropped from 100 to 5 Shame went from 85 to 0 Worthlessness dropped from 95 to 0 Loneliness fell from 100 to 10 Self-consciousness fell from 8 to 5 Hopelessness fell from 100 to 5 Stuck and defeated fell from 100 to 0 Resentment fell from 90 to 0 Disappointed in myself fell from 100 to 0 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. Orly's Daily Mood Log. End of Part 1 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. Error #1: The Quiet Out Trap 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. Error #2: The Escalation Trap 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. Error #3: The Mental Filtering Trap 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. How to Teach Parents 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. Dr. Tom's beloved pal   Start of Part 2 A = Assessment of Resistance 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? The Positives in My Negatives 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. M = Methods 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. Part 1 of the work with Tom T = Testing 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! E = Empathy 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: Positive Reframing of his negative thoughts and feelings following the initial E = Empathy phase of his session. Externalization of Voices Survey Technique Self-Disclosure (vs hiding) of his negative feelings of insecurity 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! End of Part 1 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..     Part 2 of the Jessica Session A = Assessment of Resistance 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: SADNESS 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 show that I’m responsible motivate me to complete tasks help me avoid procrastination make me vigilant and protect me from danger SHAME These feeling show that I’m concerned about others I’m human I want to please others with my career I admire my mom and want to make her proud I want her to admire me I’m humble I want to feel close to others ANGER These feelings show that I’m a caring and passionate person I have character I have a moral compass I’m feisty and strong I’m accountable My anger also empowers me 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: Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, unhappy 90 20   Foolish 100 0   Anxious, worried, nervous 90 10   Discouraged 97 5   Bad, ashamed 95 0   Frustrated, stuck, defeated 100 5   Inadequate 90 0   Angry, mad, resentful, annoyed 95 10   Lonely 92 5   Other         Then we went on to M = Methods 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. Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, unhappy 90 20 0 Foolish 100 0 3 Anxious, worried, nervous 90 10 0 Discouraged 97 5 0 Bad, ashamed 95 0 0 Frustrated, stuck, defeated 100 5 10 Inadequate 90 0 0 Angry, mad, resentful, annoyed 95 10 5 Lonely 92 5 0 Other         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.. Part 1 T = Initial 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. Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, unhappy 90     Foolish 100     Anxious, worried, nervous 90     Discouraged 97     Bad, ashamed 95     Frustrated, stuck, defeated 100     Inadequate 90     Angry, mad, resentful, annoyed 95     Lonely 92     Other         As you can see, these negative feelings were all incredibly intense. E = Empathy 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. Dr. Jacob Towery 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 Shyness in social situations Public Speaking Anxiety Performance Anxiety Test Anxiety 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:   Healthy Anger Unhealthy Anger You treat the other person with respect, even if you’re angry. You want to put the other person down. Your goal is to get closer to the other person. You want to get revenge or hurt or humiliate the other person. You hope to improve the relationship. You want to reject or distance yourself from the other person. You want to understand the other person’s mindset and find the truth in what they’re saying, even if it sounds ‘off’ or ‘disturbing’ or offensive. You want to prove that the other person is ‘wrong’ and persuade them that you are ‘right’. You want to understand and accept the other person. You insist on trying to change the other person. You express yourself thoughtfully. You express yourself impulsively. You come from a mindset of humility, curiosity, and flexibility. You come from a position of moral superiority, judgement, and rigidity. You are patient. You are pushy and demanding. Optimism that things can improve and that there’s a great potential for a more meaningful and loving connection. Hopelessness and feelings of certainty that things cannot improve. Open to what I’ve done wrong and how I’ve hurt you. Focus on what you’ve done wrong and how you’ve hurt me. I-Thou mindset. I-It mindset. You’re vulnerable and open to your hurt feelings. You put up a wall of toughness and try to hide your vulnerable true feelings.. You look for positive motives, if possible, and don’t assume that you actually understand how the other person is thinking and feeling.. You attribute malignant motives to the other person and imagine that you can read their mind and know exactly why they feel the way they do. You accept and comprehend the idea that you can feel intensely angry with someone and love them at the same time.. You may believe that anger and love are dichotomies, and that conflict and anger, in some way, are the ‘opposite’ of love or respect.. 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 12 GOOD Reasons NOT to Empathize 12 GOOD Reasons NOT to Share your Feelings 12 GOOD Reasons NOT to Treat the Other Person with Respect. 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. When Therapy Doesn’t Work-- And How to Get Unstuck (for Therapists and Patients)  By David Burns, MD 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 Depression is not addictive because in depression you are thinking I am no good, and you have negative and painful distortions about yourself. Anger, in contrast, is addictive because you are directing the distortions at other people, telling yourself that they are no good, and they will never change, and so forth. These distortions directed at others trigger feelings of moral superiority and those feelings are intensely 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. Distortions directed at others are key in conflicts with friends and loved ones as well as racial and religious hatred, and war and violence. 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. Anger CBA What are the Advantages and Disadvantages of feeling intense anger at the other person. Blame CBA What are the Advantages and Disadvantages of blaming the other person for the problem. Relationship CBA 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: Truth was on his side People are too entitled, making demands on other people. The patient has a strong value system and was willing to put everything on the line for his beliefs He was willing to show his true feelings. And many more. 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 All-or-Nothing Thinking: Seeing the other person as a total loser. Overgeneralization: Generalizing from a negative moment or characteristic and seeing them in an entirely negative way based on this one negative habit, or feature they have. We all have features that are not likeable. WE generalize from the person’s actions to their SELF. You think the person is bad. Mental Filtering: Noticing and focusing and all the things about the other person that you find offensive. Discounting the Positive: Ignoring the person’s positive qualities, or telling yourself that they’re fake or don’t count. Mind-Reading You imagine the other person’s motives. When you feel angry you nearly always attribute malignant motives to them. Sometimes there are some truths and other times there are no truths. Fortune Telling: Telling yourself that the other person will never change. Magnification and Minimization: Exaggerating the other person’s “badness” and minimizing their good qualities. Emotional Reasoning: I feel angry at you, therefore, you are scum and I want to get back at you. You must be very bad. Labeling: We label someone as a terrorist as if the person’s entire person can be reduced to a label. There are terrorist actions but…a terrorist can be considered a freedom fighter by someone else. Shoulds He shouldn’t be like that. She shouldn’t have said that. Other Blame: Telling yourself the other person is to blame and that you are the innocent victim or their badness. 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 Explain the Distortions Externalization of Voices with Acceptance Paradox, Self-Defense, and Counter-Attack Technique Semantic Technique for Should Statements Forced Empathy Positive Reframing of the other persons feelings and behaviors Individual / Interpersonal Downward Arrow Examine the Evidence How Many Minutes Technique Paradoxical Double Standard Many more 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 E = Empathize using Listening Skills A = Assertiveness—Sharing vs attacking with your anger R = Convey Respect The RJ Requires insight, communication skill, and the painful death of the “self” Examples: Why does my husband constantly criticize me? Why are men so critical? Why does my wife treat me like crap? Why can’t men express their feelings? 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: Approaching a scary, abandoned house Watching a scary movie about ghosts 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. Outcome Resistance. Reasons clients may not want the change/outcome they are asking for. Or to put this in simple words, anxious patients may not want to let go of their anxiety, fearing something bad will happen. You can use the WHAT IF technique to get to their outcome resistance. What are they the most afraid of? What’s the worst that might happen? Process Resistance. What will I have to do that I don’t want to do? 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. Are you going to start that again? Or don’t start that again! Why are you back peddling again? You just want to rest on your laurels. Why are you doing this to me again? You’re going back on your word. 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. Are you going to start that again? Or don’t start that again! 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

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. David and Rhonda are grateful that Matt can join us often on the podcast.

Shoulds and More with our Beloved Fabrice! Three little words that will make your life miserable are “shoulds,” “wants,” and “needs,” says Dr. Fabrice Nye, the father / creator of the Feeling Good Podcast several years ago. But for the purpose of this episode, we’ll add a fourth word, “Musts,” which was popularized by Dr. Albert Ellis, who referred to it as “Musterbation.” Fabrice says that, “Shoulds are a trap. . . . There’s no such thing as a should, except for the laws of nature. For example, if I drop my pen, it “should” fall to the floor because of the effects of gravity. And sure enough, it does! “But when I say, ‘I should get an A on my upcoming exam,’ i may just be setting myself up for frustration. That’s because there’s no laws of the universe saying that people will always get As on their exams. "Similarly, if I say it SHOULDN’T be raining today, I'm involved in fiction, not reality. The clouds don’t obey our whims, they are just obeying the laws that govern the weather.” Fabrice explained that when you apply shoulds to some past event, telling yourself that your shouldn’t have made some mistake, you just make yourself guilty because it sounds like you’re scolding yourself. Again, you’re living in some fictitious reality where things are always the way you want them to be, because it’s impossible to change the past Fabrice reminded us that the Anglo-Saxon origin of the word, “should,” is “scolde.” So when you “should” on yourself, you’re actually scolding yourself. Fabrice also explained that the concept of “needs” can also get us into emotional hot water, since we sometimes tell us that we “need” things that we may want but don’t really “need.” So, if you tell yourself that someone “needs” to do something for you, you are simply applying pressure to the situation. For example, you might want or prefer for the person to be on time for appointments or planned activities, but you don’t “need” them to be on time. Similarly, you might want to find someone to love, or someone to love you, but you don’t “need” love, according to Fabrice. . . . and David agrees! It has been shown in research studies that infants and young children need love to grow and develop in a healthy way, but love is not an adult human need. According to the Buddhists, “needs” are not real. They’re just cravings, or intense desires that we’ve elevated to some godly state. Of course, there ARE things that we really do “need.” For example, we “need” to breathe to stay alive, and we “need” to have gas in the car if we want to drive to San Francisco. Those things are needed to fulfill a particular goal. So the key to an actual need is adding the phrase, “...in order to...” Fabrice also described some “want” traps. For example, you may sit at your computer cruising the internet or playing digital games, all the while telling yourself “I really want to get to work on my paper,” or taxes, or whatever. But in point of fact, you DON’T want to get to work on the thing you’re putting off. You WANT to be doing exactly what you are doing. Fabrice explains that we “trick ourselves into thinking we want something (like doing our taxes) when we really want to be doing something else (watching TV, playing computer games.) So, once again, we are telling ourselves stories that don’t map onto reality." Our real “wants” are the result of an unconscious cost-benefit analysis we make in our head, where the choice that comes out on top is our real want. It’s only when I really start doing my taxes that I’ll know this is what I want to be doing (probably because the urgency of the matter made the cost-benefit analysis tip in that direction). David was trying to see if this concept of “wants” can be helpful in therapy but had trouble seeing how this might help someone who’s procrastinating. Fabrice explained it like this: First, we need to realize that we are doing what we want in the moment; so, it’s a choice. Next, we can make our cost-benefit analysis conscious and see that we’re only considering short-term factors (e.g., it’s a lot more comfortable right now to be watching TV than doing taxes). Finally, we can develop some empathy for our future self (the one who will be pulling an all-nighter three weeks from now, or who will have to pay late fees) to reevaluate our cost-benefit analysis with more complete data. Fabrice also explained that procrastination can sometimes be difficult to treat because it’s an addiction. Rhonda also commented on the use of these concepts in therapy. Fabrice concluded the podcast by saying that he watches out for those three little words in his own thinking: “should, need, or want.” Thanks for listening today. Fabrice, Rhonda, and David  

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.  Zane Pierce Rhonda, as usual, starts the podcast with a wonderful email from Andrew who really enjoyed Podcast 357, on what David learned on the streets of Palo Alto in the wild and wonderful latter half of the 1960s.  Then Angela described her Journey to Delight, which may be silly and goofy, or wonderful, or perhaps a little of each. She was inspired by a podcast interview she heard with Ross Gay, who wrote the popular Book of Delight, a book of ultra short essays he wrote every day for a year, starting on his 42nd birthday, describing “common place” things he noticed that were amazing, inspiring, or delightful. An example was noticing a weed with a beautiful flower growing out of a crack in an ugly piece of concrete.  Then Angela noticed that she felt “neutral” during and after a pleasant family hike on a pleasant and beautiful day, with the people she loved. She asked herself, “Why did I only feel neutral? And can something be done to cultivate greater delight and joy in our daily lives?  She asked herself, “I want to be more open to delight in my life—is it possible to cultivate delight? And if so, how?” She reasoned that since we have more than 100 TEAM-CBT to reduce and eliminate negative feelings, like depression, anxiety, shame, inadequacy, and even anger, couldn’t we create some methods for boosting positive feelings? Could we focus, for example, not just on how to challenge and crush our negative internal dialogues, but also on how to cultivate more positive self-talk? Can we “elevate” our more neutral moments. In order to set the agenda, she did a Cost-Benefit Analysis during one of her Thursday morning training groups with the therapist at FGI. She asked David, Rhonda and Zane to list some really GOOD reasons NOT to try to cultivate greater delight in our lives, including: People who are hurting and struggling need compassion. It’s important to see the truth and reality of the negative realities we confront every day in our personal lives as well as on the news. Negative feelings can motivate us to work hard. Negative feelings and self-criticisms often show that we have high standards and humility. And many more.  She encouraged us to list the reasons to focus on the beautiful and awesome things we sometimes ignore or overlook going on all around us all the time, including: the possibility of feeling more joy, slowing down in life, and being more present in the moment. Angela described an informal experiment she set-up to i see if adding positive self-talk to otherwise neutral activities could increase delight. Forty two therapists participated in small groups of four to do some shared activities, while some completed the activities solo. Participants completed my 5-item Happiness Scale as well as a sixth item measuring feelings of “delight” prior to and after the experiment.  The experiment was simple—engage in a neutral or common place activity. The key variable was to actively add positive self-talk to the activity. And of course there was a requirement that the positive self-talk has to be 100% true (e.g., can’t lie to yourself or say fake positive things).  In the small group, Zane and Angela walked through a park and several participants decided to swing on the park's swing set. Their positive self-talk motivated them to try out the swings, which was quite “delightful.” Then they walked separately, adding positive talk to their activities and observations. Zane described his “journey to delight,” noticing a sickly Giant Redwood that was struggling and nearly dead. But, he found green sprouts coming out of it, as the tree was still struggling to grow and survive. Zane also spotted a hummingbird on his walk. Adding positive self-talk to otherwise neutral activities increased his happiness score by 50% (swinging at the park and 20% (observing nature).  This was especially poignant since Zane tragically lost his beloved younger brother to suicide just two months ago. This was devastating, and one of the most difficult periods of his life. He said, “It turned my world upside down.” Our hearts go out to Zane, and we are grateful that you, Zane, could share this special time with us today, given the tragic and horrible circumstances you’ve had to face.  I have many happy memories with Zane, who used to be a faithful and beloved member of my Sunday morning hiking group. We had to abandon the Sunday hikes during the Covid pandemic, and now I’m limited in my walking due to low back pain. I hope to get the hikes going again one day.  Zane and his wonderful wife, Daisy have appeared on some of the most popular podcast episodes in the past, including # 79: “What’s the Secret of a ‘Meaningful’ Life? Live Therapy with Daisy.”  Angela shared that folks who participated alone did things like vacuuming up pet hair, commuting in the car, drinking coffee, going for a walk. Angela reported on the results of her experiment. She saw a 39% boost in happiness scores in the group of 42 individuals, and a boost of 75% in feelings of delight, resulting from the efforts to cultivate positive self-talk during the exercises. Examples of positive self-talk might include: “I have a strong pair of legs that allow me to walk.” “What a treat to take a break in my day.” “This tea smells so sweet.” For example, one of the participants generated self-talk while vacuuming dog hair for five minutes, a frequent and fairly unwelcome chore. Here are examples of her positive self-talk:  “I'm contributing to canine diversity by putting up with this shedding…. If there weren't people like me, the world would be all poodles and doodles.” “It's true that the work never gets done…And yet, even a little vacuuming is an improvement.”  “It's fun to see the fur get sucked into the vacuum and to find places, such as under the couch, where it hides.” We talked about some potential uses of “Delight Training,” as well as a few potholes to avoid. For example, when individuals are struggling with strong feelings of depression, anxiety, or anger, encouraging positive self-talk may make the patient feel worse, since it could be experienced as superficial or insensitive to the suffering. In addition, it might seem insensitive as well when working with individuals with genuinely negative or horrific life circumstances, such as homelessness, terminal illness, war, and so forth.  On the other hand, it may play a useful role in heightening positive feelings in individuals who have moved their negative feelings scores to zero, so they can do more than just overcome negative feelings like depression, but have some tools for exploring and enhancing the world of positive emotions. David described a patient vignette of a young woman who sought treatment because she wanted to have “more fun in life.” David asked her to make her therapeutic goals specific and real by asking, What time of day would you like to have more fun? Where will you be then? What would having more fun look like?” This led to a meaningful and challenging homework assignment with an unexpected and funny outcome.  Zane ended the podcast with some tips about positive self-talk. First, the positive thoughts have to be 100% true to be effective. This is also true, by the way, when countering distorted negative thoughts.  He said he is trying to turn this into more of a habit, noticing every day delightful and wonderful seemingly “commonplace” things, like something one of his two children say or do, riding his bicycle, or just taking a bite of a fresh, tasty apple.  He also explained that he is still grieving the loss of his brother, but the excursions into the more positive side of his life has provided a welcome balance.  Thank you for listening today! Angela, Zane, Rhonda, and David  

360: The Story of Indrani “Why can’t I get close to my daughter who I love so much?” Today, we present Part 2 of the awe-inspiring work that David and Jill did with Indrani in the Tuesday group at Stanford. Indrani was a mother with a heart-breaking but all-too-common story of a conflict with her daughter. Sometimes, we love someone tremendously, but every time we try to get close, they seem to push us away. The story should ring true and be helpful to so many people, as nearly everyone runs into conflicts at times with our family members, including our parents, siblings and children. And, as usual, the solution often involves attending to your “inner” dialogue, which is the conversation you’re having with yourself about the conflict, and the “outer” dialogue, which is what happens when you try to get close to the person you love. And today’s session illustrates not one, but two forms of enlightenment. The changes in the inner dialogue involves challenging and crushing the negative messages you’ve been giving yourself about h problem with the person you love so much. You can see Indrani’s Daily Mood Log if you click HERE. As you can see, she’s been telling herself that her daughter has shut her out of her life, and that she’ll die alone/ That’s incredibly sad! And she’s also telling herself that all of her friends have wonderful relationships with their daughters “and I don’t” and she’s blaming herself for the problem: “I deserve this treatment,” and “nothing I do pleases her.” You can also see the intensity of Indrani’s negative feelings, including sadness, anxiety, inadequacy, loneliness, embarrassment, discouragement, irritation, and more. You can also see a typical exchange with her daughter if you look at her Relationship Journal (RJ). As you may know, the whole theme of my interpersonal model in TEAM-CBT is that we create our own interpersonal reality at every moment of every day. In other words, we unknowingly create and cause the exact relationship problems that we complain about, but just don’t realize this, so we think there’s something wrong with the other person. But how can this be? If you look at Step 2 of Indrani’s RJ, her response to her daughter seems innocent enough! But stayed tuned, because Indrani makes a shocking and mind-blowing discovery during the session, and that discovery requires the exceedingly painful “death” of the “self.” But this “Great Death” is instantly followed by a “Great Rebirth.!” At the end of the session, a Tuesday group members named Keren, said this to Indrani: “You wowed me!” One of the men, Ed, could barely speak because he was sobbing. You may also be sobbing for joy when you listen to this heart-warming story. In part 1, today’s podcast, you’ll hear the initial T = Testing and E = Empathy. In part 2, in next week’s podcast, you’ll hear the M = Methods, including Jill and David’s incredible work with Indrani on her R and her rather sudden discovery, in Step 4, of exactly how and why she’d been driving her daughter away—and how to stop doing that and begin to communicate in a way with a far greater chance of enhancing closeness and love. The Jill and David turn to Imani’s Daily Mood Log so she can smash her distorted negative thoughts with the Externalization of Voices, and several role reversals illustrating the integration of Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique.) You can see Imani’s initial and final Brief Mood Surveys plus her Evaluation of Therapy Session, We are extremely grateful to Indrani for giving us this very intimate glimpse into her inner life in a way that will illuminate and inspire every person with the good fortune to listen to Indrani’s amazing Journey this evening! PS I emailed Indrani this morning to see how she's doing, and recevied this wonderful reply: I’m still feeling great…very light and hopeful. I’ve listened to the audio. I sound goofy at times but loved re-living the moment when the truth dawned on me and how I felt immediately afterwards. My daughter Soni ( like the Japanese electronic company :) is coming on Thursday. I would’ve been filled with intense anticipatory anxiety but now I can’t wait to give her a big hug and use what I’ve learnt to connect with her. I’m looking forward to watching the video with Soni. Thank you so much Dr. Burns and Jill! Thanks for listening! Rhonda, Jill, and David

359: The Story of Indrani “Why can’t I get close to my daughter who I love so much?” Today, we present the awe-inspiring work that David and Jill did with Indrani in the Tuesday group at Stanford. Indrani was a mother with a heart-breaking but all-too-common story of a conflict with her daughter. Sometimes, we love someone tremendously, but every time we try to get close, they seem to push us away. The story should ring true and be helpful to so many people, as nearly everyone runs into conflicts at times with our family members, including our parents, siblings and children. And, as usual, the solution often involves attending to your “inner” dialogue, which is the conversation you’re having with yourself about the conflict, and the “outer” dialogue, which is what happens when you try to get close to the person you love. And today’s session illustrates not one, but two forms of enlightenment. The changes in the inner dialogue involves challenging and crushing the negative messages you’ve been giving yourself about h problem with the person you love so much. You can see Indrani’s Daily Mood Log if you click HERE. As you can see, she’s been telling herself that her daughter has shut her out of her life, and that she’ll die alone/ That’s incredibly sad! And she’s also telling herself that all of her friends have wonderful relationships with their daughters “and I don’t” and she’s blaming herself for the problem: “I deserve this treatment,” and “nothing I do pleases her.” You can also see the intensity of Indrani’s negative feelings, including sadness, anxiety, inadequacy, loneliness, embarrassment, discouragement, irritation, and more. You can also see a typical exchange with her daughter if you look at her Relationship Journal (RJ). As you may know, the whole theme of my interpersonal model in TEAM-CBT is that we create our own interpersonal reality at every moment of every day. In other words, we unknowingly create and cause the exact relationship problems that we complain about, but just don’t realize this, so we think there’s something wrong with the other person. But how can this be? If you look at Step 2 of Indrani’s RJ, her response to her daughter seems innocent enough! But stayed tuned, because Indrani makes a shocking and mind-blowing discovery during the session, and that discovery requires the exceedingly painful “death” of the “self.” But this “Great Death” is instantly followed by a “Great Rebirth.!” At the end of the session, a Tuesday group members named Keren, said this to Indrani: “You wowed me!” One of the men, Ed, could barely speak because he was sobbing. You may also be sobbing for joy when you listen to this heart-warming story. In part 1, today’s podcast, you’ll hear the initial T = Testing and E = Empathy. In part 2, in next week’s podcast, you’ll hear the M = Methods, including Jill and David’s incredible work with Indrani on her R and her rather sudden discovery, in Step 4, of exactly how and why she’d been driving her daughter away—and how to stop doing that and begin to communicate in a way with a far greater chance of enhancing closeness and love. The Jill and David turn to Imani’s Daily Mood Log so she can smash her distorted negative thoughts with the Externalization of Voices, and several role reversals illustrating the integration of Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique.) You can see Imani’s initial and final Brief Mood Surveys plus her Evaluation of Therapy Session, We are extremely grateful to Indrani for giving us this very intimate glimpse into her inner life in a way that will illuminate and inspire every person with the good fortune to listen to Indrani’s amazing Journey this evening! Thanks for listening! Rhonda, Jill, and David

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! Blind spot, especially in relationship problems To get experience in the “patient” role Sometimes, we all need a little help from a friend, and that can sometimes be vastly faster than trying to do everything on your own. But in terms of empathy, I believe you CAN treat yourself with empathy, warmth, and compassion, and that is actually one of the keys to recovery, whether or not you’re in treatment with a shrink!   4. 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? Hi Dr. David and Dr. Rhonda, I have a question if you have a chance, and maybe this is better for an Ask David. David talks about healthy emotions sometimes, and this feels like a faint through-line to EFT model. Does David have a framework for understanding healthy emotions or emotional needs? 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. Thanks, Zach David’s Response Thanks for the excellent question. I have to confess that I don’t know much about EFT, but I think there’s a lot of overlap in different “therapies” since many people “borrow” ideas from other experts, and get so excited about them that they call them their own, and simply give them a new name, claiming to have something entirely new. And it sounds like there are some definitely similarities between my TEAM-CBT and what is called “EFT.” If this is true, I’m certain I didn’t do the “borrowing” since I don’t attend to the work of others in the field, for better or worse. At any rate, I have always taught my students that each negative feeling has a healthy and an unhealthy version, as you can see in the following table. The main difference is that the healthy version results from valid negative thoughts, and the unhealthy version results from distorted negative thoughts. However, in the past 25 years or so, I’ve taken a new look at so-called “unhealthy negative feelings” in my TEAM-CBT. There, we reframe the negative feelings, showing what’s beautiful and awesome about each one. IN other words, we genuinely try to sell the patient on NOT changing. Paradoxically, this approach, which I call Positive Reframing, seems to melt the patient’s resistance to change, and that nearly always opens the door to the possibility of rapid change. Healthy vs Unhealthy Negative Feelings Healthy Version Unhealthy Version Sadness, grief when you’ve lost someone or something you loved Depression, worthlessness, hopelessness Healthy fear when you’re in danger Anxiety, nervousness, worry, and panic, and phobias Healthy remorse when you’ve hurt someone you love Neurotic guilt, blaming yourself for something you’re not entirely, or at all, responsible for Healthy inadequacy and awareness of your very real shortcomings and limitations Worthlessness, inferiority Missing someone you love Desperate loneliness, abandonment, feeling unlovable Discouragement when you fail or when things don’t work you Hopelessness Sharing your anger in the spirit of love and respect Unhealthy anger, aggression, acting out your anger with the goal of hurting or upsetting the other person, or getting back at them   Thanks so much for listening today! Warmly, Rhonda and David  

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 Spiritual Desert experience: Sadness as celebration Dating / Relationships / R-Rated Having fun and making a movie: "Uptightness”   Part 2 (not yet recorded: let me  know if you'd like a Part 2!) More Stanford stories not yet covered: let me know if interested! 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 Medical School 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 Dr. Allen Barbour’s Medical Outpatient Clinic 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!   Here’s the Stanford group feedback from group after telling stories 1 – 5 Positive Feelings about the Training   Not at all true Somewhat true Moderately true Very true Completely true N/A 1. I felt I could trust my trainer. 0 0 0 0 17 1 My trainer paid careful attention to what I said 0 0 0 0 7 11 My trainer critiqued my work in a sensitive manner. 0 0 0 0 7 11 I felt good about the training I received. 0 0 0 0 17 1 Overall, I was satisfied with my most recent training session. 0 0 0 0 17 1 Negative Feelings during Training   Not at all true Somewhat true Moderately true Very true Completely true Sometimes I felt uncomfortable during the training. 18 0 0 0 0 Sometimes I felt defensive during the training. 18 0 0 0 0 Sometimes I felt frustrated during the training. 18 0 0 0 0 Sometimes I felt anxious during the training. 18 0 0 0 0 Sometimes I felt insecure during the training. 16 2 0 0 0 Helpfulness of the Training   Not at all true Somewhat true Moderately true Very true Completely true N/A I expect to use these ideas with patients I am now treating 0 0 2 1 11 4 What I am learning seems useful in my clinical training. 0 0 1 2 13 2 My trainer and I are working together effectively. 0 0 0 2 10 6 The training was helpful to me. 0 0 0 1 16 1 I felt I was learning and growing during the training session. 0 0 0 1 16 1 Respectfulness and Safety of the Training   Not at all True Somewhat true Moderately true Very true Completely true N/A My trainer was sensitive to potentially relevant cultural, racial, religious, age, gender, or sexual identity issues that might impact the therapy. 1 0 2 0 13 2 My trainer created a safe and warm space for all identities. 1 0 1 0 14 2 Difficulties with the Questionnaire   Not at all true Somewhat true Moderately true Very true Completely true It was hard to be completely honest answering some questions. 16 1 0 0 1 My answers weren’t always completely honest. 16 1 0 0 1 Sometimes I did not answer the way I really felt inside. 16 1 0 0 1   Please describe what you specifically disliked about the training? What could have been improved? Were there some things you disagreed with or did not understand? Nothing N/A Was too short na I'm starting to catch on to the fact that David has read more than 3 books... Nerd. :) It is funny coming from David and I believe he used it affectionally... most of use won't get away with the term "Chainaman" perhaps Asian American Loved the group tonight n/a Nothing I disliked. My answer of "somewhat insecure" from above was about my comments and whether they were helpful or "good enough." Please describe what you specifically liked about the training? What was the most helpful? Were there some things you learned? I really enjoyed learning from David's stories. Thank you for sharing these personal stories with us. I had been looking forward to the evening's stories but I didn't know emotional and impactful they would be. I was especially touched by David's & Cai's tears and appreciate how much they both shared. It had to be especially difficult to share over Zoom because sometimes it can sound flat. With most people muted it can be hard to hear the feedback from the audience but the connection still felt very powerful. I truly appreciate your openness and willingness to show your vulnerable side. Just like many others, I was deeply moved by your heartfelt tears as you shared stories about the woman you believed would succumb to cancer, your beautiful encounter with your wife Sara, and the journey of creating "Uptightness." You didn't have to let us into those deeply intimate and personal experiences, and for that, I am genuinely grateful. This was absolutely amazing! It couldn’t have been more special. Thank you Dr Burns! You are a national treasure and gift to us all. Can’t wait for the podcast so that I can re-live it exposure and being uncomfortable with adult stuff so silly but real for me I was touched by the depth of emotion David manifested in telling some of the stories, his deep compassion and humility, and the reality of celebration of sadness. I liked feeling closer to David both from his sharing deep feelings and by his telling about life events like how he met Melanie. It was cool to have stories illustrating powerful lessons and even some that illustrate the mundane (e.g. mostly not a lot happened when David spent a week disclosing every feeling). What a wonderful night. These stories brought that time period alive for me, and having not lived through that era, that was a real treat. The only thing I was surprised about, and a bit sad, was seeing that David appeared to be a little self-conscious or something. David, I hope I can reassure you that even though I was silent and didn't have any questions, you had my full attention. It was like watching a profound and entertaining movie. - Ed W I really loved hearing about the spiritual connections with others that you had, David. I also loved seeing the photos afterward and you showing us who you were talking about in your stories. What a beautiful, magical time! Some very interesting and very touching stories. Made me feel closer to the group and gave some insights into the 60s and the development of TEAM CBT That was beautiful. More and more I'm convinced therapy is art verified by science. This very human tradition of telling stories is so important to our work as therapists/people. I enjoyed this greatly. A two hour work of art I was fortunate enough to have experienced. Thank you, much love. It was mesmerizing and holy God listening to the stories now I understand how he could have come up with such an amazing Tool It was lovely to travel back in time and get snap shots of David's live in the 60s. I appreciated the tender moments of sadness and also the spiritual mystical moments. I like David even more knowing that his calling was to council people, and the journey he has taken to become a conventional healer. It is an honor to be part of this training, almost feels like a type of lineage. I mostly found it just very enjoyable and fun and salacious. But I also liked the tears and the parts about people hiding their suffering and how we all really suffer but often have a hard time showing it. That was beautiful. Fabulous! How wonderful to learn more about David, learn about his "weird" past and shadow side, and share in his authentic expression of intense feelings. He really opened up and it did make me feel closer to him! The desert story was inspirational to me, and Cai's story as well...I, too, love the book Siddartha. Interesting to learn of the origins of techniques such as Externalization of Voices and Downward Arrow. Really contextualizes it for me. Not to mention bringing the "magic" of California in the 60s back to life. Thank you! Left me yearning for more! It was a spellbinding evening, and it felt to me like we were right there with you, David, in the desert seeing the multicolored clouds with our tears flowing, or at the psychodrama marathon crying for the woman who was dying, or on in a field with you and lots of naked ladies at the "Uptightness" event. And now it makes so much sense to me how your methods like EoV and the Downward Arrow all grew out of these experiences you shared with us tonight of tapping deeply into that River of Emotions that you talk about. Thank you, David, for sharing this with us! Seeing David’s tears. Love him even more. Learned so much from the stories I liked this evening very much. I felt very close to you, David, and to the others who shared, and I felt honored to be a part of it. There were so many good stories. I think your story of being in the desert and the woman suddenly giving up drinking might be an example of a powerful prayer-- I know it sounds pretty goofy and I would have thought so too when I was an atheist not long ago, but I've had some experiences that have really led me to believe some seemingly goofy things. Please describe what you learned in today’s group12 responses It was such a moving & emotional evening filled with incredible stories, some of which seem too wild to be true but you certainly had the pictures to back it up! Even though I'd been working with the pictures they really came to life after hearing the context and learning more about the people in them. Thank you! It was terrific to hear the origin story of the greatest psychotherapy approach ever developed the founding go team cbt I learned it is unnecessary to be uptight except for cinematic purposes. We are all connected and affect each other on an energetic level I need to think about all these things for a bit to say exactly. In simple words enlightening It's important to be more raw, more open to others' suffering. But also to have fun, be wild, take chances! David's amazing stories of his experiences in the 60s. How David discovered the River of Emotions and how to tap into it. How being open minded leads to great things including connection to others in kind and loving ways Too much to say Thanks for listening today!, David and Rhonda

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 Won’t listen Does not understand me Always has to be right  Always criticizes me Constantly complains and ignores my advice Constantly brags and talks about himself / herself Doesn’t value my thinking or ideas. Is defensive and argumentative Doesn’t care about my feelings. Complaints about the other person’s lack of A = Assertiveness Cannot (or will not) express his or her feelings Cannot deal with negative feelings Expects me to read his or her mind Clams up and refuses to talk to me Won’t be honest with me pouts and slams doors, insisting s/he isn’t mad! won’t tell me how she / he is feeling. isn’t honest with me. suddenly explodes for no reason, out of the blue. Complaints about the other person’s lack of R = Respect Always has to get his or her way Is stubborn Is controlling Does all the taking, while I do all the giving Uses me Puts me down Is judgmental Does not care about me or respect me Only cares about is himself / herself Constantly complains and ignores my advice. Explanation. When you are using the Relationship Journal, you will usually have a complaint about the other person. For example, you may complain that she or he “never listens,” or “is always si critical,” or “constantly complains but never listen to my advice.” If you write down one thing the other person said in Step 1 of the RJ, and exactly what you said in Step 2, you can usually easily analyze your response with the EAR Checklist. That shows what you did wrong, and why your response was ineffective. You can also use the Bad Communication Checklist to pinpoint your communication errors, and some people prefer this format. In Step 4, you go spell out precisely why your response will FORCE the other person to keep doing the exact thing you’re complaining about. One easy way to conceptualize the nature of your complaint about the other person is with our convenient EAR algorithm. This document can help you “see” the problem you’re complaining about when you do Step 4 of the RJ. That makes it much easier to discover exactly how you are triggering and reinforces the exact problem you’re complaining about. LMK what you think! Clay writes: Hello David, I know you no longer practice, but could I please get an opinion from you on EMDR? So far I have done about six sessions of EMDR and I feel worse than when I began. Does one typically feel worse before one feels better with EMDR? I know you are for Team CBT, and I think it has a lot of merit and science behind it! It just seems a little magical to me that by alternately tapping that I am going to resolve traumas or anxiety issues that happened a long time ago and maybe even recently, but I am going into it with an open mind and the possibilities. Best to you and your family, David, and thank you for the revolution in cognitive therapy you started with Aaron Beck and Albert Ellis! Kind regards, Clay Wilson Hi Clay, I’ve never been an EMDR enthusiast. To me, it’s just cognitive exposure, which definitely can have value in anxiety, coupled with “eye jiggling.” Many of it’s proponents seem to think that they have found the holy grail, and I have no doubt that a few will slam me for me non-supportive response! And please remember that I’m a cynic, so take it with a grain of salt. In TEAM, we use more than a hundred M = Methods, and only after doing the T, E, A steps, which are absolutely crucial to success in most cases. Best, david PS I’m copying Rhonda and Matt. If we used your question on an Ask David, would you be open to that, with or without your correct first name? Happy to disguise your name. David D. Burns, MD Dear David, I greatly value your ideas and that you are a cynic. In 6 sessions of the EMDR, I have not felt any better. You are absolutely free to use my name and you don't need to disguise it at all. I live in Columbus, Montana and as far as I know, there is only one person in Bozeman who does Team CBT. I sent her an email but didn't hear back but it's 100 miles from us anyway. Thank you very, very much for your view on EMDR! I was thinking something similar myself. All the very best to you and your family! Most Sincerely, Clay David’s Response HI Clay, You’re welcome. My website is full of free resources, anxiety class, depression class, more than 300 TEAM podcasts, and more. My book, When Panic Attacks, is pretty cheap in paperback. Also, beta testing of thee Feeling Good App is still free. T = Testing, E = Empathy, A = Addressing Resistance, and M = Methods (more than 100.) A is likely the most important step! Thanks, best, david Matt’s Response Hi Dan and David, My guess is that EMDR showed some early results due to the tendency of most therapists to avoid exposure techniques and try to 'smooth over' anxious thinking and trauma, rather than just dive in and explore it, fearlessly. I suspect this created a large cohort of anxious and traumatized patients, waiting in the wings, for such treatment, so it showed immediate favorable data. However, this method is only one of dozens, and the setup is key. Why would you want to overcome something traumatic? Wouldn't it be more useful to remember it and avoid anything that resembles it? Meaning, there may be powerful methods, including exposure and (usually) less-effective methods, like 'eye-jiggling' and other distraction techniques out there for anyone, but why bother with these if the symptoms are helpful and appropriate? This is the main idea in TEAM . People recover when they want to recover, not when someone applies the correct methodology. -Matt Hi Dan, David, and Matt:  In addition to being a TEAM therapist, I also practice EMDR.  I find it to be very effective, especially when used within the TEAM structure.  It may not be for everyone, but it's great to have many options for our clients. -Rhonda  David’s comment. Yes, and here Matt’s is pointing out some of the paradoxical “Outcome Resistance” strategies we use with anxious patients when doing TEAM therapy. We become the voice of the patient’s resistance to change, and verbalize all the really positive things about the anxiety symptoms: how they protect us from danger and express our core values as human beings. Paradoxically, this often reduces resistance and opens the door to change. In TEAM, we treat the human being with systematic TEAM therapy. We do not treat symptoms with techniques. The meaning of this may be hard to “see” if you haven’t seen or experienced it. But there are a large number of actual therapy sessions your can listen to in the podcasts. Best, David Thanks for asking such terrific questions and for listening! We all greatly appreciate your support. Keep your questions and comments (negative as well as positive) coming! Rhonda, Matt, and David

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   We finished today’s podcast with some entertaining role-playing exercises, using the Five Secrets of Effective Communication in interactions with extremely difficult individuals. This gave me the chance to role-play some incredibly obnoxious and practically impossible to please. My favorite role! Enjoy! Warmly, Rhonda, Matt, and David

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 free 5-secrets practice groups groups that focus on changing habits groups that practice a variety of TEAM tools a book club focused on When Panic Attacks and more! All these groups are free and open to anyone worldwide. To see the growing list, go to https://www.feelinggreattherapycenter.com/free. This list is invaluable, and check the link from time to time because the offerings will likely continue to expand. Keep in mind that these are NOT therapy groups, but layperson-led self-improvement groups. Brandon and Rhonda remarked that these free groups are part of a heart-warming movement which continues the culture of generosity that David has created, starting with David’s decades-long free weekly training groups for mental health professionals. The new self-help groups also carry the spirit of relating to others with deep empathy. The goal is to create an atmosphere of giving and support in mutual healing. A second goals is to learn to appreciate each other despite our differences. And so, the ripples that David has created continue to spread, and you can become a part of this process! Nicholas Santascoy is a research psychologist, academic coach and learning specialist who discovered Feeling Good in 2005.  He found it tremendously helpful and years later, began working with a TEAM therapist who suggested Brandon’s Book Club. When the book club reached the Daily Mood Journal section, he asked if he could start a free DMJ practice group, which he did, and it’s still going on each week, more than two years later. He was thoughtful about the group’s structure, making it clear to the participants from the beginning that he is NOT a therapist and that this is not therapy. It is simply a place to practice TEAM with support – an important disclaimer for any non-therapist running a practice group. In his groups, each person spends 10 minutes at the start working on some common task, like describing an upsetting event for a Daily Mood Log, or suggesting positive reframing for a negative thought or feelings, and so forth. Or they might go through a sequence starting with one negative emotion, one negative thought, one cognitive distortion, one positive reframe, and one positive thought. His group has also worked with the exercises described in the two free chapters on habits and addictions offered at the bottom of Dr. Burns’ website. Nicholas described working with a man with intense performance anxiety who had an upcoming job interview with a panel of eight individuals who were evaluating him. He was intimidated and anxious, but reluctant to give up his anxiety for a number of reasons. First, he was convinced that if he didn’t worry, he wouldn’t prepare effectively. In addition, he was convinced that he needed anxiety to do his best during the interview. Nicholas encouraged him to test these beliefs with experiments. He discovered, much to his surprise, that he was still strongly motivated to prepare for the interview when he was feeling relaxed and confident. He also recorded his interview and reviewed it afterwards. He was surprised to discover  that his best performance during the interview was when his anxiety had dropped to zero. Ana Teresa Silva is a Portuguese veterinary doctor who decided she wanted to work with people and became a coach in 2020. Ana Teresa developed a free Portuguese Five Secrets practice group in May of 2021. This quickly became an international group in English, free and open to anyone, and ran for two years and got rave reviews from participants. After that, she handed over the leadership to Linda Roth, M.Ed. This kind of group, in my (David’s) opinion is incredibly important because learning the Five Secrets is a lot like learning to play the piano. It’s possible to make beautiful music, but the Five Secrets are challenging to learn. Practice, combined with humility and the intense desire to learn, are the keys to learning and personal change. Patricia O’Neil, a former schoolteacher, loves David’s books like Feeling Great, When Panic Attacks, Feeling Good Together and more. Patricia experienced a very severe, prolonged and immobilizing depression, and tried ALL of the standard medical treatments, even including electroconvulsive therapy, but her depression continued. She then started reading Feeling Great and joined Brandon and Heather’s Feeling Great Book Club in 2022, and began to pull herself out of depression.  After several weeks she asked if there was a group for people who want to work their way through the book together in-between Book Club meetings, perhaps even daily, to “apply the strategies the best we can.” Brandon encouraged Patricia to start her own study group. She did! And not only that, she started many other groups as well – all completely free - including a When Panic Attacks Book Club, her daily Daily Mood Journal group, an eating healthy accountability chart, a coaches in training group and her own free advanced Five Secrets Practice group for people who have completed a Five Secrets Deep Dive series. Several of the participants in today’s podcast had anxiety about being on the podcast. Patricia generously volunteered some of her negative thoughts, including: I might not do well. I’m gonna mess up! Brandon might regret asking me to join the group today. My flaws and imperfections will be on display. She said that these thoughts contained many of the familiar cognitive distortions, such as Fortune Telling, Magnification, and Should Statements, to name just a few. She also described some of the strategies she used to challenge these thoughts, including these positive thoughts: The whole future of the world doesn’t depend on how well I do today! I probably WILL mess up, and that’s okay! Then she bravely and tearfully described her own battles with depression since her retirement several years ago, and her gratitude at having found so many skills to deal with negative mood swings more effectively. Her comments were touching and inspiring, and actually embodied the goal of the practice groups that are rapidly emerging. The goals including: provide a structure for free ongoing practice and learning give individuals around the world the chance to join the emerging community of TEAM enthusiasts provide opportunities to connect with others in the spirit of openness, acceptance, and compassion. Most humans are hungry, even desperate, for love, learning, and relief of suffering, along with a connection with others who also care. Brandon and his many fans and colleagues are transforming this idealistic vision into a practical reality. At the end of this moving interview, Brandon mentioned a number of additional groups that are rapidly forming including two Signal text groups created by Derek Gurney. “Mission Accomplished or Refused,” is a place to “report on plans to tackle aversive tasks” and take accountability – which is an effective tool for changing habits. He has also created an  “Exposure Celebration” class, which sounds like a terrific chance to do exposure with the support and reinforcement from others. This is something tremendously helpful for people struggle with all types of anxiety. Again, please click here to see more information about these wonderful and completely free Grassroots TEAM CBT groups! And if YOU have a free TEAM practice group you’d like to start or have started and want to add to the list, please email Brandon Vance, MD (brandonvance@gmail.com). In fact, I’ve always dreamed of free self-help groups for mood problems, with much the same spirit of lay healing you find in Alcoholics Anonymous. And now, in my old age, it is tremendously encouraging to see this happening. I have to pinch myself, in fact! Thanks, Brandon, Nicholas, Ana Teresa, and Patricia! Warmly, David and Rhonda  

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.” Self-Directed Should Statements. Lee appears to believe that he “should” be able to explain his thinking to any patient. He wants to convey respect, responsiveness, and care when denying a request. This is, of course, an expression of his high standards, his compassion, and his desire to communicate clearly to his patients. But, as is so often the case, Lee takes this goal a little to far, think he should “always” be able to do this, regardless of how psychotic or confused or demanding a patient might be. Essentially, the healthy pursuit of excellence as a psychiatrist has gone a little too far and has arguably morphed into a self-defeating kind of medical perfectionism. Self-Directed Shoulds typically trigger feelings of guilt, shame, anxiety, and inadequacy. They are often accompanied by several other distortions, including All-or-Nothing Thinking, Mind-Reading, and Self-Blame, to name just a few. Other-Directed Should Statements. Lee appears to think that his patients “should” understand and acknowledge his thinking if he’s being reasonable and realistic. He may also believe that if he’s doing his best, then his patients “should” argue fairly and acknowledge when they understand what he tells them and “shouldn’t” be manipulative, unreasonable or argumentative. Other-Directed Shoulds often trigger feelings of frustration and anger, and are often associated with All-or-Nothing Thinking, Mind-Reading, Emotional Reasoning, and Other-Blame, to name just a few. Another teaching point is that we nearly always create our own interpersonal reality, but we don’t realize that because we feel like victims and see the problem as coming from outside of ourselves. Lee’s urge to continue to try to “win” the arguments with patients actually forces them to keep arguing their case and trying over and over again to get their way. That’s just human nature. We’ve all seen that people can be pretty obstinate and determined to get their way, no matter what. That’s why a focus on what you can do to change will often lead to a change in other people; in contrast, repeated efforts to persuade them to change is almost never effective. By way of analogy, my wife and I have recently had a bit of a problem with our cat, SweetiePie. She was a rescue cat, and we love her to death, and do everything we can to make her happy. She loves us intensely and shows her gratitude with loud purring almost all day long when she’s not asleep or out in the back yard exploring. BUT, she has been pestering us for cat candy, and has gained too much weight. Here’s what happens. She jumps up on my desk, and puts her paw on my keyboard, and stands if front of the computer terminal so I can’t see. So, I give her two or three pieces of cat candy on her perch next to me. She jumps up and greedily devours it. Next, she jumps back on the desk and puts her paw on the keyboard. I “explain” to her that she’s eating too much candy, and try to put her back on her perch, so she swats me with her claws and draws blood if I’m not quick to pull my hand away. So, I give her a few more pieces of candy, which she devours and then goes to sleep. Similar routine with my wife. She follows her, crying like she’s on the verge of death, and swatting at her ankles until she gets cat candy and / or a 30 minute lap snuggle. So, in short, we have been “forcing” her, inadvertently,  out of love, to manipulate us for cat candy. In other words, we “reward” her manipulations by giving her cat candy and love. As a result, our pour girl is gaining too much weight. Of course, the solution is simple. Melanie has agreed to give her only four pieces of cat candy per day, and I am limiting her to two pieces, just so she’ll know she’s still loved. And when she tries to swat me with her claws, I just explain in a kindly way that I don’t like that and put her on the floor. She caught on right away and seems to have accepted the new routine. Of course, we continue to give her abundant helpings of love every day, many times a day, as the love has zero calories! So, what’s the bottom line? If you’re trying to learn the Five Secrets of Effective Communication, and you want to change the way you communicate with others, remember to attend to your Inner Dialogue, as well as what you are actually saying to the other person during the conflict, especially if you’re getting anxious, defensive, angry, frustrated or upset. If you write down your negative thoughts, I think you’ll find many similar distortions to the ones described above, and this can give you another handle on change the way you think, feel, and connect with the people you care about, as well as the ones you don’t! Incidentally, the belief that we are separate from others and from our environment is the essence of evil, according to some Buddhists, and perhaps nearly all of the world’s religions have had similar beliefs, though couched in different language. But what this means to me is that when we struggle with friends of loved ones, and we are locked into frustrating conflicts, we typically feel like we are “separate” from the other person who is “doing something” to us. And this perception can not only trigger anger and frustration, but sometimes even violence. As humans, we seem to have great difficulty “seeing” our own role in the conflict. And sometimes, we don’t even WANT to, because the so-called “Great Death” of the self can be very painful. This is especially true when we see ourselves as morally superior to the other person who is “bad” or “to blame.” We are indebted to Lee for giving us this superb example of a problem that nearly all human beings struggle with, and also sharing his vulnerability and humanness with all of us in such an open and generous way! And we salute and thank Lee for courageously showing us the way with an intensely personal and real example. Contact info Dr. Rhonda Barovsky practices in Walnut Creek and Berkeley, California. She can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 5 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. You can reach Dr. Burns at david@feelinggood.com. You can reach Jill Levitt, Ph.D. at jilllevitt@feelinggoodinstitute.com. She is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California (www.feelinggoodinstitute.com) You can reach Lee at bananaquitting@gmail.com Group Feedback The following are a few of the comments in the feedback at the end of the Tuesday class. These are comments from the mental health professionals who observed the session with Lee. Please describe what you specifically disliked about the training? What could have been improved? Were there some things you disagreed with or did not understand? LOVED it! NOTHING Can't think of anything I only wish that we could have more time for this work with Lee. I kept feeling like I wanted to jump in and try some of these skills myself.   Please describe what you specifically liked about the training? What was the most helpful? Were there some things you learned? I liked the externalization of resistance and would've like to see more with that or maybe even a “rules & roles” regarding patient/doctor relationships. I really liked Lee’s work. I also struggle with saying no, and I liked all of the role reversals and honest feedback from everyone involved. I found Jill's insight at the end of the session regarding the conceptualization of the problem, particularly the internal versus external solution (during the “no” practice), to be quite valuable. It was clear that Lee was facing conflicting desires - the need to act in the best interests of his clients while also seeking acceptance and approval. Taking the time to delve deeper into those internal factors may have further strengthened the effectiveness of the external solution (the “no” practice). Was helpful to see the miracle cure/goal clarified, as well as the 'acid test'. Good to see the model in action! I just enjoyed Lee's honesty , caring and professionalism. He brought up an issue that has been close to my heart as I worked with schizophrenic patients in clinic and day hospitalization settings and have experienced EXACTELY what Lee described. You feel between the devil and the deep blue sea when the medical staff conveniently toss responsibility to the less professional staff and when those in the trenches need to be there for the patients by saying NO. I LOVED David's comment about being disrespectful to patients with schizophrenia by going on and on with lofty brainy arguments while the loving thing to do is to be empathic stroking and firm. From my experience when I am real with my patients, they feel the best. Thank you, Lee, David and Jill. This was beautiful , heartwarming, and I am so touched to belong in this group. David and Jill's exquisite empathy, the Positive Reframe, and the NO practice. EVERYTHING!!! This was truly incredible! David and Jill are an unbeatable tag "TEAM!" Jill's warmth and empathy and teasing out the variables of Lee's story that were not always apparently obvious. Lee's vulnerability and seeing his depth and caring as a Psychiatrist was heartening and impressive. It helped me understand the flow of TEAM CBT and how things fit together better by seeing a live session from the beginning. I LOVED that Dr. Burns and Jill had to go down several different avenues to see what would work best. This closely reflects my own experience of therapy with my patients. Seeing them struggle a little made me feel even more sure that TEAM is the only approach that makes sense and cures people. This was a really wonderful session. I appreciate Lee volunteering, sharing with us his work challenges, and allowing us to see his kind and caring personality. I loved the masterful work of Jill and David. It seems to me that practicing responding to his patients with the use of the 5 secrets was imperative and I was amazed to see how that helped dropping down the feelings on the DML before we got to work on the Negative Thoughts. Once again, TEAM works like a charm! That this was a powerful real life issue that Lee shared. I enjoyed the empathy and how that led to sorting out conceptualization and miracle cure. David and Jill's combined efforts to go in many directions to help Lee see where he is stuck. I struggle in exactly the way Lee does in these sorts of situations, and it was so helpful and inspiring to me to see him do this work. Thank you, Lee! I was deeply moved by your deep caring for your patients and values around wanting your patients to have agency and understanding when there's so little in their world that they can control. I wish every psychiatrist had more Lee in him/her/them! I appreciate that Lee opened up himself in the group and I could observe the personal work of David and Jill, the amazing masters of TEAM-CBT. I admire Lee's compassion and warm heart toward his patients and I owed a lot to Lee who has very high standards to make things clear, just as he has done in his teaching in our Newbie group. And I think his sadness and anger might be an expression of his passion toward justice and dignity of his hospitalized patients. Appreciated Lee sharing with the group and doing personal work on a challenging problem. Liked when Jill brought up the internal versus external solution and then the session switched gears to work on the negative thoughts that made it so difficult for Lee to say no. Really enjoy the personal work, and getting to see the TEAM process unfold in skillful hands. I appreciate that you gave Lee time to explain his points, and that he was able to be truthful and disagree at times, and then you asked why and he explained further. This led to a more nuanced exploration and conceptualization of his issues and goals. I liked the focusing of a major part of the problem of "saying no" to a relationship / Five Secrets issue...resulting from internal and external shoulds. I appreciated the comparison with parent/child discipline, and not getting sucked into arguments. I also appreciate that you were able to pinpoint the problems around trying to get desperate, even schizophrenic patients, to understand one's point of view. It was great seeing the modeling of how to respond to some of these difficult patient situations. And how to clearly define the agenda when a patient is unclear about their goals. Also, so admiring of Lee. I liked how Jill and David navigated figuring out what Lee wanted to work on (when they came up with the three options). Issues that have "internal" and "external" components to them are difficult for me, and I often get confused. Seeing Jill and David work that out helps me wrap my head around how to go about it, thanks. Please describe what you learned in today’s group. I appreciate Lee's vulnerability and I have so much respect for how he cares for his patients. I appreciated seeing the multiple role-playing attempts and was bummed when we ran out of time. I have so much admiration for Lee and feel for how much he's struggling. Personal work, externalization of voices, magic dial, Daily Mood Log (DML), 5 secrets, etc. How Five Secrets and No practice fit within the DML work That they could have started on the internal work of negative thoughts or the external work of "NO practice" TEAM at it's best! I observed NO practice and would like to learn more specifically about it ... Seeing the TEAM model unfold step by step in real time is always an incredibly valuable learning experience. Hearing Jill entertain potential directions to go in (i.e. crushing negative thoughts vs. No practice.) Learning challenging scenarios in context of "NO" practice was really awesome! Just magnificent overall! THANK YOU!!! Always feel so privileged to be part of this uniquely wonderful community of like-minded professionals! We are so lucky! I don't have to be smooth and have all the right answers immediately. This process is highly collaborative. How to employ the team model especially conceptualization and role play with NO practice and Five Secrets practice. How dealing with severely mentally ill pts can be so difficult. There's a sixth secret in effective communication: the willingness to use one's power in a kindly way to give the shot and get it over with. It's so helpful to me to add this secret to my armamentarium! Positive reframing and No practice, along with Externalization of Voices and Externalization of Resistance. I learned something about Lee, and about the difficulties of psychiatric hospital work for doctors! Also, seeing the process unfold skillfully, teasing out the problem to work on, Externalization of Resistance, Positive Reframing, Externalization of Voices, No/5 Secrets Practice, etc. How to be clear on agenda setting when patients are unclear on their goals. I was reminded about how to ask about a client's goal in order to guide agenda-setting. It was nice seeing the five secrets role-play / no practice. I've been inspired to start practicing daily like David said he did. Can never get enough of that!

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.   1. When a client expresses concerns in multiple areas of their life, such as mood, relationships, and habits, is there a particular hierarchy that you follow? In particular, what do you do with patients who use marijuana excessively but have no interest in changing or reducing their use? I'm particularly interested in your perspective on the hesitancy within the therapeutic community to treat individuals with co-occurring depression and anxiety, alongside marijuana habits or addictions that they do not wish to address. How do you approach and navigate this complex situation, and what are your thoughts on effectively addressing the client's mental health concerns while considering the impact of their substance use on the therapeutic process? With the increasing acceptance and use of medical and recreational marijuana, do you believe it is still morally or ethically justifiable to turn away clients who use marijuana and express no desire to quit? It appears to be a prevalent practice, and I would appreciate your insights on this matter. Casey Zeigler Matt: Great Question, Casey! For me it depends on the pattern of usage and reasons for using Marijuana. For example, if someone gets anxious and then uses marijuana to reduce their anxiety, then I'd be unable to help them treat their anxiety if they weren't willing to set marijuana aside, for a while, to practice some new methods. I might ask, 'imagine you could feel calm and relaxed, but didn't need marijuana to accomplish this. What would it be worth to you, to have that ability? For example, would you be willing to go through an uncomfortable period of deprivation and awkwardly failing at methods to reduce your anxiety, in order to get there?" David: in a Harvard study years ago, individuals with benzo addictions were randomly assigned to two withdrawal groups: Klonopin-only slow withdrawal, and Klonopin slow withdrawal plus group (I think) CBT. The success in terms of numbers of patients who successfully withdrew was far greater in the CBT group. Or, if they used Marijuana to avoid feeling depressed, I'd wonder if they would be willing to set that aside temporarily, in order to prove that they could feel great without Marijuana. My approach is to identify what the patient wants and to be realistic about the approach to achieve those results. There's also long-term data showing that daily use of marijuana is associated with worse mental health, in the long-term. David: I think these decisions have to be individualized, and consultation with a colleague when in doubt can be very helpful.2. I have a question about anger. How do you help clients control their anger? 2. How do you help clients control their anger? I was going to mention it to you as a good topic to cover anyway in a podcast, because it is the one emotion that has not particularly been dealt with in the podcast. This is ironic, since anger is apparently the one emotion we don't acknowledge!). I did a search and there were only two that touched on it and neither covered how someone can learn to control their anger. I have had several clients who talk of how they snap at their children or partners and want to learn to deal with it. Does it work to use a daily mood log in these cases, as the emotions are more like explosive reactions, and maybe less easy to defeat with distortion-free positive thoughts? Thanks Andy Perrson Matt: Thanks, Andy! I can help people overcome anger, but they probably don't want the type of help I can offer! David: individuals beta testing the Feeling Good app have shown dramatic and rapid anger reductions. In a group or individual therapy context, I would use TEAM systematically. I do not typically “throw methods” at feelings, problems, diagnoses, etc. I treat humans, finding out what’s going on in their lives, conceptualizing the problem, melting away resistance, and choosing methods based on all of that. All that being said, the CBA or Paradoxical CBA are almost always the first techniques with anyone who is angry: vignette about the angry doctor and the angry banker. 3. Do you have any tips to use TEAM skills for very short time session(about 15 to 20 minutes). I am not yet running my private practice. I am employed in other person's private clinic as a psychiatrist and usually prescribe pills and the time per patient is at most 20 minutes. Luci Eunkyoung Yang Matt and Rhonda; This would require a focus on 'homework' outside of session. Happy to discuss. David: Can empathize and refer to groups, app, books for those who want more help. 4. If David never went into the medical / mental health field, what career path do you think you would have chosen? A few guesses, a magician (I believe he referenced in a podcast an affinity for magicians), theatre (Brigadoon story - fear of heights), politician (David sometimes has an opinion on a variety of topics), lawyer (David knows all about black/white thinking, as well as being able to see things in shades of grey), scientist (creator of TEAM-CBT), writer (best selling author) or entrepreneur (what couldn't he create/sell?) Whatever the path, he would have been a leader in that field too for sure and I'm so grateful that he chose ours. Best, Todd

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.) The Cost-Benefit Analysis (CBA): You weight the advantages against the disadvantages of trying to be perfect. The Semantic Technique, to find out how to word your new belief if you decide that your perfectionism belief isn’t working for you The purpose of those two techniques is to provide intellectual change. Tonight, you will join us again as we aim for emotional change at the gut level. This will be our agenda for the students in the class you will observe: 1. Please describe an example of a specific time when you felt upset due to perfectionism. What were your negative thoughts? How were you feeling? What was happening? 2. Downward Arrow Technique: Suppose you weren’t perfect, or you failed or screwed up in some way. Why would that be upsetting to you? What would that mean to you. 3. Externalization of Voices (Optional: possibly we will do this, maybe just mention it, depending on time.) 4. Experimental Technique / Examine the Evidence 5. Feared Fantasy 6. Wrap-up and Teaching Points As you can see, some exercises will be performed in the large group, with everyone present and contributing, and some exercises will be in the small, breakout groups. The small groups provide more time for participants to practice. We plan on recording both of the small groups so you can observe the training techniques we use for mental health professionals. Last week our focus was motivational, so we asked: is to your advantage to aim for perfection? How will this mind set help you and how will it hurt you? Tonight, one of the key techniques will focus on TRUTH: is it TRUE that you need to aim for perfection? We will be using the Experimental Technique and / or Examine the Evidence to see if we can answer this question. In addition, we will go into an Alice-in-Wonderland Nightmare World and meet an imaginary monster who claims superiority because she or he really is perfect and really has achieved incredibly more than anyone. This can sometimes help us answer two questions: Is it possible to be or become a “more worthwhile” or “superior” human being? Would it be desirable if you could? I hope you enjoyed this new format of “dropping in” on my Tuesday training group at Stanford. Let Rhonda and me know what you think. It was just an experiment, and we want to know what you might have liked or disliked about it. Thanks! Our free weekly Tuesday and Wednesday training groups are open to therapists of all persuasions from all around the world. For information including the requirements, you can contact: Tuesday night training group with David and Jill, Contact Ed Walton: EdWalton100@gmail.com Wednesday mid-day group with Dr. Rhonda Barovsky and Richard Lam, Contact Ana Teresa Silva:  ateresasilva6@gmail.com

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: What is perfectionism? How would you define it? What is the difference between perfectionism and the healthy pursuit of excellence? Then we went on to the Cost-Benefit Analysis (CBA) in small groups. I forgot to record my small group, but you will hear a long list of advantages and disadvantages discussed when the large group reconvenes. As I mentioned about, I would encourage you to do your own CBA while we are in the small group. When we reconvened in the large group, we talked about the therapeutic strategies you would use once the patient has balanced the advantages against the disadvantages of perfectionism, including Sitting with Open Hands with patients who are reluctant to give up their perfectionism. I also discussed my strategy of aiming for “average” or even “below average,” as opposed to perfection. As I’ve aged, I’ve actually lowered my standards so low that everything looks pretty awesome to me! And my productivity, as well as the quality of my work, has actually improved greatly as a result. This paradoxical strategy may seem foolish to many devoted perfectionists at first, but it has proven exceedingly powerful and helpful in my life since I screw up so often! Seeing failures and mistakes as opportunities to learn and grow, rather than signs of failure or inadequacy, has been huge for me. Joy seems to spark my creativity and productivity way better than feelings of shame and anxiety. After the CBA exercise, we used the Semantic Technique to revise the perfectionistic belief, like, “I should always try to be perfect,” or “My worthwhileness as a human being depends on my performance (or achievements, etc.). The goal, as you will see, is to reword the belief with this goal in mind: Your new belief can reduce or eliminate most or all of the disadvantages or perfectionism while preserving most or all of the advantages. We DID record Jill’s small group, so you can hear her students working on the Semantic Revision of their perfectionistic belief, but I would strongly recommend that you turn off your podcast and see if you can revise your own perfectionistic belief while we are doing our small group work. Again, this was a 20-minute exercise. I am attaching some of the feedback from the first Tuesday group on perfectionism, Part 1. Next week, you’ll hear Part 2 of the Master Class on Perfectionism. If you are a therapist, you might want to join one of our weekly training groups. The group I conduct with Dr. Jill Levitt is the Tuesday group, and we meet from 5 to 7:30 (PST) on Tuesdays. In addition, Dr. Rhonda Barovsky and Richard Lam have a Wednesday training group that meets from blank to blank PST. Both groups involve an introductory 12-week curriculum for individuals who are not familiar with TEAM-CBT. After that, you may join the advanced group, learning with 40 to 50 colleagues every week. Both groups are free, but you will be required to: Sign the consent form for group membership and agree to the terms on it. Purchase the required course materials, including my psychotherapy eBook, Tools, Not Schools, of Therapy. Purchase the Therapist’s Toolkit and use the assessment instruments with every patient / client at every session. These tools are for sale in the shop at feelinggood.com, and discounts are available for therapists who want but cannot afford the tools. Practice during sessions using role-playing techniques and receive immediate specific feedback on what you did effectively and ineffectively so as to refine your skills. Do homework and use the techniques with your patients between sessions. Attend at least ¾ of the training groups. These are NOT drop-in groups. The free weekly training is available to licensed health / mental health professionals as well as graduate students in mental health who are studying to become psychiatrists, psychologists, counselors, clinical social workers, and so forth. TEAM-CBT is immensely powerful and looks easy, but it’s not. A great deal of commitment, time, and training is always needed to develop expertise. Many of our group members have continued with the group for many years, and we encourage that. Part of the training involves live personal work, which is recommended but not required. Jill and I believe that doing your own personal work is vitally important on the road to world class therapy skills. As you probably know, Rhonda and I publish many of those sessions as two-part podcasts, but only with the permission of the participants who are in the “patient” role on one of the evenings when we do personal work. Probably 15% or 20% of the sessions feature personal work with members who volunteer and ask for help. Social anxiety and feelings that “I’m not good enough” as well as relationship problems are popular themes for the individuals doing personal work on any given night. The personal work does not involve the development of an actual therapeutic relationship. It is simply a one-session, 3.5 hour experience in front of the group which is part of your personal development, so you can experience the TEAM-CBT in action in real time. If you have loose ends or unresolved issues at the end of your session, you can continue working on them with your own therapist. Dr. Levitt and I will not be involved in the development of an ongoing therapeutic relationship with you. The focus of the class is training, not treatment. After each class, members provide negative and positive feedback. The following are selected excerpts from tonight’s group, with light editing to improve readability. I think you will enjoy reviewing the feedback, especially if you are thinking of joining one of our training groups. The feedback is used to improve the teaching methods. Contact Information: 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

Six Cool Ask David Questions from Carlos and Greg Carlos asks: 1. Are your tools available in Spanish? 2. Is there any evidence that TEAM can help patients with Borderline Personality Disorder (BPD)? 3. How do you get patients with BDP to stop jumping from problem to problem? 4. How do you get them to stop endless venting during therapy sessions? Greg asks: 5. What comes first, thoughts or feelings? 6. Can't a genuinely negative or tragic event directly cause negative feelings, without having to have negative thoughts?   Dear Dr. Burns: 1. I would like to use your BMS but I mostly work with patients in Mexico. Has there been any standardization of your tests in any Spanish speaking country? David and Rhonda address this.  You can email Victoria Chicural, who is one of the TEAM-CBT leaders in Mexico (along with Silvina Carla Bucci), at victoriachl@yahoo.com and ask her about access to TEAM-CBT forms that have been translated into Spanish. 2. I am wondering if TEAM has proven to be effective in the treatment of BPD (Borderline Personality Disorder). I use it a lot, but I have found quite a few challenging elements. David describes his published work, indicating an excellent response to TEAM-CBT in patients with BPD. 3. People suffering from BPD usually have trouble prioritizing tasks and activities. The same happens when it comes to setting objectives. Because of their emotion dysregulation, they usually decide to work on one objective, and later on, they sometimes say: "Well, this objective is not THAT important anymore. Let's do another." For them, doing the specificity part can be really challenging because their perspective changes very quickly and they usually go back to the former objective when they're being challenged by a similar situation!!! How do you get them to prioritize objectives and not to switch from one to another so quickly? Or, do you think I could be making a mistake when setting objectives? David describes the strategies he has developed for coping with this type of clinical problem, including the development of his Concept of Self-Help Memo that he required every new patient to fill out prior to their first therapy session. 4. BPD usually come up with a lot of material to the session. They may be facing complex PTSD but also dysfunctionality at work, at school, etc. They want to say everything in a single session even if we have agreed to follow one single objective. Many sessions turn into endless talking without getting anywhere - some of them argue they need to vent out what they feel - but as time goes by, they complain that therapy is not working! How do you deal with a patient who is overwhelmed with numerous factors in a session where you have a previously set objective? David describes the strategies he has developed for coping with this type of clinical problem, Carlos S Bouchanm, Clinical Psychologist David’s Response Hi Carlos, I think these would make for excellent Ask David podcast questions. If so, can we use your name and read your questions? I reported on the effectiveness of the forerunner of TEAM in the treatment of BPD is the Journal of Clinical and Consulting Psychology in the 1990s. TEAM was specifically developed for this population, since 28% of my patients in Philadelphia had BPD. In the live podcast, I will address the excellent questions you asked about treating individuals with BPD. Thanks! David From: Greg Hi David, Thanks for everything you do and for the great podcast! I have another couple questions possibly for the “Ask David” segment of the podcast. 5. Can you say some more about automatic thoughts? CBT is based on the idea that we’re thinking things that produce feelings, but with an automatic thought it just kind of pops up and is there. It’s not like actively, intentionally thinking it. Other schools of thought (for example Somatic Experiencing) posit that feelings from the nervous system occur first and that the thoughts are actually the product of that, which seems to run counter to the CBT view. This has been a little challenging and confusing. David and Rhonda discuss this, including new research on the causal links between emotions and thoughts. 6. How do you apply TEAM CBT to worries about real and true things, like a real diagnosis or a tragic event? It would seem that it’s not just one’s thoughts about it, but an actual threat or upsetting event causing feelings because that is simply how one would feel about. Maybe the thinking is accurate? This, too, has been particularly challenging and confusing, so I’d love to hear more on this. David and Rhonda discuss how thoughts trigger all of your feelings, even after a genuinely tragic event. Thank You, Greg L. David’s Response Thanks, Gary. These are great questions, and perhaps we can address them om an Ask David podcast! There are strong, clear answers that might be interesting or helpful, as nearly everyone has these questions! Best, david Thanks for joining us today! Rhonda, and David

A British Family Doctor on Burnout, Recovery and T.E.A.M in 10 Minute Consultations! Today, Rhonda and David interview Dr. Tom Gedman, a family doctor in England and one of the founders of TEAM-UK, along with Dr. Peter Spurrier who has also been a guest on a Feeling Good Podcast. Rhonda started the podcast with a kind email from an enthusiastic podcast fan who loved our podcasts with Dr. Mark Noble (#167 and #265) on the “Brainology” of TEAM-CBT. He said these podcasts were “pure gold” and appreciated a look behind the curtains to see how TEAM actually worked at the level of the brain. Tom described his burn out episodes, which started during his third year of medical school, resulting from a familiar theme—the belief that he was inferior and just not “good enough.” His inferiority complex was a severe, total body experience, with “horrible thoughts” for six months. After he recovered, he worried about going into that state again. And the stress returned again during his medical internship. He explained that as a General Practitioner (GP) in the British medical system, you only have ten minutes for each patient, and felt like all the pressure was on him to get it right, and stated that “the pressure broke me.” In Britain, you can get free therapy as a GP, and went to Dr. Peter Spurrier for help. Peter was using the TEAM-CBT he’d learned when he came to California the previous summer for one of David’s four-day intensives, and Tom described him as “a natural. We made a deep connection right away and the Positive Reframing really clicked!” Tom’s negative thoughts included: 1. I’m not good enough. 2. I’ll fail my patients. 3. I’ll do them harm. 4. I’m not smart enough. 5. I’ll never be normal. He explained that the last thought triggered feelings of hopelessness, which really was the worst emotion of all. He discovered the Feeling Good Podcasts and listened to about 200 of them in just two weeks! And after two or three hour-long sessions with Peter, he recovered and actually felt like he was on a “high” for about six months. He says, “I had almost limitless confidence!” Then he had an as-predicted relapse which disappeared after a 30-minute tune-up with Peter. Tom said that the he’d always admired Carl Rogers, who emphasized empathy, and began using the Five Secrets of Effective Communication in his medical practice. This helped him clinically, and he discovered that “you don’t always have to ‘help;’ skillful listening is often enough. For example, patients often have to wait for months to be seen medically, and they’re angry and frustrated at first. I acknowledge their frustration and let them know that I feel sad as well. This calms them down immediately.” He also gave an example of how trying to “help” a man with agoraphobia simply put the man into a state of rage. “I tried to convince him that exposure would be good for him, but we just got into an argument, and he threatened to report me to the authorities to have my medical license revoked! That experience taught me something really important about ‘helping.’ Many people have intense resistance and just want to be heard and understood.” For example, one of his patients was in tears because of her father’s Parkinson’s Disease. The patients was helped greatly by learning He that her emotional distress was actually her love for her father, and she suddenly felt proud of her “symptoms.” Another patient with a massive opiate addiction opened up about a severely disturbing childhood incident he’d never before talked about, and then was able to cut his opiate use “way down.” We also discussed Tom’s new plans for his medical practice, working with indigent individuals, and explored the possibility of testing my Feeling Good App with this population for free to see how they would take to it. He discovered that a group in England has “stolen” my names, and also have a “Feeling Good App” and a “Feeling Good Podcast,” which causes me considerable distress. We may have to rename our app the “Real Feeling Good App,” or some such name! Dr. Tom can be reached at BlueprintMedical.co.UK or at DrTomGedman.com. Tom, Rhonda, and I would also like to urge any listeners in or near England to attend the upcoming four day TEAM-CBT intensive in England from August 14 – 17th. This four day training conference will be awesome and only costs 440 pounds. Participants will receive 38 CPD points as well as credits in the TEAM-CBT certification program. For more information about the conference, go to www.TEAMCBT.UK. Thanks for listening! Rhonda, Tom, and David

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: This relapse proves that the therapy did not work. I’m a failure. I’m a hopeless case and I’ll be depressed forever. When I thought I’d recovered I was just fooling myself. I’ve been he same worthless person the whole time. My recovery was just a fluke. It’s crucial to challenge these thoughts with the Externalization of Voices technique ahead of time, BEFORE the patient relapses. That’s because they can easily see the many distortions in these thoughts when they’re in a good mood. But if you don’t do RPT, and wait until the patient relapses, the patient may be devastated, or even suicidal, and you, the therapist, will have lost much or all of your credibility. In contrast, when I prepare the patient for relapse, I tell them that their first relapse will actually be a GOOD thing, because when they pull out of the relapse, then they’ll know for sure that they have the tools they need to defeat their negative thoughts whenever they’re upset for the rest of their life. And that is the crucial difference between FEELING better, which is what happens the first time they recover, and GETTTING better, which is what happens when they recover from their first relapse. I had them record their role-playing with me defeating their relapse thoughts with Externalization of Voices, and tell them to listen to that recording whenever they relapse. And that if they can’t pull out of the relapse on their own, they can always come back for a session or two for a tune-up. I also tell my patients I hope they will relapse often, because if they don’t ever relapse, I won’t ever see them again, and this is a sad thought since I’ve just gotten to know them and really like them. When I was in clinical practice, relapses were rare. Only a handful of patients ever returned for a tune-up, and it was almost always one or two sessions and then they were on their way again. Of course, this was not a controlled outcome study, since I was in private practice, but  it was definitely encouraging. In summary, RPT can save you from a lot of grief when your patients relapse, and it may even save the lives of some of them. It doesn’t take long, 30 minutes or so at most, but the payoffs can be tremendous. Thank you for listening today! Veena, Rhonda, Jill, and David

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: Sadness. This feeling shows that I care for people and want to give them the best. It shows that I also care for my own dreams of having a baby. And it shows how much I love my mother. Anxiety, worry. This is a warning signal, reminding me to be alert and do my best, and do what the doctors require. Guilt. Shows that I’m humble and willing to be accountable and examine what I’ve done and look at my own mistakes. Self-Consciousness. Protects me by making me cautious so I don’t just blurt out everything. Defectiveness. I see my flaws, and allows me to get closer to others, and to feel happy for the success of others. Hopelessness. When I told my husband I felt hopeless, he became SO supportive. Also, I gave myself some space so I could create an action plan. You can see the goals Veena set for each emotion on her Daily Mood Log if you click HERE. Veena with her in-laws M = Methods During the methods phase of the session, we used a variety of techniques, especially Externalization of Voices with the Acceptance Paradox, Self-Defense, and the CAT (Counterattack Technique.) We did quite a few role-reversals, which is typical, before Veena got to wins that were “huge.” There were lots of tears and laughter, and eventually Veena blew all of her negative thoughts out of the water. It was inspiring to observe this process, and to be a part of it. You can see her final Daily Mood Log if you click HERE. I think it is fair to say the Veena experienced a kind of enlightenment which was profound. Final T = Testing You can see Veena’s end-of-session Brief Mood Survey and Evaluation of Therapy Session if you click HERE. You can also see her final Daily Mood LOG if you click here. Our work with Veena was some of the most inspiring work that I can recall. It was tremendously mood-uplifting, and took on a spiritual quality. You will have to listen to the session to get a feel for how majestic it was. But in my opinion, Veena did not just recover, but she achieved enlightenment, which including discovering how to love herself and her extended family as well! The following is an email I sent Veena the next morning: Hi Veena, Thanks. You were totally awesome last night, thanks so much for your contribution. I am sure the podcast will reach huge numbers of people and make a big impact on peoples’ lives. I cannot remember a more exciting and loving session. We will see what the groups thinks in the feedback. I did not copy or read the chats during the session, but perhaps you or Jill did. . . We will invite you to join us on a podcast recording to get some follow-up information from you, as folks will be very interested, for the two-part podcast. Yes, I think we really were walking on holy ground last night! Thanks so much for making that happen! I am trying to recall (and will do more of this) the teaching points from last night, and a few seem important to me. They seem awfully basic and simple, but still of towering importance and have to be “seen” to be understood at a deep level. 1. In TEAM, even when a problem is “real,” it is still our thoughts that create our emotions. Our thoughts really DO create all of our feelings. 2. Those thoughts can be subtly distorted in all kinds of ways and seem determined to trick us into believing things that are not true. And even super smart people, like Veena, can be fooled. 3. We are not aiming for improvement, although that is obviously desirable, but a dramatic transformation of the human spirit and outlook. 4. Warmth, tenderness, and compassion—for others and for yourself--are important and powerful. 5. There is a strong mind-body connection, and healing your soul can often help to heal your body. 6. Good therapy can sometimes be much more than just “therapy.” Something almost magical can sometimes happen, and the change can sometimes happen rapidly. However, many people do not like hearing this, and some are even angered by this idea! This is especially true of people who have suffered and struggled for many years without success in changing the way they think and feel. 7. Recovery sometimes requires courage and trust. Just more babbling from the old guy! Apologies if it sounds ridiculous or “off.” If other teaching points come to mind, please let us know so I can add them to the list! I am betting that Jill and Veena can maybe add to this list! (and edit it as well) Warmly, david Below, you will find some excepts from the feedback that the participants provided after the session. Please describe what you specifically disliked about the training? What could have been improved? Were there some things you disagreed with or did not understand?  Nothing. It was beautiful. I wouldn't want to change anything about tonight's experience. It was so moving! Please describe what you specifically liked about the training? What was the most helpful? Were there some things you learned? I loved Veena's personal work and besides my admiration and pride of her and the gratefulness to David and Jill for sharing this wonderful work . . . I enjoy the empathy and validation as well as the trust in the process that was so beautifully demonstrated. Beautiful job by all concerned. Very impressed with Veena and how clearly she "got it" when she used the CAT (Counterattack Technique). I was very moved by Veena's story and her courage in sharing it with us. I felt as if we were witnessing a kind of history because, in the past, wives who couldn't bear children were often devalued and even rejected. Veena pushed back against that kind of thinking and instead chose to love herself. By working toward dispelling the distorted thoughts, she affirmed not only herself, but women with similar experiences now and throughout history. When she affirmed that her mother, mother-in-law, and husband would be empathetic and wouldn't actually reject her, I felt elated, thinking that the world is making progress and becoming a more compassionate place. I was also touched by the following ideas: feeling genuine sadness without distortions; locating the source of pain in distorted self-critical thoughts; painful experiences bringing loved ones closer together. The safe space that was created, the sensitivity with which the topic was handled and the respect accorded to the client. It’s incredible how the trainers (Dr. Burns & Jill), set aside their ailments, and were with Veena through her journey of anticipatory loss, and her fears and apprehensions, along with her inner battle of dealing with deeply entrenched social conditionings, that are hard to face and ward off. I loved the session. Enjoyed watching the whole team model unfold. I’m so grateful to Veena for sharing this previous part of her life with all of us. It was a huge honor. I am constantly surprised by Dr Burns’ and Jill’s mastery of TEAM and their deep empathy skills. This was moving and exhilarating…all at once. Observing two great therapists in action. I liked how Jill and David would make notes to the class about what step they were going on to next. Veena was so amazing and brave to share her experience. As a 23 year old woman with fears of fertility issues myself due to genetics, I found the experience extremely profound and impactful on a personal level. It was awesome to go from the NEWBIE group to this session whereby a lot of the skills we were learning individually were incorporated sequentially into the session. Thank you to everyone!! I liked seeing david and jill go through the entire team model. I liked the pointing out of the Emotional Reasoning distortion and even using the straight forward technique. Excellent! I really liked seeing an entire session completed in one sitting. A very beautiful night. I really felt for Veena and what she is going through, and it was great to see her recovery. David and Jill were empathic and so knowledgeable. The humor in dark moments. the tears from time to time It was exciting to see how as Veena shed the self-blame, simultaneously she was able to see the people in her life as the caring, kind people she knows them to be--and no longer to feel afraid that they would reject her. Accepting herself allowed her to see others as accepting, and not critical. What training could be better than watching David and Jill tag TEAM thru the model! Thanks to Veena's willingness to be vulnerable and her bravery doing this personal work and inviting us all into her world and her pain. It felt like we were all a web of love and support surrounding her and a privilege to get to know her. It was extraordinarily rich and illuminating. I loved everything: the incredible empathy Jill and David demonstrated and how things were turned around for Veena. I was amazed that this was accomplished in such a short period of time; I always am when it comes to live work! I also loved knowing Veena more and seeing how wonderful of a person she is; I have so much admiration for her!!! Incredible empathy and 5 secrets from both Jill & David! So much warmth and love from the group. Seamless incorporation of the steps & methods. Please describe what you learned in today’s group15 responses DML at it's best!!!! TEAM-CBT, done by skillful therapists, with open and vulnerable client, can be such a gift! I learned again how to go through the entire team-CBT process of crushing negative thoughts and helping clients to feel better. There were so many moments of subtle shifts by Jill. Each one of them were penny drop moments for me. . . Thank you both. That people have a lot of beautiful qualities. I felt I learnt anew the power of empathy and the importance of asking our clients specifically what caused the change. Thank you so much Veena. I got some therapy by proxy tonight. I felt myself take a kind of journey with you from fearful for you, and judgmental (of your aunties!) to warm and open and loving - by witnessing your transformation. A better understanding and appreciation of the entire team model and using that for a real life situation. More of the artfulness and symphony of the steps being followed with empathy being woven again and again throughout and bringing out the birth of what is really true about the self, mother, mother-in-law, and husband rather than the assumptions and self-deprecation. On how to get from T to M with E and A in the middle! I loved David's insight that this is what it means to be in a loving relationship--to hurt at times. So wonderful to get to watch Jill move through TEAM in her warm, empathic, brilliantly thoughtful way, with David interweaving his work of genius!!! So grateful to be part of this incredible community! Thanks so much! The importance of Thought Empathy and flexibility with using different techniques, as I tend to be quite rigid. For example, I love how David went right into EOV which I believe would work wonderfully with someone who knows TEAM well. It definitely did work for Veena. So very helpful to see TEAM in action in its entirety by the masters of TEAM CBT! Thank you for listening today! Veena, Rhonda, Jill, and David

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 T = Testing and E = Empathy At the start of the session, we reviewed Veena's Brief Mood Survey just prior to the start of the session. You can review it if you click on it here. Veena was tearful and said that to make matters worse, her mother has been recently diagnosed with brain cancer, and although she is doing “okay,” she is not doing “great.” Veena explained that she has always dreamed of being a mother, and feels like she is lettinhttps://feelinggood.com/wp-content/uploads/2023/04/01-BMS-wt-ETS_veena-1.pdfg down the many people who love her and want to see her have a baby. She and her husband first talked about having children when Veena was 24, but they decided to defer that for a few years because of the intense demands of her graduate schooling. Now Veena is blaming herself, thinking she “should” have gotten pregnant when she was 24. I mentioned to Veena that my parents tried but were unable to create a pregnancy, so they finally adopted 3 children. Then I came along unexpectedly, after they had given up. I also said that I’ve treated many women who felt like they couldn’t become pregnant, who then became pregnant. You can listen to the dramatic podcasts featuring my session with Daisy and her husband, Zane (#79 and #80) as well as podcasts 268 and 269 featuring a session with Carly (Click here for list of podcasts with links). Both women became pregnant shortly after those sessions, and I hope we can do the same for Veena! However, the key is overcoming the tremendous despair, shame, anxiety, and disappointment that the woman feels, so that the body can heal and prepare for the pregnancy. You can see Veenas partially completed Daily Mood Log if you click here. As you can see, her negative feelings are extreme, and she is telling herself that I may never be a mother. I will ruin Sumit’s (her husband’s) life with her. My marriage may go “down the line” because of the absence of a kid. It’s all my fault for postponing the pregnancy when I was 24. My in-laws, who love me so much, may start ignoring me because I cannot give them an heir. I will always be looked down on and sidelined by my own people. My mother is ill, and I will not be a good daughter if I cannot give her a grandchild. There is no meaning to life without children. My own body cannot suffice for my baby. Her belief in these thoughts ranged from 60 to 80 or more, and she rated most at 100%. Veena with parents I asked Veena how she was feeling after opening up in front of so many colleagues in the Tuesday group. She said she felt sensitive and exposed, and was afraid they don’t understand and will also judge her for not starting earlier with attempts to become pregnant. Although we were still in the Empathy phase of the session, I suggested she might want to do an experiment to find out how they were feeling. Although this idea made her anxious, she asked quite a number of the Tuesday group members how they felt, and received an outpour of warmth, love, tenderness, and support. We asked Veena how we were doing in terms of Empathy. Did we understand how she was thinking? How she was feeling inside? And did she feel accepted. She gave us an A+, and so we were ready to move on to the A = Assessment of Resistance, which you will hear at the start of next week’s podcast. Thank you for listening today! Veena, Rhonda, Jill, and David

Making Space for Grief Featuring Thai-An Truong, LPC, LADC Today, we feature a popular podcast guest, Thai-An Truong who joins us from Oklahoma. Thai-An is a level 5 Certified TEAM therapist and trainer who specializes in post-partum problems as well as anxiety disorders, with a special focus on OCD. Today Thai-An describes a TEAM-CBT technique to help with grief. She believes that empathy is always crucial, and emphasizes that people who have lost a loved one need to be encouraged to express and accept their feelings and to make space for their grief. However, because empathy alone may not be enough, it is often helpful to go beyond empathy and offer specialized techniques to help the patient deal with feelings of grief and loss. In her work specializing in women struggling with post-partum depression, she has seen many women grieving over a loss—such as the loss of a pregnancy, or the loss of a parent when their child is young, or the loss of an infant at birth, or during the first couple months after delivery. She said that the entire TEAM model can be invaluable, including the initial Testing and Empathy, the Daily Mood Log to detect the grieving patient’s (often distorted) negative thoughts, as well as the Assessment of Resistance (the positive reframing step, and the Methods. Healthy grief is often complicated by feelings such as depression, guilt, anger, and more. These feelings can complicate and get in the way of healthy grieving. For example, Rhonda treated a woman who was struggling with guilt over the death of her son, who was in great pain because of advanced, metastatic cancer. At one point, she told him that it was okay to “let go,” and her son died shortly after that. But then, she felt guilty and blamed herself for his death, thinking he might have lived several more days if she had not said that. Thai-An said that losing a son or daughter is one of the greatest pains a parent can have. You may beat up on yourself with “I should have done X” or “I shouldn’t have said or done Y.” But these negative, self-critical thoughts and feelings will nearly always be expressions of your core values as a human being, and your love for the child you lost. This can sometimes be eye-opening, and a relief for the person who is grieving. Thai-An has struggled with grief. She told us about the loss of one of her best friends 16 years ago. He was like a brother, a young man with bipolar manic-depressive illness. At times during manic episodes, he would get high and go out “teaching” on the streets. During one of these episodes something tragic happened—Thai-An was unable to find out what—but her friend was found dead in an alley. Thai-An felt a profound sadness and regret, and to compound the problem, her friend’s mother cut ties with Thai-An, who didn’t even know if a funeral was held or was able to ask any questions about what happened to him.. Thai-An felt understandably hurt and angry,. She recently found out he was buried near a Buddhist Temple in Houston, Texas. She emphasized the value of maintaining a ritual with the person who has died so as to continue the relationship. For example, a woman had a beautiful baby boy who died of an overwhelming infection shortly after he was born. This woman loves nature, and thinks of her son whenever she gardens. For example, when she sees a little bird, she thinks, “that little bird looks just like him!” Thai-An feels that a wide variety of rituals can nurture the bond with the person who died. You might light a candle, or even bake a cake for the baby or person you have lost. The goal is not to achieve some kind of “closure” that is so often emphasized in the media, but rather to continue a positive and meaningful relationship with the person you have lost. Thai-An illustrated a therapeutic technique she calls the Grief Method that involves doing a role-play with the person who has died. The therapist first gathers messages that the grieving patient would like to share with their deceased loved one. The therapist then takes on the role of the patient as the patient takes on the role of the person who has diedThis gives the patient the chance to have a conversation with the love one they have lost. In the following role play, Rhonda played the role of Sam, the young man who died of overwhelming cancer, and Thai-An played the role of his mother, who was grieving and feeling guilty about her son’s tragic death. Thai-An (as Mother): Hi Sam, I really miss you every single day. Rhonda (as Sam): Hi Mom, you’re the person I miss the most. Thai-An (as Mother): I’m sorry we had an argument shortly before you died. Rhonda (as Sam): It’s no big deal. . . We got into little fights pretty often. . . but we always got over it. Thai-An (as Mother): I regret that I left when the doctor told me to leave the room. I should have stayed, so I could be with you when you died. Rhonda (as Sam): I understood that they pushed you to leave the room, and I know that you would have stayed if they’d let you. . . I was in a lot of pain, and I was ready to leave. You gave me a lot of reassurance. Now I’m with grandma. Thai-An (as Mother): I would have done everything for you. Rhonda and Thai-An processed the experience together, and they both cried, even though it was only a role play. Thai-An emphasized the importance of letting your negative feelings flow, and continuing your bond with the person or beloved pet you have lost. For parents who have suffered the loss of a child, Thai-An recommends the book Shattered: Surviving the Loss of a Child by Gary Roe. To access her free grief training for therapists, you can visit courses.teamcbttraining.com/grief. This summer, Thai-An will be offering a special 14-week training course (2 hours / week) which will focus on treating individuals and couples with relationship problems using TEAM. For more information on this and other TEAM training courses, go to courses.teamcbttraining.com. . Thank you for tuning in today! Rhonda, Thai-An, and David

The Invitation Step in Family Life: "Dad! Don't give me that psychology crap!" Today we are joined by our beloved Mike Christensen and his wonderful daughter, Caelyn, for a discussion of one of the humblest but most important and challenging tools in TEAM-CBT, the Invitation Step. We will focus on how this can be important in family life as well. Caelyn will be entering college in the fall, and plans to major in psychology, but she has already picked up a lot of TEAM-CBT from her dad. We’ll tell you more about her at the end of the show notes. The invitation step is the bridge from the E = Empathy phase of TEAM-CBT to the A = Assessment of Resistance, but you don’t issue an invitation until you get an “A” in Empathy from your patient. This generally takes about 25 minutes or so with a new patient if you empathize skillfully using the Five Secrets of Effective Communication. There are two types of Invitations: the Straightforward and the Paradoxical. The Straightforward Invitation is for reasonably cooperative and motivated individuals who are struggling with individual mood problems, like depression and anxiety, and it’s fairly simple. You simply say something along these lines: Jim (or whatever the patient’s name is), you’ve told me some pretty heartbreaking and painful problems you’re confronting, including X, Y, and Z, and I’d love to help you change the way you’ve been thinking and feeling. I’m wondering if this might be a good time to roll up our sleeves and get to work, or if you need more time to talk and vent, because that’s important and I don’t want to jump in before you’re ready. Typically, the person will say “I’m ready,” and you’re all set to set the agenda for the session and reduce the patient’s resistance to change using the many familiar TEAM-CBT techniques, like Miracle Cure Question, Magic Button, Positive Reframing, Magic Dial, and more. The Paradoxical Invitation is for patients who seem unmotivated or even oppositional, and is intended for patients who are struggling with Relationship Problems or Habits and Addictions. Unlike the Straightforward Invitation, your assumption is that the patient probably is NOT asking for help, but just wants to vent, so you might say something along these lines: Sarah (or whatever the patient’s name is), you’ve told me some pretty upsetting things about your conflict with your sister ever since you were young. You say she constantly criticizes you and says things that aren’t really true, and that you’ve tried everything, but nothing works. For example, she insists that you look down on her because you have a PhD, and she didn’t graduate from college, and when you tell her that’s not true she just gets enraged. I can understand how frustrating that must be for you. I’ve got some really cool tools that might help you turn things around and develop a more loving relationship with her, and I think you’d really learn these tools quickly because you’re clearly very smart, but I’m not hearing that you’re asking for that. I’m thinking that you mainly wanted to let me know how difficult and impossible she is. Am I reading you right? I’d love to work with you on your relationship, but would totally understand if that isn’t what you’re looking for. So, in the Paradoxical Invitation, you’re asking the patient to put their cards on the table and acknowledge that they’re NOT looking for help. This prevents a power struggle and you can ask them if there’s something they DO want help with. At the start of today’s podcast, Mike pointed out that the Invitation Step is not only important in therapy, but in family life as well. For example, a lot of parents ask him, “How do I help my teen?” Well, the first answer is to stop trying to help and use the Five Secrets of Effective Communication to listen and understand where your teen is coming from. This is actually hard to do, because so many parents struggle with the compulsion to throw “help” at their kids, and this usually just creates a lot of tension. At the same time, Mike emphasizes that many parents ask, “Well, what do I do when I’m doing empathizing?” Mike says, “That’s the time to issue your invitation. If I don’t do that, Caelyn gets irritated and says, “Don’t’ give me that psychology crap!” If I jump in and try to help or give advice (which is what all parents do almost all of the time) it just ends up in a power struggle. Mike sometimes asks this question: “Did you just want to get that off your chest? What do you want going forward?” Mike and Caelyn did some role-playing to illustrate how this is done, including bad parent technique and excellent parent technique. Caelyn described a disturbing interaction with an angry customer where she works, and Mike first played the “bad dad” and then the “good dad”. Caelyn was delightfully wise and skillful and is heading for a great career in counseling or psychology. For more on this topic, you might want to listen to the podcast #164 on “How to help and how NOT to help!” LINK: How to HELP, and how NOT to Help! Rhonda and I love Mike, and Caelyn as well, and were touched by getting to take a look inside of a real and beautiful father-daughter relationship! Caelyn Bio Sketch Caelyn is a keen student of psychology and is starting her university career in the fall of 2023 She loves animals (her Cat Evie and horse Tulio top the list) and has studied positive reinforcement focused training with horses, under Adele Shaw, at The Willing Equine in Texas. She has read a number of Doctor Burns's books and  implements his CBT principles into her writing. Currently she works full time in customer service at a beauty salon and part time at a garden center where she gets regular opportunities to practice  her 5 secrets skills.  She is a big fan of Taylor Swift. Thank you, Mike and Caelyn, for an awesome interview today! Warmly, Rhonda and David

The Outer Bully Featuring Matthew May, MD Today we are proud to be joined again by our old pal, Matthew May, MD. This is a special two-part edition of Ask David, focusing on two of the most important problems that trigger emotional and interpersonal suffering. Last week, Matt led our discussion of the Inner Bully that causes the lion’s share of internal suffering in the world. Feelings of depression and anxiety always result from the harsh distorted messages we give ourselves, telling ourselves we’re “less than,” or “defective,” or “unlovable,” and so forth. However, the world is also filled with Outer Bullies who can be threatening, even violent. Today we describe how you can often deal with the Outer bully with the Five Secrets of Effective Communication (LINK). Today’s podcast was inspired by a question submitted by Guillermo, one of our podcast fans: Hello, Dr Burns I’ve seen some cases of bullying lately in schools. Would the 5 secrets help a kid who is being bullied in school? (Not physical bullying). I have a son who will be going to middle school next year and wonder about this. David’s Reply Hi Guillermo, Thanks, I might read question on podcast and address it. Might have two consecutive shows on the "inner bully" and then the "outer bully." I know one thing for sure, although I am not an expert in this area, and haven't worked much with kids. But ultimately, only your thoughts can upset you. The words and criticisms of others will never upset you, unless you buy into them. So, the good old Daily Mood Log is always the first step. Once you no longer find bullying threatening, it becomes much easier to deal with it. The bully relies on getting you all scared and terrified and hurt and so forth. Warmly, david Matt began today’s podcast with a real case description working with a violent, involuntarily hospitalized, 6’6” patient weighing 300 pounds snuck into his office while Matt was dictating his notes, locked the door, and announced that he was going to kill Matt because the involuntary hospitalization was “illegal.” The man had been brought to the hospital by the police in a psychotic manic state because of bizarre behavior at his home that troubled the neighbors. Matt was terrified and said, “That was just one occasion when the Five Secrets of Effective Communication saved my life!” Link to Five Secrets Here's what Matt said to the man. I will indicate the communication technique(s) in each sentence in parentheses at the end of each sentence: “You’re right! (Disarming Technique) You served your country and fought for our freedom (Stroking) and now we’re taking away your freedom. (Disarming Technique) I feel the same way you do, (I Feel Statement). Can you tell me more about what you’ve been going through?  (Inquiry)” The man was taken aback and immediately sat down and began to open up. Matt continued to empathize, using the Five Secrets, and after a few minutes the patient fell asleep in his chair. He was then transferred to a higher security hospital ward. Essentially, Matt sided with him, rather than getting defensive or arguing, and saw the truth in what the man was saying, in spite of the fact that he was floridly psychotic, and treated the man with respect. David summarized the case of a colleague of his who was kidnapped by a violent serial rapist. She also used the Five Secrets, which transformed the entire nature of the interaction, and the rapist gave himself up to the police. He also described being bullied by two violent teenagers in a gigantic jeep when he was driving home from the drugstore, where he’d rented an enormous carpet cleaner. David’s use of the Five Secrets in response to violent threats prevented violence, but also turned a potentially hostile and abusive interaction into a joyous and warm one. We concluded with Bullying Practice, saying the worst imaginable things to each other, like “David, you’re a terrible person,” or “Matt, you’re a bad therapist,” or “Rhonda, you’re an insignificant person,” and then responding with the Five Secrets. It was an unexpectedly fun exercise, and the Five Secrets triumphed big time every time! The Outer Bully had no chance at all! However, this level of skill requires that you’ve mastered your own inner Bully, so you’re not buying into what the bully says to you. This gives you a sense of peace and confidence that makes the Five Secrets a piece of cake, so to speak! David, Rhonda, and Matt want to emphasize that we make the Five Secrets look really easy and almost magical. Nothing can be further from the truth. We do hope to inspire you with examples of what’s possible, but mastering these powerful tools takes an enormous amount of dedication, determination, and practice. If you’d like to learn more, I would strongly recommend reading David’s book, Feeling Good Together, and doing the written exercises while reading. This would be an excellent first step! (Include book cover with link to Amazon.) Here, by the way, is an interesting link to a Ted Talk on bullying that you might enjoy. One of our colleagues, Dr. Daniele Leavy, found it and shared the link with our Tuesday group. Link to Ted Talk on Bullying Daniele explains: The speaker does a good job of differentiating what is commonly referred to as bullying from assault or criminal behavior, and demonstrates how to playfully use Disarming and Stroking to deflect the bullying. Thanks for joining us today! Matt, Rhonda, and David

Featuring Matthew May, MD Today, Part 1. The Inner Bully Next week, Part 2. The Outer Bully There are two types of dialogues that can get us in trouble. The first is your “Inner Dialogue.” Your Inner Dialogue sometimes consists of negative thoughts and perceptions of yourself and the world, which are often dominated by the familiar cognitive distortions that trigger internal mood problems, like depression, anxiety, guilt, shame, inadequacy, loneliness, hopelessness, and more. Examples would be “I’m a failure because . . . “ or “I should be better than I am,” or “I’m really going to blow it when I give my talk, and a myriad of variations on these themes. Your Inner Dialogue often consists of mean-spirited things you say to yourself, much like the schoolyard bully who intimidates younger, weaker children. The only difference is that you are doing this to yourself, often without noticing or realizing  what that voice inside your brain is up to. When you challenge and crush these distorted perceptions, you can CHANGE the way you FEEL. Your Outer Dialogue consists of the things you say when you have with interactions with other people, and this can be especially important when you’re dealing with others who are critical of you, or even threatening you with violence.  The strategies are quite different from the strategies you might use to challenge and defeat your Inner bully. Today, Rhonda, Matt and I will demonstrate various strategies for defeating the Inner Bully. Next week, in Part 2, we will demonstrate strategies for defeating the Outer Bully! Those strategies, in extreme cases, might even save your life one day, as you’ll see next week. Rhonda starts the podcast by reading an awesome comment by certified TEAM-CBT therapist Dan Prine, who commented in a kindly way on podcast 334, where we interviewed Michael Yapko on hypnosis. Then we focus on multiple techniques to challenge two negative thoughts with a variety of strategies. The first negative thought is one we’ve seen on a number of occasions from women who had abortions as teenagers, and then experienced extreme depression and guilt later in life because of their thought, “I’m a bad person because I murdered my baby.” Using role-playing, we illustrated E = Empathy, using the Five Secrets of Effective Communication, followed by A = the Assessment of Resistance, using the Magic Button, Positive Reframing, and Magic Dial, followed by M = Methods. Methods included Examine the Evidence, the Double Standard Technique, the Externalization of Voices (with Self-Defense, the Acceptance Paradox, and the CAT, or Counter-/Attack Technique, along with the Socratic Technique, and more. Then we focused on a thought familiar to Rhonda during moments of insecurity and self-doubt: “I don’t matter!” This thought has plagued Rhonda since she was a child. She recalled her father often saying, “c"Who are you? You don't matter!" She told herself, “he’s saying that because I don’t matter.” Even the memory causes great pain and agitation. Of course, on some level, her father’s comments never had any effect on her. Only your thoughts can cause you to feel one way or another. But this was devastating to Rhonda because she believed what her father said, which is understandable, and those thoughts caused the pain. We again illustrated many approaches to challenging this thought, but one of the techniques that was most helpful was the CAT. During the Externalization of Voices, the Positive Rhonda said this to her Inner Bully: “I’m not going to listen to you anymore! I’ve had enough of your BS!” Thank you for listening today. Remember to tune in to the Outer Bully next week! Rhonda, Matt, and David

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.” Orly shared a number of additional negative thoughts: 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. Orly said she already had the tools for working on her negative thoughts and her relationship problems, but really wanted help with #3 and #4. So we first worked with her Triple Paradox that she brought to the session. This is a key tool in working with any habit or addiction, and Orly did an amazing job with it. You’ will enjoy that portion of the session and learn a great deal if you pay close attention. M = Methods We did a little work with Orly’s tempting thoughts from her Habit and Addiction log (click here to review.) Orly was extremely effective in challenging the tempting thoughts. Thanks to Jill’s brilliant guidance, we next decided to focus on cognitive flooding (exposure,) and gave Orly the assignment of scheduling one hour every evening for the next three weeks experiencing negative feelings and simply tolerating them, refusing to give in to the urge to binge.’ We also made her accountable, asking her to record her moods during each flooding session and to send a report the Tuesday group  the following morning. Either “Mission Accomplished” or “I stubbornly refused.” T = End of Session Testing You can click to see Orly’s Brief Mood Survey and Evaluation of Therapy Session at the end of the session. As you can see, she reported significant improvements in all of her feelings, and gave Jill and David perfect scores on the Empathy and Helpfulness Scales, as well as the other therapy process scales. Group Q and A After live work, we spent 30 minutes responding to questions and comments from the group participants. If you like, you can review just a few of the many comments in the feedback from the training group. 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. I loved the focus on feeling more. Recently, I read an article that stated CBT encourages clients to feel less and I didn't agree that was true at all. Tonight's session supported the sense of doubt I had. I thought the flooding concept was extremely helpful. Follow-Up Today, we recorded a live follow-up with Orly and Jill. Orly is doing great, and was very inspired. Jill made some (as usual) brilliant teaching points as well. If you like, you can also review one of her evening Emotional Eating Flooding sessions. Thanks again for listening! See you all next week. Warmly, Rhonda, Jill, Orly, and David

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. Jill empathized, using Thought Empathy, Feeling Empathy, and warmth, and then we asked, “What’s our grade? How good a job have we done in understanding how you think, how you’re feeling, and accepting you?” She gave us an A, meaning it was time to get on to the next phase of the session. Orly also shared that she never told her parents about the abuse, and never felt really close to her mother, who had her and two boys, all within 19 months. She said, “I was a problem for her, and always challenged her. Orly told friends about the abuse, but not her folks because she was desperately afraid they might not empathize or support her. She added, “Deep down, I fear that I am not really lovable, and that it might be too late for me.” I would add that feelings of hopelessness are so common in all of our patients, and this is what makes our work so challenging for us and painful for our patients—and also so rewarding when we can provide genuine, rapid, and profound relief. But will that really be possible for Orly? Next week we will set the agenda for the session and select some methods that might be helpful for Orly. End of Part 1 Thanks again for listening! Warmly, Rhonda, Jill, Orly, and David

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: It honors the depth of the love and the depth of our relationship with Kris. Our grief has motivated us to cherish our riding group and to cling together even more closely. Tears can be the purest form of love. Tears allow us to keep the other person alive in our hearts and minds. I mentioned how I talk to three people I’ve lost every day when I do my “slogging:” my beloved cat Obie, and two dear colleagues I’ve lost, Ann Hantz in Philadelphia and Marilyn Coffy from Oakland. Mike described how touched he was when visiting Kris’ family, and how his mom had arranged all of Kris’ bicycles in the garage, ready to be ridden, with all of his racing jerseys on display. Mike confessed that also felt angry and often thought: “You bugger. It  should have been someone else!” Mike has endured many tragic losses in his life, including the devastating death of his older sister when he was just 15, and the tragic loss of his son, Graeme Michael, who died shortly before birth. Mike reminded us about the various conceptualizations we use in TEAM-CBT, which can include individual mood problems (like depression or anxiety), personal relationship problems, habits and addictions, and “non-problems.” A non-problem refers to people who do not have distorted negative thoughts or problems that need to be solved—they just have strong and appropriate negative feelings, and the job of the therapist is simple: resist trying to “help,” and instead use the Five Secrets of Effective Communication to listen and give the grieving person the chance to vent and expression their feelings. With this in mind, Mike described the support he received from colleagues at the Feeling Good Institute, including one who told him to make sure he was feeling sad! He greatly appreciated this! In my clinical experience, “non-problems” were actually rare, but there were several patients who only needed to vent and receive support. one of my favorite chapters In my first book, Feeling Good, was Chapter 3. entitled Sadness is not Depression. I described my experience as a medical student with a terminally ill elderly man in the Stanford Hospital who reminded me of my grandfather. His extended family had gathered around the bedside as he was slipping into a coma from liver failure due to metastatic kidney cancer, and asked “Would it be okay for you to remove his catheter? It was a bit uncomfortable for him, and we’re not sure if he still needs it.” I was very inexperienced and asked at the nursing station if it would be okay to remove it, and if so, how would I do it. They said he was, in fact, dying, and would not last much longer, and explained how to remove the catheter. I pulled the curtain around his bed, and did that and told the family, with tears in my eyes, “He can still hear you, but not for much longer, so it’s time to tell him how much you love him and say goodbye.” Tears were flowing down my cheeks and they began to cry as well, and began saying good bye. I went to the room where the medical students and resident make their notes, and wept. The family later told the department chairman how much they appreciated what I did for them. I was a pretty terrible medical student, and for the most part had a bad attitude, but that was on moment I still feel very proud of. There are several differences between sadness and depression. First, the thoughts that trigger depression, like “I’m defective. There must be something wrong with me,” are distorted. Depression, as I’ve often said, is the world’s oldest con. In contrast, Mike’s thoughts, like the thoughts that trigger healthy grief, are not distorted, like “I miss Kris. I admired him and loved him, and he made a tremendous difference in my life, and the lives of all who knew him.” Second, depression can go on and on endlessly. I’ve had patients who told me that they’d never had even one happy moment in their entire lives. Healthy grief, in contrast, only needs to be accepted and expressed, and runs its course naturally, If grief is extended, or impairing the person’s life, then it’s a certainty that distorted thoughts are present and preventing the person from healthy grieving. In this case, treatment can be enormously helpful. Finally, depression robs us of joy, hope, and productivity. Life often seems meaningless and worthless. Grief, in contrast, though painful, enriches us and provides us with a deeper level of meaning and gratitude for life. Rhonda and I are very sad for Mike’s many losses, now and in the past as well. But we are both grateful to have him as a friend, and cherish him tremendously. Thank you, Mike, for letting us in today! Warmly, Mike, Rhonda and David Following the session, I emailed Mike to ask a couple questions about peoples’ names, and also find out if we might have perhaps let him down during the podcast, not given him enough space to grieve, and so forth. When I get worried about things like that, I have found that checking it out usually beats “Mind-Reading” by a pretty huge margin. Here’s the wonderful email that Mike sent. It will give you a deeper view of his inner warmth and depth. Hi David, Thank you for your kind words. I experienced our time together as deeply moving and came out of it with a renewed sense of purpose in the sadness. I guess my hope was that we might be able to illustrate and share the value in empathy and the positive reframe in our grief work. That was enhanced to a new level for me with the way you guided me to explore some aspects I had missed. I wouldn't change a thing about it. It also opened up the way in which your stories and the journey we go on with clients can provide healing for others. I am so grateful that you were willing to take that time to revisit them. Our son's name was Graeme Michael. He was in between our oldest (Thomas now 25) and our middle daughter (Janae now 22). We (my wife Janna and I) never had the opportunity to hear his voice or see him smile. We were informed that it was a chord accident. Janna knew something was wrong and an ultrasound confirmed that she would have to deliver him knowing he was already gone. The first time we held him was also the last. Whenever people ask me how many children I have I say 3 (Thomas, Janae & Caelyn -19  & you will meet soon)  but in my mind it is always 4. Thank you for asking. My wife Janna is a nurse and the director of a pregnancy outreach program. She has been blessed with the opportunity to work with at-risk pregnant moms and young families for 17 years and our experience has brought incredible connection and support to so many (I also worked there for 7 years part time with the young dads). While we would never wish our journey on anyone, the suffering of loss has given us insight, motivation, inspiration, understanding and opportunities that we would never have without it. The sadness has deep purpose and meaning and continues to be an expression of our love for Graeme and all the young families we meet. Mike

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: “I’m just doing Rhonda a favor in dating you.” “You look a lot older than your picture!” “I haven’t gotten over my last relationship yet.” “You’re not smart enough.” “You’re just not very interesting.” We demonstrated the FF on the podcast, and Amy knocked them out of the park, using humor plus the Acceptance Paradox. She said that when they’d done that at the women’s group, in greatly reduced Amy’s fear and trepidation prior to their first date. Amy said she was also greatly helped by being in my small practice group the following Tuesday at our weekly psychotherapy training group. We were working on the “Interpersonal Downward Arrow,” a technique I developed that quickly illuminates the roles people play in problematic relationships. Amy discovered that she was playing the role of the inadequate, inferior, insecure person, and this was illuminating. One bad thing about this role is that it quickly becomes a self-fulfilling prophecy because if you see yourself as inferior, you will chase, and come across as insecure, and that will cause the other person, in most cases, to reject you. David suggested a technique he described in his book, Intimate Connections (which you can see below). called the Queen Bee Phenomenon. Instead of playing the insecure role, you give yourself all kinds of positive messages about how sexy and awesome and desirable you are. Once you get into that mind-set, this mind-set can also act as a self-fulfilling prophecy. That’s because of the Burns Rule, which states that in any relationship, especially at the start, one person will be the pursued, and the other person will be the pursuer. The pursued person has all the power, and the pursuer is usually rejected. So why not utilize the Queen Bee Phenomenon and let the guys chase you? This idea was transformative for our wonderful Amy, who is now happily, giddily, engaged, and she tell her story today with her typical wit, humor, and charm. She emphasized another important concept from Intimate Connections. Self-love has to come first. Once you chose to love and like yourself, your fear of being alone disappears, and you discover that you can be incredibly happy when you’re alone. Then, you will no longer “need” men; and as a result, men will need and chase you. That’s another expression of the Burns Rule which states: Men (all people actually) ONLY want what they CAN’T get, and NEVER want what they CAN get. So, if you don’t “need” other people, they will have to chase you! And that’s what happened! Rhonda, Amy, and David also reviewed the principles of effective flirting. 1, Be playful, and not heavy or serious. 2. Have fun. 3. Give playful, specific compliments. Amy has developed a game called “Flirty Dice” which helped her and many others. It is suitable for anyone 14 years or older and can be obtained at the Feeling Great Therapy Center. At the same time that her love life zoomed into orbit, her clinical practice did the same. This is common—when you become a source of joy, others just naturally are attracted to you. Kind of like human magnetism. Amy sees people virtually from all over California. She practices TEAM-CBT and specializes in the treatment of depression and anxiety, and of course, dating and relationship issues. So, if you want to give your love-life a kick-start, or recovery from rejection, contact her at babyfreud@gmail.com Thanks for listening today! Last month, (January 2023), we broke our one month download record (>182,000 downloads), so thank you for that. We will surpass 6 million downloads shortly. Rhonda, Amy, and David

Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 2 Mariusz and his wondaful family. Last week, you heard Part 1 of the personal work that Rhonda and I did with Dr. Mariusz Wirga, which included initial T = Testing and E = Empathy. Today, you'll hear the conclusion of our work, including the Assessment of Resistance, Methods, final Testing and follow-up. I am repeating this darling photo Mariusz's beloved cat, with his tail strait up, showing pride and love for Mariusz! Orangina at her favorite scratching post, with tail straight in the air to show pride and love for Mariusz!  A = Assessment of Resistance Once we empathized, we issued a Straightforward Invitation, asking Mariusz if he needed more time to talk and have us listen, or was ready to focus on the problem and see what we might do to help. Mariusz wanted to get to work, and said his goal for the session was to reduce his perfectionism, but when I asked the Magic Button question, he said he would not press it, even if the Magic Button would bring about a sudden and dramatic elimination of all of his negative thoughts and feelings. So, together, we listed the many positives and advantages of his negative thoughts and feelings, including: My anxiety keeps me on my toes. My feelings of inadequacy keep me humble. My hopelessness protects me from disappointment in the session with Rhonda and David isn’t effective. My hopelessness and loneliness show how much I care. My hopelessness shows how helpless I feel to free myself from the many pressures and heavy weights I have been carrying for many years. My negative thoughts and feelings show how much I care for others, including my wife and kids. My suffering with depression and anxiety increases my compassion and understanding of my patients who are suffering and frightened. My anxiety protects me from danger. My anxiety is motivating. My self-criticisms show that I have high standards. My loneliness shows that I welcome intimacy and close relationships. My sadness shows that I am realistic and willing to look at the dark side of life. As you likely know, this process is called Positive Reframing, which is looking at the positive side of things that appear to be negative. Effective Positive Reframing isn’t just listing positives from a list or book, like Feeling Great,  It’s suddenly “seeing” something that you hadn’t previously realized, and having an “ah-ha” moment. So, I asked Mariusz if he could see any additional positives in his fairly intense feelings of sadness and depression. To help him, I primed the pump a little bit by pointing out that sadness and depression are the feelings you have when you’ve lost something or someone your really cared about, or when you notice that something incredibly important is missing from you life. At this point, Mariusz became tearful and said he’d been very lonely as a child. Saying this gave him a “choking pain.” But he said he always turned away from his pain, and distracted himself, with work and activities. He said “I was an obedient child, and I was an only child. Both of my parents worked. “You say something is missing. I think what is missing is life I’m too busy. I’m always distracting myself. But I’m afraid that if I slow down, I won’t be able to pay my bills. I believe that 95%. Then I’ll be a burden. I’ll lose the respect of my family.” At the end of the Positive Reframing, he set his goals for the session, which you can see if you click on his Daily Mood Log again. As you can see, he did not seem to want to reduce his feelings to super low levels, which was surprising to me. M = Methods Rhonda suggested we could do a Feared Fantasy and asked what he thoughts others would think about him, but never dare to say, if he did slow down and they judged him. They’d think: You’re unreliable. We won’t include you anymore. We hate you. We reject you. We’ll tell the world about you. And his worst core fear was ending up in a homeless camp. We did role reversals using the Feared Fantasy Technique until he hit the ball out of the park, and did the same using the Externalization of Voices to defeat the negative thoughts on his Daily Mood Log. When you listen to the session, you’ll see that there was a lot of tenderness at this point, and we discussed our love for cats, and what we can learn from them—the joys of being average and loved and loving your life. We gave Mariusz several homework assignments: Finish your Daily Mood Log in writing, completing the Positive Thoughts and make sure you’ve crushed all of you negative thoughts. Experiment with being open and vulnerable with loved ones (wife and family) as well as colleagues. Practice saying no to colleagues who make requests on your time, and cut down on activities that are not cost-effective. T = End of Session Testing You can find Mariusz final Daily Mood Log if you click HERE, and his end of Session Brief Mood Survey if you click HERE, and his Patient’s Report of Therapy Session if you click HERE. David, add three links when you get documents. Rhonda and I wish to thank you, Mariusz, for a brave and touching session! You gave me the chance to process some of my own perfectionism, and to express my gratitude once again for the stray cats that my wife and I have adopted who have taught me so much about love, acceptance, and the simple things in life! Follow-Up I emailed Mariusz to find out what happened when he decided to become more open and vulnerable with wife, patients, and colleagues. He wrote back: Right before the Eureka moment, there is this state of dense confusion. So I was hesitant about where to go, but there was no visible path to choose yet. It feels like your brain is not getting it. It feels dense, also in an intellectual way. Like your brain stops working. It is quite dark and heavy. And then suddenly, the tears come and things become clear and light (in the sense of brightness and lifted weight). And that you all for listening today! Last month, January, was our biggest month so far, with more than 182 thousand downloads of Feeling Good Podcasts, and this is due, in large part, to your support of our efforts and sharing the show with friends and colleagues who might benefit from it! Thanks again, Mariusz! You are shooting into orbit! I'm SO proud of you and happy for you, and grateful to have had the chance to get to know you on a deeper and more human level, and to share a little of myself with you, too! Several days later, he sent me three addition al Negative Thoughts for his Daily Mood Log. They are touching, take a look at how he challenged and smashed them! Warmly, Rhonda, Mariusz, and David

Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 1 Mariusz and his wondaful family. In today’s episode, Rhonda and I do live TEAM-CBT with Psychiatrist Mariusz Wirga, MD, who has struggled with perfectionism his entire life. Our training philosophy for TEAM-CBT involves doing your own personal work for a variety of reasons, including: 1. When you sit in the patient’s seat, you develop a radically different perception of the value of the various components of TEAM, including T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods. 2. When you experience your own recovery, or “enlightenment,” you have a crystal clear vision of what’s actually involved in rapid, effective treatment. 3. You will be able to tell your patients, “I understand how you feel because I’ve been there myself, and it will be my pleasure to show you the path out of the woods.” This message makes a highly beneficial impact on most patients. Bio sketch, by Rhonda Among his many other accomplishments, Mariusz organized the highly successful first world congress for TEAM-CBT in Warsaw, Poland in 2022. He is planning a second four-day TEAM-CBT intensive in Warsaw from March 30 to April 2, 2023. If you are interested in attending, you can learn more at www.teamcbt.eu or www.teamcbt.pl. Mariusz says, " "For the first time ever we will teach a parallel track for business and corporate applications of TEAM CBT at the 4-Day Warsaw Intensive (www.teamcbt.eu & www.teamcbt.pl). It will be taught by our singular Dr. Leigh Harrington, with Polish psychologist and TEAM CBT therapist Patrycja Sawicka-Sikora. In 2023, there will also be major TEAM-CBT conferences in Bristol, UK (August 14-17, 2023, www.feelinggood.uk.com ) and Mexico City (November 6-9, 2023, www.teamcbt.mx )" In today's podcast we will listen to the Testing and Empathy portions of his session. Next week, you will hear the Assessment of Resistance and Methods and exciting conclusion of his session. T = Testing We began by reviewing Mariusz’s scores on the pre-session Brief Mood Survey, which you can review. We will, of course, ask him to take this test at the end of the session, so we can see how effective or ineffective we were in helping him change the way he’s thinking and feeling. Mariusz's beloved cat, Orangina, played a featured role in his session with Rhonda and David! E = Empathy We discussed his anxiety which had spiked in apprehension of today’s live session. He had several negative thoughts that we elicited with a brief Downward Arrow Technique. The percents indicate how strongly he believed each one. I will be talking about private issues, and people will think less of me. 70% Then people will be less likely to want to see me for therapy. 50% My patients might be disappointed in me. 50% This could affect me financially, and I won’t be able to pay the bills, and my daughter’s wedding is coming up. 50% (Mariusz, my estimate on % belief.) If that happens, my wife and kids will turn against me. (Need % belief that you had at the time, Mariusz.) My also reviewed the Daily Mood Log that Mariusz prepared prior to today’s session. Feel free to review it. As you can see, he woke up in the middle of the night and remembered that he’d forgotten to send a form he promised to send to a patient whom he’d seen two days earlier. You can also see that his negative feelings were very elevated, ranging from 60% to 85% for loneliness, embarrassment, sadness, inadequacy, frustration and anger,  to 100% for guilt, shame, and anxiety. If you review his DML, you will also see that he’d recorded 10 self-critical thoughts, and many of them were Should and Shouldn’t Statements. For example, “I should have sent her the homework. I shouldn’t have made such a basic therapy error.” He also identified the many distortions in each thought. All-or-Nothing Thinking, which is the mother of perfectionism, was present in most of them. Other common distortions included Should Statements, Overgeneralization, Magnification, and Self-Blame, to name just a few. Mariusz’s belief in all of his negative thoughts was high. You may recall the two requirements for feeling upset: 1. Your mind has to be filled with negative thoughts. 2. You have to believe those thoughts. Mariusz also described his extremely busy and demanding schedule, including the groups he runs in the hospital for cancer patients, his clinical practice, research, teaching, organizing large international TEAM-CBT conferences, and more. His hectic schedule means he always has to be moving fast, so mistakes and slip ups are fairly common. That’s when he beats up o himself, gets anxious, and has trouble sleeping, which compounds everything. He also beats up on himself and feels guilty for falling behind in some of his commitments. Rhonda and I empathized, using the Five Secrets of Effective Communication, and then Rhonda asked him to grade our empathy. He gave us an A+. Orangina at her favorite scratching post, the one that Mariusz got for her, with her tail straight in the air to show pride and love for Mariusz! This ends Part 1 of the work with Mariusz. Next week, you'll hear the exciting conclusion of his session. Warmly, Rhonda, Mariusz, and David

What IS Hypnosis? Transcending Old Myths Today, Rhonda and I interview Dr. Michael Yapko, a clinical psychologist and expert in clinical applications of hypnosis. Michael D. Yapko, Ph.D. is a clinical psychologist residing near San Diego, California. He is internationally recognized for his groundbreaking work in applying clinical hypnosis, especially in the active treatment of depression. He has taught in more than 30 countries across six continents, and all over the United States. He has been a vocal critic of the medical model of depression and instead advocates for a social perspective, suggesting the problem is less in your biochemistry and more in your circumstances and perspectives. His YouTube lecture on “How to Recover from Depression” has now been viewed nearly 5 million times. Dr. Yapko is the author of 16 books, including his newest book for professionals called Process-Oriented Hypnosis, and his classic hypnosis text, Trancework (5th edition). His popular general audience books  include Depression is Contagious and Breaking the Patterns of Depression. His works have been translated into 10 languages. He is also the Chief Content Advisor for MindsetHealth, a digital hypnotherapy mental health app. More information about Dr. Yapko’s work is available on his website: www.yapko.com. On the personal side, Dr. Yapko is happily married to his wife, Diane, a pediatric speech-language pathologist. Together, they enjoy hiking in the Great Outdoors in their spare time. Michael’s first experience with hypnosis was as an undergraduate psychology student at the University of Michigan. He went to a clinical course on the topic of hypnosis which featured a live hypnosis demonstration. The demonstration subject was a woman who was suffering with intense chronic leg pain following a traumatic auto accident three years earlier. The relentless pain had disabled her and greatly impacted her life on many levels. Michael said he listened to her sad story in skeptical awe, unable to imagine what the hypnotist could possibly say to someone suffering so much that would be helpful to her. He was deeply absorbed in observing every nuance of the interaction wondering what help hypnosis might offer in such dramatic circumstances. The initial phase of the interaction was simply a series of suggestions for relaxing and focusing her attention. He gradually offered suggestions to visualize the pain as a dark, viscous liquid that could flow down her leg, out of her foot, into her shoe, and then spill out onto the floor as a “harmless puddle of pain.” And it was gooey! After re-alerting her from hypnosis, she became tearful and reported that she was pain-free for the first time in almost three years! The change in her appearance was both obvious and deeply impressive. Observing this dramatic demonstration of hypnosis for reducing chronic pain was a transformative experience for Dr. Yapko. He literally thought in that moment that hypnosis had remarkable potentials and that he would dedicate himself to learning all he could about the intricacies of hypnosis and its merits in a wide array of clinical interventions. The demonstration blew Dr. Yapko’s young mind and led to a 50-year career practicing, studying, writing about, and teaching clinical hypnosis to health care professionals worldwide. Although he has recently retired from active clinical practice, he continues to offer trainings and says his fascination with hypnosis is just as strong as ever today. There are a number of striking areas of overlap between Michael’s use of methods of clinical hypnosis and traditional Cognitive Therapy. For example, he routinely uses the Experimental Technique, and gives experiential homework assignments to help patients “see” or discover something that they have not previously seen or realized that would be helpful to them. This can be important when treating patients who hold rigid beliefs that can become the basis for emotional distress. However, the types of experiential experiments Michael suggests are sometimes more ambiguous in their purpose, and are sometimes more paradoxical, but all are designed to lead the patients to a shift in their mindset. In one example, Michael described a severely depressed woman who felt like a victim and constantly compared herself to others she actually knew very little, if anything, about. Then she felt terrible about herself because she was convinced that everyone else was happy and had beautiful, problem-free, ideal lives and she didn’t. She had developed unrealistic perceptions of other people on the basis of little or no actual data. These thoughts made her miserable and she was convinced she was the only one who had been singled out for misery. Of course, we can see many of the familiar cognitive distortions, including Mind-Reading, which is assuming, without evidence, that we know how other people are thinking and feeling or how their lives are going. For most people, this process is so reflexive and unconscious they don’t realize what they’re doing. As Michael said, “too often people think things and then make the mistake of believing themselves.” To her detriment, this woman had never tested her assumptions about others. Michael’s view was similar to that of cognitive therapists, that there would need to be a change in her way of reaching unfounded conclusions if she was going to feel better about herself and her life. But what kind of experiment, or exercise, could he assign to help her discover that her thinking WASN’T always correct ? Telling her to “stop doing that!” would not likely help her. Instead, Michael did a hypnosis session with her and oriented her to the idea that forming interpretations or conclusions without evidence is a reliable path to making mistakes that can be costly. Then Michael gave her an easy assignment that had the potential to make obvious how readily she formed conclusions without any evidence. He encouraged her to go on a hike in a state park near San Diego. The trail he wanted her to go on is called the Azalea Springs Trail, an easy three mile walk. The trail’s name suggests a beautiful trail with flowers and flowing springs and sounds like an awesome, inspiring experience. But in reality, the hiking trail goes through barren desert brush, eventually leading to a clearing. In the center of the clearing, there’s a rusty pipe sticking up out of the soil with a small amount of water dripping out. A sign attached to the pipe reads, “Azalea Springs.” All the expectations of an abundance of beautiful azaleas and a lovely flowing spring naturally exploded in only a moment! When she read the sign and realized how far off her expectations were from the reality, she suddenly “got it” and burst out laughing. She learned in a powerfully memorable way that our expectations are not always the way things are. Subsequently, having absorbed that powerful learning, she regularly caught herself making assumptions about others and using them to build them up and tear herself down. This hurtful pattern changed dramatically, giving rise to a much happier and more satisfying life. Michael also uses the Survey Technique, which is common in TEAM therapy. He described a shy man who desperately wanted to be married and fantasized living in domestic bliss in a house with a picket fence. But he was convinced that no woman would ever be interested in him because he’d been hospitalized for two weeks for depression 15 years earlier. Again, he was rigidly fixated on this unfortunate idea, which he believed to be absolutely true. Michael first conducted a hypnosis session that introduced the idea that “someone can be very sure…and very wrong.” Hypnosis often makes it possible to loosen the hold of unhelpful ideas and shift to a more useful perspective. This is because people in hypnosis process information differently than when in their usual frame of awareness. Having a rational conversation with someone is quite different than guiding someone through a hypnotic experience which can create possibilities that rational conversation alone simply can’t. Hypnosis is all about focus and Michael describes how people’s problems are often problems of focus: they focus on what’s wrong and miss what’s right, or they focus on the unchangeable past and miss positive future possibilities. Those of you who are familiar with CBT or TEAM may recognize these distortions as Mental Filtering and Discounting the Positive. It’s important to appreciate that hypnosis is NOT the therapy. Rather, it’s a vehicle for delivering therapeutic ideas and perspectives at a deeper level that can give rise to more adaptive automatic responses. Following hypnosis Michael gave his patient the assignment to generate a series of general questions that he’d be interested in hearing women answer. Michael included the following question as number 7 on his 10 question survey: “Would you consider dating, getting involved with, and even marrying a man if you knew he’d been hospitalized for two weeks for depression 15 years ago?”  Michael then convinced him to go to the local mall and randomly stop women and ask them to respond to some survey questions he was researching. He could tell a number of women that he was conducting a brief survey and would appreciate getting their opinions. Although he got many varying opinions, he was shocked to discover that the vast majority of women said it would NOT be an issue. He had built his misery around a belief that had no bearing on how women actually felt. Once again, although Michael emphasizes the value of hypnosis, his  therapy techniques have some overlap with Cognitive Therapy. He promotes the idea that the shifts in both physiology and cognition that take place during hypnosis can provide a multi-dimensional foundation for amplifying the effects of virtually any type of psychotherapy. In fact, in his classic text on hypnosis, Trancework (5th edition), Michael cites numerous studies that show that hypnosis can enhance therapeutic outcomes for Cognitive Therapy. And why not? After all, every therapy utilizes suggestions in one form or another! Michael emphasizes the importance of psychotherapy homework between sessions which is also key in TEAM therapy as well as Cognitive Therapy. He will not give patients the room to “skip” or “forget” to do their homework assignments and uses hypnosis to build their curiosity and willingness to explore new possibilities by carrying out assignments. He described different factions in the world of hypnosis. Just as there are different approaches to psychotherapy, there are also differing views about the nature of hypnosis. For example, some experts promote the idea that hypnosis is an intrapersonal (within the person) phenomenon, a “fixed” or unchanging trait the person may have. They use “suggestibility tests” to assess whether and how responsive the patient might be to hypnosis. Michael and other experts view hypnosis differently, seeing it not as a fixed trait a person does or doesn’t have, but rather as a product of many different factors, including the patient’s expectations, the context in which it is being applied, the purpose for which it is being applied, and the quality of the therapeutic relationship that involves empathy and trust. He also believes that almost everyone has the capacity for hypnosis, but different people clearly have different aptitudes, or innate skills, for experiencing various aspects of hypnosis. For example, some people may have a greater capacity for pain reduction or elimination, while others may have a greater capacity for vivid visual imagination and fantasy, and so forth. Hypnosis provides an opportunity for people to discover their hidden strengths and talents. Can you imagine what it does for someone’s self-image, Michael asks, when they discover through hypnosis that they have untapped abilities they can use to handle a situation skillfully that previously had overwhelmed them? In fact, this is what draws Michael to hypnosis: the way it can empower people to discover and use more of their untapped innate resources. This is the exact opposite of the unfortunate myth perpetuated through hypnosis stage shows and Hollywood productions that somehow hypnosis diminishes people’s sense of control. That’s very important, so I’ll repeat it. The myth-based view is that hypnosis makes people obedient to the powerful hypnotist, who is often painted as a Svengali type of character. But in reality, hypnosis can be used to help make people more powerful, more autonomous, and more independent. Just the opposite! Michael has authored 16 books, including nine on the clinical applications of hypnosis. His latest book, entitled, Process-Oriented Hypnosis: Focusing on the Forest, Not the Trees, focuses on how, and not why, people generate their own problems and can be obtained at Amazon. Thanks so much for listening! And thanks so much, Michael, for sharing your wealth of experience and giving us the latest scoop on clinical hypnosis! Warmly, Rhonda, Michael, and David

Ask David: Featuring Matt May, MD What causes anxiety? Is recovery permanent? What if the cognitive distortions aren't helpful? Do hormones cause anxiety and depression? What's the role of vitamins and nutrition? How do Exposure and Response Prevention work? And many more answers to your questions! In today’s podcast, three shrinks discuss many intriguing questions about anxiety from individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Several of the questions were answered on the podcast, and a great many more are answered in the show notes below. But first, Rhonda opened the podcast by reading an endorsement from a listener named Rob, with a link. Here it is! Hi Dr. Burns: I'm a long-time listener/reader, first-time caller. I stumbled upon this endorsement for Feeling Good today, and I thought it was worth sharing with you. I can't think of a better endorsement for a book. I hope you enjoy it! "I’ve replaced my copy close to ten times, as I keep lending it to friends who never give it back." https://girlboss.com/blogs/read/feeling-good-david-burns-review Have a great day! Rob Thanks, Rob! And now, for the many excellent questions submitted by listeners like you! Many were answered in depth on the podcast, but you'll see that all questions have written answers as well. When you talk about someone recovering, is that free of panic attacks and anxiety forever, or a great decrease in symptoms but you will always be an anxious person to a certain extent? Especially for someone who has fundamentally been anxious since they were young so not episodic but continuous. David's Answer. Some people are anxiety-prone, and that is likely due to a genetic cause. I am like that, for example. Once you are 100% free of any form of anxiety, like my public speaking anxiety, you need to continue with exposure, or the old anxiety will try to come creeping back in. So, I do public speaking all the time! What if your client/patient understands the Cognitive Distortions but doesn’t believe them to be true? David's Answer. It is hard for me to comprehend what you mean. But I will say this. Anxiety and depression and other negative feelings result 100% from distorted negative thoughts. And the exact moment when you stop believing the thought that’s triggering your anxiety or depression, you will almost instantly feel relief. And here’s the precise answer to your question. When someone says, “I understand the distortions but it doesn’t help,” they still believe their negative thoughts. Resistance, too, is an issue. Nearly 100% of therapeutic failure results from jumping in and trying to help the patient without first comprehending the many reasons why the patient will fight against the therapist’s efforts to “help.” Has research been done on the possible relationship in hormone levels in women and anxiety or depression? Especially during pregnancy, post pregnancy, and those going through menopause? Also, can negative thoughts also depend on the person’s nutrition? Could it be that vitamins that are lacking? David's Answer.  First, I am not aware of any convincing evidence linking hormone levels with depression, anxiety, irritability, or any other negative feelings. However, we can say with certainty that whatever the cause, which is unknown, distorted thoughts will always be present and will be the trigger for the negative feelings. In or near the first chapter of my most recent book, Feeling Great, I describe case of post pregnancy depression, and you can take a look and see the mother’s negative thoughts clearly. And you will also see that the moment she crushed those thoughts, her depression disappeared! People want to “biologize” emotional problems, and I started out as a “biological psychiatrist” and researcher, but found the biological explanations to be erroneous and unhelpful. Could you please give a brief overview about Exposure with Response Prevention for OCD treatment.  Thank you! David's Answer. Sure, these are tools that can be helpful, along with many other kinds of tools, in the treatment of anxiety, including OCD. They are not, for the most part, treatments. I use four models in the treatment of every anxious patient: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. Exposure is facing your fears and enduring the anxiety until the anxiety subsides and disappears. Response Prevention is refusing to give in to the superstitious rituals OCD users when anxious, like counting, arranging things in a certain way, and so forth. END OF QUESTIONS DISCUSSED LIVE ON THE PODCAST The answers to the questions below were written by Dr. Burns but not discussed on the Podcast. Questions can I ask to overcome the Cognitive Distortion “jumping to conclusions”? That is the toughest for me. David’s Answer. I would need a specific example. Jumping to Conclusions includes a vast array of topics and negative thoughts. Fortune Telling and Mind Reading are the most common forms of Jumping to Conclusions. Feelings of hopelessness always result from Fortune Telling. All forms of anxiety always result from Fortune Telling as well. Social Anxiety typically includes Mind-Reading, and Mind-Reading is almost universal in relationship conflicts. In addition, I never treat a distortion, an emotion, a diagnosis, or a problem. I treat human beings systematically, using the T E A M algorithm. Matt’s Answer. There are many methods in TEAM that can be applied in the form of a question. These methods and how they are carried out, depends on the circumstances and the specific thoughts a person is having. Below are some examples of negative thoughts (NT’s) and the types of questions that might help overcome them. (NT): ‘Something really bad is going to happen’  (Be Specific Technique): ‘Like what? What’s going to happen?’  NT: ‘I’ll fail my biology test’  What-If Technique: ‘What if I failed my biology test, why would I be worried about that? (write down any new thoughts) What if those things happened, too, what then? (write down any new thoughts) What’s the absolute worst thing that could happen? (write this down).  Measurement: How certain am I, that these things will happen? On a scale from 0 – 100%, how likely are each of these predictions, in the form of negative thoughts, to occur?  Socratic Outcome Resistance: What do each of these negative thoughts say about my values that I can feel proud of? (write these down) What is appropriate about how I’m feeling and thinking? (write these down) What are the advantages of having these thoughts? (write these down). What would I be afraid of, if I didn’t have this thought? (write these down)  Pivot Question: Given the many positive values related to worrying, the advantages of doing so, the disadvantages of a carefree existence and the many reasons why my worry is appropriate, why would I change this?  Forgetful Clone (Double-Standard Amnestic Technique for Outcome Resistance): What would you say, to a dear friend, in an identical situation, when they asked these questions: ‘I’m really worried about failing my biology test, would you be willing to help me? (if ‘yes’, then continue) … Don’t I need to keep worrying? Won’t that protect me from failing? Don’t I need to worry, so that I’m highly motivated to succeed? Don’t I need to worry, so I avoid making mistakes? Don’t I need to worry, to maximize my rate of learning new material? Won’t I get lured into a false sense of security, if I stop worrying? Won’t I jinx it, if I get too confident? What would you recommend to me? How much do you think I should worry? I am prepared to do so … would it be helpful for me to go into a sustained panic, at this time?’  Cost-Benefit Analysis: Is worrying about failure worth the price? How would you weigh the advantages of worrying about failure against the disadvantages? What are the pro’s and con’s? How would you divide 100 points, to reflect the power of these two arguments?  Examine the Evidence, Motivational: What evidence is there that worrying improves academic performance, concentration and learning? What evidence is there that worrying worsens academic performance, concentration and learning? Magic Dial Question: ‘‘Should I remain maximally worried, at all times, forever? (If not, keep going) ’What amount of worry is best, for me, in this moment?’, ‘How about future moments? How frequently do I need to worry and for how long?’  Process Resistance for Activity Scheduling, Worry Breaks/Cognitive Flooding, Self-Monitoring/Response Prevention: ‘Would it be alright to ignore my worry most of the time and only focus on it during scheduled times? Let’s say I could learn how to be extremely calm and focused most of the day, without worry … would I be willing to worry as intensely as possible, for ten minutes, three times per day, to achieve this? When my worry comes up at other times, would I be willing to observe and record that event, then return to the task on my schedule?  Socratic Questioning: Am I absolutely certain that this thought is true, that I will fail? How do I know that I will fail? What specific questions will be on the Biology test that I will get wrong? What number grade will I get? A 60? 58? 39?’, ‘Would I bet money on my getting precisely that grade? Why not?’.  Examine the Evidence (cognitive): ‘What evidence is there that I will fail? What evidence is there that I will pass?  Reattribution: Let’s say that I fail. Would that be entirely my fault? Are there any other factors, outside my control, that might have contributed to this outcome? My genetics, for example? Or the nature of the world, into which I was born? Did I choose my genetics? Did I choose the world into which I was born, when I was born, my parents, teachers, etc.? Could any of these factors have played any role in the outcomes in my life?  Other examples of Inquiry-based methods, using different NT’s:  Negative Thought: ‘People will be angry and judge me, if I fail’  Interpersonal Downward Arrow: ‘What kind of people are they, if they judge me and look down on me, when I fail? How would I feel towards those types of people? Is it possible I feel angry? How do I express that feeling? What ‘rule’ am I following, in my relationships?’  Outcome Resistance: What’s good about me, for feeling anxious, rather than angry? What are the advantages of keeping my feelings inside? What would I be afraid of, if I expressed my feelings?  Process Resistance, 5-Secrets: Would I be willing to spend the time to learn the skills required to express my feelings, including anger, to people, in a way that made them feel good?  Negative Thought: ‘I’ll get sick and die’  Be Specific: ‘When? What time of day will that occur? What illness is going to kill me?’  Negative Thought: ‘I’ll lose my mind, crack up and go crazy’  Examine the Evidence: Has that ever happened to me? When was the last time? When you are working with clients, how do you handle it when they can challenge their thoughts very convincingly using a variety of techniques, state that they can see the logic in their restructured thought BUT they are still experiencing heightened anxiety and state that this hasn’t helped them? David’s Answer. They still have a strong belief in their negative thoughts. It is 100% untrue that they have “challenged them very convincingly.” Here’s an example. Let’s say you have an intense fear of glass elevators. You will say, “I can see that they are unsafe, but I am still terrified of going in one.” The moment you get on the elevator your belief that you are in danger will suddenly skyrocket to 100%. In other words, you still believe your negative thoughts. Of course, it is nearly always easy to overcome phobias, including an elevator phobia. As stated above, I use four models in treating every anxious patient. Simplistic formulas are just that—Simplistic! Treating humans is not like changing the oil in your car! Matt’s Answer: I am hard pressed to add anything of value to David’s awesome response, above. I might just reiterate that the Cognitive model, challenging the logic behind negative, anxiety-producing thoughts, is the least powerful of the approaches we have to anxiety. It is necessary, but almost always insufficient. Exposure, motivational methods and Hidden emotion are the real heavy-hitters. Until trying these, it is likely that the negative thoughts can be disproven ‘intellectually’ but not at the emotional level. How do you work with clients who state they are anxious all the time, experience strong somatic symptoms (body sensations) and cannot identify specific thoughts. They don’t catastrophize these somatic symptoms but really, really dislike them and want them gone! David’s Answer. I just ask them to make up some negative thoughts. That works well. For example, they may have the belief that the anxiety must be avoided because it may never disappear, or may believe that they are on the verge of going crazy, and so forth. Matt’s Answer, Anxiety can cause people’s brains to shut down, experiencing the ‘deer in the headlights’ phenomenon. Try to identify just one upsetting thought, then use the ‘what-if’ technique to expand on that. You’ll be off and running! How do you do techniques with a person who has active suicidal thoughts? David’s Answer. I don’t “do techniques.” I find out if they’re actively suicidal and in danger. If I know for certain that the person is safe, I treat them like human beings, with T E A M. I’m not a formula person. Each person will be different, and will respond to different methods. My books and podcasts are chock full of examples of actively suicidal people who responded. Matt’s Answer. I let them know that I don’t have the skill to help them unless I know they’re safe. If I’m worried for their safety, I’ll be afraid to use aggressive methods that may be required for them to recover. I’d need them to convince me of their safety before agreeing to work with them. If they can do so, I offer TEAM. If not, I ask if they’re willing to escalate the level of their care, e.g. to meet with me while hospitalized in a safe setting. I don’t work with patients who are at risk of harming themselves because I don’t believe in my ability to be helpful to them. Is it really okay to keep continuing the experimental technique when the patient does not want to continue? And, what if the therapist is not confident and something goes wrong in this situation? David’s Answer. I would need a specific example, but you are right that 75% or so of therapists are afraid of exposure and will not use it, fearing that something will “go wrong!” Matt’s Answer. It’s important to identify the resistance before initiating the method of exposure and to talk it through. Why would they not want to continue? What are they afraid of, if they get really anxious, during exposure? Write this down. Then, surrender, acknowledging that these are some excellent reasons to avoid exposure, in which case we can’t help them with their anxiety. Perhaps there’s something else they want help with? If they can convince you, and themselves, that exposure is precisely what they want to do, and they’re willing to keep doing it, even if it makes them very anxious, it’s appropriate to push a bit, in the moment of their doing exposure, to bolster them and help them through the rough patch. That said, I always give my patients a way out, if they don’t want to continue. That’s their choice, I just want them to be aware of the consequences, including a worsening of their anxiety. When doing experimental method, or the exposure method for example with who has sweating issue, how do you handle the hyper-vigilance he would have with people around, especially if someone actually laughed at him? David’s Answer. I would use the Feared Fantasy Technique, and Self-Disclosure. I would likely go with the patient into the real world to do these things, and have done so on hundreds of occasions. How would you work with someone who suffers from  Selective/Situational Mutism? David’s Answer. I have not run into that in my clinical practice. But 100% of the time, I would want to know what the patient’s agenda is. I would also want to know if there are powerful motivational factors that need to be addressed, looking at the whole person rather than the symptom. How different are Team CBT treatments for teens as compared to adults? David’s Answer. My experience is limited, but I would say no difference, really. I have loved working with teens, even though my main focus was on adults. When working with little kids, I think you need to incorporate play and games, although the basic concepts are the same. For example, you can do Externalization of Voices with puppets, the “Bad, Mean Self” and the “Positive, Loving Self,” or some such. We have featured shrinks who work with kids on many times on our podcasts. Thanks for joining us today! Matt, Rhonda, and David

Ask David: Featuring Matt May, MD How can I help my son? Is rapid recovery just "First Aid?" Do early "attachment wounds" cause anxiety? What's the Hidden Emotion Model? Are anxious people overly "nice?" And more! In today’s podcast, three shrinks discuss many intriguing questions about anxiety from listeners like you, and begin with a question from a man who is worried about his relationship with his 11 year old son, who is just starting to get cranky and a bit rebellious. Then we field questions posed by thousands of individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Most of the answers included in the show notes below were written prior to the podcast, so the live podcast will contain more information than the answers presented below. Guillermo asks: How can I get close to my 11 year old son? Hi, Dr Burns Thank you for all the knowledge you share through your books and your podcasts. “the way you think creates the way you feel” has changed the way i view life. I wanted to share an exchange I had with my 11 yo son 2 days ago. I was asking him to move some stuff around to clean his room and he was not loving it so his attitude reflected that, then i asked him about a particular lovely drawing of his that i found (from kindergarten) and he was dismissive and said “just throw it away” and i raised my voice and said “I CAN ALSO HAVE A BAD ATTITUDE, WOULD YOU LIKE FOR ME TO TALK TO YOU LIKE THIS?” (I was rude and loud) To which, he got startled and teary eyed and said “no”. And i immediately felt bad, noting that i pushed him away when i wanted to get closer to him. I later came to his room and apologized for my behavior and gave him a hug. I said “im sorry i raised my voice, im sure that hurt you and that hurts me bc you're the most important person in the world to me” and i gave him a hug. That same night I heard podcast 278 or 279 and you said “the road to enlightenment is a lonely one, my friend” when responding to someone asking about the other person in a relationship. I thought, damn that’s true hahaha. I was going to say sorry but was thinking about what happened, this just reinforced it so much! After this I went over to his room to apologize. I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this? Thank you again for all you do, Guillermo David’s answer: I can't tell you what to do, but I loved your last sentence, " I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this?" In my book, Feeling Great, my dear colleague, Dr. Jill Levitt did this exact thing with her son with fantastic results. Said almost that exact thing! Warmly, david ANSWERS TO DAVID'S PESI ANXIETY LECTURE QUESTIONS Is this rapid response merely first-aid. Am I right in assuming the sustained work (psychodynamic, therapy, body work etc.) is still required? David's answer. Nope! But of course, all humans are unique, and some will require a longer course of treatment than others, but this is not due to any “first aid” problem! Matt’s Answer: I agree with a lot of this.  While we are frequently seeing rapid and complete elimination of negative feelings, like depression and anxiety, while using the TEAM model, we expect 100% of people to ‘relapse’, at some point in the future.  Educating people about this is important and part of ‘Relapse Prevention’.  Part of Relapse Prevention involves accepting the impermanence of things, including our euphoric, enlightened experiences.  As the Buddhists say, ‘we all drift in and out of enlightenment’.  Relapses, the ‘drifting in-and-out’ is a sign of a healthy brain.  Recovery is a bit like learning a new language, including how to talk-back to your negative thoughts.  While you can learn a new language, your healthy brain will not permanently forget your native tongue, so you’ll occasionally go back to old habits in thinking.  So, achieving optimal mental health requires an ongoing practice with the methodology.  Rather than some new methodology, however, the one that is effective will be the one that helped you recover, in the first place.  If it was Exposure, you’ll have to keep on doing that.  If it was talking back to your negative thoughts, then you’ll have to do that, occasionally, etc.  This can be a bit disappointing or disheartening to hear, if you were expecting permanence or perfection.  Paradoxically, accepting the imperfect and impermanent nature of our reality is what leads to relief and recovery.  That is to say, ‘Enlightenment’ is not a ‘perfect’ mental state but an acceptance of an imperfect one.  If this seems distasteful, Enlightenment may not be what you’re after!  For those of you willing to embrace and appreciate your average, imperfect and impermanent experiences in life, you are very likely to recovery.  You’ll still need Relapse Prevention, including a commitment to continue to practice on an ongoing basis.  This leads to a higher level of recovery, in which you become your own ‘best therapist’.  Another place where I agree with you is that one might achieve (imperfect) recovery from anxiety and depression, and even take on the responsibility of maintaining these results, and yet still not be satisfied with some other aspects of life.  It’s possible (in fact likely) for any given person to suffer, not only from mood problems, like anxiety and depression, but from other types of problems, like unwanted habits or addictions, or relationship problems.  TEAM contains methodologies that address these concerns as well.  ‘Recovery’ from these conditions is the same as for mood problems, in that recovery will be imperfect and impermanent and require practice to sustain.  What type of practice that might be depends on the individual and we can’t predict, in advance, what types of exercises will be effective, for a particular person.  In fact, there’s a danger in assuming we know what will be effective and closing our minds to alternative approaches.  It’s a common error, for therapists, to pick up one tool and use that, regardless of results, rather than trying new approaches.  This is kind of like having a hammer in your hand, and seeing all your patients as nails!  I like how David says it: ‘Treat people, not conditions’.  So, I think I agree with what you’re saying, in that it requires trial-and-error with multiple methodologies to achieve initial recoveries, as well as ongoing practice to achieve optimal results.  I also feel compelled to observe the tendency for certain dangerous and wrong ideas to persist in our culture, kind of like ‘Urban Legends’ or ‘Mythology’.  One example is the revolution that occurred in medicine when people realized that pathogens, like viruses and bacteria, cause disease.  It had previously been thought that disease states were caused by an imbalance of the ‘Four Humours’, blood, bile, phelgm and calor (heat).  The treatment, for pretty much anything that ailed you, back then, was leeches and blood-letting, in hopes of restoring the balance of these ‘humours’.  A revolution in our understanding of disease occurred with the invention of the microscope.  It was now possible to visualize microscopic organisms, like bacteria, that we now know, after many experiments, are responsible for disease states. This allowed us to develop medications, like Penicillin, that kill bacteria and lead to rapid recoveries from infections, like pneumonia and immunizations that prevent infection.  Despite undeniable scientific evidence, people are prone to believing the old mythology, keeping the wrong and outdated model alive.  For example, many people are afraid, on a cold day, because they think that exposure to cold temperatures will lead to having a disease, which is even called a ‘cold’.  Meanwhile, we know, scientifically, that it’s not cold temperatures or an imbalance of any ‘humour’, that is causing colds, flus, and pneumonia.  It is microorganisms, like viruses and bacteria.  If you don’t want to get a cold, it’s better to sanitize your hands and wear a mask, than to bundle up on a cold day.  Instead of bloodletting and leeches, try vaccines and antibiotics.  Of course, people also make up new mythologies, around these, much to their detriment and at great cost to society.  My advice would be to listen to develop a skeptical mind and read the scientific literature.  Or, try to understand Neil DeGrasse Tyson, when he says, ‘Science is True, whether you believe it, or not’.  A similar revolution in our understanding has occurred in the field of Mental Health.  Like seeing bacteria, for the first time, after the invention of the microscope, we are returning to the understanding (which ancient Greek and Buddhist philosophers noted, as well) that it is our negative thinking that causes our suffering, more than our circumstances.  We know, now, that psychoanalysis is not required, to optimize mental health, any more than bloodletting or leeches is required to treat Pneumonia.  Thanks to Dr. David Burns, there is now a rapid, highly effective and medication-free treatment for depression and anxiety, called TEAM. Is the Hidden Emotion Model suitable for anxiety caused by early attachment wounds? David's answer. These big words are out of my pay scale, although they certainly sound erudite! In fact, the cause of anxiety is totally unknown, so when you say “caused by” we are in different universes! But the simple answer is yes, in 75% of cases, anxiety is helped greatly by the Hidden Emotion Model. Thanks! Matt’s Answer:  The Hidden Emotion model would always be on my list of methods to try, for an individual who wanted help reducing their anxiety.  That said, it’s better to select methods based on an individual’s specific negative thoughts rather than the presence or absence of trauma in childhood.  In fact, the assumption that we know the cause of anxiety is problematic because it may lead to a kind of therapeutic ‘tunnel-vision’ and delayed recovery, as time is wasted, trying the same approach, repeatedly, expecting different results. For example, assuming that ‘early attachment wounds’ are the ‘cause’ of anxiety may trigger the false belief that the most effective treatment would be many years, even decades, of Psychoanalysis.  This has been disproven, scientifically, yet it lingers in our minds, as a kind of mythology, passed down from our past.  Rather than subjecting our patients to decades on the couch, talking about their childhoods, it’s far more effective to ‘fail our way to success’, using multiple methods and measuring outcomes after each one, to discover what is actually effective for them.  Once you find the method(s) that are helpful, these will continue to be helpful, for that individual, throughout their lifespan, and it’s just a matter of practice. Another question about the Hidden Emotion model: when do you consider it “niceness” in anxious people and when is it the fear/anxiety to upset others due to the anxiety? David's answer. That can happen, but not usually in my experience. The “niceness” typically results from automatic suppression of uncomfortable feelings and problems. When they hidden problem or feeling is brought to conscious awareness, in most cases the anxious individual deals with it or expresses the feelings, and that’s when the anxiety typically disappears completely. As a part of my anxiety disorder, at times, I feel flat, emotionless and disconnected from everything around me. How do you treat that? David's answer. I use T E A M, not formulas! I do not treat symptoms, I teat humans. Matt’s Answer:  You could start with a Daily Mood Log, writing down the details of what was happening, in one specific moment in time, when you felt this way.  Include what you were thinking and feeling, including ‘flat’, ‘emotionless’ and ‘disconnected’.  For example, let’s imagine you had thoughts like, ‘nothing will ever change’, ‘this is pointless’, ‘I’ll never feel better’ and/or, ‘I shouldn’t be feeling so disconnected and flat’ or ‘I should be more in-touch with my emotions’ and/or ‘I need to be more up-beat’ or ‘people will reject me if I’m not more enthusiastic’.  You’d have to identify your particular thoughts, these are just guesses. After this, you could decide what, if anything you wanted to change.  If some change is desired, you might imagine a ‘magic button’ that would achieve that change, without any effort on your part.  For example, the button might eliminate all the upsetting feelings on your Daily Mood Log.  However, everything else in your life would remain the same.  Can you identify any reasons NOT to press that button?  Are there any positive values you have, related to these thoughts?  Would there be any down-side to pressing that button?  This represents your ‘Outcome Resistance’.  Typically, there will be many pieces of resistance that would need to be acknowledged or addressed before methods will be effective in helping you.  You can read in one of David’s many excellent books, like ‘Feeling Great’ and ‘When Panic Attacks’ how to make the most of this approach and what the next steps are. Thanks for listening today. MANY more cool questions on the best treatment techniques for anxiety next week. Matt, Rhonda, and David

What's the Antidepressant Myth? Have We Been Scammed?     Today, Rhonda and I interview one of our heroes, Dr. Irving Kirsch, who is a giant in depression research and a fun, down-to-earth human being at the same time! Dr. Kirsch is Associate Director of the Program in Placebo Studies and the Therapeutic Relationship, and a lecturer on medicine at the Harvard Medical School (Beth Israel Deaconess Medical Center). He is also Emeritus Professor of Psychology at the University of Hull (UK) and the University of Connecticut (USA). Dr. Kirsch has published 10 books, more than 250 scientific journal articles and 40 book chapters on placebo effects, antidepressant medication, hypnosis, and suggestion. He originated the concept of response expectancy. This is the expectation that people have that a given treatment or intervention will be helpful. Kirsch’s 2002 meta-analysis on the efficacy of antidepressants influenced official guidelines for the treatment of depression in the United Kingdom. His 2008 meta-analysis was covered extensively in the international media and listed by the British Psychological Society as one of the “10 most controversial psychology studies ever published.” His book, The Emperor’s New Drugs: Exploding the Antidepressant Myth, has been published in English, French, Italian, Japanese, Turkish, and Polish, and was shortlisted for the prestigious “Mind Book of the Year” award. It was also the topic of a 60 Minutes segment on CBS and a 5-page cover story in Newsweek. In 2015, the University of Basel (Switzerland) awarded Irving Kirsch an Honorary Doctorate in Psychology. In 2019, the Society for Clinical and Experimental Hypnosis honored him with their “Living Human Treasure Award.” In today’s podcast, we cover a wide range of topics, including a patient-level reanalysis of all of the data on the effects of antidepressant medications versus placebos submitted to the FDA. This analysis included more than 70,000 depressed individuals and indicated something troubling and surprising. The difference in improvement between individuals treated with antidepressants and individuals receiving antidepressant medications was only 1.8 points on the Hamilton Rating Scale for Depression. This test can range from 0 to 50, and a difference of 1.8 points is not clinically significant. In addition, the beneficial antidepressant effects observed in both the placebo and “antidepressant” groups are large, with reductions of around 10 points or so on the Hamilton Scale. These were the shocking discoveries that led to his popular book, The Emperor’s New Drugs (LINK), and to his appearance on the Sunday evening 60 Minutes TV show. In addition, Dr. Kirsch agreed that tiny difference between the “effects” of antidepressants vs placebos could be the result of problems in the experimental design used by drug companies. Because they give patients in the placebo groups pills with inactive ingredients, there are no side effects in the placebo groups. This makes it fairly easy for individuals to guess what group they were assigned to—the “real” antidepressant group or the placebo group. This might account for the differences in the groups, since many individuals in the medication groups may think, “Hey, I’m getting some side effects. I must be in the antidepressant group. That’s terrific!” This thought would be expected to trigger some mood elevation, but it’s the thought, and not the pill, that causes this. In contrast, some individual in the placebo groups may have the thought, “Hey, I’m not getting any of the side effects they described. I must be in the placebo group!” And this thought may trigger disappointment, and a worsening of depression. This would contribute to differences between the drug and placebo groups in drug company outcome studies with new chemicals that they hope to get approved as “antidepressants.” This problem could easily be corrected by the use of active placebos, like atropine, which produces dry mouth, a side effect of many antidepressants and has been used as an active placebo in a small number of trials. Most of the studies using active placebos have failed to show any significant effect of the antidepressant over the active placebo. Drug companies have been reluctant to implement this change in their research designs, perhaps due to the fear that it will “erase” the tiny differences that they have been reporting. This would be of potential concern since billions of dollars are at stake if the FDA gives you permission to call your new chemical an “antidepressant.” We also discussed Dr. Kirsch’s unlikely journey to Harvard. When he was in England, planning to return to the United States, he asked a colleague at Harvard if it would be possible for him to get a library card so he’d have access to articles in research journals. His colleague told him that it was difficult to obtain a library card for people not affiliated with Harvard. However, they were willing to offer him a position as Instructor on Medicine, given that he was the Associate Director of the  Program in Placebo Studies and the Therapeutic Relationship, which was hosted at one of the Harvard teaching hospitals. That’s a wow! But certainly deserved, and a most fortunate affiliation with unanticipated and highly positive consequences that have led to many important discoveries on how the placebo effect actually works. The placebo effect is not a bad thing, and has been one of the doctor’s best “medicines” for hundreds if not thousands of years. On the podcast, we also discussed the confusion—for patients, doctors, and researchers alike—caused by the placebo effect. For example, many people who receive antidepressants do improve, and some recover completely. They will SWEAR by antidepressants, and may feel hurt or disappointed by the results of Dr. Kirsch’s research. But in fact, there is no discernable difference between the effects of placebos and so-called “real” effects. And one of the downsides of the confusion about placebos is that people who take antidepressants and improve have improved because of changes in their thinking, and not from the antidepressant. But they wrongly give credit to the pills they took, whereas they deserve the real credit for overcoming their feelings of depression. We discussed many other topics, including pushback he has received from the psychiatric community and some in the general public as well who have not taken kindly to his findings. I, too, have experienced that when I have summarized the data in the Food and Drug Administration, and have had to be very careful in how I present this information, because none of us want to discourage anyone who is depressed. We have also invited Dr. Kirsch to consult with us on the research design we use in our beta testing of the Feeling Good App, and have developed tests of “expectations” (the so-called placebo effect) that we will use in our latest beta test as well. We want to “walk the walk” and not just “talk the talk” and find out how much the improvement we see in beta testers might be due to a placebo, or “mega-placebo” effect. Rhonda and I were honored and thrilled to have this chance to interview Dr. Irving Kirsch, a friend and research giant for sure! Thanks so much for listening to today’s podcast! Irving, Rhonda, and David

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. I (David) would note that physical contact might be something to be careful with. Of course, when you are teaching martial arts, it may be perfectly justified and desirable. I came from the psychotherapy perspective, and I have been trained that ANY touching of a patient other than shaking hands at the initial and final sessions is grounds for a malpractice suit as well as an ethics charge. Dor also made some really illuminating comments on the A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) At the initial evaluation, he talks to the teachers, parents, and students. The agendas from teachers and parents are things like “he has an anger problem” or a problem paying attention in class, or whatever. However, 90% of the time, the children frequently are unaware of those agendas, or have no interest in the goals of the teachers and parents. Instead, he finds out what the children want to work on, and finds this to be the most and only effective way to approach the treatment. He says that it is fairly easy to set goals with children of any age, even as young as 4 years old, but those in the 8 to 11 years of age are the most difficult. He said that the children’s goals may be to learn how to hit back when they are being bullied in school, or to have fun and make friends with other kids. I was delighted to hear about Dor’s methods of setting goals with his kids and have felt strongly along these lines for many years! I say, Kudos, Dor! He also described doing a Cost-Benefit Analysis of crying when being bullied, and also helps his children see the positives in their symptoms using Positive Reframing. Dor explains: For example, I worked with a child who was bullied at school. In order for the work to be effective, I asked that the boy who bullied him be included in the group as well. After seeing the bullying happening in real time, I had two private five minute sessions with each child while the other kids played. In these sessions I used empathy techniques and received a score of 10 I started fooling around with the TEAM-CBT Agenda-Setting techniques. The goal was for the child who suffers from bullying to choose to behave in a different way. The child said he was willing to do it to prove to me that he is strong and to get back at the kids who beat him. I then talked to the bully boy and asked him if he was willing to help me work with that boy. He was happy to do it because he wanted him to stop crying all the time and get punished for it. After that the M = Methods part was really easy and fun. I hade the bully train the kid =whom he’d bulled. Two meetings after that they were best friends. In my experience (and I have done this process several times) the bully is the best therapist for a child who suffers from bullying! After Dor described his approach to helping kids who are being bullied, he said that if the parents or authorities step in to help it can make things worse because they child is placed in the role of being a baby, which may intensify the bullying. David asks: Dor, is a safety plan for the child important? Can the child always learn to deal with the bullying on their own? Any details or examples would be great! This was Dor’s answer: I didn't address it enough, but you can't provide good therapy without providing good education. That's why I like working in schools because I can easily talk to the teachers. It is clear that we as adults need to talk about values and set boundaries, and in severe cases we may need to intervene and provide a safety net for the therapeutic process. But I feel that it is my job as a therapist to give my patient the tools to deal with their problems on their own. And bullying, like any problem in a relationship, is about guilt. And as soon as I stop blaming the other and start trying to improve myself and treat the other and his wishes with respect the change begins to happen. David: I agree strongly with what you just said! My research when I was in Philadelphia years back strongly supported the notion that blame is one of the main causes of relationship conflicts. Dor continues: In another case of mine, I worked with a child who complained that whoever was sitting on him was yelling at him and throwing things at him. I wasn't sure what could be done and gave him all kinds of bad suggestions At this point a 10-year-old boy with autism stopped me () and asked him what he asked the boy who was bothering him. He said that the he was criticized for the exact same thing--he was making noises that disturbed the boy next to him. From there we continued with homework to find out what is bothering that child, to tell him that he is right, and to ask him if he is ready to stop hitting and yelling at the second patient and his behavior will change. It was a huge success. Dor continues to talk about the idea of specificity which is so central to TEAM-CBT: I discovered that the techniques we teach children should be direct and simple. In the past we believed in all kinds of indirect techniques that were supposed to somehow help the child. The idea is to stop using general definitions like "self-confidence" "concentration abilities" and "social problems." Instead, we can start being specific in our goals and techniques. Rhonda and I were thrilled to learn about Dor’s terrific work adapting TEAM to working with very young people. I encouraged Dor to consider a book on TEAM for TOTS (or some other title) so other therapists can learn how to adapt TEAM to work with children with specific problems such as intense shyness, autism spectrum problem, ADHD, anger issues, and more. Several days after the recording session, Dor was already working on his book. Awesome! Thanks so much for listening today! Rhonda, Dor, and David If you wish to contact Dor, you can email him at: dorstra@gmail.com

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”? Narcissism involves: Grandiose fantasies and feelings, thinking that you are superior to others Lack of empathy for others Extreme self-centeredness Intolerance to criticism or disapproval Urges for revenge on anyone who crosses you. We do not know whether these are just extremes of personality characteristics that everyone has in varying degrees, or whether it actually consists of a “disorder” that is qualitatively different and distinct. But it is definitely true that all of the characteristics I have bulleted above do exist to some degree in most, if not all, human beings. How do you treat narcissistic patient? I do not treat diagnoses, just human beings. This is a radical departure from the way many mental health professionals approach their work. No matter who I’m treating, I always start with the T and E of TEAM (Test and Empathy) and then move on to A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) The main idea is to find out what, if anything, the patient wants help with. It would be rare for someone with narcissistic qualities to want help with their narcissism. Generally, they want help with a troubled relationship or with feelings of depression, anxiety, or anger. Then I would ask them to zero in on one specific moment when they were upset and wanting help, and deal with Outcome and Process Resistance. If the patient can convince me that she or he does want help, then I move on to M = Methods, and the methods would have to do with the nature of the problem they want help with. I once presented a case illustrating rather dramatic and rapid recovery in a patient I was treating for depression and anxiety. To my way of thinking, it was a great outcome. However, during the Q and A I got an angry rebuke from a therapist in the audience who pointed out that I hadn’t treated the patient’s “obvious narcissism.” This is the “great divide.” I don’t feel like it’s my calling to evangelize for any model of “ideal mental health.” For the most part, and there are always exceptions to every rule, I do not impose my agenda on the patients, but try to work with what they want to change. I might suggest possible ways we could work together, but in the final analysis it is up to the patient. I liken my role to that of a plumber. If you’ve got a broken toilet, give me a call and I’ll fix it. But I don’t go from door to door promoting copper pipes! How can you deal with narcissistic individuals in the real world? Once again, it depends on the specific moment that you want help with. However, I always like to emphasize the value of the Disarming Technique and Stroking when interacting with someone with strong narcissistic tendencies. The goal, in my opinion, might be on “dealing with them skillfully” as opposed to “changing” them or “winning.” For example, (David can give example of Erik’s friend when growing up.) What are the causes of narcissism?  Scientists do not know, for the most part, what causes most of the so-called “mental disorders” listed in the Diagnostic and Statistical Manual of the American Psychiatric Association, but it seems possible, even likely, that there could be genetic and environmental causes, and the environmental causes could have to do with the past (childhood influences) and present. For example, when people begin to experience significant success, in academics, sports, or some other field, others begin to admire them and want to be with them. This can fire up our egos, and can feel good. And as they level of fame and status increases, the attraction of others intensifies, and eventually people fear saying no or contradicting the narcissistic person who has such power. So, the narcissistic person is constantly reinforced, even for bad behavior or irrational beliefs, with little or no negative feedback to correct his or her course of actions and thinking. Some experts also point to profound feelings of shame and insecurity under the surface, which might also be genetic, at least in part, or triggered by adverse childhood experiences. What you have to let go of to relate to someone who is narcissistic? To my way of thinking, you have to give up the idea that the narcissistic person is going to take you seriously or care about you, You may also have to give up the notion that you are going to “change” or “help” them. You may have to use a more manipulative approach, using lots of Disarming and Stroking, instead of being so sincere and serious. This involves “letting go,” and moving forward with your life. What is “Malignant Narcissism?” This is a severe form of narcissism where the person will resort to extreme tactics to get their way, including murder. You see this in politics and cults. Names like Jim Jones, Adolph Hitler, and even some politicians today around the world, and many despots throughout human history. What does it mean when someone is “manipulative?” David explain that he’s heard that term for years, decades really, but did not understand what it meant until a few weeks ago, based on a personal experience. The group contrasts a relationship based on using people, and seeing them as objects, vs a relationship based on warmth, vulnerability, trust, respect, and openness. Thanks for listening today! Matt, Rhonda, and David

"Overcoming Toxic Shame" Join Dr. Jill Levitt and me  at our fabulous new workshop Sunday, February 5th, 2023 8:30am - 4:30pm PST - 7 CE units Click here for information and registration In today's podcast, David and Jill describe their new workshop on Overcoming Toxic Shame. This workshop will feature video snippets from a fantastic session with a beloved colleague named Melanie who struggled with intense feelings of anxiety and shame for more than 8 years. You will see her transformation from utter despair to joy in a single therapy session lasting roughly two hours, and you will get the chance to learn and practice the techniques that were so transformative for her. Most mental health professionals also struggle with feelings of shame because of their belief that they aren't "good enough" and from fears of being found out. You will have the chance to heal yourself while you master cool new techniques to transform the lives of your patients! In today's podcast, David and Jill do a live demonstration of a couple of the many techniques they will illustrate on February, which will include the Paradoxical Double Standardl Technique, Externalization of Voices, and the Feared Fantasy. You will not only witness a remarkable change in Melanie, as well as a sudden, severe and unexpected relapse half way through the session. David ang Jill will ask, "If you were the therapist, what would you do right now?" What follows is AMAZING! Jill practices and serves as the Director of Training at the Feeling Good Institute in Mountain View California. She is also co-leader of my Tuesday evening weekly training group at Stanford (now entirely virtual). This group is totally free and is available to mental health professional in the Bay Area and around the world. You can reach Dr. Burns at david@feelinggood.com.

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: Identify the Distortions in his thoughts Examine the Evidence Externalization of Voices Self-Disclosure Rejection Practice The Experimental Technique The Feared Fantasy And more. Cody received an abundant outpouring of love, respect, and encouragement from those in attendance (LINK). We also gave Cody two “homework” assignments to complete following the group. 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. If you'd like to see Cody's complet4ed Daily Mood Log, you can check this LINK. If you'd like to see Cody's intimal and final Brief Mood Survey plus Evaluation of Therapy session, check this LINK. As you can see, there were dramatic changes in all of his negative feelings. However, he wanted to retain some anger toward his childhood friends who made fun of him. Here’s the email we received from Cody about his homework assignment. Hello groupers, I can proudly say mission accomplished! Although it took me around 7 hours to do it, I did it. A lot of emotions came up as I kept trying and chickening out. I really feel like something has changed in me, by the last person I felt almost no anxiety and now I keep asking myself why I was ever afraid of this (I hope it sticks. I know I'll need to keep up this momentum I'm sure). Having to do this email and being held accountable to you all was what drove me to the finish line. Thanks again, see you all next week! Thanks to you, Cody. You were incredibly inspiring in group and after and the work you did will touch the hearts of many people, just as you have already touched the hearts of all the people in our group! And thank you all for listening! Cody, Rhonda, and David

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. Tune in next week for the exciting conclusion of the live work with Cody! David and Rhonda

Curing YOUR Social Anxiety— The Ridiculously Cheap and Awesome Shame-Attacking Marathon Jacob Towery, MD Michael Luo Today, we are joined by Dr. Jacob Towery and Michael Luo to promote their  upcoming, two-day Social Anxiety Marathon. Jacob Towery, MD is an adolescent and adult psychiatrist and therapist in private practice in Palo Alto, California.  Michael Luo is a fourth year medical student at the Chicago Medical School. More on them at the end of the show notes, but here’s the scoop. Jacob and Michael will be offering a mind-blowing, two-day marathon for anyone who struggles with social anxiety, which includes shyness, public speaking anxiety, and performance anxiety. They will both be present, along with more than ten experts in TEAM-CBT, coaching participants in the latest tools for quickly overcoming all social anxiety. And here’s the amazing thing. You can come and attend, and transform your life, for only a $20 donation to one of their four listed amazing charities. For information / registration, click here How cool is that? Don’t pass this up. It will be an in-person, hands-on training experience designed to free you from the fears that narrow your life. You will learn and participate in cognitive therapy exercises, identifying and smashing the distorted thoughts that trigger social anxiety, as well as the Self-Defeating Beliefs that trigger social anxiety like the Spotlight and Brushfire Fallacies, the Approval Addiction, and more. They will also illustrate and lead you in a wide variety of Interpersonal Exposure Techniques, including Smile and Hello Practice, Self-Disclosure (which Michael demonstrates in real time on today’s show), Rejection Practice, Flirting Training, Shame Attacking Exercises, and more. David claims that Jacob is likely the world’s top expert in Shame Attacking Exercises, and we illustrate several on the podcast. Rhonda described a Shame Attacking Exercise that I challenged her with. It was incredibly terrifying, but turned out really well! David also described the impact of self-disclosure on a wealthy and powerful businessman he treated who was so insecure that he was even terrified to be around his wife and children. People who are socially anxious nearly always try hard to hide their negative feelings out of a sense of shame, so others, even friends and family and colleagues, typically aren’t aware of how they feel inside. Michael courageously discloses his own negative thoughts that triggered feelings of social anxiety at being around Jacob, his mentor. Maybe I’ll make a mistake. I might be wasting Jacob’s time. Then he might not want to mentor me. These thoughts caused feelings of loneliness and shame. I felt much closer to Michael when he disclose these feelings. Jacob added that he was totally unaware that Michael had been struggling with these thoughts and feelings. The treatment of social anxiety is profoundly serious, because we are involved in changing the lives of people who are suffering and lonely and inhibited, but the treatment can also be fun, hilarious and of course, enlightening. Michael wraps up the show by describing the transformation this training has had on his own life. If you wish to attend, act rapidly because space is limited and will be given out on a first-come, first-serve basis. I hope you can attend, and make sure you let Rhonda and David know about your experiences! Thanks for listening today! Rhonda, Jacob, Michael, and David

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! You can contact Dr. Kyle Jones at kyle@feelinggoodinstitute.com End of Part 2

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! Stay tuned for Part 2 next week.

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! During the podcast, we used some TEAM-CBT to deal with these concerns live, in real time, using Positive Reframing, Identify the Distortions, Examine the Evidence, and Externalization of Voices to smash these thoughts. If you’d like to see the Positive Reframing Table he brought to the session, you can check here. In Kevin’s case, the RC calculations, which are simple and only take a minute, gave him a huge gift—the confirmation of his immense technical therapeutic skills as well as his empathy. But what if you’re not like Kevin, and you discover that your RCs are not so great, and that your Empathy ratings are in the failing range. Isn’t that kind of terrible? Well, it depends on how big your ego is, and how motivated you are to improve. I’ve gotten plenty of horrible ratings on the ETS, and have had lots of sessions with poor outcomes, including sessions when I wrongly believed I was doing a great job. It DOES hurt. But over the years, my patients have dramatically shaped my therapy approach, and have become my greatest teachers by far. I now enjoy pretty tremendous outcomes with the vast majority of the people I treat, but could never have improved without the constant feedback. Psychotherapy skills are a lot like athletic workouts, and they say, “no pain, no gain.” This is definitely just as true for shrinks. Are you a shrink? Do you have the courage to check out your skills? Here are a couple more random comments. Over the years I’ve seen the scores of many therapists in training, and many established shrinks in the community. And sometimes I’ve been surprised that some of the big name, flashy people were actually very unskilled in real therapy situations. And I’ve also seen that some of the giants of our field, were humble, kindly individuals, like Kevin, who were quietly working miracles, but not even realizing it. And I also had this brainstorm. If you’re a patient, and your shrink refuses to use the BMS and ETS, for whatever reason, you could take the test prior to and after each session, and calculate your therapist’s Empathy Scores and Recovery Coefficient scores. Mmm. I am thinking there might be a business model in here somewhere! Like a website where you could take the tests and get all the calculations automatically. And maybe that type of information could be published... After all, wouldn’t patients LOVE to have this information BEFORE going to a new shrink for treatment. And isn’t that EXACTLY where our field should be moving? Accountability and transparency? I hope you enjoyed meeting the incredible Kevin Cornelius today. Thank you for listening and supporting our Feeling Good Podcasts! Warmly, david

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. We asked Keren what kinds of feelings she was hiding from her mother. 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. At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating. I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice. Then we did some Externalization of Voices with the thoughts on Keren’s Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique. You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session In addition, Keren and Jill will be with us to record the follow-up. T = End-of-Session Testing You can review Keren’s BMS and EOTS (Patient’s Evaluation of Therapy Session) at the end of the session at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she’s had the chance to share more of her feelings with her mom. Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she’s had the chance to do her “homework” following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while still leaving some room for improvement. On the EOTs, you will see that our Empathy and Helpfulness scores were perfect, along with our scores on the Satisfaction with Session, Commitment to homework, unexpressed Negative Feelings, and honesty scales. Here’s what she like “the least” about the session: “Nothing. This has been a powerful experience.” Here’s what she like “the best” about the session: “This has been empowering. The hidden emotion is like a blind spot. I know it is there, but I cannot see it. I loved when David pointed to my avoidance, and I am glad we focused on the hidden emotion. Jill and David were able to see the depth in situation and I feel seen and understood.” Follow-Up We exchanged a number of emails following the session, and will also talk to Keren and Jill live on the podcast so you can catch up on what happened. But here is an excerpt from one of Keren’s emails: Here is what has happened so far: On Friday morning, she made some comments about my gray hair and that the fridge gasket was not properly clean. I got really annoyed, but did not say anything. To be honest, I was too angry to use the 5 secrets and needed time to cool off. About after half an hour later, on our way to the acupuncturist, I told her that I love having her over and that it is special to me that we spend time together. She thanked me for everything that I am doing for her on this trip. Then I added: "this morning, when I came to check on you, you commented on my hair and then you told me to clean the fridge gasket..." I was going to follow up with 5 secrets, but before I was able to finish, she interrupted me and said "Gosh, I am so critical! I am sorry, I didn't mean it that way. I can see now why your sister gets upset with me. I can't believe myself." I told her that I love her honesty and while her criticism comes from a caring loving place the how and when she says things sets tone. This was a breakthrough because even though I did not finish using the 5 secrets I got through to her and felt heard. It was encouraging for me to feel that I could be understood and accepted by her.  I have clients who say that they love the 5 secrets, but like to call it the 3 secrets because they find it effective enough to use only 3. (I still encouraged them to use all 5). I can see now what they mean, I did not finish my 5 secrets spiel and got some good results. I believe that my conservation with my mother will further trickle during her stay. Perhaps because there is a lot to cover, or perhaps it's the way we communicate. In either case, I feel good about having the talks that I previously dreaded. I have not had any panic attacks since, but I don't think they have completely gone. I believe they will be there to remind me to address certain emotions that need addressing.. . . I will keep you posted and may even send this to the group. Just need to think about it a bit longer. Responses from the Tuesday Group who observed our work with Keren Here are just a few of the comments from the 35 therapists who observed the session. This is part of the feedback we get on the quality of our teaching at the end of every Tuesday training group. Please describe what you specifically disliked about the training/ Nothing. The live work was fascinating to watch. David and Jill were masterful as always! This was a truly moving and inspiring and helpful session. I can't think of anything I didn't like about it. Nothing I disliked. I think I would have liked to see Keren do more deliberate practice with the 5 secrets with grading and more roleplaying. Conceptualization was a bit hard to follow. Please describe what you specifically liked about the training. Thank you for such an authentic, moving, beautiful session. And tour-de-force demonstration of TEAM therapy. Observing David and Jill as co therapists in service of Keren was an amazing learning opportunity! The power between them was exponential and felt like they successfully addressed every angle. . .  I had not considered using EOV and loved how effective that was in crushing Keren's thoughts. I also loved how Jill finessed gently guiding her to address Hidden Emotion, having clear conviction that this was where the "action" was. I can understand what Keren said that she wants to be closer but does not want to be enmeshed. I think that it helped us in our work with immigrants and those who live away from where they were born. The discussion about the desire to be a parent or not, was another aspect of the work that I really respected. Excellent class tonight! Keren's gift to the class was priceless and David and Jill's masterful teaching was outstanding as always. Thank you!!! I got to feel closer to her and to several group members through their sharing. David touched me with the notion that opening up to one's parents is an important gift that many of them don't get to receive. Thanks for listening today! Rhonda, Keren, Jill, and David

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. Keren expressed considerable enthusiasm for options 2 and 3. I (David) pointed out that she appeared to be ignoring / avoiding the first option, and raised the question of whether that meant it might be the most productive, but scariest, of the three options. Keren conceded that this rang true, and wanted to start out with learning to express her feelings more openly and directly, but in a respectful and loving way. In next week’s podcast, you’ll find out what happened! 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. We asked Keren what kinds of feelings she was hiding from her mother. 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. At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating. I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice. Then we did some Externalization of Voices with the thoughts on Keren’s Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique. You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session In addition, Keren and Jill will be with us to record the follow-up. T = End-of-Session Testing You can review Keren’s BMS and EOTS (Patient’s Evaluation of Therapy Session) at the end of the session at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she’s had the chance to share more of her feelings with her mom. Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she’s had the chance to do her “homework” following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while still leaving some room for improvement. On the EOTs, you will see that our Empathy and Helpfulness scores were perfect, along with our scores on the Satisfaction with Session, Commitment to homework, unexpressed Negative Feelings, and honesty scales. Here’s what she like “the least” about the session: “Nothing. This has been a powerful experience.” Here’s what she like “the best” about the session: “This has been empowering. The hidden emotion is like a blind spot. I know it is there, but I cannot see it. I loved when David pointed to my avoidance, and I am glad we focused on the hidden emotion. Jill and David were able to see the depth in situation and I feel seen and understood.” Follow-Up We exchanged a number of emails following the session, and will also talk to Keren and Jill live on the podcast so you can catch up on what happened. But here is an excerpt from one of Keren’s emails: Here is what has happened so far: On Friday morning, she made some comments about my gray hair and that the fridge gasket was not properly clean. I got really annoyed, but did not say anything. To be honest, I was too angry to use the 5 secrets and needed time to cool off. About after half an hour later, on our way to the acupuncturist, I told her that I love having her over and that it is special to me that we spend time together. She thanked me for everything that I am doing for her on this trip. Then I added: "this morning, when I came to check on you, you commented on my hair and then you told me to clean the fridge gasket..." I was going to follow up with 5 secrets, but before I was able to finish, she interrupted me and said "Gosh, I am so critical! I am sorry, I didn't mean it that way. I can see now why your sister gets upset with me. I can't believe myself." I told her that I love her honesty and while her criticism comes from a caring loving place the how and when she says things sets tone. This was a breakthrough because even though I did not finish using the 5 secrets I got through to her and felt heard. It was encouraging for me to feel that I could be understood and accepted by her.  I have clients who say that they love the 5 secrets, but like to call it the 3 secrets because they find it effective enough to use only 3. (I still encouraged them to use all 5). I can see now what they mean, I did not finish my 5 secrets spiel and got some good results. I believe that my conservation with my mother will further trickle during her stay. Perhaps because there is a lot to cover, or perhaps it's the way we communicate. In either case, I feel good about having the talks that I previously dreaded. I have not had any panic attacks since, but I don't think they have completely gone. I believe they will be there to remind me to address certain emotions that need addressing.. . . I will keep you posted and may even send this to the group. Just need to think about it a bit longer. Responses from the Tuesday Group who observed our work with Keren Here are just a few of the comments from the 35 therapists who observed the session. This is part of the feedback we get on the quality of our teaching at the end of every Tuesday training group. Please describe what you specifically disliked about the training/ Nothing. The live work was fascinating to watch. David and Jill were masterful as always! This was a truly moving and inspiring and helpful session. I can't think of anything I didn't like about it. Nothing I disliked. I think I would have liked to see Keren do more deliberate practice with the 5 secrets with grading and more roleplaying. Conceptualization was a bit hard to follow. Please describe what you specifically liked about the training. Thank you for such an authentic, moving, beautiful session. And tour-de-force demonstration of TEAM therapy. Observing David and Jill as co therapists in service of Keren was an amazing learning opportunity! The power between them was exponential and felt like they successfully addressed every angle. . .  I had not considered using EOV and loved how effective that was in crushing Keren's thoughts. I also loved how Jill finessed gently guiding her to address Hidden Emotion, having clear conviction that this was where the "action" was. I can understand what Keren said that she wants to be closer but does not want to be enmeshed. I think that it helped us in our work with immigrants and those who live away from where they were born. The discussion about the desire to be a parent or not, was another aspect of the work that I really respected. Excellent class tonight! Keren's gift to the class was priceless and David and Jill's masterful teaching was outstanding as always. Thank you!!! I got to feel closer to her and to several group members through their sharing. David touched me with the notion that opening up to one's parents is an important gift that many of them don't get to receive. Thanks for listening today! Rhonda, Keren, Jill, and David

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? Can hypnosis be used for evil? David and Matt describe their experiences, both as kids and later as shrinks, with hypnosis. David and Matt both used hypnosis early in their careers, especially in David’s one-session treatment for smoking cessation, which Matt also used. But as their TEAM-CBT skills have grown, both of them use it much less frequently. It can be used for many purposes. In a recent podcast # (link) with Dr. Jeffrey Lazarus, we learned that it can be used for warts as well as a wide range of psychosomatic problems, like Irritable Bowel Syndrome and tics, as well as bedwetting, school phobia, performance anxiety, and more. Matt strongly believes that agenda setting (also called Assessment of Resistance) is just as important in hypnosis as in TEAM-CBT. You have to first bring the patient’s subconscious resistance to conscious awareness and melt it away using paradoxical techniques in order to optimize the chances of success with hypnosis. Matt pointed out that hypnotic states can be quite powerful, and can even be used for surgery, but emphasizes that people will never td what they genuinely don’t want to do when hypnotized. He says that hypnosis is really a form of willful collaboration between the hypnotist and the hypnotic subject. Although stage hypnotists seem to have some kind of “Svengali” power over the volunteers who come up to the stage to be hypnotized, these people are actually subconsciously volunteering to act silly and have fun in front of the audience. This doesn’t mean they are faking it, but it does put these shows into a slightly different perspective. David described many goofy things he did as a teenager after he purchased a book called “25 Ways to Hypnotize Your Friends” at a magic store in Phoenix for 25 cents, and found that the techniques actually worked with many of his friends. He sometimes had a lot of fun giving post-hypnotic suggestions, and that he and his friends found hypnosis to be incredibly exciting and fascinating. Once he hypnotized a friend named Jerry and told Jerry that after he woke up, every time he heard the word, “TV,” he would shout out “Boing” in a loud voice without realizing it. In addition, his subconscious mind would keep track of how many “TVs” he heard, and then he’d should Boing that exact number of times. David explains: Then we went to the local Dairy Queen a few blocks away all ordered at the window, one by one. When it was Jerry’s turn to order, and the lady asked him what he wanted, we all started saying “TV, TV, TV” as fast as we could, and Jerry would shout out “boing, boing, boing” in a loud, confident voice! She said, “I didn’t quite get what you want to order,” and when Jerry tried to order, we did it again. It seemed incredibly funny, and fun, but in retrospect I WAS using hypnosis to kind of take advantage of someone, so you might say it CAN be used for evil, perhaps. However, Jerry didn’t seem to mind, and we all thought it was a pretty exciting adventure. When I was a senior in high school, one of my teachers said that hypnosis was dangerous and told me to stop hypnotizing my friends, so I got scared and gave it up until I became a psychiatrist years later. Like anything, hypnosis is just a tool, and it can be helpful for suggestible individuals, but we have more than 100 techniques in TEAM-CBT, because no one tool has the answer for everybody and every problem. David and Matt both agree with anxiety, depression, and anger are very much like self-induced trances, since you are giving yourself and believing messages (hypnotic suggestions) that aren’t actually true. For example: The depression trance: “I’m no good. I’ll be depressed forever.” The anxiety trance: “Something awful is about to happen. I’m in incredible danger.” The anger trance: “You’re no good!” Psychotherapy can be seen as an attempt to get each patient to “wake up” from the trance that has trapped them. In David’s opinion, politicians sometimes put their followers in trance-like states, getting them to believe repeated suggestions that are blatantly untrue. We saw this in WWII, where Hitler essentially “hypnotized” an entire nation to believe some horrific lies and to spur them to unspeakably horrific actions. Of course, as Matt has pointed out, you have to WANT to be hypnotized, so possibly the German people wanted to see themselves as superior human beings who had been victimized unfairly by evil forces that needed to be eradicated. So, killing and the abuse of him beings became the focus and purpose of the nation. Is this possibly also happening today? And is that why narcissistic leaders want to control the media, so they can control the “hypnotic messages” that people get, and why they lash out in such a hostile way at anyone who dares to challenge or contradict them? Is it possible to fall out of love? A podcast listener says she often falls out of love with her husband, but after they talk things over, and resolve their differences, she falls in love again. She wants more on this topic, so Matt, Rhonda and David discuss the pitfalls of pursuing perfect, romantic love. David reminds us that some of the most successful marriages are in India, where the parents decide who you will marry. David said that when he was in private practice in Philadelphia, 60% of the patients he saw did not have a loving partner, and most were trying to find someone to love. That’s why this is one of his favorite topics. Then Matt, Rhonda and David contrast healthy vs unhealthy love, and Matt created the following table that contrasts them. Perfect Love By Matt with a little editing from David Unhealthy Love Healthy Love You rush to put the other person on a pedestal without knowing them. You fantasize that they are perfect and wonderful in every way. You take your time getting to know each other in a curious, vulnerable and respectful way, recognizing that neither of you is perfect. You believe that you need the other person and couldn’t be happy without them. You’re confident and content on your own but also enjoy the company of the other person. You selfishly focus on getting what you want from the other person. You focus on what you can give the other person, and what you can do, to improve the relationship. You imagine you will be in love forever. You accept that relationships require careful tending and nurturing, and realize that there will be moments of conflict, disappointment, and hurt feelings, which can sometimes be intense. You tell yourself that you’ll never and should never have any conflicts or disagreements. You see conflict as opportunities, in disguise, for greater understanding and closeness.   Cheerleading vs. Empathy Rhonda describes a recent traumatic experience which was profoundly disturbing to her. However, when she tried to tell a friend how upset she was, her friend did “cheerleading,” telling her that she shouldn’t be so upset, that she’d feel better again soon, and so forth. Rhonda said it was very annoying to be on the receiving end, and her friends efforts to cheer her up actually made her feel worse. Then, when two friends simply used the Five Secrets of Effective Communication to “listen,” it was a great relief. David recounted a similar experience when his beloved cat, Obie, disappeared in the middle of the night, and was likely killed by a predator animal in the woods behind his house. When David told his Tuesday group what had happened, one member of the group similarly tried to cheer him up, which triggered an angry rebuke from David, who told her NOT to try to take his grief away. He said, “My grief is my loving connection to Obie, who was my best friend in the whole world. I will grieve his loss for the rest of my life. And to this very day, I talk to Obie, as well as my good friend Marilyn Coffy who passed away recently, every time I go out slogging. This is not a problem that I need help with, but a gift of love.” We’ve touched on the codependent urge to cheerlead that so many people, including shrinks, have. For example, our podcast on “How to help, and how NOT to help,” covers this topic pretty thoroughly. However, we decided to focus on cheerleading again today, since it is such an important topic, and is a bit of an addiction that many people have. The following is a chart we discussed during the podcast, and you might find it helpful. Cheerleading vs. Empathy by David , Rhonda, and Matt Cheerleading Empathy You’re trying to cheer someone up to make them feel better. You are not trying to cheer them up. Instead, you acknowledge how they’re thinking and feeling, and you encourage them to vent and open up. You don’t acknowledge the validity of the person’s negative thoughts and emotions. In fact, when you try to cheer them up, you’re essentially telling that they’re wrong to feel upset. It’s a subtle put down, or even a micro-aggression. You find the grain of truth in what the person is saying, even if you think they’re exaggerating the negatives in their life.   Paradoxically, when you agree with them in a respectful way, they will typically feel some relief and support. The effect is irritating to almost everybody who’s upset, because you aren’t listening or showing any compassion or respect. You’re telling them that you don’t want to hear what they have to say. Cheerleading is condescending. Listening and acknowledging how they feel is a form of humility and an expression of respect. You’re trying to control the other person. You’re telling them how they should think and feel. There’s no acceptance. You’re sitting with open hands and not trying to change or control the other person. You’re just trying to understand and support them in their suffering. Cheerleading is cheap and easy to learn. You’re like a used car salesman, trying to promote your product. Empathy is difficult and challenging to learn because you have to let go of the idea that you know what’s best for other people. Listening requires going into the darkness with the other person, this requires courage and vulnerability. You say generally nice things about someone, like you’re “a good person,” or “a survivor,” thinking those formulaic words will somehow change the way the other person is thinking and feeling. You might also say, “don’t be so hard on yourself,” or “think of all the positive things in your life,” or “you’ll be fine.” You focus on the other person’s specific thoughts and zero in on exactly what they’re saying and how they might be feeling, rather than throwing vague, general positives at them. These positives are simply an annoying attempt to distract the person from their genuine feelings. You encourage the person to share and experience their negative thoughts and feelings. You believe your role is to “help,” “fix” or “save” the other person, who is broken. Your role is to be with the other person in a loving way without trying to help or save them. You are being self-centered because you’re essentially preaching the gospel and exclusively promoting your own ideas. You are being other-centered, focusing entirely on what the other person is saying. You’re talking “at” the other person. You are NOT talking AT them, you are being WITH them. When you empathize, you give the other person zero, and zero in, instead, on how they’re thinking and feeling. That’s why I (David) call Empathy the “zero technique.” But, paradoxically, when you give them “nothing” you are giving them “everything.” In case you’re interested in honing your own empathy skills, you can take a look at the Five Secrets of Effective Communication (link). To develop these skills, you might want to read Feeling Good Together (link), but make sure you do the written exercises while reading. Otherwise, you’ll only get intellectual understanding of them, whereas skill is what you actually need, and that can only be developed with practice! Sadly, most people, including therapists, believe that their empathy skills are already excellent, but that is rarely valid! In fact, there’s a ton of room for improvement in ALL of us! We thank you for joining us today. Please keep your excellent questions and warm comments coming in. Rhonda and David want to thank Matt for his frequent, brilliant, and heart-warming appearances on the Feeling Good Podcast. Remember that we’re still trying to grow our show, and recent hit 6 million downloads. We are currently getting around 160,000 downloads per month, which is terrific. It would help us a lot if you give a five star review for our show wherever you get your podcasts, as that might boost our ratings. We love our fans and thank you for listening!

Horrific World Events: Can TEAM-CBT Help Us? Featuring Live work with Meina Last week, we presented Part 1 of the session with Meina, a young woman struggling enormously because of her feelings about the new Iranian revolution. Today, we present the exciting and unexpected conclusion and follow up of the incredible session with Meina. Part 2: The Conclusion When Meina returned, her mood scores were very similar to what they’d been at the start of the previous session. This indicated that empathy alone was not sufficient to trigger any meaningful changes in how she felt. She said that she’d had some fears about what listeners might think, since, as we mentioned, Meina rarely, if ever, opens up about how she’s feeling inside, so talking openly on the podcast definitely means facing her fears and venturing into some radically new territory. The ineffectiveness of Empathy alone is important, because she graded our Empathy as an A+. Many therapists wrongly believe that empathy is the most healing tool we have in therapy. This is idealistic, but wrong. Empathy is definitely important, but without the A and the M of TEAM-CBT, very little, if anything, will change. And, in most instances, patients appreciate good listening, that’s for sure, but they want more. They want tangible changes in how the feel and interact with others. Today, Meina showed more emotion. She mentioned that she’d been a Michael Jackson fan, and liked his song about how our (inner) voices don’t get out. She was feeling tearful, and angry, and said that in her work, her voice was not coming out, and this was a matter of great distress. She also mentioned that after she cried and expressed her rage about the young woman who was murdered by the morality police, an annoying “eye twitch” that she’d had for six months suddenly disappeared. Meina has also had many experiences in the past of experiencing health anxiety symptoms whenever she’s upset about something and hides or suppresses her negative feelings, like anger. She had participated in many of David’s Sunday hikes before the pandemic, and sometimes had weird somatic sensations, fearing she had some neurologic disorder, only to have her symptoms instantly vanish when she finally expressed her anger. Many of you will recognize this as David’s “Hidden Emotion Technique.” She also said she’s afraid she’ll be seen and stereotyped as an “angry woman” if she shows her anger, and said she may even have an Anger Phobia, thinking that anger shows that you’re a “violent person.” She said that she’s always been quick to get angry, and wanted to focus the session on anger. Her goal for the session had shifted in the two days since we did Part 1, and she now wanted to learn how to express her anger more effectively. M = Methods In the rest of the session, we used the TEAM interpersonal model to deal with an intense conflict Meina had recently when she was trying to get her colleagues to issue a statement on behalf of her institution supporting the women in Iran who were protesting, and had partially complete the Relationship Journal in preparation for today’s session. As you may recall, when you use the RJ, you will discover—and this can be quite shocking—that you are actually causing the very relationship problems that you are complaining about. And this came as a huge surprise to Meina. The remainder of the session was incredibly inspiring, and Mina did some magical work. I’ll let you listen to the rest of the session to see how the work unfolded. If you’d like to review Meina’s RJ, you can click this LINK. End of Session T = Testing If you’d like to see Meina’s end-of-session mood ratings, along with her Evaluation of Therapy Session, you can check this LINK. If you’d like to refresh yourself on the Five Secrets of Effective Communication, you can click this LINK. I was incredibly proud of the brilliant and inspiring work that Meina did during this session. She experienced the “Great Death” of her “self,” along with the “Great Rebirth,” or the “waking up” of the “non-self.” At the start of this podcast, we asked the question of whether TEAM-CBT could be of help when people are struggling because of events that are both real and horrific. Now perhaps you see my answer: a resounding and unexpected YES. However, there are a couple of disclaimers. First, the person has to be asking for help, and Meina definitely was. Having an agenda that makes sense to the patient is always, in fact, one of the most important keys to successful therapy. Second, the therapy will usually be totally unexpected, and the work we do with each person will be highly individual. We’re not in the business of creating simple formulas to deal with this or that problem. Instead, TEAM emphasizes a step-by-step process which will be unique and totally different for every person you work with. And finally, we have to thank our old friend, Epictetus, for once again reminding us that our feelings do not result from what’s happening, but rather from our thoughts about it. And the goal is NOT to blame you for the way you feel, but rather to give you the key to unlock the door and free yourself from the suffering you’ve endured. Meina, Rhonda, and I hope the incredible and brave work that Meina did in this session will be helpful for you, too!

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% E = Empathy In the empathy phase of the session, Rhonda and David simply listened, as Meina described terrifying memories of the being a child during the Iran Iraq war, and being left alone to care for her younger sister when her parents were away every day, and bombs were coming down all over the city. She said that on many occasions she was so scared that she wanted to commit suicide by jumping out of the window of their apartment in Iran. And now, all those terrifying memories have come flooding her mind again, triggered by the events in Iran, as well as her fears and run-ins with the “morality police” when she was a young woman. She expressed profound connection with the young women who are now fighting the intense suppression of human rights in Iran, all in the name of religion! Once their car was stopped, and a policeman put a gun to her mother’s head because she had not covered her hair properly. She also described the attempts always to separate the girls and the boys to prevent any type of dating or romantic behavior, and the constant fear of being imprisoned if you did the wrong thing. Meina tells us: I saw friends who were beaten up, and was humiliated for eating an apple. I was arrested for wanting to go to parties to listen to music. I lived in constant fear of being tortured and had panic attacks by night and by day. . . I left Iran when I was 22 and have never gone back, for fear of ending up in prison. . . Then, when I finally escaped to the United States, I never fit in. The young people were interested in the latest music, and did not seem interested in my story, in my experiences. I never felt like I fit in. I think I’ve felt lonely my entire life. Now I feel embarrassed, being from Iran, because it’s such a violent country. . . And I have panic attacks every night. I cope by imagining that I’m in Iran, visiting and counseling girls who have been imprisoned, and giving them tips on how to use the Five Secrets of Effective Communication so they won’t be tortured, raped, and murdered. Meina said she still feels alone, since few people, including her husband, are really interested in her story, including her horrific memories of growing up in Iran, or how she feels now. She said she also feels intensely guilty, since she still has friends and one relative in Iran who are facing desperate circumstances, while she enjoys comfort and safety here in California. She rated us as an A+ on empathy, so that brought us to A = Assessment of Resistance. She added that she always hides her emotions, something she learned to do for survival in Iran, and that she’s afraid to let them out, and continues to hold and hide them. As a result, she struggles with constant tension and anxiety of constantly hiding her anger. David commented on the paradox that she looks chipper and in control, and can be funny at times. But she feels incredible loneliness because other people rarely know or care about how she actually feels. She added: What if I’m just being selfish. Maybe I shouldn’t complain so much! A = Assessment of Resistance Meina said this about her goals for the session: I know I’m not in a position to change what’s happening in Iran, but what I do want help with is the fact that I’m so overwhelmed with negative feelings that I’m losing my effectiveness at work and I also don’t seem to be able to connect with my friends and colleagues. I don’t want to have such hatred and anger for the morality police. And I don’t want all those painful memories to keep coming back and ruining my life, like my uncle and grandmother who suffered from dementia and almost constant terror towards the ends of their lives. At this point, we ran out of time, and had to schedule the remainder of the session two days later. End of Part 1 Tune in next week for the fantastic and unexpected conclusion of the work with Meina!

Audrey Kodye Sunny Choi Diversity: Trauma and Training featuring Sunny Choi and Audrey Kodye Rhonda and I are proud to feature Audrey Kodye, a psychologist with a private practice in Canada, and Sunny Choi, LCSW, who specializes in the treatment of underserved populations in the San Francisco Bay Area. In today’s podcast, these beloved TEAM-CBT therapists bring us an important discussion on the impact of racial, gender, religious and sexual bias, including tips on how to incorporate relevant questions into our initial evaluations of all new patients, as well as illuminating ideas on how to maximize treatment effectiveness with TEAM-CBT. Both Audrey, who was born in Mauritius, and Sunny, who was born in Hong Kong, describe their experiences with bias and violence, both when growing up, and as adults, and how these experiences shaped core feelings of not being “good enough.” Sunny explained that how he incorporated the negative messages that were triggered by his traumatic experiences: I grew up in a privileged family in Hong Kong, and was favored as a male child. When we came to the United States, I was 12 years old and undocumented. I got beaten up because I had slanted eyes, and I was hated because I was gay. I worked super hard, getting a degree in engineering from UCLA and a master's in management from Stanford, and became successful, but got more and more depressed due to my belief that I “wasn’t good enough.” Now I work with marginalized populations, the poor, people of color, LGBTQ, immigrants, and abused women. Audrey said: I’ve also felt like I wasn’t good enough. . . . I’m a light-skinned black woman from Africa, from a lower-class family in Mauritius. . . . My ancestors had to be very resilient due to prejudice, and I’m very proud of them. I’ve also struggled with social anxiety and depression due to the racial trauma I’ve experienced. Sunny and Audrey have both been helped by TEAM-CBT, and feel it has a great dealt to offer and have appreciated that diversity is celebrated in the personal work so many people do in David and Jill’s Tuesday training group. They say that “TEAM has helped us and our patients as well!.” They gave some valuable tips on how to incorporate diversity awareness in to treatment with TEAM, but the same tips would be helpful to anyone interacting with a friend or colleague who may have been the victim of abuse. Sunny added: “I got scared and anxious when thinking about this topic prior to today’s podcast. What I’ve been through has definitely shaped my behavior, my thinking, and my feelings, and the hatred is still happening today.” He tearfully described the experience of his cousin who has a Chinese restaurant in Oakland, and someone threw a rock through the window to act out on their hatred for Asian Americans. Audre said: "I also felt sad and anxious while preparing for the podcast. It’s not easy to talk about racism and discrimination, and I felt a lot of self-doubt about my own experiences with racism and discrimination before the podcast, because they have so often been invalidated. People get defensive and are often incredulous. They don’t believe it. So you run into conflict and opposition and defensiveness when you try to speak out." David agreed and emphasized how sensitive and defensive people can be when our “blind spots” are confronted, especially when we’ve been in a state of denial, thinking of ourselves as totally innocent when we’re not! They discussed three keys in thinking about racism and discrimination: 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.” David points out that this is similar to Freud’s model of depression, which he thought of as “anger turned inwards.” Although Aaron Beck railed against this construct, I have to admit that the negative thoughts of people who are depressed nearly always do have a hostile, bullying tone. David also compares racial discrimination and hatred to the three components of “Abuse Contract” he often explains in his work with abuse victims. There are three parts to the contract: 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. And in spite of the absurdity and cruelty of this “contract,” human beings seem to have the capacity to buy into it, and this includes children and adults as well. Sunny also emphasized that Asians especially are told NOT to be angry, and that’s why it can be so helpful to use the Five Secrets with trauma patients as well as Positive Reframing to encourage acceptance of anger and seeing that it can be entirely healthy and justified. Sunny and Audrey provided additional tips on working with marginalized groups. The most important thing is to ask about trauma and encourage the person to talk about it, as opposed to keeping these experiences hidden, even in therapy. He They said that many patients will open up immediately, and will often use the entire therapy hour just venting. The experience of being heard and supported can be deeply appreciated, and can also provide important clues to the origins of the patient’s feelings of depression, shame, and anxiety. Simple, obvious questions are all that are needed, such as: “Have you ever experienced racism, rape or sexual trauma, or homophobia. Have you ever been bullied or beaten? Sunny gave many additional examples of subtle racism when he was working in Silicon Valley as a manager. But colleagues he didn’t know often thought a person he was supervising was the manager, and he was the person being supervised. Audrey described similar experiences when people told her she was super smart, and that was probably because she was “mixed”--that is, not purely of African descent--or because she’d worked “really hard,” implying others who belong to her ethnic group do not. Again, an apparent compliment which is really a subtle put-down. Sunny tearfully described how he took years and years of voice training, trying to change his accent to sound “less Chinese.” Now he says, “I finally feel okay with who I am!” Although, I think Rhonda and David might say, Audrey and Sunny, we love you, and you’re way more than “okay” in our eyes. You’re our teachers and you’re showing us the way, and making us aware of our own many errors and biases, in a kindly and loving way. Thank you!” Thanks for listening today! Rhonda, Sunny, Audrey, and David

TEAM-CBT with children and teens, featuring Jeffrey Lazarus, MD Tics, Irritable Bowel Syndrome, Chronic Pain, Bedwetting, Fears, Phobias, Performance Anxiety, and more In TEAM, we usually conceptualize four categories of problems: depression, anxiety disorders, relationship problems, and habits and addictions. Although there are similarities in the treatment of each of these targets, there are also important differences. Today’s guest, Jeffrey Lazarus, MD, is a pediatrician who specializes in a fifth category, somatic complaints, which can include physical symptoms like chronic pain, dizziness and fatigue without any known medical cause. This category also includes as irritable bowel syndrome, headaches, tics with and without Tourette syndrome, bed wetting, and a wide range of other problems which are common in kids and sometimes in adults as well. Dr. Lazarus also works with anxiety disorders, such as test anxiety, sports performance anxiety, public speaking anxiety, school phobia and more. Although Dr. Lazarus worked as a general pediatrician for the first 27 years of his career, he switched to hypnotherapy when the painful plantar warts on his feet were unexpectedly cured following a single hypnotherapy session from a colleague. Dr. Lazarus was so impressed that he began studying hypnosis and incorporating it into his work with children, teens, and adults. He now works from a TEAM perspective, incorporating Testing, Empathy, Paradoxical Agenda Setting (also called Assessment of Resistance), and a variety of cognitive methods, along with hypnosis. He began today’s podcast with a case of a young man he was treating for persistent bed wetting, and was surprised when his patient slammed him in the written feedback on the Evaluation of Therapy Session form following the session, labeling Dr. Lazarus as a bit “narcissistic.” At the start of the next session, Dr. Lazarus responded non-defensively with the Five Secrets of Effective Communication. This won the boy over, leading to a successful outcome. Jeff said that the Evaluation of Therapy Session form and the Five Secrets have “saved him” on several occasions with disgruntled patients. Jeff then presented several fascinating cases where motivational factors and resistance played a major role in the treatment, and emphasized that treatment failure would probably have been inevitable if these factors had not been brought to conscious awareness. For example, a teenager who frequently had to go home from school because of somatic symptoms listed, at Dr. Lazarus’ suggested, the many advantages of his symptoms, such as “I don’t have to go to school,” “I get extra attention this way,” and more. After this intervention, the boy decided that it just wasn’t worth it, because there were lots of fun things he was missing out on at school, and his symptoms rapidly subsided. In another case of bed-wetting, Jeff discovered that a 10-year old knew that he wouldn’t be permitted to go on sleep overs at his cousin’s house until he outgrew his bed-wetting problem. But when he “listened” and encouraged the boy to talk about his distress, the boy explained that his cousin had a “creepy dog” that frightened him, so he actually didn’t want to go on sleepovers. Jeff encouraged the boy to tell his parents what was really going on, and when his mother said he wouldn’t have to go on any sleepovers unless he wanted to, his bed-wetting suddenly disappeared. He described many additional cases where motivational factors dominated his patient’s problems, including a promising teenage tennis star who suddenly developed a fear of flying which made it impossible to go with her parents to important weekend tournaments. But with Dr. Lazarus’ support, she confessed that her life was dominated by school, study, and going to tennis tournaments, with no free time to be a “normal teenager.” She finally confided that she was just “tennissed out” and wanted to have more fun in life, to have dates, and so forth. By subconsciously developed a flying phobia, she was subtly going on strike, and saying “I don’t want to do this anymore.” But by developing a symptom, she could continue to be nice and say “I can’t do this,” rather than saying “I don’t want to do this anymore.” These subconscious maneuvers are not manipulative, but automatic. When brought to conscious awareness, the patient finds himself or herself in control, and can decide to go in a different direction. This patient mustered up the courage to tell her parents and her coach, who were understanding, and her fear of flying suddenly disappeared as mysteriously as it had first appeared. Dr. Lazarus emphasized that the child’s complaints are real—they’re not making up the symptoms, and they need empathy and support, and the chance to tell their story. Parents are nearly always focused on “pushing” and “helping,” efforts that just make the problem worse because the child pushes back. Although parents do this out of love, their misguided efforts to “help” can actually be a barrier to successful treatment. Jeff said he often does what he respectfully and affectionately calls a “parentectomy,” which means encouraging the parents to stay out of the picture regarding the individual patient problem and homework he assigns. I have called this tendency of symptoms to be hiding the patient’s actual motives the “Hidden Emotion Phenomenon,” and it’s equally common and powerful with adults with anxiety disorders as well. Essentially, anxiety prone individuals, including children, teens and adults, tend to be exceptionally “nice,” and are often people pleasers. So, they may not always listen to their feelings, which then turn out indirectly, as this or that type of anxiety or somatic complaint. Essentially, the symptoms are saying what the patient’s mouth cannot say! Instead of trying to solve the problem, you can view the symptoms as a subconscious solution to a problem that’s being suppressed and not verbalized. Bringing the problem to conscious awareness can make it possible for adult and young patients to express their needs and feelings directly, which typically leads to a rapid disappearance of the initial complaint. If you’d like to learn more about Jeff’s fascinating clinical work, and perhaps learn more about this ‘Hidden Emotion” phenomenon, and how he integrates hypnosis with TEAM-CBT, you can view a number of resources, including video clips from actual therapy sessions, at his website, JeffLazarausMD.com And, if you’d like, you can contact him directly at JeffLazarusMD@gmail.com. Thanks for listening today! Rhonda, Jeff, and David

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 Very easy explanation why these specific types of women reject me I don't have to make any changes about myself ( clothes) or behaviors ( more charming) Familiar feeling and comfort in familiarity I can feel sorry for myself and have a pity party Gives me something to complain about with my friends lol My fantasy ( sexual and relationship) of these specific women remains unchallenged and is a great distraction when bored Shows I accept I am not perfect and defective I accept responsibility for my failings Don't have to get angry or upset about my mother's poor parenting skills Incredibly easy cop out whenever I fail to achieve any type of goal Can quit working towards a goal when face adversity Next, Roy identified some distortions in this belief. Distortions in believing There is Something Wrong with Me -emotional reasoning -self blame -overgeneralization Why? Feels like there is something wrong with me. I am assuming 100% blame. I am not focused on any positive things done in my life I am stuck because my mother said what's wrong with you when I was a kid. I concluded there must be something wrong with me. Whenever I get rejected this core belief surfaces. Is this what you had in mind? All the Best and THANKS Roy David’s response Hi Roy, Thanks for the email. Everything about you and me could be improved. Is that all you mean when you say “there’s something wrong with me?” Or are you saying you have a “self” that is somehow damaged.? If so, was your “self” always damaged, from the time of birth? Or did it “become damaged” at some point? If the answer is yes, at what point did your “self” become “damaged?” To me, conversations about “selves” have no meaning. Conversations about specific flaws or problems do have meaning. You are kind of kicking your dating problem up into the clouds of abstraction, to my way of thinking, when you obsess about a “damaged self.” Lots of colleagues who used to come to my Sunday hikes had dating problems, in your age range, and most eventually solved them. But talk about “damaged selves” was never part of the dialogue that I can recall. I wrote a book on dating, Intimate Connections. Just my thinking! d More from David after an email exchange I don’t think you answered, or attempted to answer, my question. One problem is that you would like to date and have sex with more younger women who are in great shape. That is something specific and clear. I understand it, anybody can make sense of what you are saying. When you say, “In addition, I believe I have a ‘self’ that is defective (or whatever), I don’t “get” what you are talking about. Can you explain this at the fourth-grade level? Do you mean that you get upset when you get rejected? Is that all you mean? Or do you mean that you get frustrated and disappointed when you cannot get a date with X, Y, or Z woman? Nearly all men have these reactions at times. Does this mean there is “something wrong” with their “selves?” There are lots of reasons why woman A might not be attracted to man B. Do you agree? Which reason makes the man’s “self” not good enough. She may not be attracted to him because he is chasing her, for example. This means that his dating style needs some fine tuning, and perhaps that he needs to learn to be happy when he is alone, and that he does not “need” love or her love, etc. Those are specific things, easily changed. But I don’t get the “self” bit! We all having varying qualities and ratings. Take math. Everyone has a certain skill in math. 50% of people are above average, and 50% are below average, in math. Do you agree? Is there some skill level that means that there is something “wrong” with your “self?” Thanks! D On today’s podcast, Rhonda, Matt and David discuss effective and ineffective approaches to dating, including a mind-set that may be a huge turn-off to women. They also illustrate how to challenge some of Roy’s distorted thoughts using three strategies: Self-Defense The Acceptance Paradox The CAT, or Counter-Attack Technique Matt and Rhonda speculate that Roy may be harboring some anger toward his mother, and toward women in general. David is less convinced, but more focused on change in the here-and-now, regardless of causes, which can sometimes be difficult to prove. At any rate, if Roy’s goal is to develop more loving and rewarding relationships., there are many available tools. 2. Lynn asks: Do you have any recommendations for someone with health anxiety? I am a long time fan of your work, and I have a long history of health anxiety. My therapist tells me that this is really death anxiety. I'm not sure I agree...but do you have any recommendations for someone with health anxiety? ( imaginal exposure therapy has not been helpful) I'd be eternally grateful for any insight. David’s reply Thanks for the kind words, Paul. I will try to include this in an upcoming Ask David segment! Matt’s reply: Using uncovering techniques, like the ‘What if’ technique, Hidden Emotion, Downward Arrow and Interpersonal Downward Arrow could help answer this question.  If you had a problem with your health, what would you worry about, most?  If you were having a problem with your health, what would you worry about, in terms of how other people would treat you?  What would it mean, about you, if you had a problem with your health.  Identify the specific negative thoughts behind your suffering will help your therapist identify methods that could help you.  As far as Death Anxiety, you could consider a chapter in Feeling Good, where David breaks this fear down into more specific parts.  Are you afraid of the process of dying?  The moment of Death?  What comes after?  If so, what are you afraid of, specifically?  Most people don’t fear Death, it doesn’t really exist, like a shadow, just the contrast to something real, Life. In the podcast, Matt, Rhonda, and David emphasize the role of the Hidden Emotional Model in the treatment of Health Anxiety, and describe two dramatic cases involving rapid recovery, one of them personal—David’s belief he had a lymphoma in his armpit shortly after completing his psychiatric training. The other involved a college student with a long history of health anxiety who David and Matt hypnotized. While in the trance, she suddenly “remembered” what she was actually upset about, and burst into tears. This was a life-changing moment! Thanks for listening today! Matt, Rhonda, and David

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? " 1. Rhonda asks: How can you respond to someone who yes-butts you? 2. Thomas asks: Do we have a self? Does God exist? 3. Thomas also asks: Ellis said we should upset ourselves over someone else’s problems, but how about Putin, and Russia? 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. Rhonda asks: How can you respond to someone who yes-butts you? David’s Reply Thanks, Rhonda. We can demonstrate this with Matt on the podcast recording later today! Matt’s Reply: The answer is to fall back to Empathy and try to see how we are creating the problem.  For example, when we are giving advice, we may have fallen into a trap, in which we are getting ahead of their resistance and would want to get behind it. As often happens, the question, and its answer, went in an unexpected direction. Rhonda, like many therapists, noticed that one of her social anxiety patients was subtly resisting exposure—facing her fears. Matt and Rhonda model how to respond to patients who keep putting off the exposure. This answer illustrates how therapists and the general public alike can improve your use of the Five Secrets of Effective Communication (LINK) with the use of “Deliberate Practice,” with role reversals and immediate feedback on your technique. Rhonda starts with a low grade, and then rapidly achieves an A grade! Click here for the Five Secrets of Effective Communication 2. Thomas asks: Do we have a self? Does God exist? Thank you for giving me your time and attention. I appreciate it, even if we don't agree. I have talked about whether or not God and the self exist. David Hume made the argument about not having a self, only perception. Of course, questions arise if we don’t have a “self.” Thomas Thomas also comments on Nathaniel Brandon: Why do we use the words who? Him? Her? He she they.?? I certainly don't believe Nathaniel Brandon’s horseshit. He talks about a teenage self, a father self, and a child self And all that is just horseshit. But do we have any self? David’s response: Hi Thomas, Thanks for your question! You ask, “But do we have any self?” You ask about God, too. People have been asking for my chapter on the “Death of the Self,” and my efforts to debunk the idea of a “self.” I have not had the time and motivation to bring that chapter back to life, since it is so hard for people to “get” what I’ve been trying to say, which is exactly what Wittgenstein and the Buddha were trying to say. But I will try to share one idea with you, in the hopes that it might make sense. As I have previously suggested, these questions about some “self” or “God” have no meaning. For example, how about this question: ‘What would it look like if someone had no ‘self?’ What, exactly, are we talking about? I know what this question means: “So you think Henry is too high on himself.” This means that we think some person named Henry is arrogant or narcissistic, something like that, and we want to know if someone agrees with us. I understand this question, it makes sense. There is a distinct difference between people who are quite humble and folks who are overly impressed with themselves. So, we are talking and using words in a way that has meaning and makes sense. However, I cannot answer the following question because it does not make any sense to me: “Does Henry have a ‘self’?” So, this question, to me, is language that is out of gear, like a car in neutral gear. No matter how hard you press on the accelerator, it will not move forward or backward. If you cannot “see” or “grasp” the difference between my examples of a meaningful question and a nonsensical non-question, that’s okay. In my experience, few people can grasp or “get” this. But to me, the difference is quite obvious. Is it okay if I use your email as a somewhat edited “Ask David?” I can change your name if you prefer. I don’t think people will “get” my answer, but hope springs eternal! David Matt’s Response Many brilliant minds have addressed this question in more eloquent and thorough ways than I could, including the Stanford-trained neurologist and philosopher, Sam Harris, in his book, ‘Free Will’ and Jay Garfield in his book, ‘Losing Ourselves’ There’s very little I can say, about this topic, that hasn’t been said more eloquently by individuals like these and many others. Meanwhile, I’m glad that this question has arisen on the podcast because I see clinical utility in the implications of this question, including in the treatment of depression, anxiety, anger, narcissistic pride and relationship problems. For example, I might be thinking, ‘I’m so mad at my (bad) self for eating all those cookies’.  Or, I’m so proud of myself for making a million dollars’.  I might start to think I deserve more, because of my special self and feel superior and angry, ‘that persons (bad self) shouldn’t have cut me off in traffic!’. When we take the ‘self’ out of the equation, we realize that these thoughts don’t make sense.  If our brains are just following the laws of physics, without any self, jumping in there to influence the process, then we couldn’t have done differently, with the brains we had, and neither could anyone else. Hence, the idea that people have ‘selves’, which can be good or bad, make decisions and the like, is a setup for suffering.  In the cookie example, I would have to train my brain, through practice with therapy methods, to develop a different set of habits, rewiring of my brain, to reach for a salad rather than a cookie.  I can’t simply insist that my ‘self’ rewire my brain for me.  I’d have to practice and do my TEAM therapy homework! Anger and Narcissism are some of the hardest-to-defeat problems.  However, realizing other people are simply doing what their brains are programmed to do, takes away the anger and blame.  Just like we wouldn’t hold a grudge for years against a wild animal that bit us, we could also forgive and accept a person who bit us.   and we can’t feel unnecessarily superior or proud of our ‘self’ if we accomplish something wonderful, because we don’t’ have a ‘self’ that did those things, just a brain and the right environment, neither of which we can take credit for. This approach is called ‘reattribution’ in TEAM, which is useful for defeating ‘self-blame’ and ‘other (self) blame’. Here are some other methods to leverage the no-self concept and free your mind of this hazardous way of thinking: 1. Experimental Technique:  Try to define what a ‘self’ is.  Then conduct an experiment to see whether the self is capable of doing the things you think it can do.  For example, can your ‘self’ stop understanding the words you are seeing on this page?  Or does your brain helplessly decipher the shapes of these letters into meaningful sounds and language?  Can your self exert its free will to decide to focus exclusively on one thing for one minute, like your breath or a point on the wall?    It can’t.  If your self can’t do such simple tasks, what can it do?  One can see meditation as a kind of ‘experiment’ to see whether our ‘self’ is calling the shots, using its free will, or if our brains are just doing what brains do. 2. Socratic Questioning: You can ask questions that can’t be answered to show that the ‘self’ is more like a ‘unicorn’ than a cat.  For example, how big is the ‘self’?  What’s it made of? Where is it located?  Can you see it on a MRI?  No radiologist has ever visualized a ‘self’ and you probably realize you can’t answer these questions, any more than you can, ‘what do Unicorns like to eat?’, bringing us closer to understanding that it’s probably a made up thing. 3. Examine the Evidence: What evidence is there that there’s a Self?  What evidence is there that there is no self? On the latter side, Consider Occam’s Razor, which suggests that the better hypothesis is the simpler one which still explains the observations.  One hypothesis is we have a brain generating consciousness.  Another hypothesis is that we have a brain that generates consciousness and a self that is having those experiences, operating the brain.  Based on Occam’s Razor, the better hypothesis is the former, that we have a brain creating consciousness. 4. Outcome Resistance: People get scared off by the idea that there’s no self or free will, that their brain is making decisions, without a self intervening.  In Christian Tradition, for example, Thomas Aquinas essentially invented the concept of ‘free will’ so that God’s punishment of Adam and Eve could be explained, morally. Otherwise, God would seem rather cruel, to create a system where he knew that would happen.  This is an example of how ‘free will’ and the ‘self’ are linked to blame and anger. Even if you don’t believe in God, you might be concerned that the idea that there is no free will would mean that the criminal justice system would fall apart.  Criminals could say, ‘I had no choice’.  Talking back to these elements of ‘resistance’ could help free one’s mind. For example, without free will, it’s true that blaming other people and retaliatory justice wouldn’t make sense.  However, one could still enforce laws, only in a compassionate way, for the sake of protecting others making the same mistake.  A murderer, if they realized this, could mind meaning in fulfilling their sentence, realizing they were doing a service to humanity, rather than being punished for their bad self.  Instead of seeing other people as having ‘bad’ selves, we can have a sense of sadness, connection and concern, even with a murderer, when carrying out justice, understanding that, ‘there but for the grace of God, go I’. David mentions, in passing, a mild red flag with the concept of "free will." He points out that this is another concept, like "God" or the "self," that has no meaning, if you really grasp what Ludwig Wittgenstein was trying to say in his classic book, Philosophical Investigations. One way to "see" this, although it is admittedly almost impossible to "see:" because it is so simple and obvious, would be to ask yourself, "What would it look like if we "had" something called "free will?" And what would it look like if we "didn't?" The question is NOT "do we have free will," but rather, "Does this concept have any meaning? Once you suddenly "see" that the answer is no, you will be liberated from many philosophical dilemmas. But as they say, enlightenment can be a lonely road! the Buddha, as well as Wittgenstein, ran into this problem that people could not "grasp" the simple and obvious things they were trying so hard to say! As humans, we get spellbound by the words we using, thinking that nouns, like "self," must refer to some "thing" that either exists or doesn't exist! To my way of thinking the question is NOT "Does god exist" or "do human have free will," but rather, do these questions make sense? Do they mean anything? The answer, to my way of thinking (DB), is no. However, . . . you might not "get" this! 3. Thomas also asks about Dr. Albert Ellis Hi David, Do you agree with Ellis that one is better off without making oneself upset over other people's problems? What about Putin and Russia and all the violence, another mass shooting, and trump running for president again? Ellis didn't think one should be disturbed about these things. Or at least upset. What do you think? David’s reply Hi Thomas: Here’s my take. Healthy and appropriate negative feelings exist! One SHOULD be upset by horrific war crimes. I suspect that if Beck and Ellis, were they still alive, they would both strongly agree, but of course, I cannot speak for them! Thanks for listening today! Matt, Rhonda, and David!

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: Great determination and desire The willingness to endure the “Great Death” of the “self,” or pride. Tons of ongoing practice with immediate feedback and deliberate practice involving role reversals until you get it “right,” or receive an “A.” To get started, Rhonda and David made a list of a few of the most challenging criticisms a therapist might hear from a patient, or a parent might hear from a teenager. Criticisms from patients included: You don’t care about me! I’m not getting better. You’re not helping me! You charge too much! All you care about is your darn techniques. That’s not my child’s name! You’re not listening to me! And this one, from a first time patient referred by the courts: I got anxious last night and masturbated to your image, which I found on the internet, and it really helped! These are some criticisms from kids: Stop nagging me! Stop giving me advice. I don’t want any advice! We demonstrated the “Intimacy Exercise” I have created for our training programs. You can use this exercise to work on conflicts with patients and conflicts with loved ones. It works exactly the same way in both situations. You’ll need someone to practice with. Step 1. One of you agrees to play the critic and the other plays the role of the person being attacked (therapist or parent, for example.) Step 2. The person playing the role of the critic verbalizes the hostile comment. Step 3. The person playing the role of the therapist / parent responds as effectively as you can, using the Five Secrets of Effective Communication. Now you must STOP. The exchange is done. No further interaction in the role playing format is permitted. Step 4. The person who played the role of the therapist / parent gives himself / herself a grade between A and F. Ask yourself, “How well did I do just now?” Step 5. The person who played the role of the critic gives the therapist / parent a letter grade, and then provides the following specific kinds of feedback using Five Secrets language. Positive Feedback: Here’s what you said that worked pretty well. Your Thought Empathy was great, and your Disarming Technique was fairly good. Your Stroking was excellent, especially when you said X, Y, or Z. Negative Feedback: Here’s what you said that needs a little fine tuning: Your Feeling Empathy was completely missing—you did not acknowledge how the other person was feeling. Your “I Feel” statements were also missing, and there was no Inquiry at the end. Then you can suggest ways to include the Five Secrets elements that were missing or “off,” and demonstrate how you might improve the response to the criticism with a role reversal, followed by another round of grading and positive and negative feedback. Continue using role-reversals until both parties can get an A on the exercise, always using the same harsh criticism that you’re trying to learn how to master. Don’t try something new until you’ve mastered the thing you’re working on. The practice is powerful but hard, and requires the philosophy of “joyous failure.” This means welcoming the chance to get immediate feedback about your skills, or lack of skill, instead of getting blown away, defensive, or “yes-butting” the person who’s trying to correct your technique. You will hear some pretty dramatic examples of this on today’s podcast! The Five Secrets can be life-changing, but the price of learning is fairly stiff. If you want the rewards, the exercise we demonstrate in today’s podcast can be incredibly helpful—but scary! Also, you can read my book, Feeling Good Together, and do the written exercises while reading if you’re a therapist or a general citizen. This helps a lot. Dr. Jill Levitt said she kept Feeling Good Together on her nightstand for more than a year when she first joined by training group at Stanford. Her dedication and hard work have clearly paid off for her. If you’re a therapist, you can also read the chapters on E = Empathy in my Tools, Not Schools, of Therapy book, and make sure you do the written exercises while reading! Thanks so much! And good luck if you’re brave enough to try our “Intimacy Exercise!” David and Rhonda  

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 Grad school: 64% College: 29% High school, grammar school, other: the rest Comment: high average education level is likely due to high number of therapists Therapist No 56% Yes 33% TEAM certified therapist Yes 15% No 85% Podcast Interests Listen to improve your therapy skills? Yes 47% No 53% Listen for personal healing? Yes 90% No 10% How many episodes have you listened to? All 26% A lot 37% About half 16% Just a few 21% What elements do you value the most? Teaching Therapy Techniques 86% Live Work 72% Story Telling 58% Critical Thinking 57% Inspiration 54% Warmth 46% Laughter 42% Guest Interviews (36%) Under 30%: Tears (23%), Banter (29%), Controversy (17%), What types of podcasts appeal to you the most? Therapy Methods 194 Live work 184 Anxiety Help  168 Ask David 163 Self-Help  158 Depression Help 156 Relationship Problems 154 TEAM Training 126 Habits and Addictions 107 Procrastination  94 Guest Experts 88 Weight Loss 51 Other What do you think about paid ads? Hate it 28% Love it 20% Unsure 52% Would you recommend the podcast to a friend? Yes 96% No 4% What grade would you give the podcast? A 77% B 20% C 3% D 0% F 0% Written Responses Elements you like the best (selections 356 responses) Learning about techniques to help patients from experts in the field! Realistic and humorous portrayals and disclosure Always pick up a new concept Brilliant teaching and great techniques The idea that long- lasting change can happen quickly The use of Paradox There is done sort of therapy by proxy that seems to happen during live therapy work. Even when situations are different, amazingly meaningful. I enjoy the Q&A podcasts where you cover 4 to 5 great questions. Having Rhonda and Matt (and, of course, Dr. Burns!) give their viewpoints on topics that can be helpful to everyone is very useful. Learning how to retool my brain. I love the feeling of comfort I get from hearing your stories, both personal and from guests. I was particularly touched by Rhonda’s openness when she first joined the podcast and worked through her feelings of inadequacy. I think about those episodes a lot because I relate to them. Feel less alone The live therapy sessions. Hearing Dr. Burns, Jill, Rhonda and others do externalization of voices, positive reframing, and other techniques is SO incredibly powerful. Hundreds more! (link) Elements you like the least (selections 356 responses) The long intros sometimes before the topic gets started Boasting, rambling on and on. Sometimes the attitude towards other practices and theories is condescending and fails to appreciate the contributions different approaches make to understand and alleviate suffering. endorsement emails Something I've noticed in live coaching is that there seems to be a strong focus on externalization of voices as a method. In Feeling Great, I love your 50 methods - but I wonder why it feels like 80% of the time you focus on externalization of voices vs other methods. Honestly, that's super nit-picky. But I felt like I had to include something in the "liked least" section. Otherwise, I think the Feeling Good podcast is A+++ Not a fan of the hokey -- the weird Hello Rhondas, etc. Ditto for the four letter words. IMO these detract from the content, dumb down/lessen the credibility of the presenters and content. Distracting and make me cringe. I won't quit listening... just unprofessional and low class. Hard to complain about something this good Hundreds more (link) What other topics might interest you? Trauma work. Meaning - I find that MANY people are talking about "Childhood Trauma" as if it's a separate thing. "Trauma-Informed Therapy" seems to be a new hot topic. Wondering what you feel about trauma and this seeming growth in trauma-focus. Use 5 secrets in relationship with someone with borderline personality disorder 5 secrets training How to make friends How TEAM principles can help you raise happy/healthy kids! Discussion of how to manage anxiety when it’s hard to pinpoint the direct cause, making it hard to challenge our thoughts. Also topics on panic attacks. integrating the buddha dharma with cbt Definitely PTSD (I have PTSD from finding my partner dead after a suicide), body image, more about dating and relationships. How to treat low self esteem. How to increase happiness. How to make touch decisions about careers or other things that have pros and cons. For example, doing the decision making form and having the scores be around 0 or both negative scores. How to heal after a break up and how to manage rejection while dating (e.g., someone rejects you after a few dates) I would love to see more episodes on habits and addictions and also a life episode on shame attacking exercises! Hundreds more (link) Comment: Some of these excellent suggestions have been covered already, and you can find them on my website by using the search function and / or the list of podcasts with links. For example, we’ve already had a five part series on boosting happiness (link) as well as boosting self-esteem (link) and how to use each of the 5 secrets (link), and much more. Take a look! (link to list of podcasts) What other topics might interest you the least? Anything related to organized religion. (Disorganized religion, I'm okay with!) lol) ;) Weight loss/eating disorders promoting other therapists "worried well" privileged patients. Anxiety and phobias Can’t think of any Why TEAM CBT is superior to all other forms of therapies. Nothing it is all helpful to make me realize I am not alone and we all have our own internal struggles I love it all Therapist workshop announcements Hundreds more (link) Suggestions for improving the podcast (194 responses) Keep doing listener questions and answers and case examples.. the Buddhist perspective of not having a self and bigger picture etc Hidden emotion technique examples ongoing as I think that helps to know what common pressures people have experienced in Davids practice that we might also see etc. Maybe fewer judgy comments, including more guest speakers, more inclusivity. Always love the live work Keep bringing in therapist from around the country in the world to talk about what they do with team No, just please keep making it. DON'T CHANGE A THING! I mention above but I think getting David out to more of the enormous self-help podcasts would really help spread the word and open a lot of people’s eyes. A big one that I think would be a great fit is the Tim Ferriss podcast Comment: Thanks. I’d love to be on any podcasts with large audiences. Please contact them and tell them to invite me! I’m not comfortable and don’t have the time to do this or the resources to hire a PR / marketing person, but they might respond to suggestions from listeners. It seems like a majority of the live therapy patients are TEAM CBT therapists so sometimes that can make me wonder if the techniques are as helpful to someone who doesn't already believe in the efficacy of the treatment. I'd like to see more treatment with people who are unfamiliar with TEAM CBT, although I realize that may not be possible. Comment: I do not generally work with the general public because that would be tantamount to entering into a therapeutic relationship and would expose me to liability issues. Since I work for free, I cannot and will not take this chance, and liability insurance is costly. When I work with therapists, it is personal work in the context of their training, and is not construed as the start of a therapeutic relationship. I have done extensive research with large numbers of people, comparing the ease and nature of treating shrinks vs the general public, and there is absolutely no difference in the types of problems they have, the intensity, or the speed of recovery. If anyone would like to volunteer to indemnify me, which would be immensely costly for you, I’ll happily work with anyone! Hundreds more (link) Why would you or wouldn’t you recommend it to a friend? I already have multiple times. Because the advice is different to what I hear elsewhere, it’s compassionate, blunt, and takes an inward look with a huge dose of kindness. It can change the way you live life Rhonda and David are so genuine together, smart, funny and informative It would help them, especially friends with depression or anxiety It is the highest quality methodology delivered by the highest quality therapists!! It helped and encouraged me too much advertising and plugging Because it offers real practical information that could be useful to anyone It helped me get out of a black hole It’s entertaining and informative. Life skills everyone should learn! Read both Feeling Good and Feeling Great. Dr. Burns’ content has saved my life! The five secrets has rewired my brain and helped me save my relationship, too! And Dr. Burns’ personality and sense of humor is just the icing on the cake. Hundreds more (link) Thank you to all who responded!  We appreciate you! 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 In addition, other negative feelings typically go hand-in-hand with social anxiety, such as shame and loneliness, as well as depression and feelings of inferiority and even hopelessness. This workshop will focus on therapists looking for training. However, the general public are also included, since you will get the chance to practice and work on your own fears during the workshop. I (David) have noticed that feelings of social anxiety, especially performance anxiety, are almost universal among therapists, at least judging from those who attend our weekly TEAM-CBT training group at Stanford. So, come to heal yourself AND to learn how to heal your patients and loved ones. We will be covering not one, but four treatment models for social anxiety in the workshop: 1. The motivational model: Nearly all anxious individuals resist exposure, which is a crucial part of the treatment. Most therapists also resist exposure for a variety of reasons, thinking the patient is too fragile, or the technique will be too dangerous or upsetting for their patients. This is unfortunate, since this pretty much dooms the treatment to failure, especially if you are aiming for a “cure” rather than endless talk and hand-holding. 2. The Cognitive Model. Although usually not completely curative, the Daily Mood Log is essential to treatment, so you can find out exactly what patient are thinking and feeling at one specific moment when they were feeling anxious. I present the case of Jason, a young man feeling shy and anxious while standing in line to check his groceries one Saturday morning at the local grocery store. Many cognitive techniques are incredibly important and useful in the treatment of social anxiety, including Explain the Distortions, the three types of Downward Arrow (uncovering) Techniques, the Double Standard Technique, Externalization of Voices, the Feared Fantasy, and more. Although these methods are helpful and illuminating, they will rarely or never be quite enough for a complete cure. For that you will need: 3. The Exposure Model. In the workshop, we will be teaching: Smile and Hello Practice: In today’s podcast Jill discussed the purpose of this technique, how to introduce this technique to your patients, and how to implement it. This is an example of the many techniques we will teach on October 2. David provided a dramatic example of how this humble technique changed the life of a young man from India. Flirting Training Talk Show Host Rejection Practice Feared Fantasy: We role-played how I used this humor-based technique in my work with Jason Self-Disclosure Survey Technique Shame-Attacking Exercises. We will also explain how to use several techniques crucial to the reduction of the patient’s resistance: Dangling the Carrot Gentle Ultimatum Sitting with Open Hands Fallback Position However, many therapists have intense resistance to making patient accountable with these techniques that are absolutely central to TEAM-CBT, thinking they are cruel or crude or narcissistic, or some such thing. In the podcast, Jill illustrates a beautiful and gentle but firm way of introducing these techniques to patients, and emphasizes that they are actually ethical, therapeutic, and necessary for a good outcome. She also emphasizes, and I totally agree, the importance of going with the patient into the real world to do the Exposure Techniques. I have used extreme exposure techniques on hundreds of occasions when treating anxious colleagues on Sunday hikes for example, urging them to stop hikers we meet and disclose their own shyness, for example. The advantages of doing this type of thing in the real world include the ability to coach the “patient” with the best examples of how to use whatever technique you’re advocating, and to be there to support the patient during and after the experience. 4. The Hidden Emotion Model. This technique is often extremely helpful in the treatment of any form of anxiety, but is perhaps less often used in the treatment of social anxiety. I can think of one example when it was extremely helpful. This was a woman whose boss kept pressuring her to give presentations about their company locally and to groups in other locations as well. She opted out because of her social anxiety. But lurking behind her symptoms were her feelings of resentment about being asked to do too much. Once she brought these feelings to conscious awareness, she decided to discuss his expectations, her feelings, and her compensation with her boss. This worked well, and her public speaking anxiety magically disappeared. Although this pattern is not common, it is always worth consideration in your treatment plan, because family and friends often pressure people with social anxiety to confront their fears, and this typically does trigger feelings of resentment and resistance. We also discussed two Self-Defeating Beliefs that are nearly universal in individuals with social anxiety: the Spotlight and Brushfire Fallacies. In the podcast, I give examples of several techniques that were life-changing for patients. Jill emphasizes that one of the underlying treatment themes is how to “wake up” from your trance so you can learn not to take yourself so seriously and begin to have fun and enjoy yourself and others way more. Improvement is not the goal of treatment. The goal of treatment is word that many mental health professionals fear and resent: CURE! In the podcast, I describe the difference between a 100% cure for any form of anxiety, and a 200% cure. Do you know the difference? I give an example of my own fear of heights when I was in high school. Of course, that’s a phobia, and not a form of social anxiety, but you can also have a 200% cure for social anxiety, too! In a 100% cure your fears go to zero. You are no longer particularly anxious about talking to strangers, or public speaking, for example. In a 200% cure, you come to LOVE the very thing that terrified you in the past. Rhonda, Jill and I think this will be a powerful one day experience. We will focus on a common problem that is usually treatable fairly quickly, and often with fabulous and life-changing results. We hope you can join us! For registration information, please go to: CBTforSocialAnxiety.com Thanks! Jill, Rhonda, and David

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: Loss of a loved one, including friends, family, colleagues, or even a beloved pet Betrayal by someone you trusted Being trapped in an abusive relationship Being abandoned or neglected as a child Not being accepted by your family due to sexual orientation, religious preference, choice of life partner, or other factors Feelings of isolation due to COVID A dead marriage Infidelity And more. Of course, Social anxiety is one of the most common causes of loneliness, and last week we interviewed two individual, Cai Chen, MD, and Chan Mary Soeur, RN, BSN, who have fallen in love. Both were lonely and struggled for years with social anxiety. Their work with TEAM-CBT has not only helped them greatly with their anxiety and loneliness, but has brought them intense romantic love! Not bad! People struggling with loneliness often think there’s something “wrong” with them. For example, you may feel unlovable, and fear that you’ll be alone forever. In addition, the belief that we “need” love to feel happy and fulfilled often leaves the lonely individual feeling like they’re doomed to endless unhappiness and a lack of fulfillment if they’re alone. Mark explains that the scientific definition of loneliness is the distress you feel when you think that your ”needs” for connection and relationships differ from what you have. In addition, he believes that loneliness is not abnormal, but is rather an indication of healthy brain function that has been important to the survival of the human race. For example, feelings of loneliness motivate us to connect with others. In fact, feelings of loneliness prompt babies to cry for their mothers when they feel hungry, hurt, or alone, and this process begins within seconds of being born. We raised the question of whether the cure for loneliness is internal or external. The internal solution involves changing the way you think, and your relationship with yourself. The external solution involves trying to find a loving partner or becoming more involved in activities with others. Although this is the solution most people pursue, it often falls short. David emphasizes the important of the internal solution, and discovering that you can feel completely happy and fulfilled when you’re alone. In fact, this is the first step in overcoming loneliness that he emphasizes in his book, Intimate Connections. Mark, Rhonda and David also discuss some of the paradoxes of TEAM-CBT, and how the “need” for love often drives others away, since you are asking people to give you something you can only give yourself. In contrast, when you feel happy within, and no longer “need” the love of others, love will often pursue you. We hope you enjoyed today’s podcast, and want to thank our buddy, Professor Noble, who has made so many in our TEAM-CBT community feel less lonely and more connected! Warmly, Mark, Rhonda, and David

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: May 2, 2022. Dr. Jill Levitt and I will be teaching an exciting, full-day workshop on “Smashing Social Anxiety: Shame-Attacking and Beyond.” It will be open to shrinks and the general public alike. The focus will be on learning to treat social anxiety, including your own! For registration and more information, please go to CBTforSocialAnxiety.com. September 13, 2022: Drs. Brandon Vance and Heather Clague start two new Feeling Great Book Clubs. For registration and more information, please go to www.feelinggreattherapycenter.com/book-club. September 14, 2022. Drs. Heather Clague and Brandon Vance will start their weekly “Deep Practice” group for training in the Five Secrets of Effective Communication. This type of practice is absolutely needed if you want to use these fantastic techniques to greatly boost your clinical effectiveness or enhance your relationships with the people you care about. For registration and more information, please go to www.feelinggreattherapycenter.com/5-Secrets. Date (to be announced). Zeina Halim soon begins the first-ever book club for When Panic Attacks. This terrific group could be helpful if you’ve ever struggled with phobias, social anxiety, chronic worrying, panic attacks, OCD, PTSD, and more. For registration and more information, please go to https://feelinggood.com/2022/08/08/anxiety-book-club/ Date (to be announced). Zeina Halim will collaborate with our Feeling Good App development team in an experiment to test a month’s use of the Feeling Good app with or without a weekly practice group to supplement your work with the app. This exciting project is currently in the planning stage, but if you think you might be interested, please contact Zeina at Zeina Halim so she can contact you once we’re ready to start. As an aside, the app will be free since we’re still involved in beta tests, but the weekly practice groups will involve an additional charge. Today we feature a love story involving Dr. Cai Chen, a young psychiatrist who did his residency training in Texas and now has moved to California to be with his love, Chan Mary Soeur, RN, BSN. Both have been members of my TEAM-CBT training group at Stanford. Cai practices at the Feeling Good Institute in Mt. View, California, and Chan Mary who is pursuing a master’s degree as a Psychiatric Nurse Practitioner. Cai explains that he’d felt socially anxious and lonely for used, and used the tools in my book, Intimate Connections, when he got tired of dating sites. One crucial thing he learned is that you have to stop “chasing” if you want to find love. Then he met Chan Mary in one of the breakout groups in our weekly training group. Chan Mary said, “I also used to struggle with social anxiety. Even now, on this podcast I have thoughts that I won’t be as impressive as Cai. Cai is much better at expressing himself and being vulnerable in front of others. “I’ve been on a personal journey to get over my intense social anxiety. I’ve always held back in groups, and have never been the first one to reach out. “After listening to the Feeling Good Podcast’s episode on how to overcome social anxiety, I decided to challenge my fears and reach out to Cai. I contacted him and told him I really admired the courage he was showing in his transparency about his feelings, and in his courage to challenge his fears with the many Interpersonal Exposure Techniques we were learning about in our training. “I also decided to try another technique, Flirting Training. I told him that I thought everything he was doing was inspirational, and that I felt close to him.” Rhonda asked about the importance of taking risks if you struggle with social anxiety. Chan Mary explained it like this: “I was extremely anxious about reaching out to someone I didn’t know. For me, a simple thank you email and introducing myself was anxiety provoking because I had never done that before. I was also worried about asking too many questions because I didn’t want to come off as intrusive or even bothersome.” Chan Mary continues: “After conquering my initial fears of reaching out, I went even further, I invited him to join me for a week in Hawaii as our first date in 2021 for my vacation. I usually went on a medical mission to Cambodia, but couldn’t because of the pandemic. So I did the boldest thing ever—I met him in person in Hawaii!” Cai describes the fears he had: “I was scared. I thought, ;what if we get too close and our relationship falls apart.’ In fact, after accepting the invite, I called and told her that I’d changed my mind. She got angry, and I realized I had mixed feelings, so I turned to David’s Decision-Making Tool. (You can get it for free at the free chapter link on the bottom of the home page of David’s website.) “This tool helped me see why I was stuck, so I called Chan Marie back and asked for her forgiveness. I’d been hiding my feelings, so I told her I really liked her and had been afraid of ruining a great relationship.” Chan Mary said: “I was scared, too. But I told myself to trust myself, and that it felt safe to trust him, too.” The rest, as they say, is history. The date was terrific, and after some initial hesitation, Cai decided to move from Texas to California to be with “the love of my life!” Was it all roses from then on? All relationships, I’m pretty sure, have difficulties, and Cai and Chan Mary explained that they both have trouble expressing negative feelings. Cai explained it like this: “I always try to be nice, so I push my negative feelings down, and automatically sweep them under the rug. Chan Mary helps me with this. She pushes me to tell her what I’m upset about. And although it’s frightening at first, once we express our negative feelings they kid of fizzle out. Chan Mary has become an expert in David’s five Secrets of Effective Communication, and that has helped tremendously.” Chan Mary explained her difficulties with negative feelings like this: “The Hidden Emotion Technique has been helpful for me when I start to feel anxious or upset. I have to reflect and ask myself, ‘What’s the deeper issue here?’ Often, I don’t even know what I’m upset about!” Chan Mary added: “Thank you to David and Rhonda and everyone who made the Feeling Good Podcast possible. I’m just like many of your listeners, and this podcast has been life-changing. The techniques, you shared on the podcast have transformed my life! If I did not take the steps to conquer my social anxiety, Cai and I probably would not be here today.“ Cai and Chan Mary are delightful, and their obvious love is an inspiration in this time of increasing violence in the world and such intense political divide and hatred here at home. I asked where their relationship is heading and Chan Mary hinted that Rhonda and David might be getting invitations to a wedding one day soon! Cai and Chan Mary are two of my favorite people in the whole world. It’s a privilege and a blessing to know them and share a little of their lives. This is Rhonda…. "I love Cai and Chan Mary, too. I was in the Tuesday Stanford TEAM Training group for years with Chan Mary, and feel really close to her for lots of shared experiences. I am lucky enough to see Cai every Wednesday in our International TEAM Therapy Training Group, and I always look forward to reading the wise comments he writes on the TEAM certified listserve. Next week, we’ll look at the other side of the coin, as Professor Mark Noble leads a discussion on the recent rise in loneliness, which is often associated with social anxiety. Warmly, Cai, Chan Mary, Rhonda, and David  

TEAM-CBT Celebrates Diversity Today's featured image is Sean Williams, co-founder of the BAD Group Rhonda starts today’s podcast with a terrific endorsement from Steve, from England. He really liked Feeling Great, and said he benefited from the personal work with Dr. Mark Taslimi that we published as the first live therapy on the Feeling Good Podcasts (see podcasts 29-25 and 141.) Steve wrote that the live work, and the teaching points that Dr. Jill Levitt and I made during the podcasts to explain our strategies, is the best learning by far. Rhonda and I strongly agree, and I feel fortunate to have been able to publish many additional live TEAM-CBT sessions since that time. It is my hope that some day these live therapy podcasts will be used in teaching graduate psychology classes so that future practitioners can pick up where we left off and benefit from the rapid treatment techniques we’ve developed. Today we interview Amber Warner, LCSW, Sean Williams, LCSW and Chelsea Dorcich, MFT. Amber is a Level 3 certified TEAM therapist, living and working in Lake County, where she provides mental health care in a rural community. She has a private practice that includes a virtual practice for anyone in the State of California. Amber has been a member of our Tuesday TEAM-CBT group for the past year. Chelsea is also a Level 3 Certified TEAM therapist with a private practice for anyone in the State of California. Both Chelsea and Amber work at the Feeling Good Institute in Mountain View, California. Sean is a Licensed Clinical Social Worker and also Level 3 TEAM-CBT therapist and co-founder of the TEAM CBT Clinicians of BAD, for Black African Descendants, along with Amber and Chelsea. He is a long-time and beloved member of the Tuesday training group at Stanford. He currently resides in Colorado and works for the Ohio State University where he works with active duty and retired soldiers regarding their PTSD suicidal ideation and trauma. He treats patients and also supports the Ohio State University’s research. He also has a part-time private practice for people who live in Indiana. Amber got our podcast going by saying: “My introduction to TEAM-CBT was in 2017, while at a Sunday workshop about 1 1/2 years ago. I’d been struggling with grief after accidently finding out my employer had hired others at a higher salary, so I started a Daily Mood Log and did a downward arrow (this is an uncovering technique) using one of my negative thought. I discovered that my Self-Defeating Belief (SDB) was not included in David’s list of 23 common SDBs. “I felt like all the weight of the world was on my shoulders because my employer had hired white people with less experience at higher salaries. I asked myself what I was going to do. “Do I care to stand up for myself? It felt like a heavy dilemma. I decided to face my fear and talk it over with my employer. It took some time, but things eventually turned out in my favor.” Way to go, Amber! Amber mentioned that Philip Lolonis, LCSW, a member of our TEAM-CBT community, urged us to create and teach an introductory TEAM-CBT course for African-American clinicians in 2021. Amber reached out to Sean and Chelsea and asked if they'd be interested in creating a “Clinicians of Color” group on Facebook. And that got the ball rolling. Rhonda asked, “What kinds of challenges have you faced?” Sean said that one barrier was the whole process of getting licensed. It requires a lot of time and money, nearly always meaning large loans and years of training. One goal of their group is to assist interested people through from initial training through the licensing clinicians, as well as introduce TEAM therapy to the larger therapeutic community. There are very few Black mental health professionals within the TEAM community. Amber explained that one of their goals is to provide support and encouragement to young Black men and women who might want to enter the counseling profession by attending medical school, or a doctoral or graduate school in counseling or psychology, or obtaining a certified coaching diploma. Amber also stated that TEAM-CBT has made a powerful impact on her, Chelsea and Sean, so they formed an affinity group, TEAM CBT Clinicians of B.A.D. Their primary goal is to support and encourage clinicians of color to learn and practice TEAM-CBT and explore culturally responsive methods to enhance the therapeutic alliance and improve treatment outcomes. Sean explained that he was introduced to TEAM and David’s work around the year 2000. He was looking at books in the self-help section of a Barnes and Nobles bookstore, but most of them were too expensive. He said, “Most of them were too expensive, but then I saw Feeling Good lying on a table, and it was only $8.95, so I purchased it and read about the list of cognitive distortions that David had created. That book changed my world view and changed me as a clinician. I realized that I really wanted to disseminate this information to clinicians of color.” Sean explains why he resonated with Feeling Good: “Many of the cognitive theoretical principles were extremely empowering to me. In “Feeling Good” there was a diagram of a man where it demonstrated how human beings process their experiences through thoughts, beliefs and assumptions. The whole idea of my thoughts impacting my emotions and behaviors was mind blowing to me and still is. It made me recollect on all my past struggles such as relationship break ups, job losses, public speaking anxiety, and so forth, and my reactions towards those situations unbeknownst to me at the time were primarily based on my thoughts about those events. I believe that it’s important that all people have access to these powerful therapeutic interventions regardless of race, ethnicity or culture. The reason why it’s important to disseminate these powerful tools to people of color is because people of color are reporting high rates of psychological distress but are less likely to get treated for it. “According to webmd.com ‘…African Americans are more likely to report feelings of sadness, hopelessness, and worthlessness than are adult whites. Still, in 2018, 18.6% of white Americans received mental health services, compared to less than 9% of African Americans.’ “I think TEAM-CBT can even help alleviate suffering related to racial stress. Although racism is a non-distorted reality the concepts in “Feeling Good” and the whole TEAM framework can orient a person to adopt the healthiest possible perspective when moving through those realities.” Chelsea said she learned about TEAM-CBT when she moved to the Bay Area in 2017. She says, "I also found that TEAM was a roadmap and a blessing. I could really connect. This is an amazing framework for everybody!” We also discussed one pitfall that some clinicians fall into. The idea that our thoughts, and not events, create all of our feelings can be liberating. But it can also be used to invalidate genuine, healthy anger. Racial bias and cruelty are real. "They are NOT cognitive distortions," she says. "Racial bias is very real. But TEAM-CBT can free us from the inner prison of depression and anxiety and self-doubt that results from distorted perceptions. Of course, sometimes perceptions are totally valid, and sometimes it’s time to fight and stand up for what’s right." David added that "We had to do a lot of fighting and protesting in the 1970s, when the Viet Nam war was waging, and the forces of darkness were powerful and destructive. Now, it seems, we have many more battles to fight, and we are lucky to have crusaders like Chelsea, Amber, and Sean. "Thank you for what you are doing!" Thank you all for listening today. Chelsea, Amber, Sean, Rhonda, and David Following the show, Sean kindly emailed me with some information addressing some of my questions about black people and the mental health system in the United States. He wrote: Although I was super anxious, I really enjoyed doing the podcast with you two. I used the “Dare to be Average” principles in Feeling Good to help me relax and it worked! Here’s a few additional notes about black people and our mental health system. I hope it helps! Insights into Diversity By Sean Williams, LCSW Why is it important to disseminate TEAM-CBT to people of color? Data from the American Psychiatric Association (APA) shows that only 2 percent of the estimated 41,000 psychiatrists in the U.S. are Black, and just 4 percent of psychologists are Black. On college campuses, close to 61 percent of counseling center staff are White, and 13 percent are Black, according to a 2020 Association for University and College Counseling Center Directors survey. he shortage of psychiatrists and counselors of color has severe implications for all Black individuals needing treatment. A 2019 survey by the Substance Abuse and Mental Health Services Administration (SAMHSA) found nearly 5 million, or 16 percent, of Black Americans reported having a mental illness. However, only one in three Black adults who needs mental health care receives it. Because of the scarcity of mental health professionals of color, it can be difficult for Black Americans to find a practitioner with whom they feel comfortable enough to share any race-related trauma. One 2016 study in the Journal of Black Psychology found that African American therapists and their patients often had relationships marked by a “distinct sense of solidarity … as evidenced by having a better understanding of the context of Black clients’ lives. For more information, see https://www.insightintodiversity.com/addressing-the-lack-of-black-mental-health-professionals/

306: Ask David: Featuring Matt May, MD 1. Kevin asks: Hi David, Is it possible to have a healthy relationship with someone who can be classed as “Borderline Personality Disorder”? 2. Brittany asks: How do you deal with the injustice of people who rip you off without giving you credit? 3. Paul asks: Is there a way to know if I have done the Hidden Emotion Technique correctly? 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. Kevin asks: Hi David, Is it possible to have a healthy relationship with someone who can be classed as “Borderline Personality Disorder”? Hi David, Is it possible to have a healthy relationship with someone who can be classed as “Borderline”? What are keys to being in a relationship with someone that exhibits some of these characteristics? Is it a lost cause? Is borderline personality disorder bullshit and simply a result of assumptions such as “I need love to be worthwhile” as indicated in your books? Best, Kevin David’s reply Great question, here are a couple brief responses off the top of my head: "Healthy" exists on a continuum. In my experience, the therapeutic relationship with a patient diagnosed with BPD exists on a continuum, it is not all-or=nothing, and you can have excellent interactions, but this often requires great diligence and skill in the use of the five Secrets of Effective Communication. I have not observed any unique relationship between the Love Addiction and BPD. That's because the "need" for love is pervasive in our culture, and is, in fact, one of the most common Self-Defeating Beliefs. I do believe that Other-Blame (along with Self-Blame) is a common feature of BPD, along with the unwillingness to be accountable and to have tow work hard and consistently for recovery. I have had a number of patients with BPD threaten suicide if I asked them to do psychotherapy homework, for example. At my clinical in Philadelphia, we diagnosed the ten personality disorders prospectively, at the intake evaluation, and depressed patient with and without BPD improved at almost the same rate during the first 12 weeks when treated by the forerunner of TEAM-CBT, when controlling for severity of initial depression. I published this surprising finding in the top journal for clinical psychology research, the JCCP, but it got little attention for some reason, and some of the reviewers of the article were critical of this finding which they found difficult to believe or accept. DBT has been the "go-to" method for BPD, and BPD therapists may think that CBT / TEAM-CBT would or could not be helpful. Still, I am grateful for DBT welcoming such patients and helping them, when so many therapists avoid these patients! At my clinic in Philadelphia, something in the range of 28% of our patients were diagnosed with BPD at intake. david Matt’s Reply: I’m really just guessing, but perhaps Kevin is feeling quite sad, worried and hopeless, about his relationship. Perhaps he’s been treated badly and is also angry and scared that this will continue to happen in his current relationship. If so, he might be having thoughts like, ‘This relationship will always be terrible’ or ‘They will continue to hurt me and disrespect me and treat me badly’ of maybe, ‘This is their fault, they have Borderline Personality!’. This is only a guess, but if it were the case, I would imagine Kevin could use a great deal of empathy and listening, right about now. It is possible he has been treated terribly or even abused. His partner may indeed meet the criteria for BPD, in which case they would be tremendously sensitive and frequently reactive and prone to unhealthy expressions of anger. Perhaps Kevin has displayed tremendous patience and tried very hard in the relationship, which would be admirable, but only amplify his disappointment when the same hurtful patterns continue. Kevin may even feel worthless, if he believes that the way he is being treated by others is an indicator of his worth as a person. I feel for you, Kevin, and hope you’re getting the Empathy you need. I think there is a lot we could offer someone in this situation, in addition to Empathy, as well. We certainly have the technology, in TEAM, to alleviate the worthless feelings, the anxiety and worry, the feelings of anger and hopelessness, etc. and to replace these with a sense of confidence, joy and optimism. We could also offer skills that that one could use to substantially improve the quality of their relationship. Meanwhile, there are many reasons why someone would prefer to maintain very high levels of hopelessness, anger and worry and low self-esteem in this context. For example, as a protection against getting hurt again. Or they might not want to like and admire themselves if their partner is dissatisfied with them. We’ve also discussed, on the podcast, how tempting and seductive Blame can be. When we tell ourselves, ‘It’s their fault, they have Borderline Personality Disorder’, this type of thought can give us pleasant feelings of superiority. Kevin may not have any of these thoughts or feelings. My point is that, before trying to ‘help’ someone in Kevin’s shoes, I’d certainly want to explore all the good reasons he would want to continue to feel extremely upset and all the good things this says about his sensibilities and values. In addition to Empathy and an exploration of Resistance, one tool that is sometimes helpful in this situation is the Decision Making Form. This is a simple but powerful tool, available online, thanks to David’s generosity, which one can use to compare and consider, with great care, the three options they have in a relationship: continue the status quo, end the relationship or take personal responsibility for improving the relationship. There would be pro’s and con’s to each of these options. Meanwhile, you will notice that there’s one option that is NOT on that list, which is to change the other person. Trying to change the other person, blaming them, is the cause of relationship problems and another version of the ‘status quo’. For the sake of argument, let’s imagine Kevin, or someone like him, is convincingly talking back to the resistance. Maybe he also does the ‘Relationship Journal’ and he experiences the death of the blaming self, witnesses how his behavior is causing the problem, etc., this would be a tremendous achievement, but, I would still have some questions: Would they want to feel better, now, or would they want to wait until after they have a better relationship? Would they want to embrace and accept and love their partner, now, flaws-and-all … or would they prefer to keep their guard up, until things improve? Are they still needing the other person to change, in some subtle way? The reason I’d have to ask these questions is because of my own limitation: I can only help someone feel better in this moment, the way things are, right now. Similarly, I can only help someone improve their relationship, in this moment, while their partner is still treating them badly. When people are open to these terms, their lives and relationships can transform in beautiful ways. They can come to appreciate and love themselves and others, just as they are. David, you’ve said that’s the paradoxical first step towards improvement, I think. 2. Brittany asks: How do you deal with the injustice of people who rip you off without giving you credit? Hi Dr. Burns! I hear you say often how it upsets you that people use your work and don’t give you acknowledgment or credit for it. I wondered how you deal with your thoughts like the unfairness or injustice of it. Or maybe you don’t want to deal with those thoughts because the anger helps you in some way? Like it motivates you to create more content & host more trainings etc. so people know the ideas come from you. I was just curious. I deal with similar issues at work where I work really hard for an outcome and then once it happens other employees will take credit for it or just plain ignore the fact that I played any role. I think hearing how you deal with not getting acknowledged would help me too. Thank you, Brittany David’s reply Thanks, Brittany, and good to hear from you again! Maybe we can make this an Ask David. I've been ripped off so much that I try to ignore it, since it would consume a great deal of energy. We may take legal steps once we raise money for our Feeling Good App. For the most part, I always have so much to do, and try to keep moving the ball forward. But yes, I DO get ticked off at people. Plagiarism was considered a severe violation when I grew up, and I still view it that way. Of course, all around the world we can see a tremendous amount of horror and evil being perpetuated by humans. I once asked Dr. Albert Elis a similar question, since Wayne Dwyer ripped him off. His answer was: "I just tell myself that Wayne Dwyer was an asshole, so he was just doing what he SHOULD do, since that's what assholes do! David D. Burns, MD Matt’s Reply: This question is for David, not me. However, I would like to express my deepest and most sincere gratitude to David. David has dedicated his life in the service of improving the lives of others. He has published over a hundred scientific articles and revolutionized the practice of psychotherapy in the form of the TEAM model, as well as publishing at least 12 books, including Feeling Good, the most-prescribed book for depression. He has traveled the globe to offer training seminars to therapists, as well as offering free training to countless students, trainees, residents, PsyD’s and psychologists in his groups, including his ongoing Tuesday training group. It is disturbing and upsetting that someone like David, who has offered so much, would be a target for plagiarism and theft and I admire him for continuing his work, despite all of that. 3. Paul asks: Is there a way to know if I have done the Hidden Emotion Technique correctly? Hi Dr. Burns, It blows my mind how simple yet logical TEAM CBT is. And I am really excited about potential of the app, and I sincerely hope that this will be a revolution in field of psychology and psychotherapy. I really enjoy reading Feeling Great, but some techniques I find complicated. I would like to ask, is there a way to know if I did Hidden Emotion Technique correctly ? Also, I would like to ask if fear of mental illness does count as hypochondriasis as well. At the end I would like to say, that I really appreciate your work Dr. Burns, and I hope that your work will spread around the world and get recognition it deserves, so even more people can be healed. Paul David’s reply Thanks for the kind words, Paul. I will try to include this in an upcoming Ask David segment! Matt’s reply You asked if you did the Hidden Emotion technique correctly. They say that the proof is in the pudding. Do you feel better? Are you experiencing relief? Keep in mind that the Hidden Emotion technique is one of many and may not be the correct method for some individuals. Also, for it to ‘work’ will require not only revealing the hidden emotion, but discovering how to address that emotion. Will you use cognitive techniques to untwist the thinking that is causing this emotion? Will you use the 5-Secrets to respectfully communicate that emotion in a productive way? Will you make a decision about your future that will correct the problem? There are lots of options, but the outcome, if the Hidden Emotion is successful, will be relief. You also asked if worrying about having a mental illness counts as hypochondriasis. The nice thing about this model is that I get to admire you for having all kinds of hypochondriacal worries about your mental health and point out how it’s a ‘solution’ rather than a ‘problem’ and how such worrying speaks highly of you, how responsible you are, how much you care and how much you value your mental health. I’d need you to convince me that it’s a problem!

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 Today, we interview Angel Poch, a certified life coach, registered professional counselor, and certified Level 4 TEAM therapist and trainer. She lives two hours north of Glacier National Park in British Columbia, but teaches therapists and treats people virtually from around the world. Her new booklet, “The Truth Shall Set You Free,” integrates TEAM-CBT with a Christian perspective and is available for free on her website. https://www.angelapoch.com/. She is a regular in David’s weekly virtual psychotherapy training group at Stanford and assists in the teaching. She has also worked tirelessly and selflessly behind the scenes making David’s work way more accessible to lay people as well as mental health professionals wanting to learn more about TEAM-CBT. For example, she adds links to every new Feeling Good Podcast on David’s website, so you can easily find and link to more than 300 podcasts. Check it out! She has also transformed a massive amount of David’s work into electronic tools for shrinks, accessible in David’s online shop: Recently, she has created two amazing new documents you can link to. One is a spreadsheet that lists 138 of David’s TEAM-CBT tools and techniques, like the “Anti-Procrastination Sheet” and many others, with page links to the descriptions of how to use each tool in David’s books, like Feeling Good, Feeling Great, David’s TEAM-CBT therapist eBook, and many others. Check it out! This data base will be invaluable to interested lay people, therapists, and teachers who want clear instructions on how to use the Daily Mood Log, Relationship Journal, and numerous additional tools and techniques. Derek Gurney and Angela are working on an equally awesome database for the Feeling Good Podcasts: Check it out as well! Angela begins her personal statement in today’s podcast by describing her struggles with depression and irritability, including some very dark days in 2006. Her doctor recommended an SSRI antidepressant, and she went to integrative health program, “Depression: the Way Out” that required participants to read Feeling Good https://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380810336 Although she didn’t love the book, she resonated with the idea that all of our feelings, positive and negative, result from our thoughts, or perceptions, and her depression cleared up. She liked that when she read Feeling Good, she got many new tools she could use to change her negative thoughts and feelings. She also appreciated the ideas in the book didn’t go against her belief system, which many fear about psychology. David pointed out his own father, a Lutheran minister, worried about this, and was very suspicious of psychiatrists. Angela’s thinking, which resonates with David’s, is that the core ideas of religion and psychotherapy are actually high compatible, and even synergistic. Angela explains that when she was a young child, she didn’t fit in socially or even in her own skin. “I felt like I was a boy in a woman’s body. I felt like I was in the wrong body, and prayed for help.” She started to see in a very limited, childlike way, her thoughts were distorted, that a body was just a body and she could trust God wouldn’t give her more than she could bear. These new realistic, counter thoughts relieved the negative body dysmorphia she’d been struggling with. She reports, “I decided it was okay to be flawed and not fit in.” The rest of her young childhood was mostly joyful. In middle school she was the target of mean-spirited bullying because she was a tomboy. She developed intense social anxiety and was relieved when her mom took her out of school. She was homeschooled for a few years and studied Karate to exercise and develop some confidence. High school brought new challenges. She describes responding with her version of the Five Secrets of Effective Communication to an aggressive bully who threatened her with brass knuckles and challenged her to fight her. However, the girl backed off and started telling people that Angela was her friend! After a bad relationship, Angela started to struggle with depression and described her suicide attempt when she was 18 because “I wanted the pain to stop.” She explains that: I met my husband, moved home, and started reading the Bible. I was impressed by the passage, “the truth shall set you free.” I realized I had to control my own thoughts rather than look for the approval of others, but she still didn’t totally recovery from my anxiety. The cognitive piece in Feeling Good helped Angela a lot. She states, “I pursued a lot of careers, never holding down a job for more than 6 months, and one day someone asked if I’d considered a career in counseling. . .” She went on to take one of David’s four-day live intensives in Whistler BC where she learned TEAM-CBT and hasn’t looked back since! After learning and applying TEAM, Angela was able to crush her social and other anxieties. Angela has a deep love for her Creator and has done a great deal of thought about the integration of her Christian faith with TEAM-CBT. David also has a strong interest in the overlap between TEAM-CBT and virtually all religions and spiritual paths. He described an unusual and overpowerful spiritual experience he had as a medical student crossing the Nevada desert that made a strong impact on him. Angela would like to mention, “I have a profound gratitude for David’s work. He makes things so clear and relatable. His approach is applicable to all faiths or no faith if one is truly ready to give up their negative thoughts and feelings. As we aim for the truth, and let go of the so called “self,” we find peace and joy. I will forever be indebted to him because I would not be able to help people without TEAM and that brings me joy every day!” I, David, would like to thank Angela for her intense and tireless devotion to helping spread the “gospel” of TEAM-CBT in so many ways! Thanks for listening today! Angela, Rhonda, and David I

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: Acceptance Self-Defense The CAT, or Counter-Attack Technique. David asked Jason to discuss one of the traditional Buddhist definitions of enlightenment. You are “enlightened” if you are free of greed, ignorance, and delusions. However, he sent this delightful email following the podcast recording: Hi David and Rhonda, Thank you so much again for having me on the podcast! It was a blast! I wanted to clarify an important mistake I made: A commonly accepted Buddhist definition of enlightenment is to be completely free of the three root poisons of greed, hatred, and delusion. These are considered to be the source of suffering / negative thoughts / mind states (Buddhists refer to these as Kleshas). I can't remember exactly what I said in the podcast, but I think I may have incorrectly listed the three poisons as greed, delusion, and ignorance. Delusion and Ignorance are considered to be in the same category, so I think I forgot Hatred. Oops! Looks like I'll have to brush up on my studies again! Hopefully, we can help make this clear in the show notes as well. If you or anyone you know is at all interested in learning more about Buddhism, its philosophies, and history, I highly recommend the YouTube channel Doug's Dharma. Candidly, Jason I am very grateful for the creative and life-changing contributions that Jason is making in our Feeling Good App, and I feel tremendously lucky to know Jason on a personal and professional level. His quite humility speaks loudly and boldly about the kind of loving and genuine person he is, and if you decide to beta-test our app, you will have the chance to benefit from his personal journey and his professional genius! If you’re interested, you can sign up to beta test the app at www.feelinggood.com/app. If you would like to contact Jason, you can reach him at asonmeno@feelinggoodapp.com. After reviewing the draft of the show notes, I got this link from Jason: Also, if you are interested in reading a little more of the story, I wrote this article a few years ago about some scary health challenges I had and how I ended up leaving the Buddhist retreat center and returning to school: Buddhist Enlightenment or Just Life with Diabetes? Thanks for listening today! Thanks! Rhonda, Jason, and David

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: Invitation Step Miracle Cure Question Magic Button Positive Reframing Pivot Question Magic Dial Jill issued a Straightforward Invitation, asking Nazli if she was ready to get down to work, or if she needed more time to vent. She said she was ready to go to work, so Jill asked what changes she was hoping for during the session. This is the so-called “Miracle Cure Question.” This helps to focus the session on something specific. Nazli said that her hope was to reduce or eliminate the negative thoughts and feelings that were making her clinical work so stressful. And like nearly everyone, she said she’d eagerly press the Magic Button. Then Jill and David pointed out that although we didn’t have a Magic Button, we did have some powerful techniques that could help, but it might not be the best idea to use them. That’s because there might be some positives hidden in her negative thoughts and feelings, and perhaps we should first take a look. David and Jill asked Nazli these three questions: 1. Given your circumstances, why might this negative thought or feeling be totally appropriate and understandable? 2. What are some benefits, or advantages of this negative thought or feeling? 3. What does this negative thought or feeling show about you and your core values that’s positive, beautiful, or even awesome? This technique is called Positive Reframing. The goal of Positive Reframing is to reduce the patient’s subconscious resistance to change, along with their feelings of shame about their symptoms.. Paradoxically, the moment patients see the beautiful and awesome things about their negative thoughts and feelings, their resistance to change typically disappears. Positive Reframing is one of the unique features of TEAM-CBT and it opens the door to the possibility of rapid change. As an exercise, see if you can find some positives in five of Nazli’s feelings, Anxiety Ashamed, bad Inadequate Hopeless Angry Please do this on paper, and NOT in your head, using the blank Positive Reframing Tool you’ll find at the end of the Daily Mood Log. Getting it “right” isn’t important. What is important is trying. This will get your brain circuits firing in a new way. Then, when you see the work that we did with Nazli, you might have your own “ah-ha” moment, as well as a powerful new skill that may be helpful to you as well. Okay. Did you do that yet, or do you plan to look at the answer without doing the exercise? Oh! I see! You’re planning to look at the answer. If you want to learn at a deep level, whether you’re a therapist or lay person, do the exercise first! It may be challenging at first, but it will fire up your brain circuits, so when you look at the answer, you’ll suddenly have a new and deeper understanding of Positive Reframing. When you’re done, you can check this link to see the work that Jill and I did with Nazli. But either way, I’m grateful that you’re listening to these podcasts and reading the show notes! If you click on this link, you can find the Emotions table from Nazli's Daily Mood Log showing her goals for each negative feeling after we use the Magic Dial. After we finished the Magic Dial, we went on to the M = Methods portion of the TEAM-CBT session, and helped Nazli challenge some of her negative thoughts using a variety of techniques including Explain the Distortions, the Externalization of Voices, Examine the Evidence, the Acceptance Paradox, and more. One of the thoughts she wanted to work on first was this one: “If I don’t fix this patient or make him/her satisfied, then she/he will judge me and think poorly about me.” Together with Nazli, we identified a number of distortions in this thought, including a couple more that popped into my mind while doing the show notes: Fortune-Telling: Making a negative prediction without good evidence. Mind-Reading: Assuming that I know how my patients are thinking. Hidden Should Statement: Telling myself I should be doing better. Mental Filtering: Selectively noticing the times sessions have not gone well. Discounting the Positive: Overlooking the positive feedback I typically get from patients and supervisors. Magnification and Minimization: Magnifying the importance or “awfulness” of negative feedback from patients, and overlooking the potential value of processing their negative and positive feedback with them at the next session. Emotional Reasoning: Thinking that my feelings of inadequacy and anxiety mean that I really am screwing up with patients Self-Blame: Beating up on myself constantly when I’m seeing patients. Nazli’s belief in this thought went down from 80% to the range of 10% - 20%, since there was some truth in the thought. Sometimes you’ll want to smash a negative thought, so your belief in it goes all the way to zero. Sometimes, it’s okay just to reduce your belief in a thought substantially, but not all the way to zero. We also encouraged Nazli to begin using the Brief Mood Survey (BMS) and Patient’s Evaluation of Therapy Session (EOTS) with every patient at every session so she can get immediate and accurate feedback of how she’s doing, and so she can fine-tune her therapeutic strategies based on this information. This practice is vastly more effective than Mind-Reading, since therapists’ perceptions of how patients feel tend to be wildly inaccurate most of the time. If you are a therapist, T = Testing at start and end of every  is a vitally important key to personal and professional growth, although it takes courage because sometimes—or even often—you will have to confront some information that may threaten your feelings of pride! You can see Nazli’s final ratings of her feelings on the Emotions table her Daily Mood Log at the end of the session. Since the changes in all of her negative feelings were dramatic, we asked Nazli two questions: 1. Are these ratings valid, or are you just trying to please David and Jill? 2. If so, what were the effective ingredients of your session. What, more than anything else, accounted for the significant and rapid changes you experienced? You will hear how she answered these vitally important questions on the podcast, and you can see Nazli’s BMS and EOTS after her session if you click the link. Thanks for tuning in last week and today! Once again, Rhonda, Jill and I want to thank our wonderful and courageous Nazli from the bottom of our hearts! We hope you enjoyed this session, and the chance to look behind closed doors to see how psychotherapy actually works in a real session with a real human being who, like nearly all of us, struggles at times with that ancient belief that “I’m just not good enough!” In fact, we’re all, in many ways, “not good enough,” and will probably never be “good enough.” But that is never the cause of our problems, especially our lack of self-esteem. Do you know what the actual cause is? Do you know what the solution is? Take your best shot, make a guess, and then you can click on this link. Thanks! Rhonda, Jill, Nazli, and David

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: I’m not doing a good job. This job is not for me. Should I just quit? My friends are at a better place in life. I’m 38 years old and missing out on a lot. Why am I like this? Recently, she went to visit one of her patients, a young woman struggling with lung cancer; but when Nazli entered the room, her patient said: “I don’t want to talk to you!” Nazli said, “I was devastated and felt like crying.” When you review Nazli’s Brief Mood Survey (BMS) at the start of the session, you’ll see that the only feeling that was elevated was anxiety, and that was minimal. However, her score on the Happiness Test was only 8 out of 20, indicating that she didn’t feel very worthwhile, happy, hopeful, motivated, or satisfied with her life. This meant that her negative thoughts and feelings when she was seeing patients were making a huge impact on her capacity for happiness and self-esteem. Her minimal scores on the depression, anxiety, and anger scales on the BMS also reflect the fluctuating nature of anxiety and other feelings for many people. For example, you may have little or no anxiety most of the time, and when you’re having a session with your shrink you may not feel especially anxious, either. But when you encounter the situation that triggers your anxiety, the feelings suddenly spike tremendously, along with a host of other negative feelings, and then the emotional discomfort can be overwhelming. End of Part 1 of the Nazli Session: T = Testing and E = Empathy. Next week, you will hear Part 2: A = Assessment of Resistance and M =  Methods. Thanks! Rhonda, Jill, Nazli, and David

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. Time Featured Guests 1:30-1:45 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 1:45-2:00 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 2:00-2:10 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) 2:10-2:20 Leigh Harrington, #279, Goal setting for Habits & Addictions Sarah Hester,#181, Live therapy, treatment of panic and insecurity, #193, Relapse 2:20-2:30 Brian Wright, #235, Anger in Marriage/5 Secrets Revisited 2:30-2:40 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 2:40-2:50 Stirling Moorey, #280, A Beloved Voice from the past, #289 & 290, A case of social anxiety, personal work with Anita 2:50-3:00 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.” 3:00-3:10 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

299: Ask David: Retirement blues; patients who refuse homework (and the therapists who love them); ADHD; David's new pooping story; and more!  We regret that our beloved Matt May, MD could not join us today due to an emergency involving his website. We look forward to him joining us next time for more exciting Ask David’s that will include: Does the “self” exist? Does God exist? And MUCH more! We open with two announcements: 1. Return of the awesome Feeling Great Book Club, with Drs. Brandon Vance and Heather Clague, will meet weekly, starting on September 13th. This will be a terrific experience, and only costs $12 per week with a sliding fee scale if you cannot afford it. You will go through the Feel Great book, learn techniques, have fun, and practice in small groups. This is a fantastic opportunity for everyone. For more information, go to:  https://www.feelinggreattherapycenter.com/book-club. 2. The TEAM-CBT World Congress, Warsaw Poland, August 18 - 21. This first of a kind event will take place live and virtually, and will be somewhat like David''s famous Intensives with teachers from around the world, many of whom have been featured on this podcast.  The CONGRESS will feature interactive sessions which participants can learn and practice the elements of the powerful TEAM system while receiving expert coaching on TEAM techniques. This event is organized by Daniel Minte, Mariusz Wirga, and Yehuda Bar Shalom. For more information, please go to:  https://teamcbt.eu Today’s questions: Retirement depression / anxiety; patients who refuse to do exposure or psychotherapy homework; treating procrastination and ADHD; David’s new pooping story, and more! 1. Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives? I’m in that boat. 2. M asks: My patient refuses homework and isn’t getting better. I think I’m a victim of what you’ve referred to as “reverse hypnosis.” What should I do? 3. Heather asks: Hello David! How would you treat ADHD with TEAM-CBT? 4. A asks: Hello sir, Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper? 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. In some cases, I did not have time to polish and edit my responses below. I’ve been super busy developing the Feeling Good App, which is coming along tremendously well. It has the potential to help millions around the world who are struggling with depression and anxiety, but I have to be super careful with my time these days. If interested in beta testing, you can sign up here. 1. Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives? I’m in that boat. David’s reply Have you read the introduction to Feeling Great? Or done any of the written exercises in that book, or in any of my books? Of listened to my free Ted Talk on my website? We can provide more specific information in the live discussion on the podcast. 2. M asks: My patient refuses homework and isn’t getting better. I think I’m a victim of what you’ve referred to as “reverse hypnosis.” What should I do? Dear Dr Burns, Many thanks for your blogs, podcasts, books and TEAM CBT. I have experienced (and I am experiencing) being hypnotized with a Panic Attack patient with Border Line PD- . I know this after the sessions. During the sessions I feel I cannot even think well. I see this client through SKYPE, And cannot see her face to face due to distances. I have try to follow your approach, but she’s resistant, I do include exposure exercises that she never completes. How to do a Shame Attacking Exercise when I cannot go with the patient to the places she needs to in order to do the exposure. I have even been in the phone and she driving, but 2 years later nothing works. Any thoughts will help! Many thanks in advance. M. David’s reply Thanks, great question! Some training or individual case consultation or both, or workshops, would help a lot. We have two free weekly training groups for therapists in California and therapists around the world. For example, the last two weeks in our Tuesday group we have focused on the negative thoughts and feelings therapists have during sessions that interfere with their ability to do excellent work. So your question is very timely and relevant! Also, the www.feelinggoodinstitute.com has free and paid training. Two of the finest teachers are Mike Christensen and Dr. Jill Levitt, and there are many others as well. Jill has just released an introductory recorded class on TEAM-CBT that you can purchase and watch whenever you like. She is a brilliant teacher! And yes, you HAVE been hypnotized during sessions! David 3. Heather asks: Hello David!! How would you treat ADHD with TEAM-CBT? Hi there! It is Heather Donnenwirth, from podcast 267. I hope you are doing well. I really enjoyed being apart of the podcast with you, Rhonda, and Kyle. Thanks again for including me in that experience. I have another question for you about the podcast you did on ADHD. I totally agree with you about ADHD not being a diagnosis and agree that is more helpful to treat the symptoms. Many of the clients that I work with have been diagnosed with ADHD or are convinced that they have it. Procrastination seems to be a common symptom of "ADHD" that people want help with and that can be treated easily with the TEAM model and with the anti-procrastination and motivational tools. The symptom that people ask for help with that I am feel less confident about helping them with is difficulty with focus and distractibility, and would love your thoughts about how to treat these symptoms? I have improved my own focus with motivational techniques and with practicing bringing my attention back to what I want to focus on when my mind starts to wonder. Also, taking notes has helped me to stayed focused, but I am curious if you have any other ideas about increasing focus? Sometimes the people I work with have distorted thoughts about focus as well, such as: "If I'm not interested in something, I can't focus on it," and "I need medication to focus," etc. Anyway, I value your knowledge and opinion and wondered if you have any tools for increasing focus? Also, do you treat hyperactivity and excessive talking? I have also noticed that parents some time play an enabling role with kids diagnosed with ADHD, and don't require their children to do schoolwork that they think is too hard or if they are bored and having a hard time focusing. Sorry this is long!!! I hope you are doing well!!! Warmly, Heather Donnenwirth David’s reply I’d just ask the person to focus on one moment when they had that problem and then do a Daily Mood Log, as you’ve pointed out, and also brainstorm with them on how to solve the problem. But first, would have to do empathy and assessment of resistance, same as with anybody! As you point out, the motivational factors can be enormous. For example, Adderall is just the same as Dexedrine, and highly addictive and euphoric street drug. If I had some right now, I’d be highly excited and write 30 pages of stuff! In addition, I can use ADHD as an excuse for not doing stuff that’s boring. Someone who is motivated can easily find a solution. The summary before college I was lucky to get a job in a bank in Phoenix. My job was filing checks by hand. Boy, that was boring! I made it a bit less boring by trying to find the most unusual names while I was filing checks alphabetically. One of the many unusual (to my young and uneducated ear) names was J. Karekin Moojian! As freshman in college, I found I had trouble concentrating and grasping what the professors were saying in lectures to large classes of a couple hundred or so students. And I had NO IDEA whatsoever what the teacher was talking about! What helped was simply asking another student as we were walking out of the class. I’d say, “What was the professor trying say?” Then the other student, who seemed way smarter than me, would just give a one sentence summary, and I’d suddenly “get it.” So, if you’re motivated, you can find a way! In medical school, I had to memorize gross anatomy. I had little aptitude and no interest. I had never even take a biology class in college, and did not know what was in the “abdomen” or “thorax.” So I made up little games, sitting for hours in the library memorizing stuff. It got me through—just barely1 David   4. A asks: Hello sir, Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper? Is it okay if I do the written work by typing in my laptop on a word processor or is it must that I write on a paper. Thank you. David’s reply Interesting question! Probably okay either way. No research on this issue! I slightly favor doing it by hand, but that is likely because I have done it that way for 40 + years! d Thanks for listening and reading today! Rhonda, and David

Today we feature Professor Hitendra Wadhwa PhD who has been a fan of David’s work for the past ten years. Hitendra has just published a new book, Inner Mastery, Outer Impact. Hitendra is a Professor of Practice at Columbia Business School and Founder of the Mentora Institute, and his class on Personal Leadership & Success is one of the most popular at Columbia Business School. He believes that the secret of leadership and success in business stems from inner mastery. He also has his own fascinating and skillfully produced podcast called Intersections where he interviews accomplished individuals from different spheres of human pursuit to draw out their insights and stories about the pursuit of success and happiness. One of Hitendra’s aims has been to integrate current psychological trends with  ancient wisdom in order to glean the most important ideas needed for happy and successful lives. He has backed this up with a daily meditation practice he began 20 years ago, seeking answers to the most basic questions about the meaning and purpose of our lives and a philosophy that leads to joy, connection, and productivity. Hitendra gives an example of how inner mastery can lead to outer impact. A colleague named Dan used to relentlessly find shortcomings and point to improved solutions every time Hitendra presented his work when he was first working as a business consultant. He said that he carried a grudge against Dan for several weeks because he was trying to impress his colleagues and felt put down by Dan. Of course, this type of attitude and defensiveness can easily trigger the very adversarial responses we fear. Then we tend to blame the “outer” and overlook how we might be inadvertently creating our own negative external reality. Fortunately, the opposite is equally true. When your attitude suddenly shifts, and your “inner” self changes, your outer reality will nearly always suddenly shift at the same time. One day, one of Hitendra’ s supervisors said to him: You should be more like Dan. He’s trying to help you take your game to the next level, but you don’t take a similar interest in helping him find ways to improve his work!” Hitendra explained the impact of his supervisor’s statement: “This comment suddenly turned on a light bulb in my head. I realized I was viewing Dan as an enemy, so if he criticized me, I thought he was against me, so I viewed him as the “enemy.” Instead, I decided to find the truth in his criticisms and began to view him as an ally, as a teacher, as someone who wanted to help me. “At that point, our entire relationship changed dramatically, and I felt empowered!” Of course, podcast fans will realize this as the Disarming Techniques, one of the Five Secrets of Effective Communication that David has popularized. Hitendra also discussed other themes in his new book, like what it means to “be true to yourself,” and how to discover the crown jewel within yourself, at your core. He also described how to tap into the five sources of core energy within yourself: Purpose, Wisdom, Growth, Love, and Self-Realization. He said that many people are afraid of Love, fearing that it is the same as weakness and will lead them to get taken advantage of. He suggested that in reality, love is a powerful force, and gave examples of the expression of love in a variety of successful business. He told many fun and inspiring stories, including his stuckness when trying to think of a way to honor his father’s 80th birthday. He couldn’t think of what he’d say at the celebration, because he’d always done the opposite of what his father had recommended. But then, while meditating, he saw that he’d been inspired all long by how his father had lived his life. He talked about the concept of transcendence as well as racism, and pointed out that we tend to label people based on some characteristic like skin color. But this can be very misleading, because two people who are Black, for example, will often have radically different backgrounds and life experiences. As an example, he described someone from the Caribbean who had no experience of racial discrimination when growing up. He emphasized that when we label people, we get lazy and do not respond to the reality and depth of who that person really is. Essentially, we are then putting people in “boxes” instead of seeing them for the full richness of who they are. He also said that our human identities are partly shared and partly unique. For example, Martin Luther King, Jr. learned a great deal from Mahatma Gandhi, who in turn was inspired by Leo Tolstoy—indicating a merger of three strikingly different cultures. Using story-telling, Hitendra addressed basic questions like: How do we integrate our (partially hidden) inner and outer selves? Who am I, really? What’s my purpose in the universe? He said that what many psychologists believe they “discover” is actually not new, but based on ancient wisdom, like the practice of gratitude in meditation, and shifting your mindsets, and tuning in to your capacity for compassion and kindness, and finding the best of yourself. Rhonda and I want to thank Hitendra for his journey and wonderful new book, and all of you as well for tuning in and joining us on our journey! Warmly, Rhonda, Hitendra, and David

297: Yuck! Homework! In today’s podcast, we discuss the important but dreaded topic of psychotherapy homework, and our featured guest is Alexis, whom some of you know from her fabulous work organizing beta tests for the Feeling Good App. Today, Alexis brings us a very special gift, by showing us how she "walks the walk."! At the beginning of the podcast, we discussed the two major reasons to do psychotherapy “homework:” First, the homework gives you the chance to practice and master the techniques you’re learning, so you can keep growing and strengthening your skills. And second, because it's an expression of motivation; motivation alone can have powerful anti-depressive effects and lead to rapid recovery. I also talked a research study I did with a friend and colleague who got depressed following the breakup of his relationship with the woman he’d been dating for several years. Each night he would partially fill out a Daily Mood Log, including a brief description of the upsetting even or moment. Then he would circle and rate his negative feelings on a scale of 0 (for not at all) to 100 (the worst), for how he was feeling at that very moment. Then he recorded his Negative Thoughts and indicated how strongly he believed them on a scale from (not at all) to 100 (completely). He was telling himself that he’d never find anyone to love, that he’d never find work, and so forth. Then he’d flip a coin to decide on one of two courses of action. If heads, he would jog for 30 minutes or so at a fairly fast clip and then re-rate his belief in each negative thought as well as the intensity of each type of negative feeling on the same scales of 0 to 100. If tails, he would work on his Daily Mood Log for 30 minutes and then rerate his belief in each negative though and the intensity of each type of negative feeling. He did this for several weeks and I was thrilled to see that he recovered on his own from a pretty severe bought of depression without any psychotherapy or medications. However, I did give him a little coaching on how to challenge various kinds of distortions. Once he recovered, we analyzed the data using Structural Equation Modeling. We discovered that the jogging had no effects whatsoever in reducing his belief in his negative thoughts. This finding was not consistent with the popular idea that exercise boosts brain endorphins and causes a “high.” I was not surprised, since jogging has never elevated my feelings, either, although some people do report this effect. In contrast, on the nights that he worked with his Daily Mood Log, there were massive reductions in his belief in his negative thoughts as well as his negative feelings. This finding was consistent with the idea that psychotherapy homework is very important, whether or not you are receiving treatment from a human shrink. The study also confirmed the idea that distorted negative thoughts do, in fact, cause depression and other negative feelings like anxiety, shame, inadequacy, and hopelessness, and that a reduction in your belief negative thoughts triggers recovery. Anecdotally, I would like to add that he maintained his positive mood and outlook following his recovery. His career flourished, and he got married. I showed him his negative thoughts years later, and he was shocked. He found it hard to believe that he was giving himself and believing such harsh and distorted messages at the time he was depressed. I’ve often said that there is a kind of hypnotic aspect to depression, anxiety, and even anger. You tell yourself, and believe, things that are simply not true! Recovery is a little (or a lot) like snapping out of a hypnotic trance! Here is another implication of the study of exercise vs the Daily Mood Log, as well as other studies that have confirmed the critical importance of psychotherapy homework in recovery from depression and anxiety. Because we know the importance of homework, if we are not asking our clients to do homework, then we may actually be impeding their progress rather than supporting them. That’s why I let people know prior to the start of therapy that the prognosis for a full recovery is very positive, but homework will be required and is not optional. If they feel like they don’t want to do the homework, I don’t encourage them to work with me. This is called the Gentle Ultimatum and Sitting with Open Hands. Oddly, enough, this approach seems to enhance patient motivation as well as patient compliance with homework between therapy sessions. The homework, in turn, speeds recovery and reduces patient drop-out. When I’m doing research, I try to create mathematical models that reveal causal factors that affect all human beings, and not some finding that only applies to this or that school of therapy. Therefore, it would seem to follow, that doing “homework” is just as important if you are working on your own without a therapist. And it would seem like it should be important in our app, as well. These hypotheses have been confirmed. Practice, and doing specific exercises that I’ve created, are just as important to the degree of recovery in beta testers who are using our Feeling Good App, as well as in people who are working on their own without a therapist. Today, we are joined by Alexis, who works on her own negative thoughts whenever (like the rest of us) she feels stressed out or upset. Alexis described an example of her homework, starting with this upsetting event at the start of the pandemic: Daily Mood Log Upsetting Event or Moment: Pandemic and moving back to my preferred city and leaving my mom to live alone.   Next, Alexis recorded her negative feelings: Feelings Now % Goal % After % Anxious, worried, panicky, nervous, frightened 75     Frustrated, stuck, thwarted, defeated 50     Guilty, remorseful, bad, ashamed 100     Hopeless, discouraged, pessimistic, despairing 20     Sad, blue, depressed, down, unhappy 80     Inferior, worthless, inadequate, defective, incompetent 80     Lonely, unloved, unwanted, rejected, alone, abandoned 75     Angry, mad, resentful, annoyed, irritated, upset, furious 20     Embarrassed, foolish, humiliated, self-conscious 10       As you can see, she felt intensely guilty, anxious, inadequate, and lonely, and had a few additional feelings that were somewhat elevated. Then she pinpointed two negative thoughts, along with her percent belief in each one. I’m a bad daughter. 100% I should move back in with my mom. 50% Then she identified the distortions in her thoughts, and explained why each distortion will not map onto reality. This technique is called “Explain the Distortions.” Explain the Distortions NT: I’m a bad daughter 100% All-or-Nothing Thinking. I’m focusing on the idea that I can be 100% good or bad , which doesn’t make sense, since nothing in this world is completely good or bad. Overgeneralization I’m calling myself a ”bad daughter,” as though this is label described my entire being. Mental Filtering Instead of focusing on some of the positive things that I do. I’m focusing on the idea that I’m not doing enough. Discounting the Positive I’m not thinking about all the loving things that I do for my mom and that I enjoy doing for her and with her. Mind-Reading I’m telling myself that my mother thinks that I am a bad daughter, but I don’t actually have any evidence for this. Fortune-Telling I am telling myself that I’ll never be good enough. Emotional Reasoning: I feel like a bad daughter so I think it must be true. Magnification and Minimization: I’m magnifying how important my conduct is to my mother (big ego). Should Statement: I’m telling myself that I should be a better daughter and that I shouldn’t have moved back to the city where I prefer to live. LAB: I’m labeling myself as “bad daughter.” Self-Blame: I am blaming myself for being a “bad daughter.” Other-Blame: I might be blaming my mother for expecting so much. NT: I should move back in with my mom. 50% All-or-Nothing Thinking. I’m telling myself that I’m either there 100% or not there 100%, which doesn’t really make sense. Even if I don’t live with my mom, I can still visit often and stay as long as I like. Mental Filtering I’m focusing only on my duty to a parent and not on my commitments to myself. Fortune-Telling I’m telling myself that something bad will happen to my mother and that she will be unable to care for herself. Magnification and Minimization: I’m magnifying my importance (ego!!!) Emotional Reasoning: I feel like I should live with her so it must be true. Should Statement: I am shoulding myself. Self-Blame: I’m blaming myself for leaving and for wanting to live on my own. Other-Blame: I am secretly blaming my mother for making me feel this way. Straightforward Technique You just try to challenge your negative thought with a positive thought (PT) that fulfills the Necessary and Sufficient Conditions for emotional change: The Necessary Condition: The PT must be 100% true, and not a rationalization. The Sufficient Condition: the PT must significantly or greatly reduce your belief in your Negative Thought. Negative thought: I am a bad daughter (I should move back in with my mom.) Write down a more positive and realistic thought: My mom is in average health for her age and can take care of herself. She has the financial resources to maintain her lifestyle without my help. Ask yourself: Is this negative thought really true? Maybe. I love my mom more than just about anyone. I do lots of things for her and with her and enjoy her company immensely. Do I really believe it? I do. Socratic Method When you use this technique, you ask yourself questions to lead yourself to the illogic of your negative thought. NT: I am a bad daughter Questions: Are you sometimes a good daughter? Yes Do most adult children feel like they are a bad kid sometimes? Yes NT: I should move back in with my mom Questions: Should adult children live with their parents? Not if they don't want to! Worst, Best, Average With this technique, you list the qualities of the opposite. Since you’re calling yourself a “bad daughter,” you can list the qualities of a “good daughter.” Then you can rate yourself in each quality, thinking of when you’re at your worst, when you’re at your best, and your average. Qualities of a “good daughter” Worst Best Average 1.        Calls their parents 80 100 90 2.        Visits their parents regularly 30 100 90 3.        Helps their parents 70 90 80 4.        Is financially responsible for self 80 100 90 5.        Respects their parents 0 90 80   When you’re done, you can review your ratings. If there’s one area where you need to improve, you can put together a 3 or 4 step plan for changing. Sometimes, as in Alexis’ case, you’ll realize that you’re actually doing just fine, and no change is needed! This technique was the icing on the cake, and Alexis decided that her thought, “I’m a bad daughter,” wasn’t actually true. These were her feelings at the end. Feelings Now % Goal % After % Anxious, worried, panicky, nervous, frightened 75 5 10 Frustrated, stuck, thwarted, defeated 50 0 0 Guilty, remorseful, bad, ashamed 100 0 0 Hopeless, discouraged, pessimistic, despairing 20 0 0 Sad, blue, depressed, down, unhappy 80 5 0 Inferior, worthless, inadequate, defective, incompetent 80 0 0 Lonely, unloved, unwanted, rejected, alone, abandoned 75 0 0 Angry, mad, resentful, annoyed, irritated, upset, furious 20 0 0 Embarrassed, foolish, humiliated, self-conscious 10 0 0   As you can see, Alexis put in some time and effort to challenge the negative thoughts that were triggering her unhappiness. We are indebted to Alexis for being so open and vulnerable, and for showing this how it works. Is it worth it? That was a lot of “homework!” That’s a decision you’ll have to make for yourself, of course. The Dalai Lama said that happiness is the purpose of life. That’s not entirely true, but there’s a lot of truth in it, for sure! So, the question might be, what would some greater happiness be worth to you? If you are interested in beta testing the Feeling Good App, you can sign up at www.feelinggood.com/app. Thank you Alexis for the very special gift of your knowledge, tremendous skill, and vulnerability! Until next time— Rhonda and David  

Podcast 296: Forced Empathy: A Master Class--Part 2 of 2 Last week you heard part ! of our work witt Zeina, a young professional woman struggling with a conflict with her mom. Zeina feels like her mother is too critical of her, and she finds the criticisms devastating. In today's podcast, you will hear my co therapist, Dr. Jill Levitt, and I, doing Forced Empathy with Zeina, and you will hear the exciting conclusion of the session. I am including the entiere show notes from last week, in case you have not yet reviewed them. Show notes from last week commence here. Today Dr. Jill Levitt and I do live work with Zeina Halim who has been experiencing some intense negative feelings because of her mother’s criticisms of her. Zeina is a member of my weekly training group at Stanford and has appeared on the podcast on several previous occasions (Please provide numbers plus link to podcast page on website.) Zeina is one of our small group leaders in our Tuesday training group.  She works with teens and adults in-person in her office in Menlo Park and also provides tele-health sessions for clients living anywhere in California. Dr. Jill Levitt is the co-leader of my Tuesday training group at Stanford and will be my co-therapist today. We hope for some more of the “magic” that frequently appears when we do therapy together. Today’s podcast will illustrate a number of teaching points, including these: Forced Empathy: We illustrate exactly how to use this powerful and sophisticated technique. When I first created this technique many years ago, I thought there would be little interest in it, so I rarely taught it in my workshops or training groups. In the past several years, an intense interest in this technique has emerged, so you will get to see exactly how it works. Five Secrets Resistance: There has been great interest in the Five Secrets of Effective Communication that are featured in my book, Feeling Good Together. When used skillfully, they can have a phenomenal effect on any troubled relationship. I am even aware of a case of a woman who was kidnapped at gunpoint by a violent serial rapist who planned to kill her. Out of desperation, she used the Five Secrets I had presented at a workshop he had just attended, and he let her go and turned himself in to the police. The Five Secrets literally saved her life. And yet, many of us stubbornly refuse to use the Five Secrets with family, friends and loved ones. Why do we fight against the very tools that would rapidly bring us peace, love and joy? And what can we do about our own internal “resistance”? The “inner” and “outer” solutions: Whenever you are involved in a conflict with someone, there are two battles raging at the same time. One is the “inner battle” with your own negative thoughts, telling you that you’re no good, or that the other person is to blame, and the voice that powerfully urges you to do battle. We approach the “inner battle” with the familiar Daily Mood Log, that helps you pinpoint the distorted messages you are giving yourself. You will see that those messages—the way you talk to yourself when you’re upset—are loaded with distortions; such as All-or-Nothing Thinking, Overgeneralizations, Mental Filtering, Discounting the Positive, Mind-Reading, Labeling, Should Statements and Hidden Should Statements, Emotional Reasoning, Other-Blame, and more.In today’s session, we do battle with Zeina’s distorted thoughts with the Externalization of Voices, arguably one of the most powerful psychotherapy tools ever created. The EAR Checklist / Relationship Journal. The “outer battle” involves the words you use when you respond to the other person’s criticisms of you. Here we use the Relationship Journal, another super powerful tools that allows you to analyze your own statements with the EAR Checklist and see the shocking reality that you are creating the very conflict that you are complaining about so vigorously. This involves one of the “Great Death” of the self, which can be profoundly painful, but it also leads to liberation from your self-created misery and the chance for renewed love and connection with the person you feel so alienated from. Two-hour sessions. You can do far more in a single, two-hour session than in many 50 minute sessions scheduled at weekly intervals. I have often said that this is how I always do therapy, and if you have some therapy skills, this model is vastly more effective and cost-effective as well. It puts you under pressure to accomplish something today, right now, and not in the vague or distant future. Uncovering Techniques. You will see how you can use the Man from Mars Technique to uncover more of your patient’s negative thoughts and core beliefs. This is just another way of doing the classical “Individual Downward Arrow Technique” that I developed way back in the 1970s. The Acceptance Paradoxes. There is a great deal of talk these days about Acceptance is being an important key in many schools of psychotherapy. But what is acceptance, and how do we teach it to our patients and colleagues? Today’s session with Zeina, who has a great interest in Buddhist philosophy and practices, illustrates one of more than 20 paths to acceptance, and this one in particular will teach you the steps in accepting others, especially when you are desperately trying to change them and you are insisting that they “shouldn’t” be the way they are! Self-acceptance is always about grasping a gigantic paradox—and that’s why I’ve always called it the Acceptance Paradox, which states: Accepting yourself as you are, warts and all, is actually the greatest change a human being can make. Can you see why this is a paradox? It’s because the very moment you accept yourself, everything about you and your world will appear to change. Now here’s another acceptance paradox we will explore today. The very moment when you accept another person exactly as she or he is, that person will suddenly change. Of course, that is the exact opposite of what we usually do when we desperately keep trying to “change” them, a strategy that actually forces them to be the very monster you are trying so hard to destroy. By the way, do you know what the plural form of paradox is, when you combine Self- and Other-Acceptance? The plural form is called the Acceptance Paradise. T = Testing is crucial! You cannot do truly effective therapy without the T = Testing. You will find out EXACTLY how effective—or ineffective—you are in every session with every patient. When you listen to the podcasts, you can ask yourself questions like these: How effective are Jill and David being? Will they get good empathy and helpfulness ratings from Zeina? Will we see any reductions in Zeina’s powerful negative feelings at the start of the session? Will she make a breakthrough in her relationship with her mother? At the end of the session, you will see the answers to these questions. And if you’re a therapist, that kind of powerful and precise information will allow you to grow and learn as a therapist, especially if you approach the information with humility and respect for yourself and your patients. There is almost no limit to the evolution of your therapist skills if you use the T = Testing model I have developed. There is almost no chance for personal growth if you do not use these or similar assessment tools. However, the price of growth is steep. You have to be willing to see your own failures and errors at every session with every patient, and this will often be painful. But this is the pain that can lead to your own personal transformation along with the blossoming of your own superb therapy skills. Today, in Part 1 of the Zeina session, you will hear the T = Testing and E = Empathy parts of the session. Next week, in Part 2, you will hear the very brief A = Assessment of Resistance, which really only included the “Miracle Cure Question: ”What, really, are you, Zeina, hoping for in tonight’s session?” You will also hear the amazing M = Methods portion, which will start with Forced Empathy, followed by Externalization of Voices and Five Secrets Practice, along with the final T = Testing and homework assignments for Zeina following the session. Rhonda, Jill, Zeina and I hope you enjoy the podcasts and learn a great deal from them. And we all want to thank you, Zeina for your courageous and brilliant work, sharing your inner self so openly and generously. I believe that sessions like the one our fans will witness today and next week have the potential to provide hope and healing to people around the world, not only today, but for decades to come. At least, that is my hope! I also want to thank you, Jill, for your extraordinary teaching and clinical skills, and for your brilliance and warmth. Thank you for tuning in! Rhonda, Zeina, and David Here is a follow-up note from Zeina Hello David, Jill, and the Tuesday group, Boy, do I have an update for you all! So, at first, I struggled, and I was very worried to have to potentially send an update to the group that may have been disappointing. On Saturday, I saw my mom, and I shared with her the insights that I had in our session. She was appreciative, but I didn't feel very connected to her. I had talked with her about this while she and I were on a walk, and I wondered if maybe walking while talking was taking away some of the intimacy or connection that might have happened if we had been looking at each other while talking. I also noticed that while I was externally behaving somewhat better if my mom criticized me, internally, I still hadn't progressed very far. I would still feel very distant from her; and I still wasn't doing the five secrets. Today, on Sunday, I saw my mom again. While she did not criticize me, we still got into a little bit of an argument. I was a bit angry, but as I let myself cool off, I noticed myself feeling incredibly sad inside--like a sadness that had been building and building over the past few weeks. I tried to talk with my mom about it, but she resisted at first. We had a project that we were working on together today and she thought it would be better if we talked on another day and got back to our project; I insisted, however, and asked that we please talk today. I did not realize it at the time, but I think I had some major hidden emotion stuff happening with my mom (more on this later, perhaps some hidden sadness that was masquerading as anger). I shared with her that I had felt incredibly sad and genuinely worried about our relationship. I recently moved in order to live closer to her and see her more often, but I had noticed that almost every time she came over to visit me at my new place, we would get into an argument at least once. I shared that these arguments had really been weighing on me and worrying me. I also told her that I noticed that we would get into arguments when we were at my place, but not as much when I visited her at her place, maybe because I am so particular about how I like things to be at my place. She, then, said in a very gentle and loving way, "I think ‘particular’ about your space is the operative word here." I realized that she was totally right, and I was so pleasantly surprised by how gentle and loving she was when she said it. Feeling encouraged by how the conversation was going, I shared more and said that I had noticed that I had become more sensitive around our arguments lately and that I was feeling very disconnected from her, and I didn't know how to get reconnected with her. I also shared that I had been feeling lonely in my life in general lately and made a guess that maybe my loneliness was making me expect more from our relationship. Additionally, I also guessed that I might be feeling more drained emotionally because I am doing more hours of therapy per week than I have ever done in my life, and maybe I had yet to find the right balance of how to recreate and regenerate my energy in my off-hours. I shed many tears all throughout this whole conversation. I checked in with myself and noticed that I was feeling more connected to my mom, but there felt like there was still more, particularly about my loneliness. This next paragraph might seem like a major tangent, but hang in there!--I promise it is all connected :) Then, I switched gears a little bit to share with her a different conversation and insight I had had in the past week or so about my recent feelings of loneliness. I had been having a conversation with my very dear friend, James, about how I had been feeling lonely, but was not feeling as drawn to connecting with most of my girlfriends, but only really drawn to my guy friends. Initially, I thought it was a male-female difference, but then I noticed that I was feeling drawn to my new friend Leigh Harrington, who is female. I realized that maybe the difference had more to do with the fact that almost all my male friends and Leigh were quite funny and playful people, whereas most of my girlfriends were more serious people. As for myself, I tend to be a more serious person and am not as funny or playful as many people. I realized that I was relying on other people for my laughter, playfulness and fun, rather than learning how to create that myself. Having just done some flirting training with Matthew May earlier that week, I saw that humor, like flirting, can be a learned skill and might have more to do with a willingness to take risks than an innate quality that people either have or don't have. I was feeling excited that I could learn to be funnier and flirtier and create more laughter in my life, instead of relying on other funny people for this. I shared all of this with my mom. She then went on to make a further connection that really blew me away. She said, "I bet if you start to be funnier and create more laughter for yourself and others, you will also start to feel less lonely." It felt so true! The times I feel most connected to people are when I am laughing with them. THIS is the kind of relationship and connection with my mom that I had been missing lately--when I share deeply with her and, because she knows me so well, she is able to further my insight and understanding of myself and help me to grow. I feel so connected to her now. I realize now that I think part of my resistance to using the 5 secrets with my mom was maybe a hidden emotion component--I had these deep feelings and worries about our relationship; I was confused if moving closer to her had actually helped our relationship or if it was harming it, and I was genuinely missing these kinds of deep, connecting conversations with her, which we had not had in a while. My mom has been hanging out at my place all day today and now I notice myself being easily loving and patient with her and my being "particular" about my things and my space has vanished--at least temporarily! There are a lot of take-aways for me from this whole thing, but one of the biggest ones is that I think I was trying to do five secrets without really fully going into my "I feel" statements as much as I needed to--I feel statements are often the secret that I neglect the most as a person and as a therapist. So, to connect to what we are doing this week in class, I think I would make a guess that when I ignore the five secret that I need to do the most and struggle with, it can hamper my ability to do the rest of the five secrets effectively and genuinely. I could write a lot more about all of this, but I think I will stop here for now. I hope this wasn't too confusing as I know I touched on a lot of different things. Thank you all for your time and attention. I'm open to comments or questions. Warmly, Zeina Here is a reply to Zeina from one of the Stanford Tuesday group members Gosh! Zeina, this is beautiful and so straight from the heart. Takes immense courage to do a deep dive in exploring oneself. I have been marveling at how meticulously you‘ve sifted through and worked towards addressing the different dimensions of the relationship between you and your mum. You are also an amazing raconteur, you’ve brought out the subtle nuances so beautifully! Your mail took me on an emotional roller coaster ride. It was such a compelling read and had me as a captive co-traveler, holding my breath, and crossing my fingers! I loved your insights on the “I feel”. Reading that was a personal breakthrough for me, where my relationship with my mum is concerned. That’s exactly what is missing in our relationship too … whoaaaaa! I just don’t share my feelings with her! I love how you were able to do that though, because I can feel this huge wave of resistance engulfing me, despite my insight. I know I’m not yet ready to take the next step! Funny, how tough it can be to be vulnerable before one’s own mom! More power to you Zeina for ‘daring greatly’ and taking the next step after the Tuesday class. Also, for keeping us posted and for sharing with us in such a detailed manner, and in the process, helping us all learn and grow. Deep regards for your mum as well. She comes across as a tenacious mother of a tenacious daughter … if I may say so. Warmly, Nivedita. Here is a second follow-up from Zeina. Hello David, Jill and Tuesday group, I just wanted to send another update as my relationship with my mom has continued to evolve in quite beautiful and magical ways since I sent this last email.  It seems to me that maybe she has stopped criticizing me entirely--I'm not quite sure.  Maybe I need to pay more attention.  Perhaps if she does criticize me, she does it in a gentler way or maybe I am less sensitive to it.  All I know is that she has been wonderfully supportive of me in these past few weeks and we have not gotten into a single argument.  Our relationship suddenly seems easy in a way that I have never experienced before.  I am so profoundly grateful.  I know that we will probably relapse at some point and this may not last forever, but, now I know this is possible.  Now, I know my way back here.  I have always wanted a relationship like this with my mother, and I always thought it wasn't possible because of who she was as a person. Little did I know that to have the mother I always wanted, I needed to do the changing. I knew that the 5 secrets were powerful, but I had thought that their power was more confined to a single interaction or the moment when you use them.  I don't know that I have been especially good at practicing the 5 secrets with my mom lately, yet the effect seems to keep lasting and lasting. I am truly speechless at the profound transformation that has happened.  Thank you. Thank you. Thank you. I would love any responses! Zeina Here is some of the feedback from the training group in the section, “What did you like the best about today’s training session?” Jill’s thoughtfulness in selecting the Forced Empathy technique over the Relationship Journal. Jill looked at what had worked in the past for Zeina and saw it as a potential strategy for her current concerns and the result was tremendously positive. I loved the training! I loved watching forced empathy and I began to empathize with a close relative simply by watching Zeina empathize with her mom. I was crying throughout. It is hard to describe how touched I was Zeina's honesty and her responses to forced empathy was amazing! Amazing personal work. Entire session was great learning experience for me. How Forced Empathy brought the shift in Zeina’s way of thinking. I really enjoy witnessing the live sessions including this one with Zeina. Seeing how the totality of the model comes together in real time with the clinician's judgment and intuition guiding the specific process is really enlightening and seeing someone's beliefs shift in real time is very inspiring and moving. It was a really nice way to re-join the larger group and I'm glad to hear that went into David's thinking in scheduling it. I really like the Forced Empathy. Zeina had a lot of resistance at the beginning. However, She shed tears during doing the Forced Empathy. I also like the role reversal when doing the Externalization voices. I can always learn how to deal with the difficulties of life from David and Jill's wisdom. The whole thing was so great. I was really moved by the forced empathy. I always LOVE seeing forced empathy modeled to get better at this complex skill, and I am also, like many others, almost always blown away with how powerful it is. I also thought this was a great example of multiple paths (individual mood and relationship work) and multiple methods being all used in one two-hour session so skillful and masterful. I loved the open ended approach and the ongoing exploration until the goal was formed/explored/ discovered. For me, it was a demonstration of trust in the process. I especially liked David's "The Man From Mars" that seemed to me an amazing tool with sorting out the mess of relationship work. I also loved Forced Empathy especially here with the work on mother daughter's relationship. I am really intrigued to explore it for myself in regard to my relationship with my parents and my daughter. Seeing the whole encounter with Zeina and seeing how Jill and David thought through it together, it was all so organic and incredible to witness Very helpful to see the progression of the session. Zeina's session has been a gift not only to us, but also to our mothers. Forced empathy felt like a pivot point in treatment and I loved that Z was able to go deep and connect with her mother's feelings. I have plans to travel and visit my mother next month and have been feeling anxious about it. I was reminded of the unconditional love of a mother that is beautiful and spiritual. David and Jill did amazing and transformational work. This is so inspiring! I liked everything and how the methods and techniques were woven together very skillfully. Personal work is really the best and so gratifying to see. David made a comment at the end about how it would help with motivation to use the skills and work more on them after seeing them in action and I do agree with his comment even if I'm totally not paraphrasing correctly. I LOVE personal work because it bring these skills to life in a way that role plays don't. and of course, it's all the better that someone gets a personal benefit, that's all good too. David and Jill did an amazing job again! However, Zeina’s honesty and vulnerability was the greatest gift during this session. I could relate to her struggle as well, so I was extra impressed about her determination to work on this issue. It was amazing personal work for me. I feel so grateful for this experience. This was another example of the "magic" of TEAM, especially when the therapists are the incredibly skilled Jill and David. What a great, vulnerable and poignant example of relationship issues with a parent. I was very impressed and moved by the power of the Forced Empathy technique. By Zeina's ability to feel into the point of view of her mother, and her insights and connections, especially around how the times of criticism can be seen as opportunities for greater acceptance and love. Moving and really beautiful personal work!!! I was moved to tears when Zeina cried her mother's tears during the Forced Empathy exercise and said "I need her to accept me as I am." Wow--that was so powerful! And as for so many others, this experience felt super relevant and helpful to me for one of my own important relationships, and I'm feeling excited to try out Sergio's approach on my own loved one. Forced Empathy: I loved all of it! So helpful and informative to witness live work. I immediately got why the “what’s my grade?” question was skipped (since the use of the Forced empathy technique had yielded such powerful results). I am eager to try this with a particular client who is having similar issues with their mom. On a more personal level, I felt extremely close to Zeina and seeing how vulnerable and open she was willing to be. This has melted away a lot of my resistance in using the 5 secrets with my own mom. Thank you Zeina! I liked seeing the "visitor from Mars" used to uncover Zeina's thoughts when David was having trouble understanding what the issue was. It was great to see David feeling a little "lost" and see how he worked through that. Watching the Forced Empathy technique was amazing! I also appreciated when Jill offered several options for which direction to go and explained her rationale. I found it to be a helpful learning moment and also liked the warmth that came across. I saw my mom's critical behavior as coming from love-brought tears. Same for my Dad Zeina did really powerful and enlightening work! It was also a great learning experience to observe David & Jill. I have enjoyed listening to and learning wonderful techniques from Jill and David. I can definitely relate to parent's/child criticism conflict myself, so I have learned some methods of effective communication, empathy skills, especially the opposite empathy (where you step into the shoes of a person you have a conflict with) and learn to empathize strongly vs feeling frustrated and having blame thoughts I love every time we do personal work. I always learn and grow so much personally and professionally. Thank you, Zeina for this amazing gift, and thank you, David and Jill for your masterful work. I loved every moment of it! Amazing personal work! I enjoyed the entire process. I appreciated the partnership between David and Jill. I so appreciated Zeina's work and vulnerability. I like David's creative way of doing the Ind. Downward arrow using "man from Mars" perspective. I liked getting to see, again, the power of Forced Empathy, as it illuminated how we create the very behavior in the other, that we then complain about. I loved how Zeina surrendered to doing the Forced Empathy exercise with such wonderful openness. I loved the seamless way Dr Burns and Jill moved between the methods. And Zeina’s courage to be vulnerable. Had an aha moment myself - of course her mother will criticize her because the last thing she wants is for Zeina to have disastrous finances like her own. It shows deep love and caring Another Master Class! I loved watching David and Jill working with Zeina. Change the Focus is just an amazing Method. I appreciate Zeina's vulnerable disclosures. Such generosity is much appreciated. This is an amazing group, and I feel privileged to learn from such sophisticated practitioners, who are so generous with their insights and decades’ worth experiences. Some days I just can't believe my luck to be with such heartfelt, dedicated, compassionate and wise folks! I very specifically like seeing a long personal work session...the big picture seeing the whole session. Thank you! I learned so very much and how things smooth into each other as session progresses. It was great seeing Forced Empathy demonstrated as I've never seen it before and learned so much from the overall training with Zeina, David and Jill. So glad Zeina was willing to be so vulnerable; really appreciated at the end when she said she felt pressure to empathize with her mom if she was vulnerable with her and mom laid it on thick, was wondering the same exact thing in that very moment! Loved how David diffused that for her and put less pressure on how she would handle it! So grateful to be part of this awesome group where I am growing and learning every moment! The hi quality demonstration of Five Secrets empathy by David and Jill Jill’s patience. David waiting for AHA MOMENTS and pointing them out and best of all ZEINA! Personal work is always insightful. I really like the forced empathy technique. I also enjoyed the display of creativity and flexibility of the team model. Amy would regularly explain that it was a model to be used creatively and it's exciting to know there is so much to learn. It can be adapted to each individual. Viewing therapy as a series of skills to learn rather than a step-by-step instructional book is what makes me really love TEAM. Loved how Dr Burns used the individual downward arrow so seamlessly during the empathy phase. Dr Burns empathy too was spot on when he said to Zeina that "she could not lean on her Mom." This one line was really powerful for me and resonated deeply. Loved Jill's internal solution as well as the forced empathy option along with the option of working on the good reasons not to do the 5 secrets. Jill was on a roll with her empathy ... "feels like you're walking on eggshells and don't know what will hurt her." I also liked Jill's disclosure about the times she gets critical with her boys are times when she is most concerned about them. Also liked Jill highlighting how Zeina practicing the Five Secrets was not working at a point because she was not using enough feeling empathy unlike as when doing the Forced Empathy  

Podcast 295: Forced Empathy: A Master Class--Part 1 of 2 Podcasts 294 (Part 1) and 295 (Part 2) Forced Empathy: A Master Class Today Dr. Jill Levitt and I do live work with Zeina Halim who has been experiencing some intense negative feelings because of her mother’s criticisms of her. Zeina is a member of my weekly training group at Stanford and has appeared on the podcast on several previous occasions (Please provide numbers plus link to podcast page on website.) Zeina is one of our small group leaders in our Tuesday training group.  She works with teens and adults in-person in her office in Menlo Park and also provides tele-health sessions for clients living anywhere in California. Dr. Jill Levitt is the co-leader of my Tuesday training group at Stanford and will be my co-therapist today. We hope for some more of the “magic” that frequently appears when we do therapy together. Today’s podcast will illustrate a number of teaching points, including these: Forced Empathy: We illustrate exactly how to use this powerful and sophisticated technique. When I first created this technique many years ago, I thought there would be little interest in it, so I rarely taught it in my workshops or training groups. In the past several years, an intense interest in this technique has emerged, so you will get to see exactly how it works. Five Secrets Resistance: There has been great interest in the Five Secrets of Effective Communication that are featured in my book, Feeling Good Together. When used skillfully, they can have a phenomenal effect on any troubled relationship. I am even aware of a case of a woman who was kidnapped at gunpoint by a violent serial rapist who planned to kill her. Out of desperation, she used the Five Secrets I had presented at a workshop he had just attended, and he let her go and turned himself in to the police. The Five Secrets literally saved her life. And yet, many of us stubbornly refuse to use the Five Secrets with family, friends and loved ones. Why do we fight against the very tools that would rapidly bring us peace, love and joy? And what can we do about our own internal “resistance”? The “inner” and “outer” solutions: Whenever you are involved in a conflict with someone, there are two battles raging at the same time. One is the “inner battle” with your own negative thoughts, telling you that you’re no good, or that the other person is to blame, and the voice that powerfully urges you to do battle. We approach the “inner battle” with the familiar Daily Mood Log, that helps you pinpoint the distorted messages you are giving yourself. You will see that those messages—the way you talk to yourself when you’re upset—are loaded with distortions; such as All-or-Nothing Thinking, Overgeneralizations, Mental Filtering, Discounting the Positive, Mind-Reading, Labeling, Should Statements and Hidden Should Statements, Emotional Reasoning, Other-Blame, and more. In today’s session, we do battle with Zeina’s distorted thoughts with the Externalization of Voices, arguably one of the most powerful psychotherapy tools ever created. The EAR Checklist / Relationship Journal. The “outer battle” involves the words you use when you respond to the other person’s criticisms of you. Here we use the Relationship Journal, another super powerful tools that allows you to analyze your own statements with the EAR Checklist and see the shocking reality that you are creating the very conflict that you are complaining about so vigorously. This involves one of the “Great Death” of the self, which can be profoundly painful, but it also leads to liberation from your self-created misery and the chance for renewed love and connection with the person you feel so alienated from. Two-hour sessions. You can do far more in a single, two-hour session than in many 50 minute sessions scheduled at weekly intervals. I have often said that this is how I always do therapy, and if you have some therapy skills, this model is vastly more effective and cost-effective as well. It puts you under pressure to accomplish something today, right now, and not in the vague or distant future. Uncovering Techniques. You will see how you can use the Man from Mars Technique to uncover more of your patient’s negative thoughts and core beliefs. This is just another way of doing the classical “Individual Downward Arrow Technique” that I developed way back in the 1970s. The Acceptance Paradoxes. There is a great deal of talk these days about Acceptance is being an important key in many schools of psychotherapy. But what is acceptance, and how do we teach it to our patients and colleagues? Today’s session with Zeina, who has a great interest in Buddhist philosophy and practices, illustrates one of more than 20 paths to acceptance, and this one in particular will teach you the steps in accepting others, especially when you are desperately trying to change them and you are insisting that they “shouldn’t” be the way they are! Self-acceptance is always about grasping a gigantic paradox—and that’s why I’ve always called it the Acceptance Paradox, which states: Accepting yourself as you are, warts and all, is actually the greatest change a human being can make. Can you see why this is a paradox? It’s because the very moment you accept yourself, everything about you and your world will appear to change. Now here’s another acceptance paradox we will explore today. The very moment when you accept another person exactly as she or he is, that person will suddenly change. Of course, that is the exact opposite of what we usually do when we desperately keep trying to “change” them, a strategy that actually forces them to be the very monster you are trying so hard to destroy. By the way, do you know what the plural form of paradox is, when you combine Self- and Other-Acceptance? The plural form is called the Acceptance Paradise. T = Testing is crucial! You cannot do truly effective therapy without the T = Testing. You will find out EXACTLY how effective—or ineffective—you are in every session with every patient. When you listen to the podcasts, you can ask yourself questions like these: How effective are Jill and David being? Will they get good empathy and helpfulness ratings from Zeina? Will we see any reductions in Zeina’s powerful negative feelings at the start of the session? Will she make a breakthrough in her relationship with her mother? At the end of the session, you will see the answers to these questions. And if you’re a therapist, that kind of powerful and precise information will allow you to grow and learn as a therapist, especially if you approach the information with humility and respect for yourself and your patients. There is almost no limit to the evolution of your therapist skills if you use the T = Testing model I have developed. There is almost no chance for personal growth if you do not use these or similar assessment tools. However, the price of growth is steep. You have to be willing to see your own failures and errors at every session with every patient, and this will often be painful. But this is the pain that can lead to your own personal transformation along with the blossoming of your own superb therapy skills. Today, in Part 1 of the Zeina session, you will hear the T = Testing and E = Empathy parts of the session. Next week, in Part 2, you will hear the very brief A = Assessment of Resistance, which really only included the “Miracle Cure Question: ”What, really, are you, Zeina, hoping for in tonight’s session?” You will also hear the amazing M = Methods portion, which will start with Forced Empathy, followed by Externalization of Voices and Five Secrets Practice, along with the final T = Testing and homework assignments for Zeina following the session. Rhonda, Jill, Zeina and I hope you enjoy the podcasts and learn a great deal from them. And we all want to thank you, Zeina for your courageous and brilliant work, sharing your inner self so openly and generously. I believe that sessions like the one our fans will witness today and next week have the potential to provide hope and healing to people around the world, not only today, but for decades to come. At least, that is my hope! I also want to thank you, Jill, for your extraordinary teaching and clinical skills, and for your brilliance and warmth. Thank you for tuning in! Rhonda, Zeina, and David Contact information for Jill and Zeina: please provide what you want to have included in the show notes. Here is a follow-up note from Zeina Hello David, Jill, and the Tuesday group, Boy, do I have an update for you all! So, at first, I struggled, and I was very worried to have to potentially send an update to the group that may have been disappointing. On Saturday, I saw my mom, and I shared with her the insights that I had in our session. She was appreciative, but I didn't feel very connected to her. I had talked with her about this while she and I were on a walk, and I wondered if maybe walking while talking was taking away some of the intimacy or connection that might have happened if we had been looking at each other while talking. I also noticed that while I was externally behaving somewhat better if my mom criticized me, internally, I still hadn't progressed very far. I would still feel very distant from her; and I still wasn't doing the five secrets. Today, on Sunday, I saw my mom again. While she did not criticize me, we still got into a little bit of an argument. I was a bit angry, but as I let myself cool off, I noticed myself feeling incredibly sad inside--like a sadness that had been building and building over the past few weeks. I tried to talk with my mom about it, but she resisted at first. We had a project that we were working on together today and she thought it would be better if we talked on another day and got back to our project; I insisted, however, and asked that we please talk today. I did not realize it at the time, but I think I had some major hidden emotion stuff happening with my mom (more on this later, perhaps some hidden sadness that was masquerading as anger). I shared with her that I had felt incredibly sad and genuinely worried about our relationship. I recently moved in order to live closer to her and see her more often, but I had noticed that almost every time she came over to visit me at my new place, we would get into an argument at least once. I shared that these arguments had really been weighing on me and worrying me. I also told her that I noticed that we would get into arguments when we were at my place, but not as much when I visited her at her place, maybe because I am so particular about how I like things to be at my place. She, then, said in a very gentle and loving way, "I think ‘particular’ about your space is the operative word here." I realized that she was totally right, and I was so pleasantly surprised by how gentle and loving she was when she said it. Feeling encouraged by how the conversation was going, I shared more and said that I had noticed that I had become more sensitive around our arguments lately and that I was feeling very disconnected from her, and I didn't know how to get reconnected with her. I also shared that I had been feeling lonely in my life in general lately and made a guess that maybe my loneliness was making me expect more from our relationship. Additionally, I also guessed that I might be feeling more drained emotionally because I am doing more hours of therapy per week than I have ever done in my life, and maybe I had yet to find the right balance of how to recreate and regenerate my energy in my off-hours. I shed many tears all throughout this whole conversation. I checked in with myself and noticed that I was feeling more connected to my mom, but there felt like there was still more, particularly about my loneliness. This next paragraph might seem like a major tangent, but hang in there!--I promise it is all connected :) Then, I switched gears a little bit to share with her a different conversation and insight I had had in the past week or so about my recent feelings of loneliness. I had been having a conversation with my very dear friend, James, about how I had been feeling lonely, but was not feeling as drawn to connecting with most of my girlfriends, but only really drawn to my guy friends. Initially, I thought it was a male-female difference, but then I noticed that I was feeling drawn to my new friend Leigh Harrington, who is female. I realized that maybe the difference had more to do with the fact that almost all my male friends and Leigh were quite funny and playful people, whereas most of my girlfriends were more serious people. As for myself, I tend to be a more serious person and am not as funny or playful as many people. I realized that I was relying on other people for my laughter, playfulness and fun, rather than learning how to create that myself. Having just done some flirting training with Matthew May earlier that week, I saw that humor, like flirting, can be a learned skill and might have more to do with a willingness to take risks than an innate quality that people either have or don't have. I was feeling excited that I could learn to be funnier and flirtier and create more laughter in my life, instead of relying on other funny people for this. I shared all of this with my mom. She then went on to make a further connection that really blew me away. She said, "I bet if you start to be funnier and create more laughter for yourself and others, you will also start to feel less lonely." It felt so true! The times I feel most connected to people are when I am laughing with them. THIS is the kind of relationship and connection with my mom that I had been missing lately--when I share deeply with her and, because she knows me so well, she is able to further my insight and understanding of myself and help me to grow. I feel so connected to her now. I realize now that I think part of my resistance to using the 5 secrets with my mom was maybe a hidden emotion component--I had these deep feelings and worries about our relationship; I was confused if moving closer to her had actually helped our relationship or if it was harming it, and I was genuinely missing these kinds of deep, connecting conversations with her, which we had not had in a while. My mom has been hanging out at my place all day today and now I notice myself being easily loving and patient with her and my being "particular" about my things and my space has vanished--at least temporarily! There are a lot of take-aways for me from this whole thing, but one of the biggest ones is that I think I was trying to do five secrets without really fully going into my "I feel" statements as much as I needed to--I feel statements are often the secret that I neglect the most as a person and as a therapist. So, to connect to what we are doing this week in class, I think I would make a guess that when I ignore the five secret that I need to do the most and struggle with, it can hamper my ability to do the rest of the five secrets effectively and genuinely. I could write a lot more about all of this, but I think I will stop here for now. I hope this wasn't too confusing as I know I touched on a lot of different things. Thank you all for your time and attention. I'm open to comments or questions. Warmly, Zeina Here is a reply to Zeina from one of the Stanford Tuesday group members Gosh! Zeina, this is beautiful and so straight from the heart. Takes immense courage to do a deep dive in exploring oneself. I have been marveling at how meticulously you‘ve sifted through and worked towards addressing the different dimensions of the relationship between you and your mum. You are also an amazing raconteur, you’ve brought out the subtle nuances so beautifully! Your mail took me on an emotional roller coaster ride. It was such a compelling read and had me as a captive co-traveler, holding my breath, and crossing my fingers! I loved your insights on the “I feel”. Reading that was a personal breakthrough for me, where my relationship with my mum is concerned. That’s exactly what is missing in our relationship too … whoaaaaa! I just don’t share my feelings with her! I love how you were able to do that though, because I can feel this huge wave of resistance engulfing me, despite my insight. I know I’m not yet ready to take the next step! Funny, how tough it can be to be vulnerable before one’s own mom! More power to you Zeina for ‘daring greatly’ and taking the next step after the Tuesday class. Also, for keeping us posted and for sharing with us in such a detailed manner, and in the process, helping us all learn and grow. Deep regards for your mum as well. She comes across as a tenacious mother of a tenacious daughter … if I may say so. Warmly, Nivedita. Here is a second follow-up from Zeina. Hello David, Jill and Tuesday group, I just wanted to send another update as my relationship with my mom has continued to evolve in quite beautiful and magical ways since I sent this last email.  It seems to me that maybe she has stopped criticizing me entirely--I'm not quite sure.  Maybe I need to pay more attention.  Perhaps if she does criticize me, she does it in a gentler way or maybe I am less sensitive to it.  All I know is that she has been wonderfully supportive of me in these past few weeks and we have not gotten into a single argument.  Our relationship suddenly seems easy in a way that I have never experienced before.  I am so profoundly grateful.  I know that we will probably relapse at some point and this may not last forever, but, now I know this is possible.  Now, I know my way back here.  I have always wanted a relationship like this with my mother, and I always thought it wasn't possible because of who she was as a person. Little did I know that to have the mother I always wanted, I needed to do the changing. I knew that the 5 secrets were powerful, but I had thought that their power was more confined to a single interaction or the moment when you use them.  I don't know that I have been especially good at practicing the 5 secrets with my mom lately, yet the effect seems to keep lasting and lasting. I am truly speechless at the profound transformation that has happened.  Thank you. Thank you. Thank you. I would love any responses! Zeina Here is some of the feedback from the training group in the section, “What did you like the best about today’s training session?” Jill’s thoughtfulness in selecting the Forced Empathy technique over the Relationship Journal. Jill looked at what had worked in the past for Zeina and saw it as a potential strategy for her current concerns and the result was tremendously positive. I loved the training! I loved watching forced empathy and I began to empathize with a close relative simply by watching Zeina empathize with her mom. I was crying throughout. It is hard to describe how touched I was Zeina's honesty and her responses to forced empathy was amazing! Amazing personal work. Entire session was great learning experience for me. How Forced Empathy brought the shift in Zeina’s way of thinking. I really enjoy witnessing the live sessions including this one with Zeina. Seeing how the totality of the model comes together in real time with the clinician's judgment and intuition guiding the specific process is really enlightening and seeing someone's beliefs shift in real time is very inspiring and moving. It was a really nice way to re-join the larger group and I'm glad to hear that went into David's thinking in scheduling it. I really like the Forced Empathy. Zeina had a lot of resistance at the beginning. However, She shed tears during doing the Forced Empathy. I also like the role reversal when doing the Externalization voices. I can always learn how to deal with the difficulties of life from David and Jill's wisdom. The whole thing was so great. I was really moved by the forced empathy. I always LOVE seeing forced empathy modeled to get better at this complex skill, and I am also, like many others, almost always blown away with how powerful it is. I also thought this was a great example of multiple paths (individual mood and relationship work) and multiple methods being all used in one two-hour session so skillful and masterful. I loved the open ended approach and the ongoing exploration until the goal was formed/explored/ discovered. For me, it was a demonstration of trust in the process. I especially liked David's "The Man From Mars" that seemed to me an amazing tool with sorting out the mess of relationship work. I also loved Forced Empathy especially here with the work on mother daughter's relationship. I am really intrigued to explore it for myself in regard to my relationship with my parents and my daughter. Seeing the whole encounter with Zeina and seeing how Jill and David thought through it together, it was all so organic and incredible to witness Very helpful to see the progression of the session. Zeina's session has been a gift not only to us, but also to our mothers. Forced empathy felt like a pivot point in treatment and I loved that Z was able to go deep and connect with her mother's feelings. I have plans to travel and visit my mother next month and have been feeling anxious about it. I was reminded of the unconditional love of a mother that is beautiful and spiritual. David and Jill did amazing and transformational work. This is so inspiring! I liked everything and how the methods and techniques were woven together very skillfully. Personal work is really the best and so gratifying to see. David made a comment at the end about how it would help with motivation to use the skills and work more on them after seeing them in action and I do agree with his comment even if I'm totally not paraphrasing correctly. I LOVE personal work because it bring these skills to life in a way that role plays don't. and of course, it's all the better that someone gets a personal benefit, that's all good too. David and Jill did an amazing job again! However, Zeina’s honesty and vulnerability was the greatest gift during this session. I could relate to her struggle as well, so I was extra impressed about her determination to work on this issue. It was amazing personal work for me. I feel so grateful for this experience. This was another example of the "magic" of TEAM, especially when the therapists are the incredibly skilled Jill and David. What a great, vulnerable and poignant example of relationship issues with a parent. I was very impressed and moved by the power of the Forced Empathy technique. By Zeina's ability to feel into the point of view of her mother, and her insights and connections, especially around how the times of criticism can be seen as opportunities for greater acceptance and love. Moving and really beautiful personal work!!! I was moved to tears when Zeina cried her mother's tears during the Forced Empathy exercise and said "I need her to accept me as I am." Wow--that was so powerful! And as for so many others, this experience felt super relevant and helpful to me for one of my own important relationships, and I'm feeling excited to try out Sergio's approach on my own loved one. Forced Empathy: I loved all of it! So helpful and informative to witness live work. I immediately got why the “what’s my grade?” question was skipped (since the use of the Forced empathy technique had yielded such powerful results). I am eager to try this with a particular client who is having similar issues with their mom. On a more personal level, I felt extremely close to Zeina and seeing how vulnerable and open she was willing to be. This has melted away a lot of my resistance in using the 5 secrets with my own mom. Thank you Zeina! I liked seeing the "visitor from Mars" used to uncover Zeina's thoughts when David was having trouble understanding what the issue was. It was great to see David feeling a little "lost" and see how he worked through that. Watching the Forced Empathy technique was amazing! I also appreciated when Jill offered several options for which direction to go and explained her rationale. I found it to be a helpful learning moment and also liked the warmth that came across. I saw my mom's critical behavior as coming from love-brought tears. Same for my Dad Zeina did really powerful and enlightening work! It was also a great learning experience to observe David & Jill. I have enjoyed listening to and learning wonderful techniques from Jill and David. I can definitely relate to parent's/child criticism conflict myself, so I have learned some methods of effective communication, empathy skills, especially the opposite empathy (where you step into the shoes of a person you have a conflict with) and learn to empathize strongly vs feeling frustrated and having blame thoughts I love every time we do personal work. I always learn and grow so much personally and professionally. Thank you, Zeina for this amazing gift, and thank you, David and Jill for your masterful work. I loved every moment of it! Amazing personal work! I enjoyed the entire process. I appreciated the partnership between David and Jill. I so appreciated Zeina's work and vulnerability. I like David's creative way of doing the Ind. Downward arrow using "man from Mars" perspective. I liked getting to see, again, the power of Forced Empathy, as it illuminated how we create the very behavior in the other, that we then complain about. I loved how Zeina surrendered to doing the Forced Empathy exercise with such wonderful openness. I loved the seamless way Dr Burns and Jill moved between the methods. And Zeina’s courage to be vulnerable. Had an aha moment myself - of course her mother will criticize her because the last thing she wants is for Zeina to have disastrous finances like her own. It shows deep love and caring Another Master Class! I loved watching David and Jill working with Zeina. Change the Focus is just an amazing Method. I appreciate Zeina's vulnerable disclosures. Such generosity is much appreciated. This is an amazing group, and I feel privileged to learn from such sophisticated practitioners, who are so generous with their insights and decades’ worth experiences. Some days I just can't believe my luck to be with such heartfelt, dedicated, compassionate and wise folks! I very specifically like seeing a long personal work session...the big picture seeing the whole session. Thank you! I learned so very much and how things smooth into each other as session progresses. It was great seeing Forced Empathy demonstrated as I've never seen it before and learned so much from the overall training with Zeina, David and Jill. So glad Zeina was willing to be so vulnerable; really appreciated at the end when she said she felt pressure to empathize with her mom if she was vulnerable with her and mom laid it on thick, was wondering the same exact thing in that very moment! Loved how David diffused that for her and put less pressure on how she would handle it! So grateful to be part of this awesome group where I am growing and learning every moment! The high quality demonstration of Five Secrets empathy by David and Jill Jill’s patience. David waiting for AHA MOMENTS and pointing them out and best of all ZEINA! Personal work is always insightful. I really like the forced empathy technique. I also enjoyed the display of creativity and flexibility of the team model. Amy would regularly explain that it was a model to be used creatively and it's exciting to know there is so much to learn. It can be adapted to each individual. Viewing therapy as a series of skills to learn rather than a step-by-step instructional book is what makes me really love TEAM. Loved how Dr Burns used the individual downward arrow so seamlessly during the empathy phase. Dr Burns empathy too was spot on when he said to Zeina that "she could not lean on her Mom." This one line was really powerful for me and resonated deeply. Loved Jill's internal solution as well as the forced empathy option along with the option of working on the good reasons not to do the 5 secrets. Jill was on a roll with her empathy ... "feels like you're walking on eggshells and don't know what will hurt her." I also liked Jill's disclosure about the times she gets critical with her boys are times when she is most concerned about them. Also liked Jill highlighting how Zeina practicing the Five Secrets was not working at a point because she was not using enough feeling empathy unlike as when doing the Forced Empathy  

May 30th, 2022 Our recent Ask David with Dr. Matthew May included a question on the Acceptance Paradox that triggered many enthusiastic email responses, and people were asking for more on this topic. Rhonda read several, including an email from Jeff who finally “got” the Acceptance Paradox and grasped the meaning of the “Great Death” of the Self. So, today, we’re dedicating the entire hour to this topic. In addition, I’m including a link to a partial draft of a manuscript I’m working on entitled “25 Paths to Self-Acceptance.” It’s fragmentary and far from complete, but does include some potentially useful ideas and techniques, including a vignette with a quiz about a woman from South Los Angeles who experienced what I call “instantaneous enlightenment” during one of my 5-day psychotherapy intensives several years ago at the South San Francisco Conference Center near the San Francisco airport. (LINK TO MS) First, here’s what a listener named Jeff wrote after the previous podcast. Ah! I F-I-N-A-L-L-Y get what you're saying. I've pondered this death of "self" for quite a while after reading Feeling Great and it finally sunk in. Saying "I want to improve myself" or "become a better person" is nonsensical. It's like there's an amorphous ghost "self" that I want to somehow "improve" or make "more worthwhile." But it's all made up. There is no actual "self." Meaning, I can improve skills I have - but my "self" won't be better. My skills might be - but there's no "self" to improve. I can improve my juggling skills but never my "self." Wow. Even when it comes to flaws, I can see that they're also very specific. I don't have a flawed "self" or a bad "self." I may have certain flaws but there's no "I" or "self" to be flawed or worthless. It took me a long time to see it - but now that I do, how awesome it is to stop having to IMPROVE myself. Instead, I can just let go of "my self." Thank you for the response and the additional information. That is so helpful! ! During today's show, a number of vignettes illustrating acceptance were shared, including a man from the CIA who was intensely ashamed because he didn’t have a sense of humor, and all of the men he worked with loved to hang out during breaks at work telling jokes and laughing. He pretended to laugh, but inwardly felt ashamed and inadequate, and was telling himself that he was inferior, or defective because he didn’t have a sense of humor. His enlightenment came during role-playing with a powerful technique called the Externalization of Voices. David played his Positive Self, and the patient, in the role of his Negative Self said this to David: Patient, in the role of his Negative Self: You know, you’re really inferior because you don’t have a sense of humor. You’re not a real man! David in the role of the Positive Self, responded like thi:s.Well, you know, you’re right. And in fact, I have tons of flaws. My lack of a sense of humor is just the tip of the iceberg! This struck the patient as incredibly funny, and he began laughing uncontrollably for several minutes and almost feel out of his chair. Then David said, “Not bad for someone with no sense of humor,” and that triggered even more laughter. That’s why it’s called the Acceptance Paradox. The very moment when you accept yourself, exactly as you are, warts and all, everything—all your perceptions of yourself and the world—are suddenly transformed, and your freed from the prison you’d been in for many years, or possibly for your entire life. Let me spell out what happened. For many years, my patient had been struggling with his lack of a sense of humor, and the harder he fought, the tighter the trap become. He could not change, and his life had become grim, and he felt inadequate and ashamed, thinking he wasn't a "real man," which seemed awful! The very moment he "gave up" and accepted the fact that he had no sense of humor, he suddenly found his sense of humor, and laughed uncontrollably for several minutes. That's what I mean when I say that acceptance is the greatest CHANGE a human being can make--and that's a gigantic paradox. Can you see that now? One important focus of the show was debunking the many reasons people have for resisting Self-Acceptance, such as: If I accept myself, I’ll just be ordinary, or below average, and I won’t be special. Acceptance is a slippery slope. If I accept something bad about myself, or some awful thing I did, I might end up doing something immoral or wrong. If I did something immoral or wrong, or even if I screwed up and failed to achieve my goals, I deserve to suffer. If people see that I’m flawed or “less than,” they’ll judge me. If I accept myself, I’ll lose my motivation to learn, to grow, and to improve myself. If I accept myself, I’ll have to lower my standards. I may be unhappy, even miserable at times, but at least I have high standards! When I beat up on myself, it shows that I’m honest about my flaws. If I accept myself, I will end up accepting the fact that I might really be inferior! In addition to addressing these concerns, Matt, Rhonda and David contrasted healthy vs unhealthy acceptance. For example, unhealthy acceptance is associated with feelings of depression, shame, hopelessness, paralysis, loneliness and cynicism. Healthy acceptance, in contrast, is associated with the exact opposite feelings of joy, pride, hope, creativity, intimacy, and laughter. Matt pointed out that most, and conceivably all people who resist acceptance are not “seeing” something potentially incredible and life-changing. David pointed out that the “Great Death” of the “self” that the Buddha described more than 2500 years ago is not really the “death” that people fear, but is really the “Great Rebirth.” When you “lose” your “self,” you actually lose nothing, because there was nothing there in the first place. But you gain the world, along with liberation from your suffering. And that’s every bit as true today as it was at the time of the Buddha! Thanks for joining us today. Rhonda, Matt, and David

293: The Five Secrets with Violent and Angry Individuals, Featuring Heather Clague, MD Heather Clague MD is a Level 5 TEAM therapist and trainer with a practice in Oakland, California and consult-liaison psychiatrist at Highland Hospital in Oakland. In addition to running an online consultation group for TEAM therapists, she is faculty for All Things CBT,  teaches for the Feeling Good Institute, and has taught the Five Secrets of Effective Communication to medical staff. Her writing can be found at psychotherapy.net. With Dr. Brandon Vance, Heather co-leads the Feeling Great Book Club, a book club for everyone, everywhere who wants to learn the magic of TEAM. In today’s podcast, Rhonda and David speak with Dr. Heather Clague who describes her working in the psychiatric emergency room at Highland Hospital in Oakland, California, and other emergency facilities including Fairmont Hospital in San Leandro, California, interacting with hostile and psychotic individuals who often have to be held against their will because they are a danger to themselves or others, or unable to care for themselves. Although today’s podcast will be of special interest to mental health professionals, it will also be of great interest to anyone having to interact with strangers, friends or family members who are angry and abusive. She explained that In these types of settings, we often have to give patients the opposite of what they want. For example, if they’re involuntarily hospitalized for dangerous behavior, we have to restrain them, or keep them in the hospital, when they desperately want out. Or, if they want to stay in the hospital, we may have to discharge them. Many of these patients are psychotic and lack judgment, so they may shout and act out in anger and frustration. The Five Secrets (LINK) have been a godsend, and when it works, the results are amazing. For example, if a patient is screaming for us to release them, the natural instinct to get defensive just agitates them more and is rarely or never effective. If in contrast, you say, “You’re right, we are holding you against your will and you have every right to be angry,” they usually feel heard and calm right down. In one recent case, an agitated and confused homeless woman needing dialysis was near death because she was refusing treatment and refusing to take her medications. She was manic, agitated, and talking rapidly, non-stop. I said, “I think you’re really upset because we’re keeping you against your will.” The patient shouted “Yes!” Then I said, “And you’re telling us that you do have a place to go to if we let you out.” The patient said, “yes,” in a softer voice, and let the nurse come in and give her her medications, which she took. Heather described phrases she uses to get into each of the Five Secrets in high-secrets situations when you don’t have much time to think and have to respond quickly, including these: For the Disarming Technique: “You’re right,” followed by a statement affirming the truth in what the patient just said. Thought Empathy: “What you’re telling me is” followed by repeating what the patient just said. This is helped greatly by writing down what the patient said. Without writing things down, this technique tends to be impossible for mental health professionals OR the general public. In spite of this, most people refuse this advice! Feeling Empathy: “Given what you just told me, I can imagine you might be feeling X, Y, and Z” where X, Y and Z are feeling words, like “upset,” “anxious,” or “angry,” and so forth. Inquiry: Heather emphasizes two productive lines of Inquiry: “Am I getting it right?” “Can you tell me more about how you’re feeling?” “I Feel” Statements: “I’m feeling X, Y, and Z right now,” where X, Y, and Z are feeling words like sad, concerned, awkward, and so forth. When done skillfully, this technique adds warmth and genuineness, and facilitates the human connection. Heather cautions against saying “I feel like you . . . ” since this ends up not as a statement of your own feelings, but a criticism of the other person. “I feel that . . . “ has the same problem. Stroking: This conveys caring, liking and respect, but cannot be done in a formulaic way. You might say things like “I care about you and I’m really concerned that you’re struggling right now,” or ‘What you are saying is very important, and I want to understand more.” For example, you might say this to an angry patient being held against his or her will: “You’re right, I am holding you against your will, and insisting that you stay, and I don’t like it either. But I’m very concerned that if I let you out now, you might get hurt, or do something to hurt yourself, and your life is precious. I don’t think I could forgive myself if I did that.” Of course, all of this has to come from the heart and has to be done skillfully, or it will not work. Heather described other inspiring stories of challenging patients she’d worked with, and we took turns modeling Five Secrets responses to ultra-challenging patients, including one who was brought into the ER by police on a gurney in leather restraints who took one look at her doctor and said, “Boy, are you ugly!” On another occasion, she walked into the room of a male patient, introduced herself, and asked if they could talk.  He replied provocatively, “Sure, if you get into bed with me, baby.” Rhonda and Heather reminisced about their meeting at one of my four day intensives for mental health professionals several years ago at the South San Francisco Conference Center, and became best of friends. They have traveled together to India and Mexico teaching TEAM-CBT and spreading the gospel according to Burns! I also reflected on my two years of internship and residency training at Highland Hospital, and my profound gratitude and admiration for that hospital and the many dedicated and talented health professionals who serve there. Thanks for tuning in today! Heather, Rhonda, and David

David Meets the British TEAM Group, Part 2: Burns vs. Van de Kolk, Treating somatic symptoms, chronic doubters, GAD, and more! Last week, David answered four questions posed by the British TEAM-CBT group. Today, he answers five more questions, including one on controversies in the treatment of PTSD. Peter – Positive Reframing in TEAM—How much is “enough?” When you do Positive Reframing to reduce Outcome Resistance, how extensively do you have to do it? Do you have to include every emotion the patient has listed on their Dailly Mood Log? Do you also have to focus on most or all of their Negative Thoughts? What’s the best approach? Tom – Burns vs. Van De Kolk After reading The Body Keeps the Score, by trauma specialist and psychiatrist, Dr Bessel Van De Kolk, it would appear that people with complex trauma require a high degree of stabilizing work, like deep-breathing, meditation, or yoga, before they can engage with effective therapy. Otherwise, they might not have the words to describe their emotions, or might have repressed memories. In addition, they might not engage or might become destabilized and highly emotional or destructive towards themselves and other people. I wonder if that’s your experience with patients you have seen with severe complex trauma in your career? Do you think the TEAM-CBT model has limitations in this area and would you refer to a trauma specialist before embarking on TEAM therapy with such a patient? Sean – Treating Somatic Symptoms with TEAM I’m curious about dealing with the somatic experiences of patients struggling with anxiety, depression, insomnia, trauma, etc. Clients can often challenge their distorted Negative Thoughts but still struggle with the somatic symptoms. I’m curious to know David's thoughts. Hassam – Treating Chronic Doubters with TEAM I’m wondering if David has had experiences with chronic doubters - obsessive doubt in which a patient might say: "Yeah, all these cognitive techniques seem good and all, but what if really I am useless and worthless, and all of this has just been a gimmick? What if it is all a lie? What if we have missed something which really would show how worthless I am ?" Basically, this is closely related to the Pure O version of OCD. OCD is known as the doubting disease, and I really want to hear David's thoughts on how he operates with extremely sticky doubting thoughts. Jacky – Treating Generalized Anxiety Disorder (GAD) with TEAM I have a question about clients with Generalized Anxiety Disorder. When they present with multiple worries, do we need to cognitively restructure every worry? Clients with GAD often have multiple worries so we could be there for quite a while if we have to work on every single worry! End of the Part 1 Questions. David will return to the British group for Part 2 in the future, since they had many additional questions. Here is a note from Dr. Peter Spurrier to all who want more information about the UK TEAM-CBT training group: If you are interested in learning more about our group, or want to contact members, please visit us at: https://feelinggood.uk.com/ You will find contact details for many of us on the "Our TEAM CBT Practitioners" page. If you are interested in joining our TEAM-CBT training group, or want more information, you can email me (Dr. Peter Spurrier) at Docspurr@gmail.com.

David Meets the British TEAM Group, Part 1: Treating adolescents, Intrusive thoughts, TEAM-CBT homework, Surprises from the beta tests, and more. Greg – What were the Surprising Results of the Feeling Good Beta Test? What were the surprising results you referred to in the beta testing the new TEAMCBT App? Were there some things that weren’t effective or didn’t work in the way you expected? Rima – Is Psychotherapy “Homework” required in TEAM-CBT? I have a question about rapid recovery with TEAM CBT. Traditional CBT usually takes quite a lot of sessions and requires homework between sessions. How does this fit with a recovery in a single (two-hour) session? Do the patients still have to do homework? Paul – Treating PTSD with Intrusive Thoughts How can TEAM help an individual who has intrusive thoughts about a traumatic event in their past? Jessica – Treating Adolescents with TEAM-CBT Do you need to vary the therapy techniques when working with adolescents, as opposed to adults? And if so, how? Peter – Positive Reframing in TEAM—How much is “enough?” When you do Positive Reframing to reduce Outcome Resistance, how extensively do you have to do it? Do you have to include every emotion the patient has listed on their Dailly Mood Log? Do you also have to focus on most or all of their Negative Thoughts? What’s the best approach? The following questions will be answered next week in Part 2 of David's encounter with the British group. Tom – Burns vs. Van De Kolk After reading The Body Keeps the Score, by trauma specialist and psychiatrist, Dr Bessel Van De Kolk, it would appear that people with complex trauma require a high degree of stabilizing work, like deep-breathing, meditation, or yoga, before they can engage with effective therapy. Otherwise, they might not have the words to describe their emotions, or might have repressed memories. In addition, they might not engage or might become destabilized and highly emotional or destructive towards themselves and other people. I wonder if that’s your experience with patients you have seen with severe complex trauma in your career? Do you think the TEAM-CBT model has limitations in this area and would you refer to a trauma specialist before embarking on TEAM therapy with such a patient? Sean – Treating Somatic Symptoms with TEAM I’m curious about dealing with the somatic experiences of patients struggling with anxiety, depression, insomnia, trauma, etc. Clients can often challenge their distorted Negative Thoughts but still struggle with the somatic symptoms. I’m curious to know David's thoughts. Hassam – Treating Chronic Doubters with TEAM I’m wondering if David has had experiences with chronic doubters - obsessive doubt in which a patient might say: "Yeah, all these cognitive techniques seem good and all, but what if really I am useless and worthless, and all of this has just been a gimmick? What if it is all a lie? What if we have missed something which really would show how worthless I am ?" Basically, this is closely related to the Pure O version of OCD. OCD is known as the doubting disease, and I really want to hear David's thoughts on how he operates with extremely sticky doubting thoughts. Jacky – Treating Generalized Anxiety Disorder (GAD) with TEAM I have a question about clients with Generalized Anxiety Disorder. When they present with multiple worries, do we need to cognitively restructure every worry? Clients with GAD often have multiple worries so we could be there for quite a while if we have to work on every single worry! End of the Part 1 Questions. David will return to the British group for Part 2 in the future, since they had many additional questions. Here is a note from Dr. Peter Spurrier to all who want more information about the British TEAM-CBT training group: If you are interested in learning more about our group, or want to contact members, please visit us at: https://feelinggood.uk.com/ You will find contact details for many of us on the "Our TEAM CBT Practitioners" page. If you are interested in joining our TEAM-CBT training group, or want more information, you can email me (Dr. Peter Spurrier) at Docspurr@gmail.com.

Podcast 290: A Case of Social Anxiety: Featuring David with Dr. Stirling Moorey (Part 2 of 2) Last week, you heard the first part of this live therapy session with Anita, a woman struggling with severe social anxiety. David and Dr. Stirling Moorey, from London, are co-therapists. Last week included the T = Testing and E = Empathy portions of the session. Today you will hear the A = Assessment of Resistance, M = Methods, along with end of session Testing and follow-up. A = Assessment of Resistance David asked Anita if she was ready to roll up her sleeves and get to work, or if she needed more time to talk and be listened to and supported. Because she was eager to get to work, David asked the “Miracle Cure Question:” He said, “What would happen in today’s session if it went really great and knocked your socks off? She said that her negative feelings and self-critical thoughts would be greatly diminished. David asked the Magic Button Question, and she said she’d press it for sure! David said he had no Magic Button, but did have some powerful techniques that could be super helpful, but was reluctant to use them. Anita was puzzled, and this led to Positive Reframing. He encouraged Anita to ask the three questions about each Negative Thought and feeling on her Daily Mood Logs: Why might this thought or feeling be perfectly appropriate, given your circumstances? What are some advantages, or benefits, of this negative thought or feeling? What does this negative thought or feeling show about your core values that’s positive, beautiful, or even awesome? Although puzzling at first, Anita soon got into the swing of it and came up with the following list of Positives. If I tell myself “I have nothing to say” in a group, I’ll listen more and learn more. I won’t risk speaking and making a fool of myself. So my social anxiety is really a source of self-protection, or even a form of self-love. My self-criticisms show I have high standards. My high standards motivate me to work hard and do my best. My self-doubt shows that I’m humble. My concerns about being judged show that I care for the people in the group and want to have positive relationships with them. Shows I’m not pushy, dominating, or arrogant. When I tell myself that “They are all better than me,” it shows that I have room to learn from all the people who are ahead of me. This shows I want to grow and do better. This shows I’m honest and realistic about my limits and flaws. This shows I’m accountable. This gives me “vicarious joy” in the accomplishments of others, a Buddhist concept. This thought shows that I can appreciate the gifts of others, which is a gift to them. When I tell myself, “I wasted a year,” it shows that I value hard work, learning, and dong a good job. It shows that I value what other people think, and take their criticisms seriously. It shows that I want to be seen for who I am! David pointed out that there were many positives on the list, and if we had time many more could be added, but asked Anita if the positives were: Real? Important? Powerful? She gave enthusiastic “yes” answers to all three questions, and then david asked the Pivot Question: Why in the world would you want to press that Magic button, because if you do all these positives will go down the drain, right along with you negative thoughts and feelings Anita suddenly didn’t want to press the Magic Button, but agree to use the Magic Dial and lower her goals for each negative feeling, which you can see if you click here. This concluded this part of the session, which brought us to the M of TEAM. M = Methods During the Methods portion of the session, David and Stirling used a number of techniques, including: Identify the Distortions Explain the Distortions Straightforward Technique Externalization of Voices with Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique) And more, using frequent role reversal until she got to “huge” wins, which didn’t take long. Stirling also asked gave Anita how she might test if her fears about the way others saw her were accurate, and they devised some homework to do in the Wednesday training group to find out if other group members had experienced similar doubts about their abilities as therapists. This would involve using: Self-Disclosure - Survey Technique “I stubbornly refused” Technique You can see her final Daily Mood Log if you click here (LINK). We also jumped in and tried to work with Anita’s conflict with her supervisor, but ran out of time and might pick up that thread again in a future session if she is interested. I might add that both David and Stirling also used Self-Disclosure and Story-Telling during the session, as well as some spontaneous humor, which can also be viewed as a valuable treatment method, but one that is hard to explain or teach. You can see Anita's final Daily Mood Log with the outcomes of all of her negative feelings. As you can see, she exceeded her goals in every category, which is not unusual, and was feeling pretty terrific! She had the homework assignment to listen to the recording of the session and complete her DML, so you will only see a couple of the Positive Thoughts listed. Final T = Testing You can see Anita's final BMS here, and her  Evaluation of therapy Session here  As you can see, there were dramatic reductions in depression and anxiety, but only a modest boost in happiness. It would be interesting to see if the happiness goes up further after her "behavioral experiment" at Wednesday's tuesday group. Her scores on the Empathy and Helpfulness scales were perfect. Follow-up This is the email we received from Anita three days later, right after her "behavioral experiment" in Rhonda's Wednesday TEAM-CBT training group:: Hi Stirling, Rhonda, and David, I did the survey question in Rhonda’s Wednesday training group. Here’s what I said: “I am so nervous right now. I sometimes feel like I do not have much to say and so I stay silent in the group. I get anxious and think you all are so far ahead of me in your skills, so I miss out on sharing. I was wondering if any of you sometimes feel the same way?” So many hands shot, so many affirmed my question and thanked me for asking because they get anxious too. I was a little overwhelmed. Loved the experience! Rhonda I hope I did not take too much time.  Anita Rhonda, Stirling, Anita, and David

Podcast 289: A Case of Social Anxiety: Featuring David with Dr. Stirling Moorey (Part 1 of 2) Today, David is joined by one of his first students, Dr. Stirling Moorey, for co-therapy with Anita, a woman struggling with social anxiety. You may remember Stirling from Podcast 280. Stirling was one of David's first cognitive therapy students, and they spend a month doing cotherapy tether in 1979 and again in 1980. David described the magic of their work together in his first book, Feeling Good, and today they are reunited as a therapy team again for the first time in  more than 40 years! I, David, am super excited about working with Stirling again, and hope you enjoy our work with Anita. Rhonda, Stirling, and I are very grateful for Anita's courage and generosity in letting us share this very personal and real session with you! Anita is a member of the Wednesday International TEAM Training group run by Rhonda and Richard Lam, LMFT.  She lives in Nairobi, Kenya, and has a Master’s Degree in Counseling. Here is how she introduces herself: I am Anita Awuor from Nairobi, Kenya.  I have worked as a therapist for 20 years but only recently been introduced to the TEAM Model which has changed the way I work. I work with couples, individuals and families. And recently I worked with an NGO part time.  It’s an honor for me to be here to work with David, Rhonda and Stirling. Dr. Stirling Moorey had the good fortune to be trained by two founders of Cognitive Behavioral Therapy, Dr. Aaron Beck, and our own, Dr. David Burns. Stirling and David worked together in 1979, when Stirling was in medical school in London and came to Pennsylvania for an elective with Dr. Beck. Once he arrived, Dr. Beck asked David if he would work with Stirling, and then, history was made as David created the 5-Secrets of Effective Communication after watching Stirling provide deep empathy to the patients they worked with together. Stirling is currently a Consultant Psychiatrist in Cognitive Behavioral Therapy and was the Professional Head of Psychiatry for the So. London & Maudsley Trust from 2005-2013. He is currently the visiting senior lecturer at the Institute of Psychiatry, Psychology and Neuroscience in London. He is the co-author, with Steven Greer of The Oxford Guide to CBT for People with Cancer, and co-edited the book, The Therapeutic Relationship in CBT, published by Sage Publishing. T = Testing If you click here, you can take a look at Anita’s initial Brief Mood Survey, which was completed just prior to her session with Stirling and David. As you can see, her depression and anxiety scores were in the moderate to severe range, but her anger score was minimal, only 1 on a scale from 0 to 20. Her Happiness score was extremely low, and here marital satisfaction score was fairly good, but with some room for improvement, especially in the category of “resolving conflicts. E = Empathy You can take a look at the first of two Daily Mood Logs that Anita sent to us just prior to the session. It describes her anxiety while driving to a support group. As you can see, her suffering was intense. She also brought in a second Daily Mood Log which described her feelings after receiving a poor evaluation from one of her supervisors at work. The supervision did not involve her clinical work but some management work she was doing. Stirling, with backup from David, did explored and summarized Anita’s feelings. She explained that “Sadness has been a part of my life. I’m sad more often than I’m happy. Sometimes, the negative feelings are hard to live with. . . Problems in relationships often trigger my negative feelings, especially when others criticize me, and I’ve been down the last several days because of a poor evaluation I received from one of my supervisors at work. . . I don’t like criticisms or conflicts, and sometimes I tell myself that I’ll never be comfortable in groups.” Stirling asked about Anita’s negative thoughts when criticized: I’ll never be good enough. What’s wrong with me? It’s all my fault. She described a sequence where her negative thoughts about the situation lead on to more general self critical thoughts like “I’ll never be comfortable in groups” and she then ruminates about her perceived shortcomings. She said, “when I have these kinds of thoughts, the feelings of sadness, anxiety and worthlessness get very high.” David read her two Daily Mood Logs (LINK) and she described the criticisms she received from her supervisor, who suggested that Anita’s efforts had not been helpful. Anita felt hurt and angry, especially since this was the first time she’d received criticisms from her supervisor. Anita added that when she goes into a negative spiral, everything becomes ‘huge,” and she also tells herself, “I’m a bad mom.” Stirling asked what she does to cope when she’s in pain: “I cry a lot. I beat myself up. And sometimes I share my feelings with my husband, but sometimes I just hold it all inside. Sometimes sharing with my husband helps, but sometimes it doesn’t.” David asked Anita how she was feeling now, and she said that her anxiety had already gone down a lot. To bring closure to the Empathy phase of the session, David asked Anita to grade us on Empathy and she gave us As, and Rhonda had the same idea, scoring us as A +. I commented on the idea that Stirling's superb empathy skills were based, in part, on the "nothing technique." He systematically, skillfully, and compassionately summarized her words and acknowledged the pain they conveyed, without trying to make interpretations, and without trying to help or rescue. In other words, he gave her nothing but tremendous listening, which was exactly what she needed! Although this sounds simple, and nearly all therapists will think, "Oh, I do that, too," in my experience, this skill is actually quite rare. it can be taught, and that's on eo the goals of our two free weekly training groups for therapists. But learning genuine and effective use of the Five Secrets of Effective communication requires tremendous humility, dedication, and hard work on the part of the therapists who hopes to learn. End of Part 1. Next week, you will hear the exciting conclusion of the live therapy session with Anita!  

Podcast 288: TEAM-CBT for Video Game Addiction, Featuring Adam Holman, LCSW We are joined today by Adam Holman, who specializes in the treatment of teens and young adults with video game addictions. Adam was drawn to this field by his own 16 hour a day addiction to video games which caused him to fail his first two years of college. Following his recovery, he decided to become a therapist so he could specialize in the treatment of this problem, and the rest, as they say, is history. He was drawn to TEAM-CBT because of the emphasis on measuring outcomes with every patient at every session, using my Brief Mood Survey and Evaluation of Therapy Session. Prior to that, he said he felt like an “imposter,” and had no evidence that he was actually helping his patients. He explained that his clinical supervisor wasn’t much help, and simply said, “Well, Adam, your clients are coming back, aren’t they?” implying that this meant they were improving and satisfied with the treatment. Adam explains how he created his own measures first, and then found an online therapist group at Reddit, and heard about the Burns measures, which, he says, “were a gift to me and my clients.” By looking at his feedback, he learned he was “helping” too much and trying to solve problems prematurely, before really “listening” and empathizing with his patients. He had some tips for the parents of kids with gaming habits. The first is for them to recognize that the addiction is not the problem, but rather the child’s solution to the problems in his or her life. In his own case, for example, he explained that he was struggling with enormous amounts of anxiety, but felt relief when playing video games. Nearly all the kids he’s treated are struggling with depression, anxiety, and relationship problems, and often feel considerably better just by having the chance to talk and have someone show an interest in them. He said that most of his patients start out with a scowl, arms folded, defiant that someone is going to try to control them or tell them what to do, and they aren’t looking for “help” because, in most cases, their parents bring them to treatment. They are surprised when Adam empathizes and tries to understand their thoughts and feelings. He said most do have issues they want to work on, although it’s not usually their gaming habits. Initially, this can cause conflicts between Adam and the parents, because they think Adam is siding with their children instead of “fixing” them. He said the paradoxical techniques in TEAM are especially helpful, helping them identify all the really GOOD reasons for their addictions using tools like the Triple Paradox, although this is enormously confusing to the kids at first. They have to list all the positive advantages and benefits of their addictions, plus all really sucky things about quitting, as well as what the addiction / habit shows about them and their core values that’s positive and awesome. They get excited and want to share their lists with their parents. He completes the Triple Paradox with the Acid Test question: “Why in the world would you want to change, given all of the positives?” So, Adam’s second tip for parents is to focus on your relationship with your child and not on his or her gaming addiction. Adam teaches parents the Five Secrets of Effective Communication, and they find that the problem usually disappears on its own. However, he agreed that learning to use the Five Secrets skillfully requires a lot of commitment and hard work from the parents.  Adam recommends reviewing podcast episodes 65-70 on The Five Secrets to learn more. Rhonda mentioned that in many cases, the kids are struggling with social anxiety, and Adam mentioned that when they are playing video games with others online, they usually do not feel anxious because they don’t feel judged.  Once again, the games are a solution to a problem, fulfilling the need for socialization and connection. Adam uses the concept of “Sitting with Open Hands” to find out what the kids want to work on, instead of imposing an agenda on them. He described one client who was socially anxious and thought people were “creeped out” by him. Adam asked if he wanted to get over that “right now” and persuaded the young man to go outside where there was a lot of foot traffic and start doing “Smile and hello” practice as well as “Self-Disclosure” to strangers. One of the first people he said this to said he was, in fact, shocked, but added, “You made my day!” This was a huge relief. The young man began feeling less anxious in social situations. He developed an interest in tennis and felt more comfortable playing with his peers, and his interest in computer games reduced significantly. Adam uses the full spectrum of TEAM-CBT techniques in his treatment, including the Devil’s Advocate Technique, Stimulus Control, and more. Here are some of the tempting thoughts a video gamer might have: Common now, it’s okay, everyone plays! It’s going to be really fun! It’s way more fun than homework! Homework is not that important anyway. I can do the homework later. Adam’s third tip is to avoid trying to convince your child to change or to provide solutions for them. He explains that this creates a dynamic where it’s the parents vs. the child and the video game; a battle where neither side wins and both sides end up angry. For more on this topic, Adam would recommend podcast episode 146: When Helping Doesn’t Help. Related to this, he described a case of a boy with a 12-hour a day habit, and his grades were suffering. The parents had tried everything to try to fight and control his behavior, including hiding all his power cords. Feeling as though this was unfair, he stopped at a garage sale on the way home from school and bought a used Gameboy. Clearly, this type of strategy is not effective. Then the parents got better at listening, with the help of Adam, and they found success. Instead of restricting access to the games, they worked with their son to strike a balance. Their son developed an interest in skiing and the focus on video games diminished. Adam’s fourth tip for parents is to try to encourage balance and stand with your kids, working together as a team. For example, you can ask them, “We understand that you enjoy playing games because it’s fun and helps you to relax, and we want you to be able to have fun and relax! What do you think would be a healthy and appropriate use of video games?” In Summary, here are Adam’s four tips for parents: Recognize that the addiction to video games is not the problem, but rather the child’s solution to problems in their lives. There are many good reasons they have likely found to play games ranging from relieving anxiety, to social connection, to simply having fun instead of doing boring homework. The best way to support your child is to focus on your relationship with them and not necessarily the video game addiction. The Five Secrets of Effective Communication are a great tool for this. Avoid trying to convince your child to change and don’t try to provide solutions for them. While boundaries are important, this creates resistance and his often ineffective. Stand alongside your child and work with them to encourage balanced use of video games. This may involve encouraging other hobbies or agreeing on a plan together with regards to how much video game use is healthy and appropriate. If you would like to contact Adam, you can find his information at mainquestpsychotherapy.com. Warmly, David & Rhonda

287: Ask David, Featuring Matt May, MD: Acceptance. Irritating Questions. And More! Today, Rhonda, Matt and David answer several challenging questions submitted by fans like you. William asks: How would the TEAM-CBT model look with an addiction or a habit like procrastination? Robin asks: What’s the difference between a habit and an addiction? Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness! Matt asks: What’s the full list of questions that David finds irritating? Matt also asks: How do we help patients who don’t “get” the Acceptance Paradox? Phil asks: Hey David, Rhonda and Mark, Can’t thank you enough for all your hard work and effort! Where do you guys get all your energy?! 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: William asks: “How would the T.E.A.M. model look with addiction and procrastination?” I have a question about your recent podcast on weight loss with Dr. Angela Krumm. She is doing a great job … but did not need any help from others. About the T = Testing part of TEAM, you could say that Angela had lost her kilo’s. But I am not recognizing the testing in the form of a depression / anxiety test or something alike. With the E = Empathy part, it is even more strange. Where is the Empathy section? How would the T.E.A.M. model look with addiction and procrastination? Anyway, I assume you can’t expect that addiction and procrastination issues will be solved in a single therapy session? I realize that Dr. Burns empathized in the podcast, but then the ‘work’ already was done. Thanks a lot, William David’s reply Thanks, William, for your thoughtful questions. I will probably make this an Ask David, but here's the short answer. Yes, empathy must always come first. As you point out, Angela was simply discussing the methods she used for weight loss. This was not a live therapy session. And yes, in therapy sessions I always start with T = Testing, but often add the Temptations Scale as well. And yes, procrastination can usually be cured in a single (two-hour for me) session, and sometimes addictions too, but severe addictions might need ongoing support, as with AA for example. Rhonda and I did a free two-hour workshop on Habits and Addictions on January 26th, 2022, sponsored by PESI. To view it, you can click on the link and download the entire video. Then you can watch it locally on your devise. On the bottom of my homepage on www.feelinggood.com, you’ll find an offer for two free unpublished chapters on habits and addictions. D 2: Robin asks: What’s the difference between a habit and an addiction? No email, just the question. David’s reply You could check with a dictionary. I think Shakespeare said that a rose by any other name is still a rose! Technically, an addiction is associated with physiologic dependence and withdrawal symptoms during discontinuation. But once again, if “yearning” is a withdrawal symptoms, then habits, too, could be seen as addictions of sorts. You might also think of habits and addictions as two points on a continuum, with addictions being on the more severe side of the bell-shaped normal distribution curve. But all these definitions are, to some extent, arbitrary. Does “alcoholism” exist? Or just people who are drinking excessively? 3: Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness! Dr. Burns, I am a huge fan of your books and podcast, and I enjoyed your talk today on Habits and Addictions as well as your “Feeling Great” bonus chapter on the same. I struggle with a habit of internet surfing (news, social media, etc.) when I’m avoiding boring or unpleasant tasks at work. Do you feel that motivational and cognitive techniques are sufficient for addressing this habit when it often feels like my actions operate below the level of consciousness? For example, I often start surfing the internet before I even consciously realize what I’m doing! Additionally, I’ve found stimulus control to be difficult for this habit given that I work on the computer all day. Any advice on addressing this particular habit, or similar ones, would be much appreciated. Thank you for all of your work helping people! Edwin David’s reply Check out the free chapter(s) offer at bottom of my homepage. Read, do then exercises, then you can ask your question. Also, it depends on how far “below consciousness” your habit is. If it is only a couple inches below, you should be fine! D 4: Matt asks: What is the full list of questions that David finds irritating? David’s reply Good question. Most of the time, I really appreciate the comments and questions from our many fans around the world, but there are, in fact, some questions that I find irritating. This may not be the “full list,” but these are some questions that could use, perhaps, a bit of fine tuning! Some people ask vague, “help me” questions, and like “I’ve always struggled with anxiety. What should I do?” There are two problems with this question. First, I spent most of my life answering this question with inexpensive paperback books, free podcasts, free anxiety and depression classes on my website, and more. So, I don’t want to have to repeat all of that for this or any person who writes to me. Perhaps you can tell me which resources you’ve already tried, and where you’re stuck, specifically. Sometimes, I list the resources, like the “Search” function on every page of my website, www.feelinggood.com, or the list of books there, or the list of podcasts, with links, or the free classes, and more. In addition, those of you who are familiar with my work understand that I never try to help anyone on a “general” level. I can only help you at a specific moment in time. When was it? Where you when you felt anxious, or whatever? What was going on? What were you thinking and feeling at the moment? Record it on a Daily Mood Log, and highlight the Negative Thought you can’t successfully challenge. What are the distortions in that thought? Then I can give you all kinds of help! Perhaps in a future Ask David I can list some more types of problematic questions. Thanks! But while we’re at it, here’s another. Sometimes, people will ask a question that was answered 40 years ago, and ever since, as if they’ve come up with something new. In addition, if they ask questions with a kind of “gotcha” arrogance, I sometimes feel annoyed. Here’s an example. People sometimes say, “Oh, I can see that my negative thought is irrational, but it still upsets me. That shows that cognitive therapy doesn’t actually work!” Here’s what I’m thinking when I hear that: “Aren’t you special! My goodness, no one ever thought of that before!” In fact, you may be able to identify some of the distortions in your negative thought, but you DON’T see that it’s “irrational.” You STILL BELIEVE IT! I’ll say it again. Let’s say you’re trying to challenge a Negative Thought on your Daily Mood Log, like, “I’m a failure” or “I’m defective,” and you believe that thought 100%. Obviously, you’ll feel pretty bad. There are two requirements for an effective Positive thought: It must be 100% true. It must drastically reduce your belief in the Negative Thought, perhaps all the way to 0%. The very moment you stop believing the Negative Thought, your feelings will instantly change. This is not “easy,” like so many people seem to think. That’s why I’ve developed more than 100 methods for challenging distorted thoughts. You won’t need them all, and perhaps you’ll only need a few, but it’s great to have so much firepower available to relieve people of the suffering they experience from feelings of depression, panic, guilt, shame, inadequacy, loneliness, hopelessness, anger, and more. I have wondered if it would be helpful to have a place on my website where I could give the instructions for asking really good Ask David questions. Then I could require people to read it prior to submitting questions. 5: Matt also asks: How do we help patients who don’t “get” the Acceptance Paradox? I have a question about one moment in time, the actual moment of recovery. I'd like to better understand what's happening, in that moment, and why some folks, especially those with hopelessness and a strong desire to 'be better' get stuck at the brink, during 'externalization of resistance', for example, and respond in ways like, 'I'd love to accept myself, I just don't know how' and 'it's too hard to accept myself.' I have felt frustrated with clients when they say this and find it challenging to disarm. I feel tempted to disagree and argue that it's far 'harder' to criticize ourselves than to simply *not* do that. I will think, 'it's hard to put down the whip? It's hard to lower the bar? wouldn't it be harder to continue to carry the whip and keep the bar raised?'. I can see how disagreeing and arguing, here, risk empathy and agenda-setting errors. I suspect my resistance has to do with not wanting to collude with the patient's hopelessness/avoidance. I then wonder, perhaps getting hypnotized, whether there is some real difficulty, other than resistance, that I'm not understanding. I am entering these conversations with a set of assumptions, which may be incorrect, regarding what is happening in the moment of recovery: My assumptions are that the cognitive and motivational models are correct and that self-criticism, and the desire to criticize oneself (high-standards) are what result in low self-esteem and feelings of worthlessness. Hence, to make the transition from depressed to recovered, the process would start with approving of our depressed self. Putting this another way, we can't recover, before we recover ... so in the actual moment of recovery, we will be accepting our self-critical, depressed 'self', flaws-and-all, including the 'flaw' of being self-critical. Positive Reframing and successfully 'talking back' to our resistance catalyzes this change and allows us to use methods like, 'Acceptance Paradox' successfully, leading to elimination of worthless feelings, in that moment. Anything either of you would disagree with, there? If so, when a patient says, 'I want to accept myself, I just don't know how' or 'it's just too hard to accept myself', especially coupled with, 'I don't have resistance, I just can't do it', what is the best response? Thanks, Matt David’s reply The word “acceptance” has no set meaning, so I would want to start by asking the patient what they think “acceptance” is—what is it that they think they can’t or don’t want to do? Also, what time of day did you want to accept yourself, and what were you doing at that moment. What were you thinking and feeling, and who were you interacting with? What did they say and what did you say next? Interpersonal acceptance means accepting your role in a conflict, using the Relationship Journal, instead of blaming the other person. I am thinking of making a list on the various “types” of acceptance, and what methods we can use to enable each type. Acceptance might be different for depression vs anxiety vs a relationship problem vs habits and addictions, and recovery from each is associated with one of the four Great Deaths of the “self.” For example, emotional acceptance has to do with seeing the positives in all of your negative emotions, fairly easily accomplished via Positive Reframing. Specific Acceptance has to do with moving from Overgeneralizations and Labels (e.g. “I’m a failure”) to the specific: what, exactly, did I fail at? Then you can accept that specific failure and make a plan for change if you want. Then you can have Existential Acceptance, where you accept that you are a “failure” or a “worthless human being” on a general level, and this can be accomplished with Let’s Define Terms as well a sense of humor. You can also do two CBAs on the Adv and DiSalvo of Self-Acceptance vs Self-Condemnation. You can also use the Double Standard / Paradoxical Double Standard. What would you recommend to someone else with self-critical or self-condemning thoughts? And what does their Double Standard say about them that’s positive and awesome? Just some rambling thoughts! Another solution has to do with recognizing the nonsensical nature of the notion of the “self.: Fabrice says the magic mushroom therapy helps with this, as you finally “see” that the idea of the “self” is just a kind of illusion. I’m just babbling. This can be a vexing problem for sure. The buddha had little luck on it 2500 years ago, as his followers couldn’t “get it” either. Let’s add this to our Q and A list? Finally, role reversal in Ext of Voices can often help, and also “seeing” someone else discover self-acceptance in a group setting can help, too. I learned it from my cat Obie. Neither of us weas “special,” but we sure had fun hanging out! The six months I spent taking 20 hrs a week of table tennis lessons helped too. I improved but remained sucky compared to the pros, but it was tremendous fun trying! Does any of this make sense or help? David 6: Philoma asks: Hey David, Rhonda and Mark, Can’t thank you enough for all your hard work and effort! Where do you guys get all your energy?! David’s reply For me, I get excited about what I'm doing. Also, when I do my "slogging" (= slow jogging), which I hate, I have learned just to try to go about 20 feet at a time, like seeing if I can make it to that tree. This helps a lot. Also, I am very lucky to be doing mainly things I totally love and find exciting. That helps enormously. Finally, I am surrounded by people who are very positive and supportive, which makes things non-burdensome. Conflict can be fatiguing! Good relationships can be energizing. And oh, I forgot the main key to energy. One big cup of coffee in the morning! Warmly, david Phil’s reply to David: Words of wisdom, for sure! Happy slogging and all the best for a great 2022! Thanks for listening and reading today! Rhonda, Matt, and David

Helping the Poor in Heart, featuring Victoria Chicurel and Silvina Carla Bucci One of my favorite New Testament quotations comes from the “Sermon on the Mount” by Jesus: “Blessed are the poor in heart, for they shall see God.” Matthew 5:8. I’m not 100% sure what this means, exactly, but it seems to me to suggest the values of compassion and humility, as opposed to self-aggrandizement. I once had the chance to speak to a Catholic priest with a PhD in philosophy who had just returned from several years working with the indigenous people in Paraguay. He said that although the people were poor, and sometimes experiencing the effects of repression from the government, he said they were mostly happy and supported one another. He also said that when he flew into Miami and walked through the airport, he was shocked to see so many overweight and visually unappealing people, after living for many years in Paraguay among the “poor.” Who, really, is “poor,” and who, in contrast, is “wealthy?” That’s kind of the meaning I attribute to the Biblical quotation from the book of Matthew. I looked him up on Google, and apparently he worked as a tax collector in Copernicium prior to becoming a preacher in Judea. At any rate, today’s podcast features two women who are working with the poor in Mexico and in the Pomona Valley in Southern California. Victoria Chicurel and Silvina Carla Bucci and working to promote TEAM-CBT in Mexico and Victoria is working with a group of Mexican women immigrants, some un-documented, most with limited English-language skills in the Pomona Valley teaching them a simplified version of TEAM-CBT.  Victoria calls these women, Promotoras. In a pilot study sponsored by an organization called Common Good, Victoria has trained a group of approximately ten women in the ten cognitive distortions as well as the Five Secrets of Effective Communication and other simple cognitive therapy techniques, so they can teach these skills, called “psychological first-aid,” as coaches, to women without access to mental health care. These lay coaches trained are paid $15 per hour by Common Good, and the clients are treated for free. They were very enthusiastic about the results of their informal study. (The director of Common Good is Nancy Minte, the sister of one of our esteemed colleagues, Daniel Minte, LCSW.) Victoria described a shame attacking contest organized by Daniel Minte, a Level 5 TEAM therapist. Shame-Attacking Exercises were developed by the late Dr. Albert Ellis from New York City, one of the founders of cognitive therapy,. Shame-Attacking Exercises are designed to help people with social anxiety get over their fears of looking foolish in front of others. You intentionally do something bizarre in public so you can discover that the world doesn’t come to an end when you make a fool of yourself. . The goal of the contest was to do the most weird and courageous Shame Attacking Exercise. The winner was a woman who was one of the promotoras working with Victoria who suffered from severe social anxiety and who was greatly helped by a “Shame Attacking Exercise.” In one of her English classes, she stood and announced she was going to do something ridiculous to overcome her fear of making a fool of herself in public, and warned them that she had a terribly singing voice. She then burst into song, singing the national anthem of Mexico, and received enthusiastic cheers from her classmates at the end. This experience changed her life! Prior to her experience, she had been so shy that she was afraid to express her opinions in public. After the exercise, her shyness instantly become a memory and she won first place in the competition! Many others have been helped, too. I mentioned the experience of Sunny Choi who worked for years with Asian immigrants in the SF Bay area. He said that these patients did not expect long term treatment, and often responded in just four or five sessions, even if they were struggling with very severe problems. Victoria said they were seeing the same thing, and described a woman struggling with perfectionism who recovered in just five sessions. The coaches in the program use my Brief Mood Survey, translated into Spanish, to track progress, and have access to the Spanish version of my first book, Feeling Good. Silvina is working to promote TEAM-CBT in Mexico and other Spanish speaking countries like Ecuador, Peru, Spain, and Columbia. She has even created a TEAM-CBT licensing program for Spanish-speaking mental health professionals. She says that her biggest challenge is one I have run into in my efforts to teach in the United States as well: The therapists are skeptical and have an attitude of “prove it to me.” In addition, they have difficulties learning to use the Five Secrets in their clinical work and personal lives, especially “I Feel” Statements and the Disarming Technique, as well as the paradoxical techniques of TEAM-CBT. For me (David) personally, I welcome skepticism, but find the arrogance behind some if it to be hugely annoying! Sadly, I think that our field of mental health / psychotherapy consists, to a great extent, of competing “cults” that are not based on science, or on data-driven treatment, but rather the teachings of cult-leaders, like Freud and the hundreds of others who have started this or that “school” of therapy. I often say that TEAM is NOT another new therapy , or “cult,” but rather a research-based structure for how all therapy works. I would love to see the gradual disappearance of schools of therapy and the continued emergence and evolution of data-driven therapy. I applaud the efforts of Victoria and Silvina in their work with the “poor in heart.” In the mid-1980s, I developed a large scale cognitive therapy program for the residents in our inner-city neighborhood at my hospital in Philadelphia. It was a group program based on my book, Ten Days’ to Self-Esteem, and the therapists were simply people from the neighborhood who received some training in CBT and followed the Leaders Manual for The Ten Days’ to Self-Esteem groups they were directing. The program was largely free and very successful. Many of our patients could not read or write, and some were homeless. Most had few resources, and many might be considered among those are “poor in heart.” But they were definitely not poor in spirit! Our hospital had “Feeling Good” days every six months, and they even had a Feeling Good jazz band. That program was the most successful and gratifying program I have ever been associated with. Rhonda and I are very proud of these two fantastic women! If you would like to learn more about their work in Mexico and in the Pomona Valley, please feel free to contact them at www.TEAM-CBTMexico. Thanks for tuning in today! Rhonda, Victoria, Silvina, and David  

Podcast 285: TEAM-CBT for Chronic Pain. Featuring Derek Reilly-- with the Exciting Findings from a New British Outcome Study Rhonda begins the podcast with two inspiring emails about our recent podcast on “The Unexpected Results of the Latest Beta Test id the Feeling Good App, Part 1 of 2, published on2-28-2022. One is from Vivek Kishore, who used to come to all of my Sunday hikes prior to the pandemic, and Rizwan Syed, from Pakistan, who is an enthusiastic member of my Tuesday training group at Stanford as well as Rhonda’s Wednesday training group. Here’s what Vivek wrote Dear David and Jeremy, This is so amazing and has the potential to change the world. I am sure millions across the globe will benefit from this app. Can't wait for its launch. Thank you! Vivek Here’s what Rizwan wrote: Dear David: Reading your books changed my life completely. I am so much happy and optimistic about life compared to highly critical of myself and others and had been so much bitter. I am sure your team therapy app would be as mind boggling and revolutionary as had been your bibliotherapy. I am no God. Had I been one, I definitely would have chosen you as my prophet to spread my message. Rizwan Today, we interview Derek Reilly, a Cognitive Behavioral Psychotherapist, and Registered Mental Health Nurse with 20 years of clinical practice  specializing in the treatment in chronic pain. He is an Accredited CBT therapist with the British Association for Behavioral and Cognitive Psychotherapies in the United Kingdom, and a TEAM certified Level 3 TEAM-CBT therapist. Derek is also a founding member of the new TEAM-CBT UK group. He has published papers on panic, OCD, and pain. He lives in Darfield, a small village in South Yorkshire, which is a mining area in England. Derek, like a previous guest, Dr. Peter Spurrier, attended a two-day workshop I conducted on TEAM-CBT in the treatment of anxiety disorders in London in 2015. Although I felt quite discouraged during and after the workshop, thinking I’d done a poor job, and since the crowd size was modest at best, a number of those who attended apparently got the message and became excited about TEAM. Derek said that the emphasis on T = Testing and on A = Assessment of Resistance made the biggest impact on him. He explained it like this: David described the four forms of Outcome Resistance and the four forms of Process Resistance. I suddenly realized that resistance was huge in the population I was treating, and that my biggest error had been trying to “help,” which usually just triggered more resistance and yes-butting by my patients, who would complain that no one was helping them with their pain. Dropout rates were high, and I also felt frustrated with the lack of progress I was seeing in my patients. Both Derek and Peter then attended my four-day intensive at the South SF Conference Center in 2017 and got hooked. Derek said: I thought about testing, and where it could be improved, and developed my own Pain Problem Survey (PPS) of the most common kinds of negative thoughts I was seeing in my patients, as well as the negative feelings these thoughts were triggering, like frustration, anger, anxiety, and more. I asked them to rate three emotions on a scale of 0 to 10, as well as their cognitions and behaviors, and tried to figure out what the resistance was all about. I also discovered that the simple step of T = Testing helped greatly with the E = Empathy, because my patients began to feel understood. This was different from the way I’d been trained which was to push this or that technique to “help” with their pain. He said that the concept of “acceptance” is a popular and common buzzword these days among mental health professionals, but there’s a huge difference between intellectual “acceptance” and acceptance at the gut level. He liked the fact that TEAM offered specific tools to bring resistance to conscious awareness and to quickly reduce the resistance as well, as the paradoxical techniques that David has developed. Some of the common Negative Thoughts he heard from his patients included: I should bed doing things quicker. I should be responding faster. The doctor should fix me. Why is this happening to me? This is unfair! Many had been feeling demoralized that there was no medical solution, and ashamed of the fact that the could no longer work and do things that had once been automatic, like housework, or picking up and hugging the grandchildren, or going to work and earning money. Their disabilities seem to contradict their personal values, and they felt like they were letting people down. He said: Many of my patients had 10 or even 20 years of suffering and failed treatments, including multiple surgeries in some cases for back pain, for example, and often complained that nobody had been listening to them. That’s why the E of TEAM was so important, and I practiced using the Five Secrets of Effective Communication to respond to their complaints. I worked especially hard on Feeling Empathy. Previously, I’d been way to quick to try to “help,” that just turned my patients off. I was helped by the empathy technique David developed called “What’s my grade?” I ask my patients, “would you give me an A, a B, or a C or lower so far?” This was crucial. Then, when I went on to the A = Assessment of Resistance, we began to uncover, or discover, what their negative thoughts and feelings showed about them that was positive and awesome. Because I was practicing in an economically deprived area, I, and many of my colleagues, thought this would be a waste of time, and that my patients might not “get it” because it would seem too brainy or intellectual. But it was the opposite, and by the third session, many were already beginning to see things through an entirely different set of eyes. For example, they could see the many positive in their feelings of shame, inadequacy, anxiety, hopelessness, and even anger. So they began to feel proud of their negative thoughts and feelings. It was also helpful to take the “shoulds” out of their negative thoughts and feelings using methods like the Semantic Method and the Double Standard Technique. These approaches proved much more effective in helping people come to terms with loss/change. Derek described his work with a man who’d been struggling with chronic back pain and depression and daily alcohol abuse, who’d had a suicide attempt and felt useless. Derek said: He was open to examining his own role in his problems, and agreed to cut down on his alcohol intake. He found the Positive Reframing to be helpful, and saw that his negative thoughts and feelings were actually an expression of his high standards, and that his frustration was the expression of his determination not to give up. His guilt and shame showed that he had a conscience, and a moral compass, and that he was honest with himself, and that his frustration and depression about being unable to work showed his core values. Then we did the Magic Dial to see how much he wanted to dial down each negative feeling, like guilt, and used a variety of M = Methods to challenge and crush his negative thoughts. Once he pinpointed and challenged his Hidden Should Statements, his feelings of self-acceptance increased dramatically. Then we ended up using the Externalization of Voices to wipe out his negative thoughts. Derek and I discussed the role of negative emotions in patients with chronic pain and other “medical” symptoms, like dizziness, and chronic fatigue. I summarized my experience as a medical student working in Stanford’s outpatient medical clinic with Dr. Allen Barbour, and how that approach was similar to the approach that Derek was taking. I summarized my statistical modeling of three data bases that all showed identical results that the correlation between physical pain and emotional distress is not because physical pain causes emotional distress, but because emotional distress causes an amplification in the experience of pain. This is true of physical pain with a clear medical cause, such as arthritis, as well as so-called “psychogenic pain” where no physical cause can be detected. Derek summarized his recent study of 60 chronic pain patients he treated with TEAM, which was a retrospective “clinical audit,” or chart review study. The study indicated a 57% reduction in scores on the PHQ-9 & GAD7 (commonly used depression and anxiety tests). These reductions were significant at the p This is the first piece of preliminary evidence in the UK to show effective TEAM-CBT can be in the treatment of chronic pain. He is writing up these finds with a colleague, Anne Garland, a Consultant Nurse Psychotherapist, and hopes to publish them soon. He also found that other negative feelings were also comparably reduced, including the “big three:” frustration, guilt, and anxiety. Derek and his colleagues have their own Tuesday training group in England, and I will soon be joining them with Rhonda for a 90 minute Q and A session. If you’d like to learn more about Derek’s work, or if you’re interested in training, you can contact him at dwr1971@yahoo.co.uk or www.feelinggood.uk.com. Rhonda and I greatly enjoyed the recording and share great enthusiasm for Derek’s work spreading the word about TEAM-CBT in England. We hope you enjoyed the podcast as well, and thank you for your support of our efforts! Rhonda, Derek, and David

284: Ask David, Featuring Matt May, MD Defeating your Self-Defeating Beliefs. Help with fear. Dealing with people who gossip. Today, Rhonda, Matt and David answer three challenging questions submitted by fans like you. Caroline asks: I’ve done Cost Benefit Analyses (CBAs) for many of my SDBs (Self-Defeating Beliefs), and the disadvantages greatly outweigh the advantages? What’s the next step? Al asks: Can you help me with fear? Khoi asks: How do you deal with colleagues who gossip about your boss? 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: Caroline asks: I’ve done Cost Benefit Analyses (CBAs) for many of my SDBs (Self-Defeating Beliefs), and the disadvantages greatly outweigh the advantages? What’s the next step? Hi David I finally got all the CBAs from my Self-Defeating Beliefs done. I have a ton of them. I also did a CBA on Self-acceptance and a CBA on Self-Criticism. I found out, that the disadvantages of my Self-Defeating Beliefs are massively higher than the advantages. Only with Self-Acceptance the Advantages were much higher than the Disadvantages. Now that I have got all these CBAs done, what do I do with my findings? Do I rewrite my Self-Defeating Belief into something more realistic or lets say, into something with acceptance? Thanks for your help! Many greetings Caroline David’s reply Great work. Yes, you can, as a first step, or next step, rewrite each belief so the disadvantages disappear, and you get to keep the advantages. This will be different for each person, and it is called the Semantic Technique, but here is an example: SDB: Achievement Addiction: My worthwhileness depends on my productivity and achievements. Revised version: I can enjoy working hard and being productive, but my “worthwhileness” as a human being does not depend on my successes, failures, or hard work. There are many things in life I can love and enjoy. It isn’t just all about achievement and productivity. I can learn from failures and mistakes. They make me more “human,” and not “worthless” or even “less worthwhile.” In fact, I have no desire or need to be “worthwhile.” It’s a nonsensical, meaningless concept. People don’t much care about how “worthwhile” I am. They care about how I treat them! That’s just an example of how I deal with this particular belief. Giving up the “Achievement Addiction” actually helps me achieve more, because the pressure and the anxiety is gone. But I still enjoy working and creating stuff! Another dimension has to do with giving up the habit of beating up on yourself. We are talking about depression and inadequacy here. It touches also on anxiety, but anxiety can have other SDBs as well. d 2: Al asks: Can you help me with fear? Dr Burns, I need help with fear. Can you send me podcasts dealing with that subject? Thank you very much. David’s reply Tell me which of the many already published, and available via search function on my website, you have already listened to? And how much of my book, When Panic Attacks, have you read? May make this an Ask David, since it seems lots of folks are not using the massive free resources I’ve already developed. Have you take the free anxiety test and course on my website, feelinggood.com? The free anxiety course is, in fact, a compilation of some of the best podcasts on fear. david 3: Khoi asks: How do you deal with people who gossip about your boss? Hello Dr Burns, Thanks for your time to write so many great books and creating this podcast. I am from Vietnam and know about you and your book thanks to the publisher to translate into Vietnamese. When I read your book, it is very simple fact but very true at the same time. I wonder how can I not know about your book earlier? Actually, I read a lot of self-help books but I find most would say about what should I become or be, but don’t really show me how to do it. As you said, the idea I feel because I thought is not new, but I don’t know how to change my thought and beliefs after reading these books. Your books show me simple techniques but very useful and effective. And I really like your 5 Secrets of Effective Communication, especially these podcasts, because it helps me understand more clearly. One difficult situation that I don’t know how to apply, is when somebody attacks somebody else, not me. For example, my colleague criticizes my boss (behind his back) via email message or face to face with me. I am afraid if I agree with her, my boss might think I talked behind his back too. So, should I just keep silent for this case because she does not attack me? Another situation is when 2 people attack each other, like 2 of my staff argue with each other, and I cannot agree with one side because it will make the others get mad with me. Do you have any advice on this? Thanks Dr Burns. David’s reply Good question, and I will include in an Ask David, if that is okay. My short answer is that in most situations, and especially in a business environment, I do not try to "help" other people who are arguing or not getting along. That is simply asking for trouble and push back. When someone is bad mouthing another person, you can possibly use Feeling Empathy and say "it sounds like you're pretty unhappy with person X, and I know that can be uncomfortable when you're not getting along with someone," or some such general comment. Then you could distract the person with some Stroking, like "I really admired your report at the company meeting," or some such thing. We can check with Rhonda and Matt and see what they think on the live podcast. In a personal situation, you could use an "I Feel" situation, like "I actually get along with person X, but of course we all have our flaws, or some such thing. But in a work environment, I think you are right that it is important to play it safe and to be thoughtful about interactions with colleagues! So, I commend you on your excellent questions, even though I might not yet have the best answer for you! David  Rhonda, Matt, and David

Podcast 283: The O of OCD: Featuring Thai-An Truong, LPC, LADC Overview: The "O" of OCD (obsessions) is treated differently from the "C" (compulsions.) Thai-An Truong teaches us what really works! Compulsions can be treated with Response Prevention. The techniques for treating the Obsessions include Flooding, Cognitive Techniques, Motivational Techniques for Outcome and Process Resistance, the Hidden Emotion Technique, and more. OCD (Obsessive Compulsive Disorder) consists of frightening thoughts, or obsessions, plus rituals people do in an attempt to prevent or undo the danger. So, for example, if you go to bed and have the thought, “what if I left the burners on the stove turned on,” you might get up and check the burners. Doing this once could be considered normal. But if you do this repeatedly, you definitely have the symptoms of OCD. Rhonda wanted me to share how I treat the obsessions in OCD (Obsessive Compulsive Disorder), also known as "pure O." I often say I wasn’t looking to treat OCD, but OCD found me, since I do a lot of work with postpartum women struggling with feelings of depression and anxiety, they are actually about 2.5 times more likely than the general population to develop OCD. We're not sure why, but my theory is OCD attaches to the things we value the most (e.g., health, children’s well-being), and not much is valued more greatly than our baby. “Pure O” is actually a misnomer. We think that some people with OCD only have obsessions, without the rituals, because they have lots of mental rituals that people can’t see. So therapists wrongly conclude that they just have a “pure O” variety of OCD. We usually think of compulsions in OCD as mainly behavioral (e.g., handwashing too prevent contamination or checking the mail box repeatedly when you put your letter in to make sure it didn’t get “stuck”), but mental compulsions (rituals) are also very common. Obsessions are the thoughts or images that cause distress; compulsions, in contrast, are the behavioral or mental acts people engage in to try to decrease the distress. Mental acts, compulsions, and rituals can include: Praying Counting Repeating words silently Recalling events in detail Repeating a mental list to ensure safety Mentally reviewing the past like a video Self-assurance: “I’m okay, nothing bad will happen.” Saying the number 4 to reduce the distress of seeing 6, associated with the devil Thinking of a positive image to replace the disturbing obsession/thought Those are just common examples, but there are many more. Dr. Edna Foa, who has done a lot of research on OCD and the effectiveness of Exposure and Response Prevention (ERP) for the treatment of OCD states that patients who have ONLY obsessions or ONLY compulsions are unlikely to have OCD. Over 90% of people with OCD reported having both obsessions and behavioral compulsions/rituals. When mental rituals were included, just 2% reported “pure O”. Foa, E., et al (2012). Treatment That Works: Exposure and Response Prevention for OCD, Second Edition, p. 12 She states we need to assess patients carefully to weed out other disorders: Only O may be depression or GAD. Only C may be trichotillomania, Tourette’s syndrome, autism, schizophrenia – all can display repetitive and ritualistic actions. Trauma can look like OCD. For example, a woman who was raped obsessed about harm coming her way and compulsively checked the doors and windows in her apartment. She may need trauma treatment instead of OCD treatment. Specific Phobias: fear of animals (dogs, snakes, etc), heights, needles, storms, flying, driving, etc. Paraphilia: pedophilia, voyeurism, exhibitionism, etc. Dr. Burns’ EASY Diagnostic System can be a great tool for pinpointing these and many other diagnoses. How I’ve helped clients: A step-by-step approach: Disclaimer: This is not meant to be a substitute for therapy. It is frequently most helpful to have a therapist work with you through this process. Initial Assessment: Dr. Burns EASY Diagnostic System Y-BOCs – Yale-Brown Obsessive Compulsive Scale - not diagnosti. This tool is great for identifying types of obsessions, compulsions, and avoidance behaviors. T = Testing – Brief Mood Survey E = Empathy Psychoeducation about OCD and nature of obsessions The more we engage with them, try to suppress them/control them, the stickier they become Share with them about exposure and response prevention and TEAM-CBT approach to treatment Ultimate goal is to eliminate all compulsions – since they the OCD and are the food that feeds the OCD monster Normal for obsessions content to shift from one subtype to another Let them know I will not provide reassurance. Anything expressed/done once is educational, more than once becomes reassurance Include the family in this process A = Assessment of Resistance DML of most disturbing obsession Identify the feelings and thoughts to increase your understanding of the content and level of disturbance Can use the What-If Technique to identify the patient's root fear Do positive reframing ONLY ONCE – otherwise can become a big reassurance (e.g., you are a good person, etc.) Here is a driving analogy for how we don’t lose our core values or safety just because anxiety has decreased. For example, think of when you first started learning how to drive. Where was your anxiety 0-100? Mine was probably about 90%. This was tied to the values of wanting to stay safe, keep other’s safe, valuing people’s lives and my own life. Think of where your anxiety with driving is now, 0-100, after you’ve driven almost every day for months or years. Mine is mostly around 0-5%, unless I’m next to a semi, then it's maybe at 10%. Did you find that your morals and values changed once your anxiety decreased? Did you suddenly start to drive recklessly without caring about others’ well-being? Most likely not. This will be the same with our work with OCD. Through exposure, your anxiety around your obsessions will also be dialed way down, but your moral compass and values will still stay intact. 5. Use Burns' Triple Paradox for compulsions Goes beyond moment in time: make a list of all compulsions – want to stop all of them (response prevention). Go back to moment in time, list benefits of compulsions, values, and cost of change She described Voicing the Resistance (also known as Externalization of Resistance): The therapist might say: “Let’s look at this list of powerful benefits of your compulsions, the important values it shows about you, and all the costs of change. Given all those powerful reasons to keep your compulsions,  why would you want to do this work to let go of them? “After all, your compulsion give you  immediate relief from your anxiety.” "Then the therapist can review the entire list of benefits and costs of change, and ask, ”Why in the world would they want to change considering x benefit and y cost?” 4. Motivation script: I rate the patient’s motivation to get rid of compulsions (0-100) before and after the Triple Paradox, and after Voicing the Resistance. If Voicing the Resistance boosted their motivation to change, I have clients write out or record their responses when we went through Voicing the Resistance. Their homework is to read this motivation script or listen to the audio recording of it it every day and as needed, knowing that there will be moments when the temptation to engage in the compulsion is 100%. 7. M = Methods: Thai-An, do not used any traditional cognitive tools (e.g., id distortions, double standard, examine the evidence), but David does and finds them to be helpful, just not the whole ball of wax! Thai-An points out that John Hershfield, MFT,  a major author in the OCD field also talks about using identify the distortions to build awareness. Of course, David sees a missive contribution of TEAM-CBT methods that goes way beyond building "awareness." Address self-doubt in their ability to change with TEAM structure and cognitive tools Always explore hidden emotion first (case example of OCD cured by hidden emotion) Here and now exposure as obsessions come up Fear hierarchy In Vivo Exposure (case examples) – exposures in real life Imaginal exposure – exposures in your mind Anything that can’t be done in vivo Only with the most disturbing obsession (flooding Uncover core fear with What If Technique You can use David's Devil’s Advocate for the compulsions Rate how tempting it is to engage in compulsion (0-100) E.g., OCD: You really should replay that memory one more time to make sure you didn’t molest your baby; Client: That’s OCD talking and I’m choosing to move forward with my life. Record this and then process the experience after exposure: What happened during the exposure? Did your fear come true? Were you able to tolerate the distress? How was the outcome different from what you expected? What surprised you about the outcome? What did you learn from this exercises? What could you do to vary this exposure? Relapse Prevention Training should always be done following the initial recovery.. Thanks for tuning in today! Rhonda, Thia-An, and David Thai-An practices in Oklahoma City, but teaches online for everyone. For more information about her clinical work, visit www.lastingchangetherapy.com. For information about r her TEAM-CBT training, visit www.teamcbttraining.com. Through her training website, you can sign up for her free TEAM-CBT webinars, which are held every other month. Her upcoming TEAM-CBT Conference in Oklahoma will be from March 30-April 1, 2022. Here's the info about the conference: TEAM-CBT Conference: Practical Tools for Overcoming Anxiety, Depression & Addictions Get more info, register, and pay here: www.teamcbttraining.com/conference Dates: Wed, March 30th - Fri, April 1st Times: Wed: 9:00-5:30 CDT, Thurs & Fri 9:00-5:00. CEUs: 20 CEUs approved for Oklahoman psychologists, LPCs, LMFTs, LADCs, & LCSWs, including 3 of ethics and 10 specific alcohol and drug hours. 20 TEAM-CBT Certification Units approved.   Any therapist can attend, but CEUs only for Oklahomans at this time. Must attend the conference in full to get your CEUs/certification units. Not late arrivals or early departures. Perks: 25% off coupon for Dr. Burns's tools 50% off Level 1 TEAM-CBT Certification through FGI Lots of interactive, practical learning through didactics, live demos, and a live session to show the TEAM treatment process from beginning to end. You'll also see a recording of my habits & addictions process with a woman working on decreasing alcohol use. Dipti  Joshi, PhD will be joining us all the way from India and will help to teach uncovering techniques on Thursday morning.

The Feeling Good App: Part 2 of 2-- The Surprising Basic Science Findings-- How Does Psychotherapy REALLY Work? And Why Did Everything Change So Fast?   Feeling Good Podcast Special Edition #2: March 07, 2022 Today’s special podcast features the second part of the recording with David and Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the basic science findings most recent beta test, which included 140 participants. David uses an advanced form of statistics, called Structural Equation Modeling (SEM) to identify causal effects and to learn more about how the app actually works. This information has immense practical and theoretical implications. Here's a portion of what we’ve discovered so far. All seven negative feelings are high correlated because they all share an unknown Common Cause (CC) predicted by David in one of the top psychology research journals in the late 1990’s. Here’s the reference2 Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473. The CC accounts for most of the variance in all seven negative feelings, with R-square values ranging from 66% for anger, and 98% for Anxiety. Since there has to be some error variance in the estimates of the negative feelings, there is practically no room left for any significant additional causes. If you would like to see the standardized output of the SEM model, click here. The CC also has causal effects on Happiness, but these effects are much smaller, with an R-square of only 30%. This proves that Happiness has its own causes that are completely different from the factors that trigger depression. Happiness, in other words, is NOT just the absence of depression. The radical reductions in all seven negative feelings were mediated by the reduction in the user’s belief in their negative thoughts, as predicted by cognitive therapists, like Albert Ellis and Aaron Beck, as well as the Greek Stoic philosopher, Epictetus, nearly 2,000 years ago. This is the first proof of that theory! At least three components of the app have been isolated which appear to have substantial causal effects in the Common Cause, which in turn triggers simultaneous changes all negative feelings as well as happiness. Those three components include: A cognitive variable: the user’s belief in his or her negative thoughts. A motivational variable: measured with extremely precise and sensitive instruments. the user’s liking of the app. The magnitude of all three causal effects was large. However, the motivational variables and user’s liking did not have direct effects on changes in depression and other negative feelings. The changes were ALL mediated via reductions in the user’s belief in his or her negative thoughts. This finding is consistent with the hypothesis that it is impossible to reduce negative feelings without change the belief in the negative thoughts that trigger those feelings. The SEM models were replicated in two independent groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The fit of the model was outstanding in both groups, and there were few or no significant differences in the parameter estimates. This indicates that the findings are valid and do not represent capitalization on chance. David has reported extremely rapid changes in all negative feelings in his single-session treatment of individuals using TEAM-CBT. Some people have suggested that this is because he often treats mental health professionals as well as individuals who are very acquainted with his work. CLICK HERE FOR THE FULLL REPORT However, data from the beta test indicates this is not likely to be true. Mental health professionals did not respond any differently from non-professionals. In addition, the Familiarity with David or with TEAM variables did have modest effects on the degree of liking of the app, but no direct causal effects on changes in depression or the Common Cause. The basic research is just beginning and ongoing. David believes that the research potential of the Feeling Good App may be as significant as the healing effects documented in the outcome findings with the app in the previous podcast. If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training module, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques for the first time to find out if the improvements last. Research on more than 10,000 sessions by human therapists using TEAM indicates that a portion of the gains patients make during individual sessions dissipates between sessions, but the “staying power” of the gains is facilitated by the patient’s homework between sessions. As a result, patient gains tend to reach a steady state after four or five sessions. We anticipate that something similar may be documented in longitudinal studies with the app, and are eager to see what we can learn in the next study which will extend beyond one day. So, hopefully, the new study will be pretty cool, too! And who knows what we’ll discover, with your help! Make sure you sign up if you’re interested in being one of our beta testers! David and Jeremy Rhonda, Jeremy, and David  

The Unexpected Results of the Latest (and Largest) Beta Test Feeling Good Podcast Special Edition #1: February 28, 2022 Today’s special podcast features Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the most recent beta test which included 140 participants with depression ranging from no depression at all to the most severe depression that one can possibly experience. David explains that in the middle- to-late 1970’s he first conceptualized the possibility of creating an electronic version of himself that could treat people without any assistance from an actual shrink. He explains that My first fantasy was a small booth you could go into, like the ones for taking photos, where you would be presented with a hologram of a shrink who would talk with you in just the same way that a human therapist does. I also imagined creating kiosks that could be placed in groceries stores or places like Epcot Center in Disney World. where people could insert 25 cents and have their emotional or marital problems analyzed, or their depression treated, and so forth. I imagined that the kiosk would be loaded with powerful statistical software that could analyze data on the fly, and create huge data bases, and do research on the causes and cures for emotional and relationship problems. Once the internet evolved, my fantasy change slightly, and I imagined creating an electronic version of myself that would be available to anyone in the world as an app. In addition, because of some promising published research on the antidepressant effects of my first book, Feeling Good, I had a hunch that I could create an app that might be as effective, or even more effective, than human therapists. Two years ago, Jeremy and David teamed up to see if this dream was possible. Today, they present the incredible results of the latest beta test of the Feeling Good App. They measured changes in seven negative feelings as well as happiness in 140 individuals who had access to one portion of the app—the Basic Training—for one day only. The seven negative feelings were depression, anxiety, guilt and shame, inadequacy, loneliness, hopelessness, and anger. All feelings were measured on the same scale from 0 (for not at all) to 100 (for completely). The reliabilities of the negative feelings scale were .91 at the initial evaluation and .93 at the end of the day. David divided the participants into two groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The results indicated, unexpectedly, that they may have already achieved their goal. Here’s what they found: The reductions in depression in both groups, as well as the additional six negative feelings, were substantially greater than the reductions reported in large numbers of published outcome studies with cognitive therapy, other schools of therapy, and antidepressants. All seven types of feelings were dramatically reduced in both groups. For example, the depression reduction was 62%and 51% in the severe and mild groups, respectively, and the anger reduction was 70% and 81%, respectively. (Click here for the complete report). Individuals in both groups also reported boosts in happiness, with a 33% increase in the mild group and a mind-boggling 80% increase in the severe group. The lower (but significant) boost in happiness in the mild group was because many of these individuals were already pretty happy at the start of the app, so there wasn’t a lot of room for improvement. CLICK HERE FOR THE FULL REPORT One of the most exciting features of the Feeling Good App is that it does research on itself in real time and shows us which parts are the most and least effective. In fact, one part of the app in this beta test was not helpful, and actually made depression somewhat worse, on average. In spite of that, the changes in all the negative feelings were spectacular by the end of the day. We have already modified the parts that were not effective, and anticipate the app will become more and more powerful over time. This is just the beginning, and the sky’s the limit! The feedback we received on the app has been largely totally unexpected. Some things that we thought were blow-away were criticized, and some parts that we thought were weak were strongly celebrated. This experience has been much like using David’s feedback scales in therapy. Therapists learn that their perceptions of how their patient feel are often not off-base, and that many of your favorite techniques and strategies are not effective. This information, if processed with respect and humility, can transform your clinical practice. And of course, similar information is rapidly and radically transforming our app! Once again, our “patients,” or more accurately “app users,” have become our best teachers. In the next podcast a week from today, we will discuss the basic science we are doing with the help of the Feeling Good App. We are asking questions like these: How does the Feeling Good App really work? What are the ingredients of therapeutic success? What are the variables that can trigger such rapid and dramatic changes in negative feelings as well as happiness? What is the cause of depression? Is there any support for the theory that depression (and all other negative feelings) are caused by distorted negative thoughts? Is there any support for the theory that changes in negative feelings are actually mediated by reductions in our distorted negative thoughts? Is there any support for David’s prediction, first made in the Journal of Consulting and Clinical Psychology in 1998, that an unknown “Common Cause” simultaneously triggers depression and other negative feelings, like anxiety, and accounts for the strong correlations among these feelings? Here's the reference: Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473. Are some groups easier to treat and more responsive? For example, the beta group included therapists and non-therapists, as well as individuals with no or very little familiarity with David’s work, plus individuals very familiar with his work. Which groups responded better to the app? This is important because most of the world is NOT familiar with David’s work. Will they be at a disadvantage when using the app? Are the causes of negative feelings, like depression, anxiety, and anger, the same as the causes of happiness? Or does happiness have its own, totally independent causes? Stay tuned for the answers to these questions. But in the meantime, make your own predictions, and then you will find out what the data told us! If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques. So, hopefully, the new study will be pretty cool, too! David and Jeremy Rhonda, Jeremy, and David

Podcast #282: Mike Christensen on Deliberate Practice: Was David Right All Along? Rhonda and I are thrilled to welcome Mike Christiansen, head of TEAM-CBT in Canada. Mike is a fantastic clinician and teacher, and an old beloved friend. Today he talks about the impact of David’s work that is finally being felt and appreciated by innovators in the field of psychiatry and psychology. Rhonda begins the broadcast by reading a really touching endorsement from a young man in Turkey whose life was changed by David’s work after he came close to suicide. One of the key’s was David’s statement that we are disturbed, not by events, but by our thoughts about them.” Of course, that incredible idea goes back all the way to the Greek philosopher, Epictetus, nearly 2,000 years ago. It is so basic that most people don’t “get it,” but once you do, it can be mind-blowing. The young man ended his note to David by saying that, “Life is beautiful now. Thank you!” Mike described a similar enlightenment experience when he was doing counseling, and first attended one of David’s intensive workshops in Canada. He knew that his training did not provide him with the tools to make much of an impact on his patients. He was excited by what he learned, and subsequently attended many of David’s workshops, and became certified in TEAM-CBT. Mike now teaches from around the world at the Feeling Good institute in Mt. View, California. He teaches a highly acclaimed 12 week introductory course in TEAM. If you are looking for some in depth training, Rhonda and I would STRONGLY recommend this class. Mike described a vitally important new direction in psychotherapy called “Deliberate Practice,” and is co-authoring a book on this topic with Maor Katz, MD, head of the Feeling Good Institute, and two pioneers in deliberate practice, Tony Rousmaniere & Alex Vaz. Essentially, Deliberate Practice refers to two things. First, therapists must use rating scales, like the ones David has created, to assess patients progress in multiple dimensions, as well as their perceptions of therapist empathy and helpfulness, at every single session. This keep therapists on their toes, and gives them a crystal clear picture of their effectiveness or lack of effectiveness with every patient at every session. Although this can often be painful for the therapist, it can transform the therapist’s clinical skills and turn every patient into the finest teacher the clinician has ever had! Second, deliberate practice refers to refined training tools for therapists to practice on an ongoing basis, not only when learning therapy for the first time, but throughout your entire career. The key is doing short, role plan exercises that focus on specific tools, like the Five Secrets of Effective Communication during the E = Empathy step of TEAAM, or the “Invitation Step” at the start of A = Assessment of Resistance, or the Externalization of Voices during M = Methods. And here’s the most important part. After the role play, the student is given a letter grade plus specific feedback on what she or he did right and what needs improvement. Then you do repeat role reversals until the student gets an A. David compares this to the type of training a professional athlete might receive to improve his or her skills at basketball or any sport. However, this also requires great motivation and courage on the part of those who are learning and teaching, because every error is highlighted—there’s no hiding! That’s why the philosophy of learning in the spirit of “joyous failure” is crucial to survival and success! Rhonda, Mike, and David demonstrated this strategy several times, focusing on the Invitation Step of the Assessment of Resistance with an “easy” as well as a more “challenging patient. Sure enough, grades below an A WERE received, and errors WERE pointed out. And, in addition, grades of A were fairly readily achieved, showing that this type of “deliberate practice” definitely DOES work. During the podcast I took the opportunity to vent some of my frustrations with the field, and Mike and Rhonda kindly didn’t point out that I probably sounded like a half-demented loony. But I do feel strongly about this topic, and extremely proud of the amazing work that Mike is doing on so many levels. Most therapists resist rating scales. One of my students did a survey for his PhD research, and it seemed like only a small percent (less than 5%) of the psychologists he polled who advertise in the Psychology Today website are using ratings scales to track patient progress. To me, this is both unethical, anti-scientific, and totally unacceptable. Therapists have endless excuses for resisting, and all of the excuses are spurious. For example, they think patients won’t be honest, but the big problem is that the overwhelming majority of patients ARE honest, and therapists don’t want to hear the truth bout their errors and ineptitude. I do not support, but rather condemn, therapists who refuse to use rating instruments. To me, this is the “unforgivable sin” in our profession. I also believe that the use of valid and highly reliable rating instruments will eventually be required for licensure, and the “science resisters” will soon be a thing of the past. The field of psychotherapy definitely needs to move into the data-driven scientific era, and leave the current “schools of therapy,” which compete like religions, or even cults, behind, just as physics and astronomy broke away from the Catholic Church during the Copernican Revolution hundreds of years ago. So, Mike is definitely working on the cutting edge, and he’s just awesome! If you get the chance to take one of his TEAM-CBT classes, jump on it! He will connect with you intellectually, emotionally, and, if I can use a politically incorrect word, spiritually! Warmly, David, Rhonda & Mike

Sanjay asks: How can we convert our “needs” into “wants?” Vanessa asks: How can we think upon the threat of a nuclear war, or the thought of America becoming a totalitarian state, or the loss of voting rights, without becoming anxious or depressed? Cliff asks: I have pure obsessive OCD and get stuck on intrusive thoughts. What should I do? Upcoming Questions in Ask David podcasts William asks: How would the T.E.A.M. model look with addiction and procrastination? Caroline asks: I’ve done Cost Benefit Analyses (CBAs) for many of my SDBs (Self-Defeating Beliefs), and the disadvantages greatly outweigh the advantages? What’s the next step? Al asks: Can you help me with fear? Khoi asks: How do you deal with colleagues who gossip about your boss? Matt asks: How do we help patients who don’t “get” the Acceptance Paradox? Edwin asks: What’s the best treatment for internet surfing? It feels like my actions operate below the level of consciousness! Al asks: Can you help me with worrying and fear of symptoms? Paul asks: Are you planning on doing a podcast about people who are about to retire and are very anxious about the prospect and also depressed about closing that chapter in their lives?  I’m in that boat    Sanjay asks: How can we convert our “needs” into “wants?” Dear Dr. Burns I thank you for pointing out “dramatic shift” in the foot notes and it has given me immense satisfaction . So my learning from this is that ‘Low Level Solution’ remains just a “first aid” only because it is still in the category of “NEED” has not yet moved into the category of “WANT”. A further question comes to mind So what is the process / formula to keep the deepest desires of ours from not entering into NEEDs and remain in the WANT zone. and yet we can work with highest passion and love to achieve them . OR in other words , how do you keep your biggest desire of your APP in the WANT zone and still maintains the highest level passion to achieve it . what is he process to reach that stage? You have already given us the answer to this and shown us the way towards Enlightenment via FOUR GREAT DEATHS of the “self.” Still if you would like to say something more that will help us to grasp the process of keeping the desires in WANT only. warm regards Sanjay   David’s reply In reply to Sanjay Gulati. You can also do two Cost-Benefit Analyses CBA. For example, the first might be a CBA on the Adv and Disadv of Needing love, achievement, or approval, for example, and the second would be a CBA on the Adv and Dis of Wanting the same. You could also use the semantic Technique. What could you tell yourself instead of “I NEED great achievement (or love or approval or whatever) to feel happy and fulfilled.” A third could be to do an experiment and see if it is really true that happiness always or only comes from achievement, love, approval, etc. A fourth strategy would be to do a Feared Fantasy and have a conversation, in imagination or in role play with a therapist, with someone who has achieved tremendously. That person would have to explain that she or he looks down on most other people because they haven’t achieved as much, so s/he feels they are less worthwhile. You might suddenly discover that such a person doesn’t actually seem especially “worthwhile,” but more of an egotistical type. With regard to the app, I’m just having fun with it, and making all kinds of amazing discoveries. Parts of it are really effective. Other parts are ineffective and need to be changed. But it is all an adventure. I can’t control the outcome—will it be popular? Will we develop a business model that allows us to pay our bills? Maybe yes, maybe no, maybe partially. But to be honest, I don’t really care! And not “caring” or “needing” frees me up to care way more effectively, and more creatively, and more lovingly. And with inner peace along the way. Here is something else. You begin to realize that there is no such thing as “failure,” only information. For example, if people don’t like some lesson, or some word I have used, I just change it and make it better. Most of the negative and positive feedback is totally unexpected and surprising, which is really fun! I feel privileged, not pressured. These feelings are quite rewarding and addictive. I realize, too, that most people don’t really care how “successful” I am, including you. Most people do appreciate it when I treat them well, however. Same with our cat that we adopted at the local humane society after her owner died. Might make this an Ask David if it is okay! Thanks, david By the way, you subsequently emailed me and asked me to comment on “intense wants” vs. “needs,” so here’s a little more. When I was a young man, I used to collect antique paper money from around the world as a hobby. I can vividly recall seeing a rare uncut sheet of banknotes at a trade show that I feel in love with instantly. It was from the US Virgin Islands from the 1850s, if I recall correctly, and it consisted of a one thousand dollar bill and three five hundred dollar bills. It was gorgeous and I was instantly hypnotized, thinking it was one of the rarest and most desirable things in the world! But sadly, I was a poor graduate student and could not afford it, and I’m not sure the dealer, a really nice guy from New Mexico named Larry Parker, was willing to sell it. Finally, I gave up on it and stopped thinking about it. Years later, that exact same item came up in an auction in Los Angeles, and I was starting my clinical practice in Philadelphia. So I called the auctioneer, who I knew, just an hour or so before the end of the auction, and asked how much I should bid in order to be sure that I would win that intensely coveted item. At the time, the bidding was around $2,000, and I thought I could likely get a loan from the bank to buy it. The auctioneer told me that no matter how much I bid, there was no chance I could win it. I asked why. He said the wealthiest man in Caribbean was bidding on it and would pay any amount of money to get it, no matter what. I was devastated and felt my chance for true happiness and worthwhileness had just evaporated! My “intense want” was not fulfilled! Years later, similar notes started appearing in auctions, and I was able to figure out they were all reprints, including that original uncut sheet. Although they had some modest value, they were easy to obtain, and . . . suddenly I had no desire at all to own them! And it also dawned on me that all those years when I couldn’t have that “fabulous” (or so I thought) uncut sheet, I’d been absolutely happy. So much for our so-called “needs!” Vanessa asks: How can we think upon the threat of a nuclear war, or the thought of America becoming a totalitarian state, or the loss of voting rights, without becoming anxious or depressed? Hi Dr. Burns, First off thank you so much for your podcast and books. They've helped me immensely grow and I am forever appreciative! Recently, I've been hearing statements like "American democracy may not be around in 10-15 years", "America is becoming a totalitarian state'', and "We're heading to nuclear war" from both sides of the political spectrum. All of these statements make me very anxious to hear. I know that thoughts create feelings, so even if something is true (like the threat of nuclear war, or that voting rights are being infringed upon, etc.), is there a way we can think upon these issues without becoming anxious or depressed over them? Thank you so much, Vanessa B. David’s reply Hi Vanessa, Thanks. I’m sure many people have similar concerns. However, this is a very general question, and you have not given me any specific examples of your own negative thoughts. So, I can only give you an equally vague and general response, which is guaranteed not to be helpful. That’s because general questions and answers tend to be little more than babbling. All that being said, I will say that there is a healthy and an unhealthy version of every negative feeling. So, some alarm and concern is probably totally appropriate and healthy, but getting crippled with excessive anxiety and depression is perhaps not useful. Healthy negative feelings result from valid negative thoughts; unhealthy negative feelings always result from distorted negative thoughts. But, as I pointed out, without a single example of your negative thoughts, all of the “good stuff” will remain unseen! Thanks. david PS I will make this an Ask David for an upcoming podcast.   I have pure obsessive OCD and get stuck on intrusive thoughts. What should I do? Hey Doc! Very glad I ran into your work. Started with a video and have been reading and listening to your stuff for a couple days now. I’ve been diagnosed with OCD (PURE O). I struggle with intrusive thoughts. I have had a lot of trouble exposing myself to the thoughts in order to face them. I’ve tried a writing a narrative of my fears etc…. I just can’t seem to get the right exposure. A couple examples: I get stuck on… I don’t believe in God, or don’t believe enough or that maybe there isn’t a God? I get stuck on… what if I go crazy? I wish there was a dirty sink I could go touch or something tangible I could face. Any suggestions? Cliff (name disguised) David’s reply Hi Cliff, Sure, and sorry you've been struggling, and fortunately, the prognosis is very positive. But I have a few questions so I’ll know what you’ve done already. First, which of my books have you read, and did you do the written exercises while reading? For example, When Panic Attacks is all about techniques for anxiety. Second, have you done a search for OCD as well as anxiety on my website? You will find many resources. Third, have you completed the free anxiety test and class on my website? Fourth, sometimes a therapist with expertise in exposure can help with exposure, although that is one of a great many powerful techniques for treating anxiety. Trying to treat OCD or any form of anxiety with exposure alone is a huge mistake. Fifth, have you used the Hidden Emotion Technique? Let me know, and thanks. david Rhonda, Matt, and David

The Feeling Good App: Part 2 of 2-- The Surprising Basic Science Findings-- How Does Psychotherapy REALLY Work? And Why Did Everything Change So Fast?   Feeling Good Podcast Special Edition #2: March 07, 2022 Today’s special podcast features the second part of the recording with David and Jeremy Karmel, David’s founding partner of the Feeling Good App. Jeremy and David discuss the exciting results of the basic science findings most recent beta test, which included 140 participants. David uses an advanced form of statistics, called Structural Equation Modeling (SEM) to identify causal effects and to learn more about how the app actually works. This information has immense practical and theoretical implications. Here's a portion of what we’ve discovered so far. All seven negative feelings are high correlated because they all share an unknown Common Cause (CC) predicted by David in one of the top psychology research journals in the late 1990’s. Here’s the reference2 Burns, D. D., & Eidelson, R. (1998). Why are measures of depression and anxiety correlated? -- A test of the tripartite theory. Journal of Consulting and Clinical Psychology, 66(3): 461 - 473. The CC accounts for most of the variance in all seven negative feelings, with R-square values ranging from 66% for anger, and 98% for Anxiety. Since there has to be some error variance in the estimates of the negative feelings, there is practically no room left for any significant additional causes. If you would like to see the standardized output of the SEM model, click here. The CC also has causal effects on Happiness, but these effects are much smaller, with an R-square of only 30%. This proves that Happiness has its own causes that are completely different from the factors that trigger depression. Happiness, in other words, is NOT just the absence of depression. The radical reductions in all seven negative feelings were mediated by the reduction in the user’s belief in their negative thoughts, as predicted by cognitive therapists, like Albert Ellis and Aaron Beck, as well as the Greek Stoic philosopher, Epictetus, nearly 2,000 years ago. This is the first proof of that theory! At least three components of the app have been isolated which appear to have substantial causal effects in the Common Cause, which in turn triggers simultaneous changes all negative feelings as well as happiness. Those three components include: A cognitive variable: the user’s belief in his or her negative thoughts. A motivational variable: measured with extremely precise and sensitive instruments. the user’s liking of the app. The magnitude of all three causal effects was large. However, the motivational variables and user’s liking did not have direct effects on changes in depression and other negative feelings. The changes were ALL mediated via reductions in the user’s belief in his or her negative thoughts. This finding is consistent with the hypothesis that it is impossible to reduce negative feelings without change the belief in the negative thoughts that trigger those feelings. The SEM models were replicated in two independent groups, including 60 participants with moderate to extremely severe depression at the start of the day, and 73 participants with no or only mild feelings of depression. The fit of the model was outstanding in both groups, and there were few or no significant differences in the parameter estimates. This indicates that the findings are valid and do not represent capitalization on chance. David has reported extremely rapid changes in all negative feelings in his single-session treatment of individuals using TEAM-CBT. Some people have suggested that this is because he often treats mental health professionals as well as individuals who are very acquainted with his work. CLICK HERE FOR THE FULLL REPORT However, data from the beta test indicates this is not likely to be true. Mental health professionals did not respond any differently from non-professionals. In addition, the Familiarity with David or with TEAM variables did have modest effects on the degree of liking of the app, but no direct causal effects on changes in depression or the Common Cause. The basic research is just beginning and ongoing. David believes that the research potential of the Feeling Good App may be as significant as the healing effects documented in the outcome findings with the app in the previous podcast. If you are interested in participating in our upcoming beta test, you can sign up at www.feelinggood.com/app. We will be testing a radically revised version of the basic training module, plus some powerful new modules, and we will also be looking at relapse and relapse prevention techniques for the first time to find out if the improvements last. Research on more than 10,000 sessions by human therapists using TEAM indicates that a portion of the gains patients make during individual sessions dissipates between sessions, but the “staying power” of the gains is facilitated by the patient’s homework between sessions. As a result, patient gains tend to reach a steady state after four or five sessions. We anticipate that something similar may be documented in longitudinal studies with the app, and are eager to see what we can learn in the next study which will extend beyond one day. So, hopefully, the new study will be pretty cool, too! And who knows what we’ll discover, with your help! Make sure you sign up if you’re interested in being one of our beta testers! David and Jeremy Rhonda, Jeremy, and David

Podcast #280: A Beloved and Brilliant Voice from the Past: Dr. Stirling Moorey! Rhonda and I are thrilled to welcome Dr. Stirling Moorey, from London, England, to today’s podcast. Stirling was one of my first students, and he sat in with me my on all my sessions as a co-therapist for a month for two summers in the late 1970s. I wrote about Stirling in my first book, Feeling Good: The New Mood Therapy, which was published in 1980. One of the miracles of the internet, and zoom, is the chance to reunite with friends and colleagues from the past. Needless to say, Rhonda and I were SO EXCITED when Stirling accepted the invitation to join us! Rhonda starts the podcast by saying that “Dr. Stirling Moorey had the good fortune to be trained and supervised by two pioneers in the field of cognitive therapy, Drs. Aaron Beck and David Burns. In 1979, when Stirling was still in medical school in London, he did an elective with Dr. Aaron Beck at the Centre for Cognitive Therapy in Philadelphia.“ I (David) might put it a bit differently. I would say that during the early days of cognitive therapy, I had the fantastic opportunity to do co-therapy together with Stirling with many patients. I learned a tremendous amount from Stirling, even though I was, in theory, the “expert” and he, in theory, was a totally untrained and green novice. But he was phenomenal right out of the gates, and those months were among the happiest of my life. What I learned by observing Stirling’s superb interactions with my patients eventually morphed into my Five Secrets of Effective Communication and my first book, Feeling Good Together! Rhonda continues: "Stirling was one of the first British therapists to study CBT when that discipline was in its infancy. David described their fantastic collaborative work with Stirling in Feeling Good, and has described Stirling’s brilliant empathy skills in dozens of workshops. Stirling is currently a Consultant Psychiatrist in Cognitive Behaviour Therapy, and was the Professional Head of Psychotherapy for the South London and Maudsley Trust from 2005-2013. He has been a Visiting Senior Lecturer at the Institute of Psychiatry, Psychology & Neuroscience in London." Stirling is a highly regarded therapist, trainer / supervisor / teacher and workshop leader. His main research interest is in the application of CBT to life threatening illness and adversity. He was one of the first therapists to develop CBT for people with cancer and has contributed to five randomized controlled trials in both early and late stage cancer. Stirling is also co-author with Steven Greer of The Oxford Guide to CBT for People with Cancer, and has co-edited a book entitled The Therapeutic Relationship in Cognitive Behavioural Therapy, published by SAGE (Moorey & Lavender, eds.) During today’s podcast, Stirling reminds us that one of the aims of cognitive therapy is encouraging patients to examine their distorted negative thoughts and self-defeating beliefs in a way that is not threatening. If patients don’t feel validated, they may feel attacked and become defensive, which, of course, can undermine the therapist’s effectiveness. He also reminded us that the grandfather of cognitive therapy, the late Dr. Albert Ellis from New York, often attacked the beliefs of his patients in a somewhat aggressive manner, and that this can frequently trigger therapeutic resistance. In fact, an overly aggressive therapeutic style can split patients and colleagues into two camps: those who love you, and those who may stubbornly resist and oppose you. During the podcast, we reminisced a bit on shared memories, and Stirling said that “David took me under his wing with such willingness to share his knowledge and experience . . . and I was just an ordinary medical student. We had many great moments!” Although Stirling was tempted to relocate to America, he decided to remain in England, and has never regretted that decision. For one thing, he met and married his beloved Magda. My own wife, Melanie, and I were honored to take our two kids to England to attend their marriage. We all loved England and had a ball! Magda, Stirling's wife We discussed some of Stirling’s amazing work with the patients we saw together in Philadelphia, as well as his visit one summer when we were in California visiting with Melanie’s parents in Los Altos, where we now live. Stirling recalled that when we were out shopping one day, my wife and I tried to persuade him to purchase a large Stetson hat, but he resisted! Stirling described the three ways in which he encourages people to change their negative thoughts using the Socratic Technique of gentle questioning: he  asks if the negative thoughts are realistic, if they are helpful, and if an alternative perspective can be taken. The reality testing approach focuses on the important differences between healthy negative feelings, like healthy sadness or grief, which don’t usually need any treatment, and unhealthy negative feelings like depression, or a panic attack. One key difference is that healthy negative feelings always result from valid, undistorted thoughts. For example, if a loved one dies, you may tell yourself, “I still love him with all my heart, and I’ll miss the many wonderful times we spent together.” In contrast, unhealthy negative feelings result from negative thoughts about the person who died that are distorted. For example, a young woman who’s brother committed suicide told herself, “It’s my fault he was depressed because our parents love me more when we were growing up. I should have know that he was considering suicide the day he died, so I, too, deserve to die.” Of course, the distorted thoughts don’t have to result from a traumatic event. For example, a chronically depressed patient may tell himself, “I’m a loser, and I’ll be depressed forever.” A more pragmatic treatment approach focuses less on whether thoughts are distorted or not, but rather on their effects. It’s possible for a thought to be realistic but unhelpful. If a tightrope walker in the circus thinks during their act, ”If I fall I will die,” this may be realistic but not very helpful! Stirling talked about how the third way to look at changing thoughts is based on the fact that our lives always have a narrative—a story we tell ourselves about what has happened, or what is happening right now in our lives. These stories can have a powerful impact on how we all think, feel, and behave, and may often function as self-fulfilling prophecies. We can change these stories to make them more adaptive for us. For instance, rather than seeing the glass as half empty, we can see it as both half empty and half full; or we may choose to focus on what you can control vs. what you can’t. What I’ve written so far are just some general ideas, summaries of things that we talked about on the podcast. But when you listen to the podcast, you will perhaps notice the warmth, richness, and depth in the way Stirling thinks and communicates. Then you will “see” and experience his true genius and his immense compassion! We hope that we can entice Stirling to present to one of our free weekly training groups, and perhaps even see if he might agree to do another co-therapy sessions with me that we can publish on a podcast, so you can actually see and experience this master therapist in action! Rhonda, Stirling and David

Podcast 279: Dr. Leigh Harrington on Goal Setting for Habits and Addictions or Using Habits to Feel Better Today, we are joined by a very special member of the TEAM-CBT family, psychiatrist Leigh Harrington, MD, who will teach us how to set goals that work when battling habits and addictions. Leigh Harrington, MD, MPH, MHSA, is a psychiatrist, TEAM-CBT Therapist and Trainer.  Originally from Michigan, where she completed medical school and graduate school, she had the good fortune to meet Dr. David Burns in 2004 during her psychiatry residency at Stanford University when she joined his original group of Tuesday night students.  She specializes is helping therapists and individuals reach their goals especially in the areas of Interpersonal Exposure, Relationships, and Habits.  She lives in Davis, California with her two beloved daughters. Leigh begins by saying that there are many parts of the TEAM-CBT model than help when battling unwanted habits and addictions. Our habits definitely result from how we think, and the stories we tell ourselves, and treatment can sometimes be more than just treatment, but a transformational experience. She explains that “I gained 20 pounds following my last pregnancy, so I began to set three kinds of goals: Mental goals Physical goals Relationship goals” Mental goals She continues: “I focused on reducing the many Should Statements I was battering myself with, like “I should have done this or that,” or “I should do this or that.” These kinds of statements sounded demanding and triggered feelings of guilt and frustration that actually made it harder to achieve my goals. “So, I decided, instead, to notice my thoughts, and focus instead on appreciating things. This was just one of many approaches to rewiring my brain. “For example, I realized I had been letting my brain run itself each morning. When I woke up my mind would start to tell me all the things I needed to (should) do that day. . . Sometimes I would wake up feeling “okay,” but I was definitely not in a state of bliss, gratitude or joy. “Sometimes it seemed as if my mind would look to find reasons I might not be feeling top-of-the-world: ‘Well there is this issue… or this… and also this…’ “Which told me a story of my unhappiness, or simply a lack of joy. Of course, my mind was well-intentioned, trying to help me out, but it didn’t end in greater joy, but in the weight of ‘shoulds’ and reasons to feel crummy. It had become a habit--a thinking habit. “I was struck by the idea that I didn’t have to let my mind think whatever it wanted and wondered if I could break this thinking habit. In habit work, we determine the new habit we want, check our motivation, plan solutions to any problems, and commit to the new habit. “I thought I would keep my new habit simple, believable, and incorporate gratitude, as that can sometimes be helpful, too. “My new habit was to catch myself while I was still in bed, as soon as I recognized I was having thoughts, and say to myself something I believed that, was non-controversial. When I caught myself thinking any shoulds or telling myself any unhappy stories, I said to myself, ‘I love my bed. I love my house. I love my lamp.’ “This might seem simple, trivial, or silly. But the point of the new habit was not to be profound and brilliant. The point was to change my thinking in the smallest of ways and to prove to myself I could create a new thinking habit. “This simple thought habit has allowed me to start my day on a better note and has allowed me to prove to myself I can change my thinking habits.” Physical goals Leigh explains: “Here’s how I lost the 20 pounds I had gained. Instead of focusing on one strategy – like, “I will only eat vegetables,” or “I will exercise 2 hours per day,” I focused on achieving the goal by any means. I used the experimental technique and went through a series of habit experiments. “First I tried just thinking I’d like to lose the weight. I. This may seem crazy, but there have been times in my life when I’ve seemed to effortlessly loose weigh, so that seemed like an easy first go. “As you might imagine, it didn’t work as well in my 40’s as it did in my 20’s. As long as I kept giving in to my urges to have a sugary treat in the afternoon as a pick-me-up, and refusing to be in deprivation, nothing at all happened with my weight. “I also allowed myself to eat as much as I wanted to, just as I had when I was pregnant and nursing my daughter. “Since that didn’t work,. I experimented with some green juice in place of sugary snacks. I felt healthier, but there was no change in my weight. “Then I decided on a multi-pronged approach. I would keep drinking my fruit-smoothies in the morning, along with a protein shake mid-morning, and a normal lunch, plus a normal dinner – just one serving at lunch and dinner, and no more than one dessert per week, Whenever else I was hungry I would drink a protein drink and lots of water. I also committed to walking every day for 30-60 minutes and going to the gym at least once per week. “And, I committed to doing this until I saw the results I was looking for. I weighed and measured myself. But in two weeks, I had lost only one pound and zero inches. “I was discouraged. “But I was committed to stick with it, no matter what, for as long as it took. “Three weeks in thee was still not much change. “But at 4 weeks I started noticing a difference and by 12 weeks the scale read 20 pounds lighter – the same as I weighed in college. Most importantly I felt great and I experienced a sense of accomplishment! Relationship goals Leigh continued: “I also decided to focus on developing better personal relationships with six people, including my mother. I had always felt that she was critical of me, this thought caused me to distance myself from her. I had a better relationship with my dad. So I decided to focus, instead, on what I loved and appreciated about her. For example, she was amazing with my kids. “This is a little funny, but I was in the middle of a difficult time in life and hired a coach specific to this situation.  I felt sad about the loss of a friend and I found her wisdom really helpful. She suggested, ‘you only need six people, your pall bearers.’ “Since I have a tendency to enjoy and like many people, it made a lot of sense to me to focus my energy on a treasured few. “I had always prided myself on being a loyal and committed friend and didn’t’ want to give any up.  Even though the suggestion of only 6 didn’t ring true for me, it helped me drop the strongly held belief, ‘I must keep all friends forever.’ I found releasing some relationships allowed room for some really awesome new ones to grow. “I’m loving those now. And low and behold, I started enjoying hanging out with my mom, and began to realize I had a kick ass mother!” Leigh summarized some of the keys to successful goal-setting, including the importance of setting small, measurable, and specific goals. She described her upcoming “Boot Camp” on overcoming habits and addictions. For more information, contact Leigh at www.TeamTherapyTraining.com. Following today’s podcast, we received this lovely note from Leigh: Hi David and Rhonda, I so loved being with you both today!! Thank you for being so gracious and welcoming about these ideas on how to modify habits and addictions! I love growing together.  David, it really struck me how you were breaking things down into steps and making so clear for your listeners - it felt like your intellectual mind and your heart were going at the same time. Rhonda, I love how you brought up ideas and framed things in such a clear way. You guys rock!! When we finished up, I thought of a more thorough response to David’s question about slogging today. I was reminded of perfectionism and how I’m trying not to be so perfectionistic. I still remember David’s article on perfectionism from Psychology Today Magazine way back in 1980, when Feeling Good was first released. It was entitled, “The Perfectionist’s Script for Self-Defeat.” I’ve been working on doing “B” work, and I’ve gotten so much more done and - when I don’t fall into perfectionism again - having so much more fun. So, I like the idea of holding ourselves accountable, being committed to ourselves and our goals, and to letting ourselves do B work, instead of aiming for perfection. It seems kind of counter-intuitive, but that combo leads to getting more done and being a lot happier! Maybe you have some insights, David or Rhonda? Much love to you both, Leigh David wrote back: Hi Leigh, Thanks for the beautiful note. I have also struggled with perfectionism, especially when I was younger, and I agree with your conclusions 200%. But perfectionism has many tentacles, and is always lurking in the shadows, waiting to jump out and grab us again!! David Rhonda wrote back: Hi Leigh, I also struggle with perfectionism, and when I am feeling overwhelmed I tell myself, “I have an abundance of time to accomplish all I want to do today, calmly, peacefully, and with unhurried grace.'” That’s not an empty affirmation, but a positive statement created after writing out a Daily Mood Log, seeing the positives in my perfectionism, and looking at the distortions in my thoughts. Rhonda We hope you enjoyed this podcast, Rhonda, Leigh and David

  #278: Buddhist Strategies for Financial Abundance, Featuring Zeina Halim Jan 24, 2022 Today, we feature the work of Zeina Halim, a beloved member and small group leader in our Tuesday training group at Stanford, who specializes in the treatment of anxiety.  This is Zeina’s third appearance on our podcast. Previously she helped us with a fabulous program on family conflicts at the start of the pandemic (Corona Cast 3, 4-06-2020) and later did live some personal work on one of the Self-Defeating Beliefs, the Achievement Addiction (Podcasts 211, 10-12-2020, and 212, 10-19-2020).  Today Zeina brings us something radically different: Buddhist Strategies for Financial Abundance. What in the world does that mean, and why should you care?  She starts by describing her study of Buddhist practices, and cites some books that have inspired her, including The Diamond Cutter:  The Buddha on Managing Your Business and Your Life, by Geshe Michael Roach.   Zeina explains the quasi-mystical concept of “Karma,” which is the idea that you get what you give. In other words, the energy and spirit you convey to others, and to the universe, will come back to you. For example, when clients who are not a good fit for her practice contact her, Zeina goes out of her way to help those clients find a great fit with another therapist.   This “Karmic practice,” she explains, has paradoxically caused many patients to suddenly seem to show up, asking for treatment. In other words, when she meets the needs of others, the universe meets her needs.  She says that she doesn’t need to do very much at all of the kinds of traditional marketing that most other therapists do in an attempt to build their practices. This “karmic practice” has been mostly sufficient and far more effective than traditional marketing methods. This is a theme that I (David) resonated with, since I also give away almost everything for free, and have received an abundance of positive and loving gifts from the universe in return. Zeina cautions that this, and all Buddhist practices, must be done with balance and thoughtfulness: “When I started, I gave too much, and this can actually cause self-harm.”  She said that some people have raised the question: “But isn’t this an inherently selfish practice, since you are hoping for abundance for yourself?”  Her response to this is that when you receive financial abundance, you can give even more to others for free.  She also described another book of Geshe Michael Roach’s, The Karma of Love, where you try to give to the other person and meet their needs instead of worrying about whether they’re loving you enough or meeting your needs.  In a previous relationship, this led to inner peace and, paradoxically, she felt much more loved, although nothing observable had changed in the way her partner treated her. The change in her feeling loved all came from changes SHE made, not her partner. This aligns very closely with the TEAM-CBT approach to relationships, as well as the teachings of most religions. We also discussed group TEAM-CBT vs. individual therapy.  I described my phenomenal experiences in Philadelphia creating a large intensive group therapy program at my hospital, which was in a rough, inner city neighborhood. Most of our patients had few resources, and many could not read or write. Some were homeless. The program was more or less free to all of them, and our patients and their families gave us so much in return.  I was absolutely thrilled that Zeina also loves doing therapy in groups. Many patients and therapists alike think of group therapy as a kind of inferior approach, but my experience has been the opposite. If given the choice, I’d treat everyone in groups. Zeina will be starting a TEAM-CBT anxiety group within a week of this podcast. The group will focus on all the anxiety disorders, such as chronic worrying, shyness, phobias, OCD, PTSD, and more. There will be one group for adults and one for young adults, aged 18-24. If you’re interested, feel free to text Zeina at 1-408-412-5678, email her at ZeinaHalimTherapy@gmail.com or visit her website at ZeinaHalimTherapy.com  As an aside, we’ll find out if Zeina’s Buddhist Karmic Marketing works. She did not ask me to promote her group. I just decided to promote it a little bit because I’m so excited about what she’s doing, and I hope her practice grows and prospers to the max!  Thanks for joining us today! If you like what we’re doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing. This year, we’ll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen!  Rhonda, Zeina and David

Rejection Practice: A Love Story, Featuring Dr. Cai Chen Jan 17, 2022 Rhonda starts today’s podcast by reading two wonderful recent endorsements from listeners. A therapist from San Jose, Ca was moved and inspired by the two podcasts (Episodes 268 & 269, published 11-15-2021 and 11-22-2021) with Dr. Carly on the tragic loss of her baby via ectopic pregnancy, and another listener described TEAM-CBT as “revolutionary” due to the emphasis on reducing resistance. She compared the approach to the indirect hypnotic approach developed by the late Milton Erikson.  Dr. Cai Chen recently completed his psychiatric residency in Texas, and then moved to California to join the TEAM-CBT community and unite with the love of his life, who happens to be a member of our Tuesday group.  Cai attributes much of his dating success to one of the techniques he read about in my book, Intimate Connections, called “Rejection Practice,” because he practiced that technique to successfully defeat his negative thoughts about all the awful things that might happen if he tried to talk or flirt with an attractive woman.  He would tell himself things like: She’ll think I’m being too forward. She’ll be offended and might call the police. People who see me trying to flirt will be offended. I’ll be rejected.  He described what happened when he forced himself to get 20 rejections in a mall in order to overcome his fears. His stories about what happened are both funny and inspiring.  Cai also describes his initial intense resistance to using this technique, giving himself messages like, “I shouldn’t have to learn to flirt because it’s beneath me!” I heard excuses like that all the time when I was in clinical practice, working with shy, lonely men!  Rejection Practice is a powerful and potentially super-effective technique you might want to try if you’re also struggling with social anxiety or if you treat patients with this problem.  We also illustrated the hilarious Feared Fantasy Technique on the podcast, where Cai enters an Alice-in-Wonderland Nightmare World, and meets the “woman from hell” who represents all of his worst fears, and verbalizes things like this to him: You’re assaulting me and I’m going to call the police.  You’re the last person I’d ever date! You’re forgettable! you You’re too forward. I can see that you’re very insecure! In addition, he meets the “observer from hell” who verbalizes things like this to Cai:  I’m terribly offended that you tried to talk to that woman.  It’s highly inappropriate to flirt like that in broad daylight.  You shouldn’t be doing that.  I condemn and reject you! Cai was surprised to discover that the monster has no teeth and experienced some enlightenment and freedom from his fears. Rhonda, Cai, and I had a lot of fun with these techniques, and hope you enjoy them, too. Again, if you’re a therapist, you might consider including these techniques if you work with shy individuals.  We also discuss the idea of “Physician, heal thyself,” a quotation from the New Testament (Luke 4:23). We are all convinced that doing your own personal work can vastly increase your skills and depth as a clinician, because you can tell your patients, “I know what you’re going through, because I’ve been there myself. And what a joy it’s going to be to show you how to overcome your shyness and develop greater confidence, and more loving relationships with others.” And that’s exactly what happened to Cai. He found the love of his life. You’ll hear all about it if you listen to this heart-warming podcast!  Dr. Cai is just starting his TEAM-CBT practice at the Feeling Good Institute in Mountain View, California. However, since he is a trained physician and psychiatrist, he can also prescribe medications if patients need them in addition to the therapy. Dr. Cai Chen is a warm and brilliant young psychiatrist. If you would like to contact him, you can contact him at Cai@FeelingGoodInstitute.com, or call him directly at 1-916-877-4749. Thanks for joining us today! If you like what we’re doing, tell your friends about the podcasts. Your word of mouth is our main and only source of marketing, since I have refused to monetize the podcasts. So our budget is meager at best.  Still, this year, we’ll see the five millionth download of our podcasts. Thanks so much for your support and for making it all happen!  Warmly, Rhonda, Cai and David

Here are the questions for today’s Ask David, featuring special guest, back by popular demand, the extraordinary Dr. Matt May, and of course, our super-special hostess, Dr. Rhonda Barovsky! Why is my dad the way he is? Why are people the way they are? What can you do about positive distortions? More Should Statements! How can you talk to someone who refuses to talk to you?   Why is my dad the way he is? Why are people the way they are? Hi Dr. Burns and Dr. Barovsky! I love your show. Keep up the good work! I'd deeply appreciate your time and insight. My dad is 70, my mom is 67, and I'm 38. Throughout my life my dad has done things like he did earlier tonight. I was at my parent's house and my mom was telling me how Thanksgiving was going to be at my parent's cabin with the whole family like we have in years past at which my point my dad firmly said "No." My mom asked "Why?" and he just shook his head and shortly after walked out of the room to go to the bathroom, shut the door, and said "no" angrily three times in the other room to himself but loud enough for she could hear. He'll seemingly randomly act extremely possessive by angrily forbidding family get togethers, or my mom from doing things, or family to borrow things. He'll just say "No" without further explanation. Always, always, upon asking "Why?" to his "no." He'll either say angrily, "Because I said so!", say nothing, or just repeat "No" further. My mom says sometimes "Can you just gave me a reason?" and it's the same "No", silence, or "because I said so." I don't jump into the aforementioned back and fourth communication because I know such a person can't be changed and don't want to make an argumentative mess. He's never displayed any comfort with expressing the slightest vulnerability. He's very, very silent. All of my life he has displayed bullying type tendencies. Whenever I visit my parents he always shows tremendous eagerness to want to scowl and berate people for the tiniest mistakes (even people he doesn't know in public, like cashiers.) I think even the most skilled of five secrets practitioners might be outmatched. My mom tonight, and all my life, has asked me why is he like this? I've been haunted to try understand this question all my whole life too. So, I'm putting the question to you Dr. Burns and Dr. Barovsky: Why is someone like this? You must've heard of similar situations and have insight? I want to feel compassion and understanding for him. I don't want to live with baggage. And mainly, mainly I just want to relieve myself from anger thinking should, labeling, and overgeneralizing thoughts like "He shouldn't act like this", "He shouldn't be such a bully", "He's being a jerk." Thank you, Mark David’s Reply Thanks, Mark, I can certainly understand your sadness, frustration, and anger, as well as your love and concern for your mom. Scientists don’t yet know why people are the way they are. My focus is on helping people at specific moments of interaction when they want help. You have not asked for help in this email. I do make this type of statement in practically every Ask David episode, but have not had much luck in getting people to listen, because the general questions that have no answers keep rolling in. You say that your dad cannot change. To my ear, this statement is both blaming and untrue. People change at every moment of every day. The real question I always have is this, and it might not interest you. Do YOU want to change the way you interact with him? You and your mom probably both do things that trigger him, like silence, or asking WHY when it is abundantly clear that this response has a 100% guarantee of triggering him. I apologize if this is not the answer you were looking for! David   What can you do about positive distortions? How much information is there in the book (or a particular podcast) on how we address positive distortions most effectively? It is mentioned briefly that these can be more difficult to overcome, because of the more positively perceived "benefits", which may also be re-enforced externally (such as "yes, he is such a nice person, nobody wants him to express any frustration or anger occasionally - not even he himself want to do this!"). It affects motivation to any change, or, at least, creates ambivalence. Some more on this would be great, please. Thanks, Tillerich David’s Reply Hi Tillerich, Good question, and I will schedule it for an Ask David. As you point out, there usually isn’t much motivation for change when it comes to positive distortions. Positive distortions trigger habits and addictions, violence, mania, marital conflicts, and narcissism, to name just a few areas. Each is handled differently, but dealing with motivation / resistance is key in every area. David   More Should Statements Johnny asks: Can you help me disprove my negative thoughts? I manage to disprove them, but they return after a few hours. “A loser is someone who lives at home with his parents after he turns 18.” “I should be bold, confident, and secure.” “I should be better than I am.” David’s Reply Hi Johnny, Sorry you’ve been struggling. The first thing to do is A = Assessment of Resistance, since resistance is the key to nearly all therapeutic failure. Tools would include the Paradoxical Invitation followed by the “Miracle Cure” question: What are you hoping for? What kinds of changes are you asking for? This is important. For example, you mentioned a problem with procrastination. If you have a procrastination problem, the strategies would be completely different. Other tools at the “A” portion of the session would probably include The Magic Button Positive Reframing The Magic Dial The Acid Test. If you decide that you actually DO want to change the way you think and feel, given the fact that you’re still living at home, a few of the many methods that could be used include: Identify the Distortions Explain the Distortions Individual Downward Arrow Technique Semantic Technique Cost-Benefit Analysis Let’s Define Terms Be Specific Examine the Evidence. Double Standard Technique (DST): For example, would you say these things to someone else? Our son has been living with us for a while, but I don’t think of him as “a loser!” My wife and I are actually happy to provide some support while he is sorting out what he wants to do next. Paradoxical DST Externalization of Voices with three strategies: Self-Defense Acceptance Paradox CAT (Counter-Attack Technique) There are many additional techniques that could be used. But first, the action would focus on resistance and motivation. Tackling the distorted thoughts before completing the “A” step is usually not a very good idea! David D. Burns, MD   How can you talk to someone who refuses to talk to you? Hi Dr. Burns, I came across your book and podcasts during a time in which I was having a hard time communicating with my adult son. They have helped me tremendously in acknowledging my part in the problem. While I've done a lot of work on my own self-esteem, anxiety and depression, sadly it has come a little too late as my son does not want to talk to me and we are estranged. Any thoughts or advice on how to reach out to a loved one in this situation? Now that I have been practicing for the 5 secrets I want to better connect with my son and work through our issues? Thanks, Shelly David’s Reply Thanks, Shelly, I’m so sorry that you are estranged from your son. Have you done the written exercises in my book, Feeling Good Together? That’s a good place to start, as this very topic is addressed in the chapter on how to talk to someone who refuses to talk to you. The method that can be helpful is called “Multiple Choice Empathy” or “Multiple Choice Disarming.” We will likely illustrate it on the show. Rhonda, Matt, and David  

Hi everyone! This special podcast features one of our favorite people, Professor Mark Noble from the University of Rochester in New York. Professor Noble is a world-renowned neuroscientist and cancer researcher, one of the pioneers in stem cell research, and all-around good guy. He contributed a brilliant chapter on how TEAM-CBT interacts with the brain for my book, Feeling Great. For the past two years he has been a very beloved member of the Wednesday TEAM-CBT Training group, adding his wisdom and clarity to the teachings.  Rhonda and my co-teachers, Leigh Harrington and Richard Lam, and all of our students feel very honored to have him in our midst. This is our third podcast with Dr. Noble, and the first podcast to usher in the new year. We’re excited to speak with him again today. He will update us on his latest thinking on how the molecular biology of stress and learning are totally consistent with the rapid mood changes we see in TEAM-CBT. He also describes his latest writing project, tentatively entitled, The Brain User’s Guide to TEAM-CBT, and you can download it for FREE if you click here! (LINK) In this booklet Professor Noble presents the “brainological perspective” on TEAM-CBT. He emphasizes that this booklet is written at the 9th grade level so as not to intimidate anyone. If you’re curious, take a look, and feel free to share it with others who might be interested. Professor Noble explains that his new booklet was inspired by patients who ask how TEAM differs from traditional (aka “normal”) talk therapy. Of course, the differences are many and profound, but one of the questions new patients and therapists ask is whether the rapid recoveries we observe during TEAM-CBT treatment are just superficial and temporary, or even fake. Mark asserts that nothing could be further from the truth, and that the thing that makes TEAM-CBT so special is how closely it is aligned with how the human brain actually works. He explains that there are ten essential steps in TEAM, starting with Empathy. He defines Empathy as “being in a safe place, where you can share feelings without being judged.” Empathy allows the patient to access the networks in the brain where the patient’s pain may be stored as memories. The spoken and written language exercises used in TEAM actively and rapidly modify the networks that generate the feelings of depression, anxiety, shame, inadequacy and hopelessness. Dr. Noble places a great importance on the written Daily Mood Log, which he describes as arguably the “greatest development in the history of psychology.” He says that when you describe the horrible and traumatic things that happened to you, and you record your Negative Thoughts on paper in a systematic, step-by-step way, you can look at your thoughts, feelings, and painful memories as separate from your “self” and gain some distance from them. Then, when you pinpoint the many cognitive distortions in your negative thoughts, and substitute more realistic interpretations, you gain freedom and relief because you are actually re-wiring your brain. He said that most of our human thinking is called Fast Thinking. This is the automatic thinking that we do 98% of the time as we go through our daily lives. Fast thinking is great, but growth, learning and change can only result from Slow Thinking, where we reflect and analyze things. Slow thinking takes concentration and effort because you are changing actual networks in your brain when you challenge and crush your negative thoughts with powerful techniques like the Externalization of Voices. He says that we are not just telling people to “Stop it!” or “Get over it!” Quite to the contrary, we are teaching specific, powerful techniques that give you the chance to pinpoint and modify the exact brain networks that cause your negative feelings. He explains that “language is a powerful tool for figuring out exactly how we see the world when we’re feeling down, and TEAM gives us many tools in TEAM to modify the errors in our perceptions that cause so much suffering. Mark laments on the excessive misuse of medications for individuals, including children, who are struggling with behavioral and emotional problems. He wishes more people would simply sit down with the person who is upset and ask, “What’s going on? How are you feeling? What are you thinking and telling yourself?” I have had the same thought when thinking about how therapists not familiar with TEAM or Cognitive Therapy use and promote dozens of presumably therapeutic approaches without simply asking patients, “What thoughts go through your mind when you are feeling depressed, anxious, ashamed, inadequate, or hopeless?” The answers to this question provide direct and immediate access to the brain networks that need re-wiring! Mark concludes today’s podcast by saying, “I went into medical research on cancer and other serious problems because I wanted to help people who are suffering. I’m convinced that TEAM-CBT, and the powerful Daily Mood Log that David has developed, have the potential to help millions of people around the world!” Rhonda and I are grateful for Mark’s ongoing friendship and brilliance and want to wish all of you a happy and healthy 2022! We are both very grateful for your support during the past year and hope you will continue to mention our podcast to friends or colleagues who might be interested in learning about TEAM-CBT. We look forward to celebrating the five millionth download of the Feeling Good Podcast around July! Thank you! Rhonda and David

The Sara Session—Total Blow Away! (Part 2 of 2) Last week, you heard the first part of the session with Sara, a woman haunted by feelings of anxiety and inferiority from the time she grew up in a village in Mexico. Because she received a great deal of mean-spirited put-downs, she same to see herself as an "outsider" who wasn't good enough. She has finally decided to challenge this crippling and disturbing mind-set, and in today's podcast you will witness her metamorphosis. She will also join us for the fascinating follow-up to her amazing treatment session. If you click here, you can see Sara’s Brief Mood Survey at the end of the session, along with her Evaluation of Therapy Session. As you can see, the changes in her mood scores were profound, and her ratings of Jill and David on “Empathy” and “Helpfulness” were excellent. If you click here, you can see Sara’s Daily Mood Log at the end of the session. By the end of the session, all of Sara’s negative emotions had gone down dramatically, to zero or near zero levels. However, one negative feeling, jealousy, only went down to 30%, and this feeling was still nagging at her. She said she still felt inadequate and jealous of people who had accomplished more, since she’d been procrastinating for years at promoting and developing her private practice. I don’t like to leave people with loose ends, if at all possible, and Sara clearly wanted to zap the feelings of jealousy if we could, since we hadn’t focused on this emotion at all during the session. You may be fascinated by the surprise ending to the session, and the method that allowed Sara not only to blow away her feelings of jealousy, but a discovery of how she could use those feelings to connect more deeply with her childhood friends, including those who had accomplished a lot! There were quite a few teaching points, including but not limited to these: Rapid, profound, and lasting change is possible, even when people have been struggling for years or decades, or even since childhood, with feelings of depression and inadequacy. The goal of therapy is not just a reduction in depression, but a total elimination of depression along with being catapulted into a state of enlightenment, joy or even ecstasy. Sometimes Positive Reframing can blow away a negative thought, as you'll discover in the surprise ending to her session. Sara totally threw herself, body, heart and mind into this work. That commitment is a vital ingredient of success. Several days after the session, Sara sent this beautiful note to the Tuesday group. Hello, Tuesday Group! I apologize for just now sending this email. I had told David I would email the group this past weekend with an update, but I have been TOO busy dancing away (more about this in a second). 😝 Anyway, I will try to make this email short because I tend to go overboard and write too much, and I know everyone is busy. I will just share a few things that have happened since my personal work two weeks ago. I am also forwarding the email I sent David and Jill Tuesday evening after the magical evening. First of all, THANK YOU all for your awesome support and empathy during that beautiful evening. At that time, I did not realize how much this is the story of many of us in the group (the learning disability and being bullied, humiliated and teased because of it.) I felt very connected to you and felt your love and deep compassion and understanding. Thank you! So, I was not kidding when I wrote that I am dancing away. You see, during the last two weeks when I have been at a grocery or department store, I have been dancing away to the music playing in the store. For some reason my body just gets moving and doesn’t want to stop no matter what song is playing. As you can imaging, this is not typical of me. As a matter of fact, I am not a music person let alone a dancer. I prefer to listen to NPR or a Feeling Good podcast when I’m in the car and don’t play any music at home. Anyway, when I have been at a store these last few days, I have let loose. It was really funny when a lady at the end of the aisle noticed me dancing, and said to me, ‘You go girl!” We both giggled and I kept dancing even after the song was over. I am NO longer inhibited and have allowed my body to do what it needs to do, and I really don’t care what anyone thinks or says. What a liberating feeling this is! My husband also thought it was funny that I have made silly sounds, especially during meals, and we would just burst into laughter. Needless to say, a lot has gone on since my personal work. I am definitely more relaxed, and therefore, less serious and more playful. Enjoying life!!! The main shift has been my thought that has been ingrained in me my whole life: “Que van a pensar?” which translates to "What are they going to think?” I used to care and believe this !00% but now I don’t believe it (0%) and it does not matter to me what people think. My new thought now is more powerful and I believe it 100%: "I don’t care what she (they) think. What matters is what I am telling myself!” I have noticed myself shifting to this new thought quite a bit and it has been so liberating and empowering. I cannot express enough how freeing this feels. In case you are wondering, the plans for the trip to Mexico will include a visit to my birthplace and gatherings with extended family members and high school classmates as well as some site seeing. Oh, my goodness, I said, I would make this short, and here again, I went overboard. Sorry! Once again, thank you for all the love and support!!! With immense gratitude, Sara Shane I want to thank my brilliant and beloved colleague, Dr. Jill Levitt, for her brilliant work in Sara’s treatment, and I want to thank Sara for this fabulous gift she has given all of us! When you actually SEE the magic happening, it makes all the difference in the world. And when you see the actual techniques that Jill and I were using, you will hopefully realize that you, too, can learn to use TEAM-CBT in your clinical work if you are therapist, or in your personal life if you are struggling with feelings of depression, insecurity, anxiety or low self-self-esteem. Remember, too, that we still offer unlimited free TEAM-CBT training for California mental health professionals in our Tuesday group and for therapists from around the world in Rhonda's Wednesday group. If you’re interested in the Tuesday group, contact Ed Walton edwalton100@gmail.com. If you’re interested in the Wednesday group, contact Dr. Rhonda Barovsky rhonda@feelinggreattherapycenter.com. Thanks for listening! Rhonda, Jill, Sara and David

The Sara Session—Total Blow Away! (Part 1 of 2) In one of my recent Tuesday psychotherapy training groups at Stanford, we reviewed the Interpersonal Downward Arrow Technique. This is a high-speed technique I created that allows you to rapidly identify the roles that you play in your relationships with others so you can pinpoint the patterns that create tension and unhappiness for yourself as well as the people you care about. The Interpersonal Downward Arrow Technique is similar to what psychoanalysts try to do with free association on the couch, except it only takes five to ten minutes, as opposed to five to ten years. In addition, I have also developed fairly rapid ways to change and modify those dysfunctional patterns—IF this is what you want to do. Some of the psychoanalysts call these hidden patterns “core conflicts.” The late Dr. Lester Luborsky (https://en.wikipedia.org/wiki/Lester_Luborsky), a prominent psychotherapy researcher at the University of Pennsylvania School of Medicine, has written about core conflicts extensively. He gave as an example of a core conflict, a person who might have the belief that “my needs will never be met in my personal relationships.” Beliefs like this not only create unhappiness, but they can also function as self-fulfilling prophecies. In addition, most people re not aware of these “core conflicts,” and do not realize they are just beliefs. Most people just believe that “this is just the way the world is,” and think they have a profound insight into the reality of human nature. But we actually create our own interpersonal realities at every moment of every day. Since we usually cannot “see” what we’re doing, we may wrongly conclude that we’re victims of the “badness” of others. And, of course, there is always a grain of truth in that belief as well! During the training group, we had group members identify some of their own “core conflicts,” using the Interpersonal Downward Arrow Technique, and this hit one of our members, Sara Shane, like a ton of bricks. She discovered that she sees herself as “an outsider” and has always believed she is stupid and inferior to others. And this intense belief has caused tremendous suffering for Sara for decades, including her participation in the Tuesday training group, where she is usually totally silent. Sara traced this pattern to her childhood, growing up in a village in Mexico, where she was bullied and put down because she was short and overweight, and had the darkest skin of any of her many siblings. In addition, she struggled with a learning problem and was frequently put down and labeled as stupid. Sara’s sudden decent into emotional hell was fueled by the fact that she was planning the wedding of her niece at a town in Mexico which was only two hours from the town where she grew up. And the thought of showing her daughter that town filled her with feelings of shame and terror, fearing she would run into the people she grew up with, including the people who cruelly put her down. Here’s what she wrote prior to doing personal work on this problem in a subsequent Tuesday group: Hello Jill and David, Where to begin…all day yesterday it was very painful as I thought about emailing you... As I’m writing this, I am in tears and I know it is going to take me a while to write everything I want to say. But first let me say that it has taken me a long time to even sit in front of the computer because this has been very difficult for me. I had earlier said I would email you yesterday morning but I know now why I could not. I procrastinating mainly because this hurts a lot, beyond what I had earlier experienced. Right now, I am not even paying any attention to proper writing because I just want to write this without worry about correctness and just express my feelings. Let me describe what I have been feeling physically all week long since Tuesday. I have been feeling sick to my stomach especially when I was working on the DML. I felt a hole in the pit of my stomach. I felt anxiety all over my body and felt overwhelmed. At times I could not even go one. I had to push myself to complete the Cognitive Distortions on the DML. I just wanted to run away from it all. It was that painful. But I also knew this was a good thing because I was getting down to something very important that I wanted and needed to face. So the Interpersonal Downward Arrow has been very enlightening, but also, extremely painful. And David, you are absolutely right, there is no doubt in my mind (not that there ever was), that all of our problems are encapsulated in one brief moment in time and that we create our own interpersonal reality at every minute of every day. Let me explain what transpired on Tuesday that motivated me to be a volunteer during small group practice. After postponing it for more than a year due to COVID, my niece is having her destination wedding in Mexico in November. My husband and I along with our daughter are attending the wedding. While there, we were hoping to travel to show our daughter the town I was born in and where I completed my junior and senior year of high school. After more than 20 years in February 2020, I reconnected with one of my good friends from high school. During this conversation, we talked about making plans to get together with our classmates when I went to Mexico for the wedding. However, I have not been in touch with her since then. In making more concrete plans on Tuesday morning for our trip, I realized we would be able to travel to my birth town. So the possibility of visiting with my high school classmates whom I have not seen for about 38 years produced a lot of anxiety for me. This was very disturbing because this is not even a set event. It is only a possibility. Thus, I started wondering way it was making me so anxious just thinking about it and knowing that I did not need to visit with anyone if I did not want to. I was quite distraught, thus, I decided to share these feelings during small group practice. I was feeling anxious, insecure, and afraid of being judged and criticized. I’m so glad I was able to volunteer during our small group because prior to this I didn’t realize the multitude of feelings that were buried. One of the biggest revelation was how lonely I was feeling and the immense grief I was experiencing. But even more surprising was the extreme feeling of inferiority I felt although I denied it at first when Jill asked if I was feeling inferior. It was not until we were going over the “Rules” that govern the relationship that it was very clear to me how inferior I felt. And here lays all my PAIN: “I am always an outsider because I will never be good enough.” This brings me to tears! Although I understand intellectually that my suffering results from the belief that I have a self that is not good enough and a self that others can judge, as you so beautifully wrote David in your book, Feeling Great, it is still hard for me to let go emotionally. When doing the DML, I believed my negative thoughts 100% and found 7 to 8 distortions on each, which as I mentioned earlier, it was very painful to complete. Negative Thoughts: I am always an outsider because I will never be good enough I shouldn’t get close to people so I won’t be criticized nor judged I’m not professionally successful as I should be, after all, that is why I went to school Mexican people are very judgmental Perhaps instead of typing all the DML information on here, I should send you a copy along with a copy of the CBA. I will do this in a second email. Self-Defeating Beliefs: Perceived Perfectionism - My high school classmates will not accept me with all my flaws Achievement Addiction - My worthwhileness depends on my accomplishments, professional success, and the way I look (preoccupied with my overweight) Worthlessness - I’m basically worthless, defective, and inferior to others especially some of classmates Brushfire Fallacy - Everyone will talk about me and look down on me (“Mexican people are very judgmental”) Spotlight Fallacy - Talking to people feels like I have to put on an interesting mask and perform in order to impress those around me Superwoman - I should alway be strong and never appear weak in front of others As I worked through the DML, CBA, and S-DB these last few days so much has come up for me. I couldn’t help it but to feel lots of pain as some of my childhood memories emerged of the horrible times when I was humiliated, teased, and bullied primarily by family members (both immediate and extended family members). Sadly enough, in the Mexican culture, being dark completed, short, and chubby are frown upon and a reason to be ridiculed and humiliated. And unfortunately for me, I possessed all three characteristics beside having a learning disability which was translated as me being dumb, stupid, and slow. There were plenty of moments growing up that this was extremely painful especially moments when my own family crudely laughed in my face. I quickly learned to withdrawal and became rather introverted. As I got older, I also quickly learned to tell myself things like; “But one day I’m going to show them that I am not as stupid as they think I am” and “One day I will prove them wrong.” I believe this also became my strength, motivation, and determination to go to college. I was always just an average student in college, and at times, I struggled, but what got me through was my determination to succeed and ultimately prove that I could do it. However, this also created strong fears of being humiliated and ridiculed by people in general. Thus, I have protected myself from being criticized or judged by pushing and staying away from people and have been very cautious and guarded regarding having close relationships. Also, for many years, I have avoided family gatherings where I know extended family members that use to tease me when I was a child are going to be in attendance. I have been rather sensitive to people’s humor and hardly ever joked myself unless I knew the person very well. I am happy to say though that I have made some growth in this area ever since I have joined TEAM. And, that is thanks to your innate humor, David. ; ) Any way, I hope this makes sense… Thank you so much to the two of you for the opportunity to allow me to grow and learn from my painful thoughts. I know more than ever that the only way to over come this pain is by the death of my belief in the “self”. Love, Sara This will be the first of two podcasts showcasing the amazing work that Sara did in a subsequent Tuesday group. Dr. Jill Levitt and I worked together as co-therapists, and we went through the TEAM model in a step-by-step manner. In this podcast, you’ll hear the first half of the session (T = Testing and E = Empathy) and next week you’ll hear the last half of the session (A = Assessment of Resistance) and M = Methods.) If you click here, you can see Sara’s Brief Mood Survey at the start of the session. If you click here, you can see Sara’s Daily Mood Log at the start of the session. If you click here, you can see the CBA that Sara completed prior to her personal work. Thanks for listening! Rhonda, Jill, Sara and David

272 Ask David, with Special Guest, Dr. Matthew May: Shoulds, Free Treatment, Blame, and More! Here are the questions for today’s Ask David, featuring special guest, Dr. Matt May, and, of course, Dr. Rhonda Barovsky! How can I turn off my Shoulds!? Is there a downside to treating people for free? What’s the difference between Feeling Great vs Feeling Good? Isn’t it important to blame the other person when that person really IS to blame?  How can I turn off my Shoulds!? Nice podcast! (Maurice is referring to Part 2 of “I want to be a mother.”) It’s refreshing to see that we sometimes mix our needs with wants. I also have a huge problem with regret and shame, saying to myself “I should be far more ahead in life.” “I should have dated more.” “I should have used my energy to create art and being productive.” I pinpointed the moment in my daily mood log, and it occurs usually when I compare myself with people online or with people in my friend group who seem to be far more ahead in life than me in terms of career and achievements or that they used their energy of their younger years more constructive than me because they didn’t deal with depression. I tried the semantic method to soften my thoughts regarding my should statements but telling myself “I wish I did xyz,” is carrying the same weight of regret as when I “should” myself. These thoughts also seem very realistic to me and pinpointing the distortions in them is not helping me much because there is so much resistance and weight to the thought, plus the positive thought that I subsequently come up with does not crush the negative thought. I often ask myself: ”Am I really a failure?” Maurice David’s Reply Thanks, Maurice You are struggling with resistance, which is the cause of virtually all therapeutic failure. You can use Search on my website to look up podcasts on Positive Reframing, Assessment of Resistance, and Paradoxical Agenda Setting. I usually select ten to fifteen or more methods to crush any Negative Thought, but would only use them after the resistance issue has been successfully addressed. For example, we could use “Let’s Define Terms,” as one of 15 or 20 potentially helpful techniques. It might go like this: Is “a failure” someone who fails all the time, or someone who fails some of the time. If you say, “some the time,” then we’re all “failures,” so we don’t need to worry about it. If you say, “all the time,” then no one is a “failure,” so we don’t need to worry about it. If that technique is not effective, we’d have tons more to try. You can read one of my books, like Feeling Good or Feeling Great, to learn more about the Assessment of Resistance and the use of various techniques to crush distorted thoughts. Might also use this on an Ask David. Can use a fake first name, too, if you like. Please advise. david   Is there a downside to treating people for free? Dear David and Rhonda, I live in England, and I’m close friends with a team CBT therapist in Bristol (Andy Perrson), and I’ve been listening to your podcasts for the last year. I have found them to be stimulating, thought-provoking, often really humorous but above all enormously helpful in helping me journey with other people. I have just embarked on counselling training and would love to steer myself down the same avenues as my friend Andy. I’d also like to use your methodology at a later date. In the meantime, I have a question for you. I am conscious that almost all of your work now is done on a free, pro bono basis. I think that would be my preference as well especially as I have managed to cover the economics of life from other things and it would remove any feeling of conflict, or ambiguity around my motivations in helping people. But, I am also aware that there are so many advantages in there being a financial commitment from clients. Sadly, things that are free and that spring from generosity are not always valued by the recipient, things like commitment and timekeeping become relaxed. It can be awfully irritating for the therapist (a bit like making someone a cup of tea and them not drinking it), and probably a waste of time for the client. A bit like the example you often give around the outcomes for clients who don’t do homework. I would be very interested in your view on this and on balance whether it is better to charge or not charge for treatment, in the scenario where a therapist does not have a desire to charge. David comment: I think the word “therapist” in the line above was supposed to be “patient.” I hope that makes sense. Thank you again to you and Rhonda for all your hard work. Kind regards Brad Askew (Bristol, England) David’s Reply We can reply live on the podcast. The thrust might be that you can make patients accountable even if you treat them for free.   What’s the difference between Feeling Great vs Feeling Good? Dear Dr Burns, First of all, thanks for the great work that you do and also all the podcasts you did, I am planning to order a copy of Feeling Great, your latest book. I have a quick question below. I have been searching the answer on the web but still can't find the answer. Does Feeling Great cover ALL the key concepts that were discussed in your previous book, Feeling Good? Or does one need to read BOTH books to get a fuller picture? I already own a copy of Feeling Good. However, if Feeling Great already covers all the concepts discussed in Feeling Good and also comes with updates, i may just order Feeling Great and start with that instead. Thanks. Best, Calvin David’s Reply It really depends on the intensity of your interest. There is some overlap, but also significant differences. Even though Feeling Great is way newer, there are still tons of gems in Feeling Good. David   Isn’t it important to blame the other person when that person really IS to blame? Hi David, I’ve been listening to the show for awhile. Thank you for everything you do. I just listened to episode 254, and I’m not quite sure what to think about it in the context of my situation. I think it makes sense that people are afraid to look at their own faults and what brings them to a relationship and what they contribute to a situation. And that they tend to want to blame the other person to avoid working on themselves. But what about situations of more extreme abuse? How do you not blame the other person? I recently got out of a relationship where I was raped. While in the relationship, there was a lot of coercive sex where he ignored my signals to stop and then afterwards told me that things happened because I had wanted them to. Eventually his behavior escalated to the point where he drugged and raped me while I was unconscious. It’s only been 2 months since I figured out that the relationship was too unhealthy for me and left it. I’ve been in counseling 2-3 sessions per week since then. So at least I am working on myself. And I have no contact with him. Does that mean there is not a point in using the 5 secrets? Is that only for use on other people? But the things you said about blame rang true to me. I think I avoided working on my own issues for a long time, but this situation was like a giant neon arrow saying “work here!” I think I blame myself and him both. But I also worry about blaming myself too much—I think me blaming myself is one of the reasons I felt trapped and unable to leave the relationship in the first place. Because I felt at fault and ashamed of that, I didn’t tell anyone for a long time and that normalized his behavior and allowed the relationship to continue and escalate to its extreme. By not placing enough blame on him, I also didn’t consider that he might be acting selfishly, lying, or not have my best interests at heart. Which also led to the relationship continuing longer. So I am wary about where and how to place blame. Anyway, I don’t know what else to say about this except that it has all been very emotionally difficult and I never want it to happen again, so I am diligently working on myself and looking for help in all the places. Thanks, Rachel David’s Reply The thrust of the response could focus on the idea that Self-Blame and Other-Blame are both dysfunctional. I prefer the concept of accountability, and talk about this in Feeling Good Together, which might be helpful. I think Rachel is doing well to get help for herself and her own tendencies toward Self-Blame, and think that a lot of practice with the Five Secrets could also be tremendously helpful, especially for future relationships. David Rhonda, Matt, and David

Today’s podcast features Dr. Peter Spurrier, a British physician who has founded TEAM-UK. Peter describes how he spent most of his career as a physician in general practice, but was forced to see patients for only ten minutes due to the British health system. He didn’t like the “quick fix” approach to patients with emotional struggles, and at the age of 55, five years before he retired from General Practice, he decided that he wanted to do something more meaningful, so he began to get training in CBT which “helped me listen better.” However, CBT seemed stilted, and the outcomes weren’t very good, either. Then he attended a two-day “Scared Stiff” workshop I presented in London several years ago. The workshop was sponsored by my friend and colleague, Jack Hirose, from Vancouver, Canada. I was not aware that Peter was in the audience, but was really happy to hear that he like the workshop. I had been pretty disappointed in it, since the attendance was light and I ran into quite a bit of resistance from the audience. This was a huge surprise, since I thought they’d be eager to hear about all the improvements we’d made in traditional “Beckian” CBT. At the workshop, Peter purchased my Therapist’s Toolkit, but said “it just laid on my shelf for two or three years. Then, he began using it and decided to focus on TEAM-CBT full time. He began listening to the Feeling Good Podcasts, starting from #1 and eventually caught up. He says that “along the way, I learned by practicing the techniques I was hearing about.” He says he has always been a critical thinker, and initially was dubious about the T = Testing part of the TEAM treatment model. As a GP, he was required to use questionnaires for patients with anxiety and depression, but for some time he thought it wasn’t very accurate data. When he started using the Brief Mood Survey, he was shocked as he began to realize that this WAS good data, and that his reading of how his patients felt was frequently off-base. This, of course, is the foundation of the TEAM-CBT model, which is entirely and intensely data-driven. Then he attended one of my four-day summer intensives at the South San Francisco Conference Center, and loved the warm and encouraging atmosphere, commenting on the friendliness and encouragement of Rhonda, whom he met, and Dr. Angela Krumm, from the Feeling Good Institute in Mountain View, California. They both reached out to him. He said it was actually great to get the chance to work with people, and he was delighted by a demonstration I did on public speaking anxiety and social anxiety, which captivated the audience. After the intensive, Peter returned to London and founded TEAM-UK. He also looked up Dr. Stirling Moorey, who I’d mentioned in my first book, Feeling Good. I have also mentioned Stirling in numerous workshops, especially when teaching therapeutic empathy. Although Stirling was my student, I learned a great deal from him, especially in the area of empathy. Peter described an outstanding chapter on empathy, written by Stirling in a book he has co-edited with Anna Lavender entitled The Therapeutic Relationship in Cognitive Behavior Therapy. I got excited to hear this and hope we can feature Stirling on a podcast one day soon! I would love to hear about his journey since we first worked together more than forty years ago, when he was just a medical student. His particular interest has been the application of CBT to life threatening illness and adversity. He was one of the first therapists to develop CBT for people with cancer and is co-author, with Steven Greer, of The Oxford Guide to CBT for People with Cancer. I got excited to hear this and hope we can feature Stirling on a podcast one day soon! I would love to hear about his journey since we first worked together more than forty years ago, when he was just a medical student. Peter wrote an article on TEAM-CBT for the newsletter of the British CBT group entitled “CBT Today.” He got zero response for several months, and then heard from Derek Reilly who uses TEAM-CBT in the treatment of pain patients. And, slowly, others began to join Peter’s TEAM.CBT.UK group, and now there are 25 to 30 members. Click here if you'd like to see the current edition of the Feeling Good UK newsletter! Peter also talked about the visit that Rhonda recently paid to the UK and TEAM UK’s first in-person meeting, at Oxford University. “It was such a great pleasure to meet and spend time with Rhonda. She formed strong connections with the group, which we hope will endure for years to come”. Rhonda on her visit to the UK TEAM group at Oxford University. We discussed the resistance to change that we sometimes run into among mental health practitioners. Peter said, “It’s often quite hard to get people to change their ways, and organizations are not always that flexible, either.” One of the things that drew Peter to TEAM-CBT was the fact that it offered a way to embrace the best from various approaches to CBT. This is a phenomenon I have encountered and wrestled with throughout my career as well, and is one of the reasons I would personally like to see an end to all of the schools of psychotherapy, with a switch to science-based data driven therapy. TEAM-CBT is NOT another new “school” of therapy, but rather a structure for how psychotherapy actually works. Although all the hundreds of schools of therapy that have cropped up over the decades have provided some insights into human nature, and some useful treatment techniques, I believe that on balance, they hold the field back and actually function a bit like cults, all claiming to have the best answers and most effective techniques—but the outcome studies simply do not support this notion. In the treatment of depression, all of the current schools of therapy come out about the same in controlled outcome studies, and none are very impressive. In fact, only slightly more than half of the patients even experience a 50% reduction in depression symptoms, which is not very good! The British Association for Behavioral and Cognitive Therapies is the over-arching organization and accrediting group that Peter’s TEAM-UK has joined. He explains that “we are a special interest group, within their membership of roughly 15,000 CBT practitioners.” Many of the members of TEAM-UK attend Rhonda’s Wednesday training group, and there are also two practice groups, weekly, in England. If you’d like more information about their activities, please visit their excellent and appealing website, FeelingGood.UK.com. If you are a British mental health professional, or in Europe, and you would like to learn more about TEAM-CBT, I would STRONGLY encourage you to contact Peter and join one of the ongoing practice groups. You can reach Peter Spurrier  by emailing him at:  docspurr@gmail.com Peter says that if there is one piece of advice he would like to give to his younger self as a doctor and for life in general, it would be to learn, absorb and practice the “Five Secrets of Effective Communication.” Rhonda and I are huge Peter Spurrier fans and hope you enjoyed today’s interview! From Rhonda:  Meeting everyone in the TEAM-UK group was an extreme pleasure for me.  It was a wonderful experience to meet people in person that I have only met on-line, and to get acquainted with TEAM therapists I had not met before.  Everyone is a dedicated, talented and enthusiastic TEAM therapist, and excited about building community.  Plus, everyone was fun and enchanting to hang out with.  It was definitely one of the highlights of my trip to meet everyone, and to have the opportunity to engage in discussion, to learn about about their hopes, dreams, visions and plans for the future for TEAM-UK! Rhonda and I will offer a free, two-hour workshop on habits and addictions on January 26, 2022 from 11:00 AM to 1:00 PM Central Standard Time, sponsored by PESI, so watch for the links on this or their website.  If you register, you will have access to a video following the event, in case you can't attend at that specific time. if you can attend, you’ll have the chance to try some mind-blowing techniques that will help you with overeating, drinking, drug use, nail biting, excessive shopping, or whatever you secret habit / addiction happens to be. Remember this presentation will be-- for Patients, Therapists, and the General Public It's Totally FREE Rhonda and David

Today’s podcast features an esteemed colleague and beloved friend, Dr. Angela Krumm, who will describe her personal victory over a recent weight gain. We will illuminate the TEAM-CBT techniques she used so that you can use them yourself if you’d like to lose some weight. But I have to warn you that you have to do these techniques using paper and pencil. If you try to learn and use them just from listening, they will not be effective. As an aside, if you go to my website, www.feelinggood.com, you’ll find a free chapter offer at the very bottom of my home page. If you click on it, you’ll receive two unpublished chapters from my most recent book, Feeling Great, with crystal clear instructions on the methods you’ll learn about in today’s podcast. Angela’s biosketch goes next, including how she joined David’s Tuesday training group when she was a post-doctoral fellow in clinical psychology and how she ultimately developed the TEAM-CBT certification program at the FeelingGoodInstitute.com. Hopefully Angela can help with this paragraph! As the podcast begins, Angela explains how she’s always viewed herself as a very fit, health-conscious woman who actually completed some marathons in the past. But during 2021, her life has been complicated by a number of tragedies and traumas, including: Angela’s father was sadly diagnosed with terminal cancer and died within four months. Angela had many personal injuries that impacted her capacity to exercise, including a laceration of her retina and a fractured toe. In addition, she fell backwards over a ledge in her backyard and plunged eight feet. She sustained a concussion and experienced many lingering symptoms for 6 to 8 weeks including dizziness, brain fog, and sensitivity to light. She described what happened next like this: All this time my weight kept creeping up. I stopped caring about exercise, and during the COVID crisis, food become a joy and an escape. Then, I had a wake-up call, an ah-ha moment when everything suddenly changed. Angela described attending a wedding, and her husband was the photographer. When she saw herself in the photos, she was shocked that she no longer recognized herself because of the weight she’d gained. She also noticed that the day of the wedding, she’d eaten six huge but delicious chocolate chip cookies that her niece had baked. She says, It hit me, and I didn’t have to think twice. There’s a history of diabetes in my family, and I didn’t want to keep gaining weight and struggle with all the medical complications of type 2 diabetes. I want to be healthy and fit so I can live to an old age and enjoy my children and grandchildren! She used behavioral and TEAM-CBT skills to tackle the problem, starting with setting specific goals for herself. She said that lots of her patients who are overweight have vague goals, like “I want to lose some weight” or “I want to get in shape,” but general goals won’t be effective. In TEAM, you always focus on something specific. Angela explained the critical difference between Outcome Goals and Process Goals. An example of an Outcome Goal would be telling yourself that you want to lose ten pounds or whatever your goal might be. There’s a big problem with Outcome Goals. You might go on an extreme, like fasting or eating very little, so you can lose weight fairly quickly. Then you will feel happy and tell yourself that you’re done when you’ve achieved your goal. The big problem is that you haven’t modified your eating habits, and that’s exactly why you will quickly gain back all that weight you temporarily lost. Process Goals are different. Instead, you focus on the number of calories you can eat each day in order to lose weight, and then you make wise food choices within your calorie limit. In addition, you start out with a gentle but consistent exercise regimen, and then you slowly build up to more exercise. Angela started with two workouts per week and built up to four weekly workouts over time. She also set modest and realistic goals for weight loss, setting a calorie limit that would allow her two lose weight slowly, at the rate of just ½ pound per week. This plan has allowed her to lose 21 pounds, and she was looking terrific today! She has been using a free app called Lose It which provides her with all the information she needs for tracking calories bd weight, along with her BMI (Body Mass Index). She’s now on a maintenance diet of 1800 calories per day and she’s really pleased with it. We also illustrated several powerful motivational TEAM-CBT techniques, including: The Triple Paradox. You divide a piece of paper into three vertical columns where you list Advantages of your habit / addiction: First, you list all the GOOD reasons to continue with the status quo of unlimited eating and little or no exercise. Disadvantages off change: Next, you list all the negatives and hassles associated with dieting and exercise. Core values: Finally, you list what your overeating and slacking on exercise shows about you and your core values that’s positive and awesome. As you can see, instead of pushing yourself, or your patient, to change, you go in the opposite direction. You take the role of the subconscious resistance to change, and list all the really powerful reasons to continue with your habit or addiction. In other words, you try to convince yourself NOT to change! Oddly, this usually triggers tremendous motivation to CHANGE. This paradox is one of the key features in all of TEAM-CBT. You can see Angela’s Triple Paradox workshop if you click here. The Habit / Addiction Log. Here you record your tempting thoughts, such as: One more treat today won’t hurt. I deserve it/ I’ve had a tough day! That brownie looks SO GOOD! I’m an active person so I deserve to eat whatever I want. The Devil’s Advocate Technique. This is a powerful role-playing technique where you challenge and crush the tempting thoughts. We illustrate this technique with role-playing on today’s podcast. Angela plays the role of her Self-Control thoughts and Rhonda and I play the role of the Devil, tempting Angela to give in to her tempting thoughts. The Problem / Solution list. You divide a piece of paper into two columns by drawing a line down the middle. In the left column (Problems), you list all the things that will sabotage your efforts to diet. In the right column (Solutions), you list solutions for all of those problems. You can see Angela’s Problem / Solution list if you click here. We also discussed the issue of therapist resistance to these rather unconventional techniques. The problem is that therapists and counselors are trained to help. This paradoxically triggers patient resistance. TEAM-CBT requires one of the four “Great Deaths” of the therapist’s ego—the death of the co-dependent self that feels the compulsion to save, rescue or help the patient. David gave a personal example of the extremely adverse effects of “helping” when he was the patient in an interaction with a health professional at Kaiser Permanente in California. The physician’s zeal for helping actually had the opposite effect of driving David away, and he did not go to the doctor for the next ten years. So now you have a feel for the TEAM-CBT approach to habits and addictions. These methods can be surprisingly powerful but remember. You’ll have to do them on paper, as Angela did, if you want success. Rhonda and I will probably offer a free, two-hour workshop on habits and addictions in late January, and if you attend, you’ll have the chance to try some of these techniques on for size. We hope you can join us! Thanks for listening! And thank you, Angela, for sharing your personal example and for your awesome teaching. Rhonda, Angela, and David PS, I thought you might enjoy this "selfie," showing the amazing results that are possible after just a few weeks with TEAM-CBT!. Keep in mind that I'm 79. Just imagine what a few weeks of TEAM could do for you!

The featured photo shows Dr. Carly Zankman at the Big Sur with her 8 month old nephew, Micah October was Pregnancy & Infant Loss Awareness Month. We are dedicating this and last week's podcast to all the mothers and fathers who have lost infants or struggled with pregnancy complications and tragedies. This will be the second of two podcasts featuring a live therapy session with Dr. Carly Zankman, a courageous young psychologist. Dr. Zankman has been struggling with the aftermath of a traumatic ectopic pregnancy and some intense fears that she may never get the chance to be a mother. In addition, she is 100% convinced that she can never feel happy or fulfilled in life unless she becomes a mother. Last week, we featured the first half of her session with Dr. Jill Levitt and me at one of our Tuesday Stanford training groups. If you have not yet heard part one, you can link to it (podcast #268) at the list of Feeling Good Podcasts on my website. In this podcast, you will hear the conclusion of our work with Carly. We are also delighted that Carly could join us in person today to tell us what has transpired since the end of her session some months ago. You can see Carly’s Daily Mood Log (DML) and Brief Mood Survey (BMS) at the start of the session as well as her Brief Mood Survey and Evaluation of Therapy Session at the end of her session. You can also review her completed Daily Mood Log so you can see her final mood ratings along with how she challenged each Negative Thought. There were a number of teaching points in Carly’s session: Depression nearly always results from telling yourself, and believing, that you have lost, or don’t have, something you believe you “need” in order to feel happy and fulfilled. It could be something internal, like greater intelligence or talent, or something external, like a baby, or a family, or greater wealth or status. There is a difference between a high-level and a low-level solution to most depression. In a low-level solution, you find happiness by getting what you want. For example, you learn that you are pregnant, or that you got an important promotion at work, or that someone you’re attracted to has accepted a date with you. In a high level solution, you discover that you can feel happy and fulfilled without the thing you were so certain that you “needed.” Although therapeutic empathy alone has limited healing powers, it can be absolutely precious and essential. Sometimes, people have a desperate need to be heard and given the space to express their feelings and to be accepted. In addition, people who have experienced a traumatic event or series of events often need the time to describe their experiences in detail. This can function like exposure, allowing the anxiety to diminish. Therapy without a meaningful agenda is highly likely to fail. And sometimes, a therapist has to “sit with open hands,” even when the patient’s agenda may be a bit different, or even radically different, from you own. Our task is not to force the patient to conform to our standards and expectations, but to help the patient find happiness on their own terms, pursuing their own goals. The Downward Arrow Technique was helpful and revealing during the Empathy phase of the session. This technique allowed us to pinpoint Carly’s core belief, which was also a Negative Thought on her DML: “I’m never going to feel fulfilled in life without children.” It is okay for therapists to struggle with, and discuss, moments of confusion or uncertainty during a session. This type of dialogue can involve the patient and can often help you find your path forward. There were some additional steps that could have been taken but we were limited by time. For example, we could have explored the interpersonal dimension of how to enhance the communication of feelings between Carly and her husband, as well as between Carly and other family members. She sometimes feels ignored and hurt. This problem is exceptionally common and can be addressed with tools like the Relationship Journal, the Interpersonal Downward Arrow, and the Five Secrets of Effective Communication. However, this can take some time, and also requires an agenda for the patient to be willing to examine his / her role in the problem and practice some new communication skills. Our negative feelings always result from our thoughts and beliefs, and not from the actual events in our lives. However, sometimes patients can be extremely fixated on certain beliefs that trigger their pain and may even put up a powerful wall to protect those beliefs. This is human nature, and part of what makes the job of therapy incredibly challenging, fascinating, and rewarding. We are all extremely grateful to Carly for her courage in sharing this intensely personal part of her life with us. She received, as you might imagine, incredibly support from all the members of the training group during and after her session, as others had struggled with similar fears as well. You can find her Brief Mood Survey at the end of her session here, along with her Evaluation of Therapy Session. You can also review her completed Daily Mood Log so you can see her final mood ratings along with how she challenged each Negative Thought. For more on this topic, you might want to give a listen to one of Carly’s favorite podcasts, #79: “What’s the Secret of a Meaningful Life: Life Therapy with Daisy.” (https://feelinggood.com/2018/03/12/000-live-team-therapy-with-daisy/) After the group, Carly received this email from one of the Tuesday group members: Good afternoon Carly, I want to let you know what I enjoyed the work you did yesterday. Despite the challenging and emotionally charged topics you spoke with great clarity and poise. I suspect some of the points were uncomfortable to talk about at times. You went into great detail and I never felt disconnected or lost. It all seemed very fluid and I found myself following along closely to the story. That was quite impressive. I suspect this talent is very helpful for your clients. I was curious if I could get your viewpoint about the exchange you had with Jill that brought up an emotional response on your part. Burns seemed to describe it as more self-defense while I think you described it as more acceptance. Perhaps my memory is off here so feel free to correct me. To me it sounded like you didn't want to give up the idea of having a baby and tying that to fulfillment so, with Jill's lead, you stated that one way or another you will be a mother. That is important to you and you will make that happen. Perhaps this was the "self-defense" part. I am thinking that maybe the Acceptance part was the acceptance of the emotion of the strong desire to be a mother and how important this is for you. Acceptance that you have this strong desire and that is ok to feel that way. Maybe the tears you felt were the tears of liberation in realizing that it was ok to have this desire because you believe in it strongly while many people may have been pushing you to let go of that. So you may not have accepted the idea of not having kids and being ok with that but you have accepted the strong emotion that is driving you to have kids. I suppose this is also captured to some degree in the positive reframe and the dial of that emotion and NT. Am I reading the situation right? Does this make any sense or am I totally off? Thank you for any thoughts you may have. This was a great experience for me. Warm regards, Jason This was Carly’s response: Hi Jason, Thanks for reaching out with your kind words. I’m CC’ing the Tuesday group because I think your question is great and imagine others might wonder, too. I don’t know whether it was self-defense or acceptance, but let me try to explain what happened in that moment. During the Externalization of Voices, Jill took a turn at arguing against the thought, “I will never be fulfilled without children,” but instead of arguing against it, she accepted it and then proceeded to list all these ways that I could make having children possible. I don’t remember exactly what she said now (I wish someone had written it down), but hearing her say what she said led to an “a-ha” moment for me where I realized that she was right; no matter what, I will make it happen because that’s what I do and that’s who I am. She tied it back to my values that were brought out during the positive reframe, and I accepted that I don’t want to change that thought because it’s motivating for me. Hope that helps clarify! Warmly, Carly

The featured photo shows Dr. Carly Zankman at the Big Sur with her 8 month old nephew, Micah Podcast #268 : An Ectopic Pregnancy (Part 1 of 2) October was Pregnancy & Infant Loss Awareness Month. We are dedicating this and next week's podcast to all the mothers and fathers who have lost infants or struggled with pregnancy complications and tragedies. This will be the first of two podcasts featuring a live therapy session with Dr. Carly Zankman. Dr. Zankman, a 27 year-old clinical psychologist in our Tuesday training group at Stanford, is facing a serious crisis involving motherhood. She is struggling with the aftermath of a traumatic ectopic pregnancy and some intense fears that she may never get the chance to be a mother. In addition, she is 100% convinced that she can never feel happy or fulfilled in life unless she becomes a mother. The featured photo for this podcast is Dr. Zankman at the Big Sur with her 8 month old nephew, Micah. You can see the love and joy in her face, and her intense desire to become a mother herself. The session took place at my Tuesday training group at Stanford, and my co-therapist was Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, California. You can see Carly’s Daily Mood Log (DML) and Brief Mood Survey (BMS) at the start of the session  The DML reflected her feelings several weeks before, when she felt that her chances for pregnancy were greatly diminished, and the BMS reflects how she was feeling at the beginning of our session. As you can see, she was still moderately depressed and anxious, and her happiness and marital satisfaction scores were quite low, indicating that she was unhappy and somewhat dissatisfied with her relationship with her husband. Carly was also anxious about being on the podcast, due to these additional negative thoughts: I’m not going to be able to describe what I’ve been through. She believed this 70%. There’s a potential to be judged by people. She believed this 100%. In today’s podcast, you will hear the T = Testing and E = Empathy portions of the session, and in next week’s podcast you will hear the A = Assessment of Resistance and M = Methods portion of the session, and hopefully Carly will be able to join us for a follow-up to see how she’s been doing since the session. The show notes for next week's podcast will include eight teaching points. Rhonda Jill and I are all extremely grateful to Carly for her courage in sharing this intensely personal part of her life with us. She received, as you might imagine, incredibly support from all the members of the training group during and after her session, as others had struggled with similar fears as well. Thank you for listening, David, Rhonda, Jill & Carly

Hi everyone! This podcast offers specific help to LGBTQ individuals who are under attack from loved ones who might judge them and criticize their sexual orientation or gender identity. Plus, we all get slammed at times by people who judge us for all sorts of reasons, which can be immensely painful, so most of today’s discussion will apply to people more broadly. I recently received a great email from Heather Donnenwirth, a therapist in Ohio who works with LGBTQ individuals. She mentioned that some of her patients struggle with how to respond to critical or judgmental statements from loved ones, including parents, and provided several examples: "Being Gay is wrong/a sin" "If someone doesn't know if they are a man or woman, then something is messed up in their head." "We are worried that you are going to go to Hell for your lifestyle." "We don't want your partner at our house, and we don't want to see any displays of affection." Heather wanted to know how one might use the Five Secrets of Effective Communication to respond to these kinds of criticisms. I invited her to join us in the podcast, and she wrote: I was excited about this topic. Thanks so much for including me. David's work has improved my life in so many ways and Rhonda's Wednesday TEAM training group has been a wonderful way to practice my TEAM skills and improve the kind of care I can offer patients. I appreciate and admire you both so much!! Also, I can't wait to meet Kyle!! I also invited the brilliant and wonderful Kyle Jones to join us. Kyle is a TEAM therapist who joined my training group in 2016 before ever seeing a patient! He is completing his PhD in clinical psychology at Palo Alto University and his dissertation research focuses on psychologists who provide mental health treatment to LGBTQ people. Kyle joined us in 2018 for a FB Live TV program on dating and flirting strategies (https://feelinggood.com/2018/06/17/dating-strategies-today-on-fb-live-sunday-june-17-2018-at-3-pm-pst/) and in 2019 for Podcast 151 on treating LBBTQ individuals with TEAM (https://feelinggood.com/2019/07/29/151-working-with-lgbtq-patients-whats-the-team-cbt-approach/). During today’s podcast, we used the excellent statements that Heather provided in role-playing exercises with the Five Secrets of Effective Communication. We used the Intimacy Drill that I developed, which is by far the best way to master the Five Secrets. We also discussed the issue of the inner dialogue that always accompanies the outer dialogue with the person you’re in conflict with. If you get anxious, depressed, and angry when criticized, it will be much more difficult to use the Five Secrets skillfully, because you may feel defensive and resentful and inadequate. So some work with the Daily Mood Log may also be invaluable before trying to use the Five Secrets. Finally, we discussed the question of “Outcome Resistance.” This means asking yourself if you WANT to develop a more loving relationship with a loved one who is being highly critical of you because of your sexual orientation, or for any other reason. We decided it is perfectly acceptable to decide NOT to try to develop a more loving relationship, if that feels better to you. It may even be in your best interest or help keep you safe from harm if you’re an LGBTQ person facing discrimination and persecution because of your sexual orientation or gender identity. I explained my own anger toward my father who was a successful Lutheran minister. However, when he retired from his ministry at the Shepherd of the Valley Lutheran Church in Phoenix, Arizona, he began working with gay individuals at the Arizona State University, trying to convert them to a heterosexual orientation. This was profoundly disturbing to me, I felt a great deal of shame and anger, and it ultimately led to a sad rupture of our relationship. Rhonda, Heather, Kyle and David

266: Ask Matt, Rhonda, and David: Can we solve the pain in the world? How can we deal with someone who might weaponize our vulnerability? What can I do about my emotional eating? And more! Today's podcast features awesome questions from viewers like you, with answers from Rhonda, David, and our brilliant guest expert, Dr. Matthew May. Here's the list of questions, followed by partial answers (prepared prior to the podcast) from David. Ezgi Asks: Is there any way to solve pain in the world? Some people are committing suicide because they don't wanna suffer anymore. Is there any way to "finish" the suffering while we are still living in this world? Megan asks: Hi David, I was wondering what your thoughts are about using the five secrets when in communication with someone who may not be coming from a place of love or respect, or someone who might weaponize your vulnerability, such as someone with narcissistic tendencies? Telia asks: Could you please do another episode on compulsive emotional eating? I have suffered with this my whole life. Daniele asks: What “upsetting event” should I put at the top of my Daily Mood Log? Does it have to be the event that triggered your depression? Anca asks: Should I work on a different upsetting event every day and do a Daily Mood Log? What about the days when I don’t have any distorted negative thoughts? Oliver asks: Dear Dr. Burns, How much time do you require your patients to spend on their daily psychotherapy homework (Daily Mood Journal)?  What is overkill when doing Positive Reframing? Sarah asks: Hi Doctor Burns! Your podcasts have been so helpful! I want to know what you would have said to the husband, in this episode, if he were the one that came to you, first, about the marriage.(By way of explanation, Sarah is referring to an episode on the Five Secrets where the wife was blaming her husband for saying, “You never listen” for 25 years, and was shocked to discover that she was causing the very problem she was complaining about.) * * * Ezgi Asks: Is there any way to solve pain in the world? Some people are committing suicide because they don't wanna suffer anymore. Is there any way to "finish" the suffering while we are still living in this world? Thanks, Ezgi, I will read and answer this on an upcoming Ask David. I have committed my life to helping people who ask for help with depression, anxiety, and other problems. I do not evangelize or reach out, trying to convert people to some new way of thinking and feeling. Also, I only work with people one to one, (or in groups), and I think healing must begin with yourself. There are tons of free resources on my website, plus my books, like Feeling Good, and others, can be invaluable, including on the topic of suicide. You can get used copies inexpensively on Amazon, too! All the best, david * * * After Hearing Podcast 14 on the Five Secrets Megan asks: Hi David, I was wondering what your thoughts are about using the five secrets when in communication with someone who may not be coming from a place of love or respect, or someone who might weaponize your vulnerability, such as someone with narcissistic tendencies? Thank you, I appreciate you and all you do to make the world a kinder and gentler place. David’s Response Hi Megan, Please provide a specific example. What did the other person say, and what, exactly, did you say next. One exchange is enough. Then we can do something amazing, and not just BS on an abstract level that will be useless. You see yourself, based on your note, as the sweet innocent victim of the other person's "badness." Once we have a specific example of an interaction that did not go well, and you focus on your own role, things will suddenly fall into a shockingly different perspective. david Will include this in an Ask David. * * * Telia asks: Hi David, Thank you so much for your free information and podcast #155 on emotional eating. Could you please do another episode on compulsive emotional eating? I have suffered with this my whole life. I listened to episode 155 but I need more help like actual questions to ask myself or tools to use in the moment. I have suffered with this my entire life, and I know with your help I can be free from it. Thank you Telia from Australia David’s Response Hi Telia, Check out the free chapter(s) offer on bottom of my website home page. Full instructions are right there. Feel free to contact me if any questions after following the guidelines there, and doing the exercises on paper. d * * * Daniele asks: What “upsetting event” should I put at the top of my Daily Mood Log? Does it have to be the event that triggered your depression? Hello Dr. Burns, i am reading your second book, Feeling Great. The first one, the new mood couldn’t help me or i couldn’t get it done right. And now i am trying Feeling Great. I like the book and your thoughts. I have struggled with anxiety and depression since 2014 - on and off. Lately more on.... My biggest problem with the exercise is that you have to put an event that make you depressed. I don’t know exactly why it started and i so it’s difficult to find an event. What can I do? I feel depressed and don’t know why. These days the fact that i couldn’t get rid of the depression for so long is the main reason why i am depressed. Thanks for your help, Daniele from Italy David’s Response Hi Daniele, You just have to focus on one specific moment when you were upset and want help. It can even be the moment when you are working with the Daily Mood Log. d Thank you, Dr. Burns! Daniele * * * Anca asks: Do I have to complete a Daily Mood Log every day? Hello Dr Burns, Thank you so much for the podcast and all the wonderful resources you are gifting to the world! I've been listening for the last 3 months, and I can say that your discussions with your colleagues and patients have improved my mindset and my perspective on life. They helped me to identify feelings of self-blame and other-blame that I didn't even know I had. I also didn't realize how toxic they were. I've bought the Feeling Great Book and completed 2 Daily Mood Journals. I am still in the beginning and try to improve my skills for challenging the negative thoughts. I am just wondering if I am approaching this correctly - sorry if I missed this from the book - Do I need to complete the Daily Mood Log every day? I am asking this because on the days I do feel down and do have a negative event and thoughts, it takes me a lot of time to complete the log, around 2 hours. On other days I feel ok, and don't have upsetting distorted thoughts. Should I record one negative event every day, with all the negative emotions and thoughts that come with it, or work on the same upsetting event every day, taking on one or 2 thoughts at a time? Thank you for your support and your generosity. With Gratitude, Anca David’s Response Hi Anca, Will make this an Ask David. The short question is that you can work on the DML a little bit every day. I would aim for 15 to 20 minutes a day, like meditation. On some days, you will want to put in more time, which is fine, but you get 100% credit after 15 – 20 minutes. You can work on a DML over several days. This is just one idea, and ultimately you are in charge! Congrats on the fantastic work you are doing! david David * * * Oliver asks: Dear Dr. Burns, How much time do you require your patients to spend on their daily psychotherapy homework (Daily Mood Journal)?  And how much time did they actually spend on a mood journal? From my experience, I seldom complete them in 2 hours, the time you set up for one session. A daily mood journal with 5 negative thoughts would often cost me 4 to 6 hours. I am wondering how much time your patients usually spend on one daily mood journal? Besides, when I was filling out one daily mood log, more upsetting events would float in my head. To avoid being distracted, I recorded the second upsetting event on another Daily Mood Journal. But I found I never had the chance to work on it because I seldom completed the first event. I am now unemployed, so I have enough time to work on an upsetting event, even if it cost me far more than 2 hours. However, I doubt if full-time employed people have enough time to do this homework, without sacrificing the time to be spent on families, sleeping, sports, and other activities. That is somewhat upsetting. Do you require your patients to finish a Daily Mood Journal in one day? I believe the guidance on this topic is not only important for me, but also for all of your readers and patients. And another question that confuses me is that what is overkill when doing Positive Reframing? And when to decide it will be overkill or not? Thanks. Oliver Smith David’s Response Thanks, Oliver. You can do a DML over several days, no need to complete it all at once. 15 to 30 minutes per day would be excellent. ON Positive Reframing, I wait until we “get a feel for it,” and we generally have listed a dozen or even 20 or so positives. I have an app I’m working on that will help with these questions. Will read your question on an Ask David, perhaps. Thanks! * * * Sarah asks: Hi Doctor Burns! Your podcasts have been so helpful! I want to know what you would have said to the husband, in this episode, if he were the one that came to you, first, about the marriage. If we all cause the very relationship problems that we are complaining about, what is it that the husband is doing to cause Sarah not to listen to him and explode in anger? I see that Sarah is not able to listen and empathize, however, It seems like the husband is able to listen and empathize. What would his next step be? Thanks! Sara David’s Response Thanks, Sara. This is an interesting but abstract question, and I never find that answering them is productive, as 100% of the learning is in the specific example. If he were asking for help, I would ask him to write down one thing that his wife said, as well as what, exactly, he said next, thinking of an exchange that didn't go well, and an example he wanted help with. Then we’d use the EAR technique to analyze his communication errors and show how he’s causing the exact problem he’s complaining about, followed by a revised response using the Five Secrets. You could do that for yourself, and we'll see what YOU might be able to learn! For example, what is something someone said to you, and what, exactly did you say next? Or, you could make up an example for me to comment on. * * * That's it for today! Rhonda, Matt, and David

Podcast 265: An Extreme Leech Phobia: Once Bitten, Twice Shy! Today’s podcast features the treatment of an extreme leech phobia in real time, using live leeches. Dr. Danielle Kamis, a clinical psychiatrist practicing in Los Altos, California, is our courageous patient, and Dr. Matthew May, a frequent guest on the Feeling Good Podcast, conducts the treatment, while David and Rhonda observe and comment. If you ever saw the famous Humphrey Bogart movie, “African Queen,” you know how terrifying leeches can be. But why in the world would anyone working in downtown Los Altos, California, need or want treatment for a leech phobia? Danielle is an extremely brave and adventuresome young professional woman who loves traveling to remote places around the world (Danielle is an extremely brave and adventuresome young professional woman who loves traveling to remote places around the world.  She has had a keen interest in global health work and has spent a significant amount of time doing research with indigenous population in the pre-Andes mountains of Argentina. She has also spent time living with tribes deep in the Amazon forest as well as the jungles of Sumatra. These experiences have transported her back in time to better understand the core components of humans in our most natural state. She described a terrifying experience while exploring in a jungle in Sumatra, where the leeches not only invade the water, but can also drop onto you from trees. After hiking through the beautiful, lush landscape for some time, Danielle began screaming and sobbing in terror when she noticed that her foot was bleeding because of a leech that had just detached itself. This was understandably embarrassing, and she realized that she needed to overcome this fear before going on another jungle adventure. In today’s therapy session live leeches will be placed on Danielle’s skin, and she will be encouraged to surrender to the anxiety and make it as intense as possible, rather than running away or trying to control or avoid it. This is an extreme form of exposure called “flooding.” It  can be incredibly effective, and often works quickly, but requires great courage on the part of the patient and therapist, as well as a high degree of therapist skill. To prepare for today’s exposure session, Danielle obtained four live leeches, which she kept at her apartment. She said that even looking at the leeches slithering around in the water and thinking about them biting her made her fear instantly jump to 9.5 on a scale from 0 (not at all) to 10 (the most intense anxiety). She asked Matt if he’d be willing to do the leech exposure first. Matt agreed, since we never ask our patients to do anything that we wouldn’t do, ourselves. This modeling by a trusted friend or therapist can be a useful tool in the treatment of anxiety. Danielle carefully removed one of the leeches with a spoon and placed it on Matt’s forearm. After crawling around for a minute or so, the leech attached itself and begin to engorge itself on Matt’s blood. Danielle watched in fascination and fear, and then it was her turn. She bravely placed a second leech on her forearm. She was afraid it was going to be extremely painful, but was surprised when it was just a mild feeling of sandpaper on her skin. Over a period of about ten or fifteen minutes, with episodes of nausea and profuse sweating, Danielle’s anxiety gradually dropped from 9.5 at the start all the way to 1, and she felt triumphant. You can see some photos and videos of the session here, including our lunch prior to the session at the Phoa Cabin in downtown Los Altos. It is a favorite local spot that features tremendously tasty Vietnamese food.  (LINK) Teaching points in today's TEAM-CBT session include the following: Avoidance is one of the major causes of all forms of anxiety. When you avoid or try to escape from your fears, they will always intensify. Exposure is a powerful treatment tool for anxiety, but is not a treatment per se, and there are many additional tools with powerful anti-anxiety effects. I (David) use at least 40 tools in the treatment of anxiety, but exposure must always be included in the mix. It is probably impossible to cure any form of anxiety without exposure. All patients and most therapists resist and fear exposure. Patients fear exposure because of the intense anxiety they must endure and their belief that something terrible will happen if they don’t avoid their fear, and most therapists are also afraid that the patient is too fragile, or the procedure is too extreme, and something terrible will happen. However, I (David) have never had a bad outcome when using exposure. I am convinced that poor therapy skills, and not exposure, cause negative outcomes in the treatment of anxiety. Excellent empathy is extremely important in treatment of Anxiety. Danielle mentioned the importance of her trust in Matt, and in his modeling of the exposure in the treatment. I (David) strongly agree with this, as I have had to use exposure in the treatment of my own fears and phobias and have also benefitted from doing exposure with someone I trust and admire. Once you’ve beaten a phobia, and no longer fear the thing that once caused terror, fears have a way of creeping back in, especially if you do not continue to face the thing our feared. To prevent this, ongoing exposure is needed. Although Dr. May treated Danielle for this problem successfully in the past, Danielle’s intense fear of leeches had returned during the COVID pandemic. While some form of relapse is almost always inevitable, the good news is that facing your fear frequently can massively reduce the frequency and intensity of relapses. Danielle seemed pleased with her session and agreed to do ongoing exposure on her own every day with the leeches as homework. The next day, we received this email from Danielle. Hello! I had a fantastic time yesterday with you and I am so grateful for all of your support and guidance. Thank you so much for taking the time to help me overcome my fear and help others do the same! It was so wonderful and special seeing you all again in person. Here are some awesome photos from the session as well as our lunch at the Phoa Cabin, and this link contains two videos. Rhonda, Danielle, Matt, and David

  How to Get Laid! (With a Little Help from the Five Secrets of Effective Communication) One of our top TEAM-CBT teachers and therapists, Thai-An Truong, LPC, LADC from Oklahoma City, is featured in today’s podcast. Thai-An is the owner of Lasting Change Therapy, LLC, a TEAM-CBT group practice in Oklahoma that focuses on using TEAM-CBT to help women overcome depression, anxiety, and relationship problems, so they can live happier lives and have more satisfying relationships. She is passionate about working with postpartum women after overcoming her own personal struggles with postpartum depression and anxiety. She is also passionate about spreading TEAM-CBT and training therapists in this awesome treatment approach. Thai-An suggested a podcast on how one could use the Five Secrets of Effective Communication to deal with critical comments from your spouse or partner during marital conflicts. She submitted specific examples from several troubled couples she has worked with, and Rhonda submitted an example as well. Wife continues to bring up things that needs to be addressed, e.g., baby's medical needs, how he needs to set boundaries with his mom, precautions to take because of the pandemic. Husband says: "All you do is talk about stressful things. You don't even care about being romantic anymore." Wife’s typical response: "How can I be romantic with you when you aren't doing what you need to for our family?" Sex often comes up with every couple, and the criticism is typically from the husband, as in the first couple and this second couple as well. Husband says: "You never want to have sex. It's like we're roommates instead of husband and wife." Wife’s typical response: "I'm tired, and I can't just get in the mood when you haven't been nice to me all day." This couple had been trying unsuccessfully to have a baby. The wife was very critical of her husband and said: “If it wasn’t for you, I’d have a baby. I should have married someone else." Husband’s response: He said nothing and walked away. Infidelity: In this couple, the wife had an affair three years ago and the husband continues to bring it up when they get into arguments. Husband says: "Oh, you say I'm so bad because I did x. How about you cheating on me? You're the one who did the worst possible thing, and I can never trust you again." Her typical response: "It's been 3 years, why can't you just let it go so we can move on with our lives? I'm tired of you throwing this shit in my face all the time." During the podcast, we critiqued the responses to the criticisms in these four cases, using the EAR algorithm. It was easy to point out that the responses of the partner who was criticized typically failed in all three categories: No effective E = Empathy. No effective A = Assertiveness. No effective R = Respect. We also spelled out the consequences of these responses to criticism, and showed how the respondents were actually forcing their spouses to treat them in exactly the way they were complaining about. Then we used the “Intimacy Exercise” to practice more effective responses, based on the Five Secrets. This is, by far, the best way to learn the Five Secrets. Your Turn to Practice Now, here’s another example that Thai-An provided, and you, the listener, can practice with it. This wife was talking about how her friend had hurt her feelings. The husband typically goes into the advice-giving and problem-solving mode. Her criticism: "You suck at listening. I don't need you to fix it." His typical response: "I'm just trying to help." First, see if you can explain why the husband’s response was ineffective, using the EAR acronym. Ask yourself: Did he use E = Empathy and acknowledge how she was thinking and feeling? Did he use A = Assertiveness and express how he was feeling at that moment? Did he use R = Respect to convey some warmth, respect, or love during the heat of battle? Next, ask yourself about the consequences of his response. What will his wife think? What will she conclude? How will she feel? How will she likely respond to his defensiveness? Finally, put yourself in his shoes and see if you can write out a more effective response, using the Five Secrets of Effective Communication Thanks! Rhonda, Thai-An, and David

Photo features Taylor and her husband, Gregg, who is an ER / ICU physician in NYC. 263:  OCD in Kids, Featuring Dr. Taylor Chesney Rhonda starts this podcast by reading two incredible endorsements from fans like you. Thanks so much for the many kind and thoughtful emails we receive daily! Today’s podcast features Dr. Taylor Chesney, the founder and director of the Feeling Good Institute of New York City. Taylor was a member of my Tuesday training group at Stanford for several years during her doctoral training in psychology. Then she and her husband, Gregg, who is an ICU / intensive care unit doctor, returned home to NYC where she opened her clinical practice. We have featured Taylor on a number of two previous podcasts: Corona Cast 4 (published 4-09-202) and Corona Cast 6 (published 4-30-2020). We always benefit greatly from Taylor’s wisdom, warmth, and superb teaching. Taylor specializes in TEAM-CBT for children and teens, and tells us today about the upsurge in OCD (Obsessive-Compulsive Disorder) in young people, and how she approaches this problem using TEAM-CBT along with some family therapy. Taylor describes OCD as a pattern of intrusive thoughts, fears, and images that trigger feelings of anxiety. In addition, the patient engages in a series of repetitious, supposititious behaviors in an effort to avoid the fear. Sometimes the parents may get caught up in the child’s fears as well and engage in the compulsive rituals as well. The fears Taylor sees in children are similar to the fears reported by adults with OCD, such as the fear of contamination, and the compulsive habit of repeated handwashing, and more. But especially common in kids are fears that loved ones, like parents, won’t come home or will be hurt. Common OCD rituals in children include wanting things to be a certain way; for example, organizing your desk meticulously, arranging your pencils, and so forth. The patient often feels that he or she can’t stop or something terrible will happen. Another common fear is getting sick, and needing repeated reassurance that the food the child is eating is safe. David asked about the Hidden Emotion Model that is common and often helpful in adults with OCD, or any anxiety disorder. For example, if a child fears that a parent will be hurt, might this suggest that the child has repressed angry feelings toward the parent? Taylor confirmed that this dynamic was, in fact, common in children as well as adults with OCD. She emphasized the need for an alliance with the parents as a part of the treatment team. This might include urging the child to express his or her anger, wants, and so forth. Taylor speculated that the increase she’s seen in OCD may be the result of the COVID pandemic, and the uncertainty we all feel. Children have a great need for love, empathy, structure, and certainty, and OCD is just one pattern that the increase in anxiety can take. At the start of treatment, Taylor does an initial intake session with the parents, followed by two sessions with the child, and in both cases attempts to empathize and form an alliance via the Five Secrets of Effective Communication. She also wants to find out who the “patient” really is. Who is asking for help? Is it the child? Or the parents? She also wants to know who will do the work of the therapy. If the child doesn’t see the OCD symptoms as a problem, she will work with the parents. Sometimes there’s a mismatch as to what the problem is. The parents might want the child to get help with procrastination on schoolwork or household chores, but the child might want help with shyness and relationships with other kids. She describes how she uses TEAM to show the child that his or her symptoms reflect his or her core values, but that they can turn down the intensity of the fears using the Magic Dial. She emphasized a role for psychoeducation in the treatment as well, explaining the evolutionary and protective role of anxiety. It’s just that sometimes the volume gets turned up to unnecessary levels. She said that the parents are a huge part of the treatment, since the problem “lives in the house,” and the parents may fear what might happen if the child does not engage in the rituals. And, of course, Exposure and Response Prevention are important keys to successful treatment, just as they are in adults. Taylor described a compelling example of a teenager with an intense fear of vomiting in the middle of the night, who had resorted to a variety of rituals including avoiding dinner, secretly sleeping in his bathroom just in case. and more. Together, she guided him in the creation of a hierarchy of exposures as well as Positive Reframing of his symptoms. He successfully completed his treated in just six sessions. Taylor offers a 12-week introductory course on TEAM-CBT with children and adolescents, and is a superb and highly esteemed teacher. For more information, you can contact Taylor@FeelingGoodInstitute.com or look for her on the website of the www,FeelingGoodInstitute.com Rhonda and David

A Country Doctor, Part 2 of 2 A = Assessment of Resistance At the end of the moving and tearful empathy phase, we asked Jillian about her goals for the session, which included the ability to enjoy my work to give away all of my certificates set limits with my patients feel happy with what I do not have to fear my work anymore! After Jillian said she would be willing to press the Magic Button to achieve all these goals instantly if we had one, we suggested Positive Reframing first. to see what might be lost of she suddenly achieved all these goals. You can creview the Positive Reframing that we did together. Here’s Jillian’s Emotions table at the end of Positive Reframing, showing her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering while still allowing you to preserve all the awesome things about you!   Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, blue, down, unhappy 80 15   Embarrassed, foolish, humiliated, self-conscious 50 10   Anxious, nervous 90 20   Hopeless, discouraged, pessimistic, despairing 100 0   Bad 70 0   Frustrated, stuck, thwarted, defeated 90 5   Inferior, inadequate, incompetent 95 5   Angry, mad, resentful, annoyed, irritated, upset, furious 100 10     Jillian said that the Positive Reframing really opened her up, especially when we read the list of positives out loud. It kind of shocked her in a good way so see that her negative feelings were not really problems, defects, or symptoms of one or more “mental disorders,” but the expression of what was most beautiful and awesome about her as a human being, and as a physician. This Positive Reframing is one of the unique aspects of TEAM-CBT. Although we are encouraging the patient to keep the symptoms, rather than pressing the Magic Button that makes them disappear, it paradoxically eliminates or drastically reduces the resistance to change, and opens the door to the possibility of ultra-rapid recovery. M = Methods We asked Jillian what Negative Thought she wanted to work on first, and she chose #9: “I’m not having a big enough impact.” She believed this thought 100%. First, we asked Jillian to identify and explain the cognitive distortions in this thought, and she focused on these: Should Statement; Self-Blame, All-or-Nothing Thinking, Mental Filtering, and Discounting the Positive. In retrospect, I think I spotted two additional distortions: Emotional Reading (I feel I’m not having a positive impact, so I must not be having a positive impact) and Mind-Reading (my patients expect me to have the answers to all their problems and judge me when I don’t have all the answers.) Then we challenged the Negative Thought, and Jillian she was able, with a little help and a role reversal, to crush it, as you can see here. Usually, crushing one Negative Thought is about all you really have to do, because once the patient blows one Negative Thought out of the water, there is usually a kind of “cognitive click,” and the brain suddenly changes, and all the positive circuits suddenly get fired up. It’s amazing to behold, and you will hear it for yourself! The damn did suddenly break, and Jillian could clobber the rest of her Negative Thoughts fairly easily, using a combination of Self-Defense, Self-Acceptance, and a lot of the CAT technique. She suddenly appeared to be a radically and delightfully different person during the Externalization of Voices. You can see her final Daily Mood Log here. You can see her feelings on the Emotions table at the end of the session. Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, blue, down, unhappy 80 15 0 Embarrassed, foolish, humiliated, self-conscious 50 10 0 Anxious, nervous 90 20 0 Hopeless, discouraged, pessimistic, despairing 100 0 0 Bad 70 0 0 Frustrated, stuck, thwarted, defeated 90 5 0 Inferior, inadequate, incompetent 95 5 0 Angry, mad, resentful, annoyed, irritated, upset, furious 100 10 0 Jillian’s scores on my Happiness Test on the Brief Mood Survey also soared to 100% and her ratings of Jill and David on Empathy and Helpfulness tests were also perfect. After the workshop, Jillian sent this email. Hi Jill and David, As I drove home tonight from my office, I actually felt like my heart had been opened. My chest didn't feel as tight and locked-up like it normally does. It felt so relaxed. I put my baseball cap on, rolled the windows down, and listened to 90's country music (my favorite) on my drive and sang loudly. I have spent the last hour checking my new superpowers. There have been negative thoughts, but telling them to "shut the heck up. I am not listening to you" has been quite liberating. I even was greeted by my 4 year old when I got out of the car. I knelt down and hugged her without the worry of being a rotten mom, but rather one of feeling like I am the perfect mom for her, flaws and all. Thank you for this opportunity. I took a chance to email you in the first place after listening to a podcast weeks ago. I thought there would be no chance in heck that I would be selected. I am glad I had this remarkable opportunity and grateful to have worked with both of you. Much love and admiration, Jillian I hope you enjoy it as much as we did. Again, a big hug and thanks to the star or our podcast, Dr. Jillian Scherer who gave us all an incredible gift today! Thanks for listening. I hope you learned a ton and were moved emotionally. Write and let us know what you think! Jillian and Jill joined Rhonda and me for a two plus month follow-up at the end of the recording of part 2. She is still glowing and doing great, and emphasized the three main experiences that led to her amazing breakthrough: 1. When we did the Downward Arrow, she discovered that she had an underlying belief that she "should" or "must" make some kind of enormous, amazing contribution through her clinical work. Letting go of that internal demand was an enormous relief. I (David) think of this as one of the four "Great Deaths" of the "self," or "ego." 2. Learning to talk back to the relentless inner chatter that is always saying, "you're not good enough," using the CAT (Counter Attack Technique.) 3. Reframing the negative thoughts and feelings, and seeing the inner beauty in her suffering. David again emphasized that TEAM-CBT is not just about improvement, or feeling less depressed, but magic, and enlightenment. Jill summarized her new 11-hour home study course in TEAM-CBT with video and audio illustrating and teaching the four components of TEAM-CBT, Testing, Empathy, Assessment of Resistance, and Methods. This class sells for $187 and is suitable for therapists as well as the general public, and offers continuing education credit as well as certification credits in TEAM-CBT. I (David) believe that Jill is one of the truly great psychotherapy teachers, and urge you to check it out if you'd like to hear more! Rhonda, Jill, Jillian, and David

A Country Doctor, Part 1 of 2: "Nothing I do makes a difference!" This is the first of two podcasts on one of the live therapy demonstrations that Dr. Jill Levitt and I did at our psychotherapy workshop on Sunday, May 16th, 2021. I think you will find the session interesting and incredibly inspiring! Our patient is a physician in a small town in the mid-west. I want to thank Dr. Scherer for her tremendous courage in sharing this very personal experience with all of us. Dr. Levitt practices at the Feeling Good Institute in Mountain View, California, where she also serves as Director of Clinical Training. She also teaches at our weekly TEAM-CBT training group as Stanford. I am thrilled to share the audio of Jillian’s live session as a two-part podcast, since only mental health professionals are allowed to attend the workshops sponsored by the Feeling Good Institute. Many non-therapists were eager to attend, and disappointed when they learned that only shrinks could attend. But this gives all of you the chance to hear what you missed, and I think you will NOT be disappointed! When Jill and I asked for volunteers for the live demonstrations in the workshop, Jillian was the first to respond with an offer to volunteer. This was her email, describing her situation.. Hi Dr. Burns, I am writing to you offering to be a volunteer for the live demonstrations in the workshop on 5/16, if you need one. I am learning TEAM CBT, and have been enjoying it personally as well as trying to do more of it professionally. I am a family medicine physician, but I have my own direct primary care clinic. This means that I can spend 1-2 hours with a patient if needed. I have been slowly offering this to patients who want to do the work to improve their mood or anxiety. As for why I am writing, my anxiety and need to please people is huge and disruptive to my enjoyment of life. I keep striving and achieving things likely to get the attention of others. I fear not knowing the answer and making a mistake with my patients. This had caused me to develop anxiety and insomnia at my last job. I sought counseling and physician coaching, but ultimately I wound up leaving that job, moving to another state [due to intense stress and demands of that job], and starting my own practice. My current practice is going well, but I am annoyed when patients come in or call with questions I don't know the answer to. I constantly worry that I will not be able to figure something out by myself and that the patients will leave me. In addition, I continually strive for [yet another] training certificate. As you know, I did medical school, residency, and fellowship, but I also have a lactation consultant certificate, training in lifestyle medicine, and now a Level 1 TEAM-CBT certificate with enough hours for Level 2, and most recently I started a 3-year program to become a pastor for our church. And I realize that I will not have the time to sustain all of these. It is as if I love the journey of getting the certificates, but I am not great at implementing them, so I move on to something else. As for the rest of life, I have a great life, but I am melancholy most of the time. My husband is terrific, sensitive, understanding, loving, and yet, I am constantly reading marriage books because I think it could be better. My 2 children, aged 8 and 4, are smart and funny, but I live constantly thinking I am going to screw them up and so I read even more parenting books. My family medicine practice is thriving and offers me part-time work at great pay with autonomy, yet I dread Monday mornings. Overall, my life should be an A+ and enjoyable, but somehow I make it seem like everything is going wrong all the time. I have sought counseling and even TEAM-CBT earlier this year via teletherapy from FGI. I continue to do a Daily Mood Log about 3-4 times a week. I feel like we got so far, but not to complete recovery. My FGI therapist was the eighth therapist I have been to, but the others were mainly talk therapists. I just thought I would reach out in the hope that maybe you need a volunteer, and maybe I would have the opportunity to work with you live. It would be nice if my anxiety and faulty core beliefs didn't steal my joy. Sincerely, Jillian As you can see, Jillian is an incredibly dedicated physician, but feels like she is never doing enough for her patients. At the start of her session, she described her incredibly stressful previous job, when she was often on call for 72 hours at a time, often going long hours without sleep. She said, “I used to walk to work, hoping I’d get hit by a car.” Although, as you saw in her email, she finally quit, and set up her own practice in another state, she continued to struggle with depression and the belief that she wasn’t doing enough. Her constant self-criticisms robbed her of happiness, in spite of the fact that she had a fabulous practice, superb medical and human skills, and a wonderful husband and children. Her unhappiness confirms what Epictetus taught us nearly 2,000 years ago: we are upset, not by things, or events, but by our views of them. In this case, the facts of Jillian’s life are all stellar. In fact, she rates her life and practice as A+. And yet, she was still lacking in the most important dimension: happiness and self-esteem. Because of her constant and intense feelings of insecurity, Jillian heroically pursued more and more specialty trainings and certifications, thinking that eventually she would develop feelings of competence, confidence, and happiness. She even enrolled in a three-year training program to become a minister, in addition to enrolling in the certification and training program for TEAM-CBT, and more. But nothing was ever enough. That’s because, as the sages have taught through the ages, the answer is within. No amount of expertise or accomplishments will ever solve Jillian’s problem. Jillian’s life was perhaps like trying to get the elusive brass ring on the Merry Go Round, except her ride was far from merry. She told us that she sometimes had fantasies of escaping to a remote tropical island. Perhaps you, too, have sometimes felt like you’re not good enough, or that you or your accomplishments are just not good enough. Let us know what you think about the answer that Jillian found in front of a live audience that day, and whether it might apply to you as well. In today’s podcast, you will hear the first portion of her session (T = Testing and E = Empathy), and next week you will hear the fantastic conclusion (A = Assessment of Resistance) and M = Methods.) T = Testing To get started, take a look at the Daily Mood Log that Jillian shared with us at the start of her session. As you can see, Jillian’s negative feelings were all intense. You would not have known how powerful her suffering was if you had met her in her daily life. In person, she comes across as you might expect from her email: exceptionally warm, thoughtful, human, conscientious and likeable. That’s one of the really important reasons for Testing. You can see exactly what you’re dealing with, in terms of the type and severity of negative feelings. In addition, we’ll ask Jillian to rate her feelings again at the end of the session. That way, we’ll know how effective—or ineffective—the session was. This information can sometimes be humbling, but it is always illuminating. Neither Jill nor I could conceive of doing therapy without the Testing! At the end, we’ll also ask her to rate us on Empathy, Helpfulness and other dimensions using exceptionally sensitive scales that can highlight even the smallest therapeutic errors that the therapist would not otherwise be aware of. E = Empathy During the empathy phase of the session, Jill and I empathized while Jillian described her struggles with negative feelings and a lack of happiness and self-confidence. During the empathy portion, I did the downward arrow technique to learn more about Jillian’s fears and Self-Defeating Beliefs. The goal was not to change Jillian, but simply to understand the root of her suffering at a deeper level. We started with the thought, “I should know how to fix people who come to me with a problem like depression, anxiety, headaches, or headaches, or even the lack of money to pay for the medications I prescribe.” Here’s how the Downward Arrow dialogue evolved: David: And if you sometimes do not have the solution for your patients, what does that mean to you? Why is that upsetting to you? Jillian: Then people will be disappointed and leave me. David: And then what? What are you the most afraid of? Jillian: My practice will deteriorate. David: And then? Jillian: My patients will think I’m a failure. David: What would happen then? What are you the most afraid of? Jillian: Then the whole town will think I’m a failure. David: Of course, no one would want something like that to happen, but we might all experience it differently? What would that mean to you if the whole town thought you were a failure? Why would that be upsetting to you? Jillian: That would mean I’m a loser. David: And if that were true, what would that mean to you? Jillian: That would mean that I don’t mean anything to anybody. David: And then? What would happen if you didn’t mean anything to anybody? Jillian: Then there’d be no point in life. That was pretty much the bottom of the barrel. The purpose of the Downward Arrow Technique is to uncover the Self-Defeating Beliefs at the root of your suffering. Once you’ve generated your Downward Arrow list, all you have to do is review it, and then look at my list of 23 Common Self-Defeating Beliefs and circle all the ones that seem to fit. As an exercise, you might want to take a look at the list and see how many you can find before you see the ones that Jillian found! Here’s Jillian’s list: Perfectionism Perceived Perfectionism Achievement Addiction Approval Addiction Fear of Rejection Pleasing Others (Submissiveness) Worthlessness Spotlight Fallacy Brushfire Fallacy Superwoman A Country Doctor, Part 2 of 2 A = Assessment of Resistance At the end of the moving and tearful empathy phase, we asked Jillian about her goals for the session, which included the ability to enjoy my work to give away all of my certificates set limits with my patients feel happy with what I do not have to fear my work anymore! After Jillian said she would be willing to press the Magic Button to achieve all these goals instantly if we had one, we suggested Positive Reframing first. to see what might be lost of she suddenly achieved all these goals. You can creview the Positive Reframing that we did together. Here’s Jillian’s Emotions table at the end of Positive Reframing, showing her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering while still allowing you to preserve all the awesome things about you!   Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, blue, down, unhappy 80 15   Embarrassed, foolish, humiliated, self-conscious 50 10   Anxious, nervous 90 20   Hopeless, discouraged, pessimistic, despairing 100 0   Bad 70 0   Frustrated, stuck, thwarted, defeated 90 5   Inferior, inadequate, incompetent 95 5   Angry, mad, resentful, annoyed, irritated, upset, furious 100 10     Jillian said that the Positive Reframing really opened her up, especially when we read the list of positives out loud. It kind of shocked her in a good way so see that her negative feelings were not really problems, defects, or symptoms of one or more “mental disorders,” but the expression of what was most beautiful and awesome about her as a human being, and as a physician. This Positive Reframing is one of the unique aspects of TEAM-CBT. Although we are encouraging the patient to keep the symptoms, rather than pressing the Magic Button that makes them disappear, it paradoxically eliminates or drastically reduces the resistance to change, and opens the door to the possibility of ultra-rapid recovery. M = Methods We asked Jillian what Negative Thought she wanted to work on first, and she chose #9: “I’m not having a big enough impact.” She believed this thought 100%. First, we asked Jillian to identify and explain the cognitive distortions in this thought, and she focused on these: Should Statement; Self-Blame, All-or-Nothing Thinking, Mental Filtering, and Discounting the Positive. In retrospect, I think I spotted two additional distortions: Emotional Reading (I feel I’m not having a positive impact, so I must not be having a positive impact) and Mind-Reading (my patients expect me to have the answers to all their problems and judge me when I don’t have all the answers.) Then we challenged the Negative Thought, and Jillian she was able, with a little help and a role reversal, to crush it, as you can see here. Usually, crushing one Negative Thought is about all you really have to do, because once the patient blows one Negative Thought out of the water, there is usually a kind of “cognitive click,” and the brain suddenly changes, and all the positive circuits suddenly get fired up. It’s amazing to behold, and you will hear it for yourself! The dam did suddenly break, and Jillian could clobber the rest of her Negative Thoughts fairly easily, using a combination of Self-Defense, Self-Acceptance, and a lot of the CAT technique. She suddenly appeared to be a radically and delightfully different person during the Externalization of Voices. You can see her feelings on the Emotions table at the end of the session. Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, blue, down, unhappy 80 15 0 Embarrassed, foolish, humiliated, self-conscious 50 10 0 Anxious, nervous 90 20 0 Hopeless, discouraged, pessimistic, despairing 100 0 0 Bad 70 0 0 Frustrated, stuck, thwarted, defeated 90 5 0 Inferior, inadequate, incompetent 95 5 0 Angry, mad, resentful, annoyed, irritated, upset, furious 100 10 0 Jillian’s scores on my Happiness Test on the Brief Mood Survey also soared to 100% and her ratings of Jill and David on Empathy and Helpfulness tests were also perfect. After the workshop, Jillian sent this email. Hi Jill and David, As I drove home tonight from my office, I actually felt like my heart had been opened. My chest didn't feel as tight and locked-up like it normally does. It felt so relaxed. I put my baseball cap on, rolled the windows down, and listened to 90's country music (my favorite) on my drive and sang loudly. I have spent the last hour checking my new superpowers. There have been negative thoughts, but telling them to "shut the heck up. I am not listening to you" has been quite liberating. I even was greeted by my 4 year old when I got out of the car. I knelt down and hugged her without the worry of being a rotten mom, but rather one of feeling like I am the perfect mom for her, flaws and all. Thank you for this opportunity. I took a chance to email you in the first place after listening to a podcast weeks ago. I thought there would be no chance in heck that I would be selected. I am glad I had this remarkable opportunity and grateful to have worked with both of you. Much love and admiration, Jillian I hope you enjoy it as much as we did. Again, a big hug and thanks to the star or our podcast, Dr. Jillian Scherer who gave us all an incredible gift today! Thanks for listening. I hope you learned a ton and were moved emotionally. Write and let us know what you think! Rhonda, Jill, Jillian, and David

Podcast 260 TEAM-CBT Games, featuring Amy, Heather, and Brandon In today’s podcast, three of our most creative TEAM therapists describe a number of innovative games they’ve created to facilitate learning key TEAM-CBT techniques in group settings. Our guests are: Amy Specter: Amy is a Level 3 certified TEAM therapist, licensed marriage and family therapist and credentialed school counselor. She works with at-risk youth in schools and has an online private practice specializing in shyness and breakup recovery. She can be reached at amy@amyspecter.com. For a free copy of Flirty Dice or to purchase Tune In, Tune Up head over to https://www.feelinggreattherapycenter.com/   Amy Spector Brandon Vance, MD: Brandon is a Level 4 certified TEAM trainer and therapist for individuals, couples and groups.  His most recent TEAM related project is an international book club to support people in reading Feeling Great. He can be reached at: brandonvance@gmail.com Brandon Vance, MD Heather Clague, MD Heather Clague, MD is a Level 4 certified TEAM therapist and psychiatrist who works in private practice and at Highland General Hospital in Oakland.  In addition to teaching and writing about TEAM CBT, she runs Berkeley Improv that holds in-person and online improv classes for all levels. You can reach Heather at: heatherclaguemd.com Tune In / Tune Up, a card game which features spontaneous speaking situations using the Five Secrets of Effective Communication.  Heather, Brandon, and Amy guided us while we played and explained each of the following games during the podcast: Love Feast, where you make fake, over the top introductions of other people in the group Flirty Dice, where you have to flirt with some using a specified facial expression, a specified type of question, and a specific affect. Future Projection, where you talk back to a Negative Thought from the perspective of your wiser, happier self from the future. The group also discussed how these types of games can help individuals with social anxiety develop greater courage, spontaneity, and interpersonal skills. We also did a group Shame Attacking exercise and briefly described the use of this tool in the treatment of social anxiety. You can also reach Heather, Brandon, and Amy at the Feeling Great Therapy Center, where you’ll find links to Tune In / Tune Up, Flirty Dice and more Improv Games. Thanks! Rhonda and David

Podcast 259 TEAM-CBT for Eating Disorders, featuring Donna Fish In today’s podcast, Rhonda and David are delighted to welcome Donna Fish, LCSW, a New York mental health professional who’s doing pioneering work applying TEAM-CBT to eating disorders such as overeating / obesity, binging and vomiting (bulimia), and anorexia nervosa (starving oneself in combination with excessive exercising). These problems appear to be more prevalent in modern society, perhaps because of the emphasis on physical beauty as well as the availability of fattening foods and the financial resources to purchase them. Donna is an LCSW and Level 4 TEAM-CBT therapist. She is a guest lecturer on eating disorders at Columbia University and Harvard University, and author of Take the Fight Out of Food. She has been a popular guest on many radio and television shows, writes for Psychology Today magazine, and more. Donna began the interview on a personal note, reflecting on one of Dr. Burns’ workshops in 2014. She volunteered for a role-play with David illustrating the Externalization of Voices, a powerful cognitive therapy technique David developed during the mid-1970s. That experience pointed Donna in the direction of learning more TEAM-CBT. Here’s how she described her experience at the workshop: It blew my mind! I don’t easily follow any one particular ‘school of therapy, but I joined a TEAM-CBT training group that Dr. Taylor Chesney had just begun in NYC and then continued my online training until this day! I am thrilled to combine my eating disorder training and experience with the TEAM approach, and have been training therapists at Elise Munoz’s Feeling Good Center in NYC, so that they can use TEAM with the common problem of Binge/Restricting. Donna started her career as a professional dancer, and struggled with her own eating and body image issues. She saw these problems in her many peers and colleagues working as performers as well. She said: I was always on a diet, and saw foods as “good” or “bad.” I would restrict (fasting) during the week and then binge on all the “bad” foods on weekends. My life was a yo-yo of binging and restricting. Later, I taught myself how to eat in a healthy way, and how to say, “Yes, I can have that food and I can have it right now if I want it (which I do). But do I really need it right now?” This simple change in how I talked to myself freed me and cured me! When I became more accepting and less rigid in my “eating rules,” I paradoxically began to feel happier and more in control. I saw so many actors and dancers who used up tremendous amounts of emotional energy struggling with body image issues and problems with eating. That’s why I did a 3-year training program in working with eating disorders. When some of my patients who had recovered became pregnant, they worried about giving their own children an eating disorder. That’s why I wrote my book incorporating the methods that had been so helpful to them. This included a 4 Step Program to help them to give their kids a healthier relationship for life. These are the four steps: Step One: Talk To Your Kids About Nutrition Step Two: Reboot the Connection Between the Belly and the Head Step Three: Separate Hunger and Fullness from Other Feelings Step Four: Teach Your Child Skills and Develop Confidence in Decision Making I incorporated many of the ideas and techniques in TEAM-CBT, including Dr. Burns’ Decision-Making Tool, as well as his “Addiction and Habit Log.” (link to the free chapters on these tools available on the home page of my website). Donna emphasized the role of restricting in the maintenance of eating disorders. She explained that restricting and fasting actually cause and perpetuate the problem because the cognitions become ‘Tempting Thoughts’ to binge such as: “I will definitely re start my diet tomorrow, and I won’t eat that cake that I shouldn’t have had, so I may as well eat more now since I’ve already blown it.” She explained: If you commit to having a piece of that cake tomorrow as well, and in fact every single day, you are less vulnerable to the Tempting Thought of “I won’t have that ‘bad food’ tomorrow’ which tempts you to eat the cake, and then every other food that you ‘won’t eat tomorrow or again’, since you’ve already had a piece. In fact, learning how to eat a piece of cake, or whatever food you deem ‘bad,’ is imperative to learning how to eat well and balanced in order to modulate your weight. The Tempting Thought that you will Restrict Tomorrow, seduces you to binge. The Focus needs to be on Reducing the Tempting Thoughts to Restrict!  A Method like ‘Examine the Evidence’ can be used to see if Thoughts like:  “I won’t eat tomorrow or have that food again,” evolve into Tempting Thoughts that promote the ’binge’ in that moment of temptation, and it becomes a circular game of ‘Restrict/Binge’. Donna described some of the dangerous medical consequences of restricting and severe weight loss that you see in young people with anorexia, including brain shrinkage. She said that parents are sometimes ambivalent about treating their children who have anorexia for a variety of reasons, including the fact that anorexic teenagers are typically perfectionistic high achievers. But when the parents learn about the medical consequences, it sometimes changes their thinking. David adds that two parents will frequently be in conflict about the best way to deal with any problem in a child, and this conflict is nearly always the cause of the “stuckness.” When, and if, the parents decide to work together as a team, the problem nearly always improves significantly. This, in fact, is the whole idea behind the fairly successful “coercive treatment” for anorexia nervosa pioneered at the Maudsley in England. This program involves both parents sitting on the two sides of the child, and forcing him or her to eat, and not giving in to the child’s attempt to manipulate and insist that she or he cannot, or will not, eat. Although the program sounds crude, and most parents initially resist, this type of forceful intervention is effective for roughly 50% of the children with anorexia nervosa, and can be life-saving. This is critical since a significant proportion of these children ultimately die from anorexia nervosa if they don’t have effective treatment. Donna described additional medical consequences of various eating disorders, as well as the cycle of binging and vomiting, which leads to dehydration and actually causes the patient to feel bloated. One of the key cognitions in patients with bulimia and anorexia is the fear of losing control and gaining a great deal of weight, so they engage in many ritualistic activities in an attempt to gain control. However, most of these efforts actually trigger a loss of control. One of the main goals of Donna’s treatment is to change this rigid mind set which is the actual cause of the eating disorder. Donna emphasize the importance of the TEAM-Therapist’s mind set as well: I don’t need any of my patients to change. . . The use of paradox in TEAM is powerful. I work with my patient to list the many GOOD reasons for overeating. Donna described how she integrates the tools and strategies of TEAM into her brilliant work with patients with eating disorders, including David’s Triple Paradox technique. David described the Triple Paradox, which is one of the latest tools he has developed for any habit or addiction, including the eating disorders. If you'd like two never-published chapters on these tools, you will find a free offer for them on the very bottom of my home page at feelinggood.com! These two chapters were originally intended for my book, Feeling Great, but removed due to length. They are intended for therapists and the general public alike. Donna also uses the Brief Mood Survey, testing patient’s moods at the start and end of every therapy session, along with the Assessment of Resistance, the Miracle Cure question, Dangling the Carrot, and more. She also emphasized the vitally important “fractal” concept, focusing on one specific moment when the patient wants help. The idea is that all the patient’s suffering will be encapsulated in one brief moment when the patient was struggling, and the solution in that brief moment will often be the solution to all of the patient’s suffering. If you would like to contact Donna, you can email her at Donna@DonnaFish.com, or visit her website, www:DonnaFish.com. Thanks for listening today! And thank you, Donna, for illuminating how we can use TEAM-CBT in our work with individuals who are struggling with eating and body image problems. I was personally impressed with Donna, not only for her obvious and impressive mastery of the treatment of eating disorders, but also for her warmth, grace, and vulnerability, which will definitely inspire trust and positive expectations in her many patients! Rhonda and David Dr. Rhonda Barovsky practices in Walnut Creek, California. She sees clients mostly via Zoom, and in her office.  She can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com. You can reach Dr. Burns at david@feelinggood.com.

Podcast 258: Doctor, I know you’re secretly sexually attracted to me! / How to Agree with Criticisms that are Just Plain Wrong! Today’s podcast features the incredibly brilliant and kindly Dr. Matthew May, who has become a semi-regular on the Feeling Good Podcast. Our show was the result of an email from Ana Teresa Silva, who is running a new and totally free weekly practice group for the Five Secrets of Effective Communication. If you want to learn those invaluable techniques, contact her immediately before they fill up at ana silva ateresasilva6@gmail.com. Her question had to do with the incredibly important Disarming Technique, which means finding the truth in a criticism, even when the criticism seems absolutely incorrect. I’ve posted her letter and my response at the end of these show notes. Today we tackled two kinds of incredibly difficult attacks, with lots of role-playing and (hopefully) useful feedback and teaching. One was the one listed in Ana’s email, where you are accused of stealing money, but you didn’t actually steal any money. So how can you agree with that? The other was perhaps even harder—what do you do when a patient accuses you of being sexually and secretly attracted to him / her? Matt, Rhonda and David illustrate a variety of strategies for responding with the Disarming Technique as well as the rest of the Five Secrets. The role-playing is challenging and immensely interesting! David emphasizes that if you want to learn the Five Secrets, three things are mandatory: An intense desire to learn. Humility. Tons of practice. David also emphasized the intense resistance nearly all humans have to all three components of EAR: E = Empathy A = Assertiveness R = Respect. I have attached a document listening 12  GOOD Reasons NOT to Listen, Not to Share Your Feelings, and NOT to treat the other person with respect. If you want to master the Five Secrets, my book, Feeling Good Together, will be an invaluable resource. If you read it, you MUST do the written exercises while reading to get any deep understanding of this approach. Simply reading will not “do it!” I want to thank Dr. May once again for hanging out with us today. In our next podcast with Dr. May, he will describe his work with a young professional woman who loved fly fishing but had an intense fear of leeches. Make sure you tune in, it will be extremely interesting, and his patient will join us, too! If you want to contact Dr. May, you can reach him at: Here’s Ana’s email: Hi, David. Hope you are recovering well!! I got stuck with the Disarming Technique. Last week, in the Five Secret Practice Group meeting, something came up and I didn`t know how to answer. How do we “disarm” someone who blames us for a very specific behaviour that is not true? For example: “Why did you steal my money from the drawer?” I thought we could try to find some truth in the attack noticing some reasons why the person could be mad at us or doesn`t trust us, or maybe we could ask if we did something to offend or upset her, but, at some point, we have to say that we didn't steal the money, right? And we`ll be defending ourselves. Can you help me with this? Thank you! I appreciate it. ana silva Ana Here’s my response: Hi Ana, We’ll do some practice on this on today’s show. You might say, “I’m afraid I’ll have to plead guilty to your criticism. Although I didn’t and would never steal money from you, I clearly have done a terrible job of winning your trust and providing genuine warmth and support. “It’s painful for me to hear how I’ve failed, and I feel ashamed, especially since I like you so much and value our friendship. I wouldn’t be surprised if you’re feeling angry, frustrated, and disappointed, and perhaps alone, too, and perhaps even anxious. “Can you tell me more about what happened, and how you feel, and all the ways I’ve let you down and come across as untrustworthy?” This is just a try, and the details will be different depending on who the person is and what the situation is. Hope this helps! Also, Podcast 161 might also be helpful. It’s all about “hearing the music behind the words” (https://feelinggood.com/2019/10/07/161-listening-to-a-different-kind-of-music/) david Rhonda, Matt, and David (without Dr. Rutherford Knows) Rhonda and I are convinced that Dr. May is one of the greatest therapists on the planet earth. If you have a question or would like to contact Dr. May, please check out his website at: (www.matthewmaymd.com) Dr. Rhonda Barovsky practices in Walnut Creek, California, but due to Covid-19 restrictions is working via Zoom, and can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com. You can reach Dr. Burns at david@feelinggood.com.

Podcast 257: What's an Intensive? Today’s podcast features Dr. Lorraine Wong and Richard Lam who describe the intensive TEAM-CBT treatment program at the Feeling Good Institute in Mountain View, California. Dr. Wong is a board certified clinical psychologist and the Clinical Director of The Feeling Good Institute in Mountain View. Richard Lam is TEAM Certified Therapist, Trainer and Certification Program Manager at the Feeling Good Institute. An intensive is a departure from the conventional weekly 50-minute session and compresses an entire course of therapy into a brief period of time. David describes how he created this treatment approach accidentally at his hospital in Philadelphia when one of the world’s most famous and beloved actors, a man who was a great fan of Dr. Burns first book, Feeling Good: The New Mood Therapy, contacted him and asked for treatment. However, there was a catch. He only had two days available, and asked if he could fly from Hollywood to Philadelphia and book all of my sessions for two days. I was delighted to do that, and scheduled 17 back-to-back 45-minute sessions on a Thursday and Friday. He came in a disguise, and explained that fans and the paparazzi were constantly hounding him, and that he felt like a hunted animal. I asked if the disguise was effective, and he said it wasn’t working at all. People still hounded him and asked why he was wearing the disguise and asked for autographs. Because he was a powerful actor, the roleplaying techniques I have developed, like Externalization of Voices, were tremendously effective, and he actually made a complete recovery within a couple hours. Later on, I developed an intensive program for the patients in our inner-city neighborhood, with the help of the president of our hospital, and it was also incredibly effective for our patients who had few resources. However, they loved cognitive therapy! Richard and Lorraine explain how they are implementing the intensive concept at the FGI, working with people from around the United States and the world who come to Mountain View for several days for the treatment. They describe their work with a severely and chronically depressed man who came from Europe who seemed incredibly challenging at first. He was super skeptical and said that that he’d had tons of failed therapy but nothing and no one had ever helped him. He was telling himself things like this: Life isn’t worth living. I’m a special case and no one will be able to help me. Life shouldn’t be so hard. I should be able to enjoy life more. However, once they blew away his resistance using Paradoxical Agenda Setting, Richard explains that “it was a breeze to blow all of his negative thoughts out of the water.” The treatment is costly in the short-term, but can be extremely cost-effective in reality because recovery often happens rapidly. It is my impression, too, that in the hands of a skillful therapist, extended sessions and intensive treatment with TEAM-CBT can often be amazingly effective. If you would like to contact them, you can go to the FGI website (www.feelinggoodinstitute.com) or email them: Richard@feelinggoodinstitute.com or Lorraine@feelinggoodinstitute.com. Thanks for listening, and thanks to Richard and Lorraine for being especially fun and gracious guests on today’s podcast! Rhonda and David Dr. Rhonda Barovsky practices in Walnut Creek, California. She sees clients via Zoom, and in her office.  She can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com. You can reach Dr. Burns at david@feelinggood.com.

Intense Performance / Public Speaking Anxiety, Part 2 of 2 Last week we presented the first half of the session with Michelle Wharton at the Live Therapy workshop on May 16, 2021. Michelle had been struggling with years of intense public speaking anxiety, especially in professional settings. So far, we’ve commented on the T = Testing and E = Empathy portions of the session. Today, we present the exciting and inspiring conclusion of that session. A = Assessment of Resistance At the end of the moving and tearful empathy phase, we asked Michelle about her goals for the session, which included Not to have to feel this terror at full volume. Not to be stopped from volunteering for things that require public speaking and teaching, and to be able to feel some excitement in my career! After Michelle said she would be willing to press the Magic Button to achieve all these goals instantly, with no effort, we suggested a round of Positive Reframing so we could see what might be lost of she suddenly achieved all these goals. You can click here  to review the Positive Reframing that we did together, as well as Michelle’s Emotions table at the end of the Positive Reframing. You can see her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering, while still allowing you to preserve all the awesome things about you! The Positive Reframing is one of the unique aspects of TEAM-CBT. Although we are encouraging the patient to keep the symptoms, the Positive Reframing typically eliminates or drastically reduces the patient’s resistance to change, and opens the door to the possibility of rapid recovery. This will be true even if the patient has been struggling with a problem unsuccessfully for years or even decades, as was the case with Michelle. M = Methods We asked Michelle what Negative Thought she wanted to work on first, and she chose #5: “People will think you are selfish and self-preoccupied.” She believed this thought 100%. First, we asked Michelle to identify and explain the cognitive distortions in this thought. As you can see on her Daily Mood Log (LINK), she found all ten distortions. Of course, the most prominent distortion in this thought is Mind-Reading. That’s because Michelle thinks she knows how other people will be thinking and feeling about her when they find out about her intense public speaking anxiety. This distortion is nearly always present in any form of social anxiety. I know this from my clinical work and personal experience, since I have personally suffered from at least five forms of social anxiety, including extremely public speaking anxiety, when I was young. You feel absolutely certain that you’re flawed and that people will judge you! Then we challenged the Negative Thought, and Michele she was able, with a little help and a couple of role reversal, to crush it. Take a look. (LINK) Here were Michelle’s reflections on that portion of the session. First we used the Double Standard and I think that’s when I said this to the imaginary friend with the exact same problem: “I think you’re being kind of brave.” Then it evolved into Externalization of Voices. Both David and Jill played the negative Michelle and I had a little difficulty talking back to my Negative Self. I connected on a logical level, but didn’t yet have the ammunition or determination I need to blow my Negative Thoughts out of the water. David spotted my ambivalence immediately, and suggested that maybe it wasn’t something we should work on. Before he made that comment, I didn’t even realize that I had mixed feelings about giving up my intensely self-critical thoughts. At that point, I found myself making the decision to fight back and felt myself getting stronger. The next time David (as the Negative Michelle) asked if he could talk to me for a minute I told him he had only 30 seconds to make his point because it was time to back off. I had some hesitation about only using the Counter Attack to defeat the thought but David said he liked the feisty response. Then David and Jill both told me of all the positive feedback that was coming through the chat, and I was given the opportunity to use the Survey Method with a couple of audience members. I think I asked two or three people if they thought I was using up valuable time, since that was one of my painful Negative Thoughts. The both commented that they found the session incredibly helpful and that they could relate to these feelings of anxiety and shame, and that they weren’t judging me harshly at all! Here you can see how Michelle challenged thought #9. As you can see, her belief in this thought fell from 100 to 50, and then to 0. Negative Thoughts % Now % After Distortions Positive Thoughts % Belief 5. people will think that you’re selfish and self-preoccupied. 100 50 0 AON OG MF DP MAG/MIN ER LABE SS SB In fact, I’m being kind of brave!! 100         My anxiety is very real, and it’s good to ask for help. 100         My fear of public speaking is a common and exceptionally worthy problem! 100 You can see Michelle’s Emotions table at the end of the session, after she had crushed all of her Negative Thoughts. Emotions % Now % Goal % After Emotions % Now % Goal % After Down 40 5-10 5 Embarrassed, foolish, self-conscious 100 5 0 Anxious, panicky 100 20-30 0 Discouraged 70 0 0 Inferior, inadequate, incompetent 90 25 5 Frustrated, stuck 80 10 0 Lonely 80 0 0 Angry, mad, resentful, annoyed, irritated, upset, furious 60 0 0 After the workshop, Michelle sent us this email. HI David and Jill, I was going to write to you and tell that I would probably be happy to go ahead with the podcast but that I wanted to do a DML on some concerns about judgements as well as concerns about crossing of professional boundaries (worrying that I’m ‘oversharing’ with clients). Then, I just so happened to have supervision scheduled with Robyn Blake-Mortimer (another Level 4 therapist in Adelaide - I think she was Robyn Fowler when working in New York) this morning and she suggested we do some TEAM personal work on it. It was incredibly helpful and I’ve decided that I’d be happy for you to share the podcast, if Jill and Maor give permission. Robyn helped me to see that there was probably (intentional distortion!) a large impact on my life from the fact that my family survived Cycle Tracy (Christmas 1974) despite our house being 99% destroyed. Our lives were hugely affected and I (now) see a strong connection between this and the bed wetting. Which is not to say it changes the ‘ok-ness’ of the issue, rather that it helped me to see the amount of cognitive distortions that were in my worries about broadcasting the podcast (that ‘my problems should all be fixed by now’). Another liberating moment for me, thanks again to TEAM. Here’s what was left of our house after the Cyclone - just the bathroom where we were. Thank you again. M. This was my response to Michelle: Wow, Michelle, that’s fantastic, kudos, I really like the way you’ve caught the pass and you’re running for a touchdown, like a speedy wide receiver (if you follow football.) I really like all of your thinking and plans! Also, something both of you might want to consider is if we might consider turning each session into two consecutive podcasts. People love and are helped the most by live work podcasts. This is not required, and is just a thought. So proud of both of you! Warmly, david Michelle’s scores on all the scales on the Brief Mood Survey at the end of the session were zero, and her scores on the Happiness Test soared to 100%. Her ratings of Jill and David on the Empathy and Helpfulness tests were perfect as you can see at this link. Here’s what she wrote on the question on “what did you like the least about your session?” "Absolutely nothing!! This was such a gift and I feel so fortunate and incredibly grateful." Here’s what she wrote on the question on “what did you like the best about your session?” "Addressing the ambivalence, the Positive Reframing, the warmth from you both, and how it helped me to soften into and accept these feelings." On the audio, you will also hear the amazing follow-up interview we had with Michelle many weeks after this session. Thanks for listening. I hope you learned a ton and were moved emotionally and inspired. Write and let us know what you think! And thanks, too, to Michelle for giving all of us a gift that’s worth far more than gold! Rhonda, Jill, Michelle, and David

Intense Performance / Public Speaking Anxiety, Part 1 of 2 This Is podcast features the first of the two live therapy demonstrations that Dr. Jill Levitt and I did at our psychotherapy workshop on Sunday, May 16th, 2021. I hope you enjoy this dramatic and inspiring session! Jill and I believe that doing your own personal work is vitally important to the growth and credibility of a mental health professional for many reasons. First, when you’re in the patient role, you can see things from a radically different perspective, including a far greater, first-hand appreciation of the errors that shrinks make as well as what is especially helpful. Second, if you are successful in your own work, you can tell your patients, “I know what you’re going through, and how intensely painful it is, because I’ve been there myself, and I can show you how the way out of the woods as well!” This is a message that most patients welcome. And finally, the personal work you do with TEAM-CBT is a fantastic way of comprehending how this new approach really works. Our “patient” today is Michelle Wharton, a forensic and clinical psychologist from Australia. I want to thank Michelle for her tremendous courage in sharing a very personal experience with all of us. I also want to thank Dr. Levitt, who practices at the Feeling Good Institute in Mountain View, California, where she serves as Director of Clinical Training. Jill is also a co-leader at my TEAM-CBT training group at Stanford. I am especially thrilled to share Michelle’s live session with you, since only mental health professionals are allowed to attend the workshops sponsored by the Feeling Good Institute. Many non-therapists were eager to attend, and disappointed when they learned that only shrinks could attend. By way of compensation, this podcast will give all of you the chance to hear what you missed, and I think you will NOT be disappointed! When Jill and I asked for volunteers for the live demonstrations in the workshop, Michelle sent us this email, describing her situation. Hi Jil and David, I’ve just seen your email on the listserv asking for volunteers for the live therapy training on 16 May and thought I’d put up my hand. I’m an Australian clinical and forensic psychologist with Level 2 TEAM-CBT certification based in Adelaide, South Australia. I had been thinking about volunteering to do some work on social anxiety and feelings of inadequacy. I know this has impacted me at different points in my life like holding back my career contributing to perfectionism, and causing high anxiety in social settings. My anxiety is probably more work-related but does impact personal relationships where I just assume I’m not particularly important. After reading your post, it just kept playing thru my mind that I wouldn’t be a very good volunteer. This thought was keeping me awake, which paradoxically also made me think I might actually be a good volunteer. Also, from the fractal perspective, the anxiety triggered by just thinking about volunteering is probably reflective of all of my inadequacy concerns. So, I’ve attached a Daily Mood Log (DML)/ If you think it might be useful let me know. Since I’m in Australia, the workshop will be from 1am-8am in my part of the world. We scheduled Michelle at the start of the workshop, due to the tremendous time difference, but it still required enormous commitment on her part to work with us in the middle of the night! That kind of motivation is extremely helpful and often predicts rapid changes, but it’s no guarantee and we’ll have to see what happens in the session. This will be a two-part podcast. In today’s podcast, you will hear the first portion of Michelle’s session (T = Testing and E = Empathy). Next week you will hear the fantastic conclusion (A = Assessment of Resistance) and M = Methods.) I hope you enjoy the session as much as we did. Again, a big hug and thanks to Michelle, the superstar of the podcast! T = Testing To get started, take a look at the Daily Mood Log (LINK) that Michelle shared with us at the start of her session. As you can see, most of Michelle’s negative feelings were intense, especially the anxiety and embarrassment, which she rated at 100%. You would not have known how overwhelming her suffering was if you had met her in daily life because she comes across as warm, bright, personable, and likeable. But inside, a part of her is dying, and that’s the part she’s been hiding and fighting desperately to change. Her actions today—opening up and become completely vulnerable in front of a large live audience of mental health professionals—required incredible courage and was a fantastic gift to all of us. That’s one of the really important reasons for Testing. You can see exactly what you’re dealing with, in terms of the type and severity of negative feelings. Of course, we’ll ask Michelle to rate her feelings again at the end of the session. That way, we’ll know how effective—or ineffective—the session was. This information can sometimes be humbling to therapists, especially when you see that things didn’t improve during your session, but it is always illuminating. Neither Jill nor I could conceive of doing therapy without the Testing! At the end of today’s session, we’ll also ask Michelle to rate us on Empathy, Helpfulness and other dimensions, using brief but sensitive scales that will highlight even the smallest therapeutic errors that most therapists would not otherwise be aware of. Using these scales also requires therapist courage, because the information is often disturbing and unexpected, but it is always illuminating and potentially super helpful. That’s because you can discuss any low ratings you received at the start of the next session. If you do this skillfully and non-defensively, with warmth, respect and curiosity, the dialogue can greatly deepen the therapeutic relationship. So, in an odd way, we often “hope” for failing grades on the Empathy and Helpfulness Scales! But processing poor scores often involves the “great death” of the therapist’s ego. This information can be shocking, especially if you thought, as most therapists do, that your empathy skills were good or even excellent. In fact, you will witness such a failure in today’s session! Yikes! But you can also ask yourself the question—did Jill and David have to be afraid of their “failure?” Or was it actually a gift in disguise? And if you’re a therapist, and you start using “What’s My Grade,” will you have to be afraid of grades lower than an A, which is the lowest passing grade? E = Empathy During the empathy phase of the session, Jill and I empathized while Michelle described her struggles with intense and incapacitating public speaking anxiety, which is particularly intense in professional situations. Michelle was visibly shaking and tearful as she said she was grateful and horrified to have overwhelming anxiety that has had a horrible impact on her career and has held her back. She’s avoided promotions to more senior positions that might require a good bit of public speaking. She said, “I can feel myself sweating, with a dry mouth, and wondering, ‘what are they thinking?’ They’re probably wondering how I got my qualifications, and thinking I’m stupid! ”I feel distant, and the audience feels distant, and I find myself thinking that the people in the audience are critical and judgmental. I have the image of feeling isolate, alone, and crying while people are watching. “My fears have even stopped me from doing clinical supervision, which is something I would totally love doing. “There’s a lot I’m holding back. . . but I’m not sure what.” During the Empathy phase, Michelle poured her heart out, and both Jill and I did really careful empathy, summarizing her words, acknowledge her feelings, and using “I Feel” Statements to convey warmth and support. I’m not always the best at empathy, but Jill is a true master, and that is one of many reasons I love teaching and doing co-therapy with her. At the end of the Empathy phase, when we were reasonably certain we’ve done a good job, we asked Michelle to rate us on Empathy. This technique is called “What’s My Grade,” and it is frightening but can be extraordinarily helpful. And we spell it out, by asking, “Would you give as an A, a B, A C, a D?” This is a thousand times better than asking, “How are we doing,” because the patient will just say “fine.” But if you ask for a grade, you’ll get the truth. And sure enough, Michelle gave us a B! That means we’d vastly missed the mark. Was this a good or bad result? From a Buddhist perspective, it’s a great result, because “failure” does not actually “exist.” Michelle actually just gave us some information that was fantastically important. So, we simply asked, “Can you tell us about the part we missed?” And then patients will tell you something really important. Here's what she said: “The sensation in my body right now is huge. . . I can feel it in my stomach . . . And I’m asking myself what the hell am I doing? “I’m holding my hands tightly. . . I feel pressure on my throat . . . a knot in my stomach, shaky hands, and tears are streaming down my face. . . . The volume is turned way up right now. “You’re over there on one side, and I’m on the other side. . . . I feel alone. . . I feel distance. . . . This is just like standing at a podium, with a gaping divide between me and the audience. . . . I’m in a spotlight. . . . but I want to feel emotionally held. “A part of me pushes support away, because I don’t want any cheerleading. . . and I want to be able to do this for myself, and I think that I should be able to do this for myself. “I want to share something that I’ve been hiding. I’ve been holding back. Do I dare to do this?” Then Michelle tearfully described a problem she’d had with bedwetting up until she was thirteen years of age. Her parents took her to a GP and a hypnotherapist, and thought she’d grow out of it. The message she heard was, “You should get over this.” She described waking up every morning with shame, washing the sheets each morning and taking them outside to dry. And, she said, “That’s where this all started! The language I used at this time in my life was so hurtful, telling myself I couldn’t even get this right. I know that the internal bully really came to life in this moment but I had never seen it until this moment.” David made a joke at this point and asked if the bedwetting ever stopped – it took a second for that to sink in then we all laughed and discussed the value of humor within therapy. David advises that humor, like any powerful healing tool, must be used with thoughtfulness, and never to hurt a patient or put him or her down. In addition, humor is usually not a good idea with a patient who is feeling angry, as it may seem like the therapist is belittling the patient. After a bit more empathy and Jill offered an “I Feel” statement about her own nervousness prior to the start of the group and I then Jill then asked for our grade on empathy. Michelle says, “I gave you both an A and at that point and you asked if I felt ready to get to work and I said yes!” Next week, you will hear the exciting and dramatic conclusion to this session, include A = Assessment of Resistance, M = Methods, and T = Testing at the end of the session to assess changes in negative feelings, if any, as well as how Michelle graded us on Empath and Helpfulness during the session. We will also give you a live multi-week follow-up, to see if the effects stuck, or were just a flash in the pan, and what the most important keys to relapse prevention might have been! Rhonda, Jill, Michelle, and David End of Part 1

#254, Ask Matt, Rhonda, and David (with the famed Dr. Rutherford Knows) Today we are again joined by the fantastic Dr. Matthew May for an Ask David. Rhonda and I are thrilled that Matt will be joining us every month. His input will give you a broader range of insights and answers to your many excellent questions! Here are the questions we will address on today’s podcast. Karine asks: How can I help my daughter with anorexia? Shirley asks: How can you deal with people who are emotionally abusive, using the Five Secrets of Effective Communication? Guy asks: Are there any Five Secrets practice groups I could join? * * * Karine asks: How do I help my daughter with anorexia? Hello Dr. Burns, I am trying to help my daughter who is starting to have anorexia with your book as the consultations are not working and we are waiting on a list for a specialist which can take months or even year here in Quebec. I have read both of your last books and i am getting good to use it for social anxiety. However. i can’t see exactly how to apply it for eating disorder. I asked her to list the benefits she gained from not eating and i am trying to help her see the cognitive disorder in it but it is much harder (ex: i loose weight quickly...which will do ... ) i may help her see the cognitive disorder in the « which will do ... » but not in the « i will lose weight » statement ). Could you help me see the pattern i should follow please as i really think your technique can help her faster and better than the traditional psychologist conversation. Regards Karine * * * Shirley asks: How can you deal with people who are emotionally abusive, using the Five Secrets of Effective Communication. Hello David and others, I have been convinced how important using the Five Secrets of Effective Communication are. I do have a question about living with a person who is emotionally abusive. He uses his criticisms of others to manipulate and control them. How do you accept the criticism of such a person who is taking advantage of you accepting the criticism. My soul wants to rebel against these criticisms and against the person who is trying to manipulate me. How do you navigate such a relationship when the abuser will never acknowledge that they are abusing others. He lives in a fantasy world of excuse making and blaming others. Also, how do I acknowledge my weakness and allow the “death” of my ego to happen? Thanks for your consideration and help. Shirley We reviewed this problem and describe how we treat relationship conflicts using TEAM-CBT. This involves giving up blame and examining your own role in the problem. You will discover--and this might be disturbing, or enlightening, or both--that you are contributing in a BIG way to the very problem you're complaining about. You can review Shirley’s partially completed Relationship Journal if you link here. * * * Guy asks: Are there any Five Secrets practice groups I could join? David, Please consider asking one of your skilled therapists to create a Five Secrets of Effective Communication "Practice Group." Possibly the group could be run weekly (virtually) and it would be an opportunity to repeatedly practice each of the secrets. I practice on my own, but I know that learning is often strongest when working with others. Guy Marshall David’s Response Hi Guy, Ana Teresa Silva has a five secrets zoom practice group. Check with her! They are just getting started. ateresasilva6@gmail.com We have an exciting podcast scheduled the next time Matt visits. We will address the many controversies around exposure therapy, and will be joined by a patient Matt recently treated with the fear of leaches! We will also address some of the hundreds of questions submitted by the more than 6,000 fans who registered for my free 90-minute presentation on rapid Recovery from Anxiety which was sponsored by PESI. All the best, Rhonda, Matt, and David (plus Rutherford) If you would like to contact Dr. May, you can reach him at: www.MatthewMayMD.com. Matt added that people interested in treatment can schedule a free 15-minute phone call there, my schedule permitting. Dr. Rhonda Barovsky practices in Walnut Creek, California, but due to Covid-19 restrictions is working mostly via Zoom, and can be reached at rhonda@feelinggreattherapycenter.com. She is a Level 4 Certified TEAM-CBT therapist and trainer and specializes in the treatment of trauma, anxiety, depression, and relationship problems. Check out her new website: www.feelinggreattherapycenter.com.

#253: Sadness as Celebration, Part 2 In today’s podcast, Rhonda and David present Part 2 of their work with a young woman named Rose who has been struggling with profound feelings of grief since learning of a discouraging update on her father’s struggles with multiple forms of cancer. A = Assessment of Resistance At the end of the moving and tearful empathy phase, Rhonda asked Rose if she felt ready to do some work, or needed more time to talk and share her thoughts and feelings. She said she was ready to do some work, and described her goals for the session: I know I cannot change the facts, and I would not want to eliminate the grieving, but I would like to dial down the intensity of some of my emotions, particularly when I’m triggered. Next, we did some Positive Reframing to highlight what was positive about Rose’s feelings. You can click here review the list of positives that we generated. Rose’s Positive Reframing Table* Thought or Feeling List your negative thoughts or feelings, one by one, in this column. Advantages and Core Values--Ask yourself What are some advantages of this thought or feeling? How might it help, protect, or benefit me? What does this negative thought or feeling show about me that is positive and awesome? How does it reflect my core values? Sadness, depression Shows my deep love for my dad and honors the contribution and impact he’s made in my life   Shows the strength of our relationship Anxiety The anxiety is warranted in this situation, shows that I’m being realistic with the situation   It shows my love for my dad, being worried is a way of showing care and concern   It shows that I don’t want him to suffer   It motivates me to connect with him and to make every moment count   It makes me vigilant so I explore every possible treatment option   It motivates us to think about moving to be closer to him   It has motivated us to schedule another visit again in July Guilt Shows my connection to our family   Drives us to visit as much as possible   Shows that I don’t want to live with regret Feeling defective Shows that I’m honest about my flaws   Shows I feel that I’m not doing a good job supporting others, so it means I have high standards in my relationships   Shows that I’m vulnerable Lonely Shows my love for my dad and the important role he plays in my children’s life   Shows how strongly that I value relationships   Motivates me Hopelessness Shows I am being realistic   Prevents me from getting my hopes up too high   Prepares me for the inevitable   Makes me value and make each moment count   Might decide to discontinue the chemo if it causes problems and isn’t helpful   Makes me more vigilant Frustration Shows I haven’t given up or thrown in the towel Anger I will fight and contest this! Now you can review Rose’s Emotions table at the end of Positive Reframing, showing her goals for each emotion when we used the Magic Dial. The idea is to dial each feeling down to a lower level that would reduce your suffering, while still allowing you to preserve all the awesome things about you! Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, down, unhappy 100 50-60   Lonely, alone 80 10   Anxious, worried, frightened 100 30   Hopeless, discouraged, pessimistic, despairing 90 10   Guilty 80 15   Defeated 70 20   Defective 70 10   Angry 80 25   As you can see, she wanted to dial all of her feelings down to low levels, with the exception of her sadness, which was an expression of her love for her dad. M = Methods We used Explain the Distortions, the Double Standard Technique, and the Externalization of Voices, including the CAT (Counter-Attack Technique). Here’s how Rose challenged Negative Thought #1. 1. He's going to die; we're running out of time. 100 50 No distortions We’re all going to die, but I can be present on those moments when we are together. 100 David discussed healthy vs unhealthy grief, and shared some stories of love and loss. He also talked about the concept of sadness as celebration. In this case, a celebration of Rose’s love for her Dad. The impending loss, of course, is tragic, but the wonderful father daughter relationship is beautiful and perhaps somewhat scarce, as so many people have not had such a beautiful relationship with their parents. At the end, Rose said the session was “incredible and special” You can take a look at her end of session scores on the Daily Mood Log (link). After the session, Rose sent the following email: Hello David and Rhonda, Thank you so much for that amazing session today. I am feeling so much more contentment and gratitude after talking with you both. I even feel lighter and more hopeful. The key insight for me was realizing how special and precious this relationship is that I have, and rather than focusing on what I won't have. It sounds like a cliché, but it is true for me and seems to have freed up a weight. I will definitely do my homework, and will can send you the completed DML after listening to the session as that may help. And as for sharing with my dad, I'm going to be calling him to tell him what a wonderful session I had and that when it is published he can listen to it so as to have and share this beautiful experience. Thank you so much once again! Rose Markotic Thank you for listening today! Rhonda, Rose, and David

#252: Sadness as Celebration, Part 1 In today’s podcast, Rhonda and David present Part 1 of their work with a young woman named Rose. Rose is a 38-year-old mother of two boys aged 2 and 5. She works as a Therapist at an outpatient clinic, the East Bay Center for Anxiety Relief, and is a member of our Tuesday training group at Stanford. Rose sought help because of her profound grief after talking to her mother about her father’s recent visit to his oncologist. Her father has had many severe health problems in the past several years. He’s been a survivor, but suddenly the outlook seems bleak, and Rose feels tremendous sadness and fear, because of her deep love for her father. In most cases, grief does not need treatment. Clearly, grieving is healthy and even necessary when you lose someone you love. However, it can be helpful to distinguish healthy from unhealthy grief. From a cognitive therapy perspective, all feelings, including grief over the loss or impending loss of someone you love, result from your thoughts. Healthy grief results from negative thoughts that are not distorted. For example, if a loved one dies, you may think of all the things you loved about that person and the experiences you will no longer be able to share. Your sadness is actually an expression of your love. Healthy grief, in contrast, results from distorted thoughts. For example, in my book, Feeling Good, I described a young physician who became suicidal when her brother committed suicide because she told herself; “I should have known he was suicidal that day. His death was my fault, and so I, too, deserve to die.” This thought triggered intense guilt, and it contains many of the familiar cognitive distortions, including Self-Blame, Emotional Reasoning, Should Statements, and Discounting the Positive, and Fortune-Telling, to name just a few. With my help, she was able to challenge and crush her distorted thoughts, and her depression disappeared. Then she was then able to grieve his tragic death. Paradoxically, the distorted thoughts that triggered the unhealthy grief had actually prevented her from grieving in a healthy way. Today’s podcast is illuminating because Rose is experiencing a combination of healthy and unhealthy grief resulting from a mix of undistorted and distorted thoughts. The work that Rose did is incredibly inspiring, and sad. Today we will publish the first half of the session, including T = Testing and E = Empathy. Next week, we will publish the second half of the session, starting with the question, “What do we have to offer our patients once we’ve empathized?” Then you will hear the A = Assessment of Resistance and M = Methods portion of our work with Rose. T = Testing Take a look at the Daily Mood Log (LINK) that Rose shared with us at the start of her session. You will see that she had very elevated scores in 8 different categories of negative feelings, suggesting she was in pretty intense distress. We will ask her to rate these feelings again at the end of the session so we can see if she experienced any changes during the session. I’m a firm believer that all therapists should use testing at every session, and many are now doing this, but lots of therapists still refuse for a variety of reasons. I was going to say “bogus reasons,” but didn’t want to sound harsh or dogmatic! To me, the refusal of psychotherapists or psychiatrists to measure symptoms at every session is the “unforgiveable sin!” I don’t believe it is possible to do good therapy, much less world class therapy, without Testing, for a wide variety of reasons: Therapists perceptions of how patients feel, and patients feel about them, are not accurate. Measuring suicidal urges at the start and end of every session can save lives. Seeing how effective. or ineffective, you were at every session allows you to fine tune the therapy and abandon strategies and methods that aren’t working in favor of better techniques. This turns your patients into the greatest teachers you’ve ever had—IF you can take the heat! You will see, for the first time, how your patients rate your Empathy and Helpfulness at every session. At first, this information can be incredibly shocking, but if you process it with your patient at the next session in the spirit of humility, warmth, and curiosity, the experience can be transformative. E = Empathy Rose explained that she was feeling acute grief because of her father’s health problems. He had extensive surgery to remove a cancerous kidney in 2014, but the surgeons found additional unusual growths around his spleen. Her dad has also had open heart surgery, surgery to remove a bone tumor, and many other serious medical problems. She said, “he’s like a cat with nine lives, but we’re concerned that now he’s near the end.” He experienced GI distress and vomiting in September of 2020, and was hospitalized again in February of 2021, but they found nothing. In March, he was again hospitalized, and the doctor found an aggressive cancerous liposarcoma in his abdomen. Then they found more tumors in his back, and determined that it was Stage 3. The usual treatment would include radiation and more surgery, but he simply cannot stand any more surgeries, so we began to lose hope. Rhonda commented that he’s suffered greatly, and the family has suffered as well, since 2014. Rose and her family finally got to visit him in San Diego on Memorial Day, and this was helpful. She said he’s still really active with the activities he loves, including golf and gardening, and treasures every moment, and loves spending time with his two grandsons. Rose painfully described the impact of the pandemic, which meant they were only able to visit him twice in the past year. That made it especially nice to connect and see his grandsons during their Memorial Day visit. She said he was especially “present” and cherished those moments. She said: He was doing pretty well, and was telling his friends that he’s happy with what he’s accomplished in his life. He grew up in Bosnia, and was poor, with many challenges, so family is really important to him. Catholicism was the center of his culture. The whole family feels more connected now. The grief has brought us closer together. He’s started chemotherapy, but I’m pessimistic. The doctor said it was only 20% effective, and it’s expensive: $3,000 a month. I do not really know what the timeline is, but it was helpful to visit in person and to see that he can feel joy. My negative feelings typically run in the range of 50 to 60, but they can be suddenly triggered and spike much higher; for example, when I tell myself that he won’t get to see his grandchildren and share so many important moments with them when they’re growing up. He tries to comfort us when we ask how he’s doing, and he says, “I’m okay; I’m just a little tired.” My anxiety fluctuates because so much is not known. I’m not sure how this will affect him. What will the impact be? I’m afraid he’ll get depressed because he may not be able to do the activities he loves, like golf. I also struggle with feelings of guilt. Should we have visited more? Should we move from the Bay Area to San Diego? We’ve been having some zoom calls, but they’re hard. The boys compete for his attention on the calls. Rhonda asked: “You seem to have so much love for him. What has it been like to have him for a dad?” Rose answered: I have two brothers, and I’m the only daughter, so there’s always been a special connection between my dad and me, and his values of hard work and family. Soccer has been really important, and he was so proud when Croatia won the world cup. Connection has always been so important. I wanted to go to South America when I was in my 20’s, because I wanted to learn more Spanish and seek adventure. Everyone said it could be dangerous, so don’t go alone. So my dad went with me, and we had our own wonderful adventures. When I think about that, it makes the feelings of loss all the more painful, because we’re losing that connection. Rhonda and I asked for a grade on empathy. She said: “The session feels warm and I feel connected with both of you. A+” End of Part 1 Next week, you can hear the inspiring and moving conclusion of today's session.

#251, Ask Matt, Rhonda, and David (with the famed Dr. Rutherford Knows) Today we are again joined by the fantastic Dr. Matthew May for an Ask David. Rhonda and I are thrilled that Matt will be joining us every month. His input will give you a broader range of insights and answers to your many excellent questions! Today’s questions were submitted by the more than 6,000 people who registered for my free talk on July 8, 2021 on the Rapid Treatment of Anxiety Disorders which was sponsored by PESI. I was very grateful to PESI for organizing this event, since it was open to shrinks as well as the general public, and that is the same audience that Rhonda and I are trying to reach with our Feeling Good Podcast. By the way, thank you for your ongoing support of the Feeling Good podcasts. Our four millionth download should happen in August! Please keep telling friends about the podcast if you think they might be interested. The very shy but erudite Dr. Knows may again join us and make an occasional comment. Let us know if you like his input and want to hear more from him in future podcasts. If you don’t like him, we can quietly sweep him to the sidelines. Here are the questions we’ll answer today: Hello Dr Burns, excited to be here at your talk today. Could you tell us more about dependency on anti-anxiety medications (benzodiazepines like Valium, Librium Ativan, Xanax, and so forth) and how to inform the client about the dangers of addiction? If this treatment you describe for anxiety disorders is 'rapid' does it linger? Is this rapid response you describe in your treatment of anxiety disorders merely first-aid? Am I right in assuming that the sustained work of psychodynamic therapy, body work, and so forth will still be required? Can you discuss any published or ongoing empirical research on the efficacy of TEAM-CBT compared to other therapy techniques? How does Rational Emotive Behavior Therapy (REBT), developed in New York by the late Dr. Albert Ellis in the 1950s, fit into the picture? How does the cognitive distortion, Fortune Telling, apply to specific phobias? Rhonda, Matt, Rutherford, and I thank you for joining us today, and hope you enjoyed the dialogue! Rhonda, Matt, and David (plus Rutherford)

#250: How to Tell Someone, “You Suck!” Featuring special guests, Dr. Matthew May and the always exciting but pedantic Dr. Rutherford Knows, plus our podcast regulars, Rhonda and David Rhonda begins the podcast with a wonderful email from a woman who asked how you might use the Five Secrets of Effective Communication when you have to deliver give negative feedback to someone. Hi David and Rhonda, I’m an avid listener of the podcast and reader of Dr. Burns’ material. I’ve been working my way backwards listening to all the podcasts, and I now own all of Dr. Burns’ books and am working my way through those, too! I’ve especially found the live therapy on the podcast and role-play using the Five Secrets incredibly useful. The Five Secrets of Effective Communication are like a cheat code for life. As I’ve been applying it in my own life, every conflict has had a phenomenal outcome and I end up closer with the other person. It’s incredible. You’ve given many useful examples of using the Five Secrets on the podcast to respond to someone, for example, who is attacking you and you use the disarming technique and inquiry to hear more about how it’s been for them. My question is, how would you use the Five Secrets to initiate a conversation where you have to be the one to bring up something that the other person doesn’t want to hear, or that it may be painful for them to hear? I started to think about this when consulting for a CEO who needed to fire someone, but needed to keep the relationship amicable, as well as consulting with another business owner whose employee had been deceitful and she needed to have a "come-to-Jesus" talk with him. Similarly, I’ve always struggled to bring up something that's bothering me to a spouse or loved one, because I didn't know how to initiate the conversation, and keep it from devolving into an argument (my greatest fear!). Could you perhaps do a role play on the podcast to demonstrate using the Five Secrets of Effective Communication to initiate a difficult conversation, such as: Firing or correcting an employee? Telling a spouse (or loved one) when you’ve felt hurt or angry because of something they did? Obviously you would still use all the same techniques (Stroking, I Feel statements, Inquiry, etc.), but I would love to hear an example. I find the role plays especially useful and would love to hear your expert wording for how you would approach this. Thank you to both of you for all your tremendous work! Rosemary We loved this request, and model how to deliver the bad news to someone using the Five Secrets. David mentioned that when he was in clinical practice, several women he treated were reluctant to give clear negative signals to men who were chasing them, for fear of hurting their feelings. So, out of excessive “niceness,” they ended up leading the man on, sometimes for months, and hurting him even more. It is probably far more merciful and caring to be honest with someone in a kindly way, so he or she can let go and move forward with his or her life. Rhonda, Matt, and David illustrate David’s “Intimacy Drill.” In this exercise, the person delivering the bad news is Person A, and the person receiving the bad news is Person B. The drill involves four steps. First, Person A delivers the bad news to Person B, trying to use the Five Secrets of Effective Communication (link). The bad news might be telling Person B that she or he has been fired, or that you’re angry with Person B, for example. Then Person A gives himself or herself a letter grade on how well she or he did. Was it an A,  B,  C,  D, or an F? Then Person B and the observers give a letter grades to Person A as well.. Next, everyone points out what Person A did that was effective, and what was ineffective, using Five Secrets terms. For example, you might say that the Feeling Empathy and Stroking were great, but there was no “I Feel” Statement or Inquiry at the end. Then you can do a role-reversal, and try to model an improved response. This is, by far, the best way to learn the Five Secrets of Effective Communication. However, it requires non-defensiveness on the part of all who participate, and the philosophy of “joyous failure.” This means that you view your errors as opportunities for learning and growth instead of shame and defensiveness! If you want to master the Five Secrets for use in ANY situation, the “Intimacy Exercise” is a fantastic way to practice. However, remember to check your ego at the door, because you’ll probably gets some low grades and make plenty of errors, especially if you’re a beginner. But if you work at it, and keep practicing—which very few people do—you can develop some fantastic communication skills that can help you in personal and professional relationships. Today, we also introduced, in a small way, the very shy and erudite, and somewhat pompous, Dr. Rutherford Knows, who makes an occasional comment. He may agree to participate in future podcasts as well. Dr. Knows could be a really great podcast enhancement, since he (hopefully) makes the rest of us look really good! Let us know what you think! Rhonda and I are really pleased to work with Dr. May again. He is a dear friend and colleague, and, according to David and Rhonda, Matt is one of the finest therapists and teachers on planet earth! I strongly agree with this assessment of Dr. May. If you wish to contact him, you can reach him at: www.MatthewMayMD.com. Matt added that people interested in treatment can schedule a free 15-minute phone call there, my schedule permitting. Thanks! Rhonda and David Rhonda, Matt, and David (with Dr. Rutherford Knows)

Podcast 249 Update on the Amazing Feeling Great Book Clubs! July 5, 2021 Today we report on the first two Feeling Great Book Clubs, with Dr. Brandon Vance and Sunny Choi, LCSW. Brandon explained that more than 200 people signed up for the groups, and that he 100 people on the waiting list for a future book club. The first two clubs have been a tremendous success. Brandon explained why he started the Book Clubs: It’s because these are tools in the book that people who are struggling with depression and anxiety can use to get better. Roughly 10% of the people in the world have significant mental health problems causing functional problems in their lives. That’s eight hundred million people! I have asked myself how we can spread these tools to people around the world. Since I finished my psychiatric residency in 2003, I’ve been mostly working with individuals, but seeing factors influencing their mental health, like oppression, inequality, injustice, lack of safety, prejudice and othering, and environmental destruction with ensuing lack of resources. This has inspired my activism towards changing these things. I feel like we need to take action on those levels as a society. At the same time, we have powerful and empowering skills people can learn on an individual level, and these skills can be taught in group settings to relieve suffering. I think we actually need an “owner’s manual” for the mind, and could teach mental health to children, right along with the basics of reading, writing, and arithmetic, as well as adults. Some people have more access to these tools in psychotherapy, but many people in the world may not.  I would love to make these tools like those in Feeling Great more accessible to people worldwide.  The book, Feeling Great, does that, and I created the Feeling Great Book Clubs, as a way to reinforce those concepts, so people can come together in groups during this period of isolation, and learn these techniques, get support, and have their questions answered. Rhonda asked several questions, including Where do the book club members come from? Who helps them? What happens during the hour. The participants come from all over the world, including North and South America, Europe, Asia, Oceania, Africa, and the Middle East. Most are lay people, but 15% are therapists. A number of certified TEAM-CBT therapists help out voluntarily, including: Phillip Lolonis Katie Dashtban Sunny Choi Heather Clague Brandon described the breakout groups: The typical group starts with music, followed by meditation, and a general check-in on how people are feeling. This is followed by answers to questions members have submitted concerning the assigned reading for the week, and reviews of the chapters. Then everyone joins their breakout groups, which are the same each week. This facilitates the development of trust and bonding among the members in each group. There are specific instructions for the breakout groups that relate to the material in the chapters that were assigned for the week. They may discuss questions related to the chapters, or work on a skill presented in Feeling Great. For example, they may work on identifying the cognitive distortions in their thoughts. Then they may use the “Straightforward Technique” or other techniques to challenge their thoughts with “Positive Thoughts.” Last week while reading the chapters on Fortune Telling and Anxiety, we had a check-in circle, where one member describes a mildly embarrassing experience and shares some feelings she or he had. Then the other members practice responding with a couple of the Five Secrets of Communication. For example, they may use “Thought Empathy” to repeat a bit of what the person said along with an “I Feel” Statement and say, “I’m feeling sad to hear that.” In future weeks, we will use this same format but add more of the 5 secrets, including Feeling Empathy, the Disarming Technique, Stroking, and Inquiry. Sunny mentioned that it is neat to see people from the most remote corners of the globe connecting and developing friendships. He said that Brandon’s genius is in how he has created a safe environment to open up and has made the groups really fun, with singing and sharing that have made the groups a powerful and unique personal experience. Sunny explained that when he grew up in Hong Kong, he had anxiety and panic attacks, but you don’t always need a therapist to feel better. One of the most powerful groups was when Sunny shared his grief about a painful personal experience in the group, when his cousin’s restaurant was targeted and vandalized in an act of anti-Asian violence. Working with Sunny in front of the group as if he were a patient, Brandon demonstrated the Feared Fantasy Technique that they’d read about in Feeling Great that week. Brandon said Sunny’s vulnerability opened people up and made it easier for them to share their feelings and experiences. Sunny explained that many Asian people have an anti-therapist bias, but they are very receptive to learning how to use TEAM-CBT techniques in the context of a book club. The club has also stimulated the creativity of people in the group. For example, one member has started a weekly Daily Mood Log practice group and another made visual diagrams of the patient sessions discussed in the book. Sunny said that most of the group members began with the popular belief that therapy has to take a long time, but have discovered that this is not true, and that most people can improve and recover rapidly. At the end of the podcast Brandon played a beautiful audio with touching endorsements for the book club, and for Feeling Great, from people around the world. If you’d like to contact Brandon, you’ll find him at: www.brandonvancemd.com If you’d like to contact Sunny, you’ll find him at: www.bettermoodtherapy.com In the fall, Brandon will be leading two more book clubs starting in mid-August and running through mid-December. If you’d like to learn more about the book clubs or get on the waiting list for the next book club in the fall, please visit www.feelinggreattherapycenter.com/book-club. This would be a good to get on the waiting list for that group, since it is filling up rapidly! Rhonda and David

Podcast 248 Ask David and Rhonda! In today’s podcast, Rhonda and David answer some fascinating questions submitted by listeners like you! We both thank you for your interest in our show, and for your kind comments and terrific questions! The Questions Kati asks: I notice that in your therapy sessions, the negative feelings of most of your patients are reduced all the way to 0%, and many become euphoric. I was wondering whether this somewhat contradicts the idea that our negative feelings are useful to us in some way? Kati also asks: Do you believe that empathy can be ‘taught’? Yiftah asks: How could one dangle the carrot effectively and responsibly when offering a cognitive exposure exercise? Yiftah also asks: From your experience can you give examples of cases in which cognitive exposure may not be as safe or as effective? Esther asks: You say there is no convincing or consistent evidence to support most psychodynamic claims about the causes of things. What you said resonates, but aren’t you also just making claims? I have a psychodynamic supervisor, and am struggling to choose between empirically validated treatments and traditional psychodynamic approaches. Sean asks: Burns, what can you do when you are using the disarming technique and the person keeps interrupting you? Ben asks: Since exercise improves the mood of some people who are feeling down, doesn’t this prove that physiologic changes can improve mood, as opposed to changing negative thoughts? The Answers  Note: The answers below were based on David’s email exchanges with the people who asked the questions and were created before today’s podcast. Therefore, the podcast may contain new and different information from these show notes. Hopefully, both the show and the notes will be helpful to you. Rhonda and David   Kati asks I notice that in your live therapy sessions, the negative feelings of most of your patients are reduced all the way to 0%, and many become euphoric. I was wondering whether this somewhat contradicts the idea that our negative feelings are useful to us in some way. David responds Hi Kati, thank you for the kind comments! It is great to get negative feelings to zero and experience enlightenment and joy. However, no one can be happy all the time, so you will have plenty of opportunities to "learn" from negative feelings again. In addition, there is a difference between healthy and unhealthy negative feelings. Healthy sadness is not the same as clinical depression, healthy fear is not the same as a phobia or panic attack, healthy and unhealthy anger are quite different, and so forth. There will bumps in the road of life for all of us at times. * * * Kati also asks Do you believe empathy can be “taught?” As a mum (of a 15 and a 10 year old girls) and a (HS) teacher I notice some people seem to have it more ‘innately’ than others but would also love to think it is an aspect that can be intentionally developed in others in some way. If you think like me, I would love to hear your thoughts on how that could be done (i.e. what practices or strategies would be most helpful to use with young people in particular). I am still in awe that we can have a sort of conversation with such a brilliant and creative mind and I humbly hope you can address these two questions either in one of your podcasts or by responding to this message. In admiration, Kati David responds Thanks again, Kati, With regard to empathy, it is something that can be learned, but it takes commitment and practice. A good first step is the book I wrote on this topic called Feeling Good together. In addition, there is, as you say, an "aptitude" that people have for this or any skill, with a tremendous variability in the population. But regardless of your natural aptitude or lack of it, you can learn and grow tremendously. I started out with very poor listening skills. You can also search for Five Secrets of Effective Communication on the website, using the search function, and you'll find lots of podcasts teaching these skills. david * * * Yiftah asks How could one dangle the carrot effectively and responsibly when offering a cognitive exposure exercise? Dear Dr. Burns, I love your podcast and books. They have completely changed my practice and had helped my personally. In particular it was great to hear you working with Dr. Levitt with cognitive exposure, and your discussion about it. I have two questions regarding cognitive exposure with PTSD (for the podcast. First, how could one dangle the carrot effectively and responsibly when offering a cognitive exposure exercise? David responds Hi Yiftah, I try to deal with the Outcome and Process Resistance issues prior to agreeing to help any patient with anxiety. I might say something like this: “Jim, I’d really love to help you with your fears of X (whatever it is), and I’m pretty convinced that if we work together, you can make some great progress in overcoming your fears. I have more than 30 great tools to help you overcome anxiety, and you’re probably going to love all of them except for one, exposure. Confronting your fears is just one tool among many, but is a vitally important part of the process, and cure is usually impossible without exposure. “For example, I may ask you to do is (I explain the type of exposure we might use.) I know that will be terrifying, and it needs to be terrifying to be effective. I’ll be with you every step of the way, of course. But I need to know if you’d be willing to do that type of thing if I agree to work with you. “I know you’ve told me that you’ve had many therapists in the past who did not use exposure, and that might be why their treatments were not as effective as you’d hoped. And if you absolutely don’t want to use exposure, I would totally understand and support you, but sadly could not agree to treat your fear of X.” * * * Yiftah also asks From your experience can you give examples of cases in which cognitive exposure may not be as safe or as effective? You have a lot of experience with successful exposure treatments, but I had never worked with PTSD. And I hear some "PTSD experts" say that cognitive exposure is a dangerous process that can backfire. And according to papers I've read it doesn't always help. In other words, assuming that one had worked correctly with the Empathy and Assessment of resistance phases: how safe and how effective is prolonged cognitive exposure with severe PTSD? From your experience can you give examples of cases in which cognitive exposure may not be as safe or as effective? I mean are there some conditions or distorted thoughts that categorically need to be dealt with successfully before going for exposure? For example, would there be any special considerations when working with patients with thoughts connected to shame, self-blame and hopelessness, as well as habits and addictions, or relationship issues? Thank you Yiftah David responds Thanks again! Let’s assume that you are treating a veteran who is paranoid and living alone in the woods, who tells you that he is afraid of “losing it” and blowing people away with his automatic rifle. I would not want to have him fantasize blowing people away in order to overcome his fear, especially if he is prone to violence and has poor impulse control, and is psychotic. This could conceivably trigger him to do something violent, and I’d have a hard time explain my therapy methods to the police after he kills many people in the local mall. At the same time, the vast majority of anxious people who are afraid of doing something horrible or violent have OCD, and are totally safe. So, it takes judgment. Powerful techniques require therapists with exceptional skills, training, and thoughtfulness. It ALWAYS pays to be thoughtful and cautious! And this has nothing to do with cognitive exposure per se, but all of the > 100 techniques that I use. They can all hurt, including empathy, if not done skillfully, and with compassion. Backfiring occurs when therapists don’t do or know how to prepare the patient for the methods you plan to use. Anytime you “throw” techniques at patients, you are asking for trouble. Remember, TEAM is a systematic, step-by-step package that is done as a sequence. Your patient has to give you an “A” on empathy before you can even go on to the Assessment of Resistance. My experience has shown me that most therapists, including the so-called experts, do not know how to get an A grade on empathy, and may not have outstanding empathy skills. Trust is so important in the treatment of anxiety, and always has to come first. Before using any M = Methods, you will need to address the patient’s Outcome and Process Resistance, and get some agreement on what you plan to do and how you plan to do it. Should we not use a technique because it doesn’t always work? All techniques often fail. TEAM is based on “failing as fast as you can!” If you can’t use a technique that sometimes fails, then you can’t use ANY technique! Also, I never treat anxiety with one technique. I use a great many techniques drawn from four very different treatment models: the Cognitive Model the Motivational Model the Exposure Model the Hidden Emotion Model I sometimes get tired / annoyed with so-called experts who love to spout off, saying things that to my ear sound like half-truths. But then again, I do the exact same thing! At any rate, neither Jill nor I have ever had a bad outcome with any form of exposure, but we are both pretty careful, and try hard to be compassionate and to prepare the patient. You have to be thoughtful and careful. For example, Shame Attacking Exercises can be life changing, but they require half a brain on the part of the therapist. For example, I wouldn’t throw someone with poor interpersonal skills into a potentially awkward or hurtful Shame Attacking Exercise. All powerful techniques have the potential to heal or harm. The same scalpel that a surgeon uses to save a life can also be used by a murderer to slit someone’s throat. d * * * Esther asks You say there is no convincing or consistent evidence to support most psychodynamic claims about the causes of things. What you said resonates, but aren’t you also just making claims? I have a psychodynamic supervisor, and am struggling to choose between empirically validated treatments and traditional psychodynamic approaches. Hi David, I absolutely love your stuff! I’ve used some parts of feeling good in my practice as a therapist and in my personal life for some time, but I’ve recently gotten much more into your teachings and I’ve been thinking a lot about TEAM-CBT. And thank you for providing all these free resources for the public! In episode 230 (about 22 minutes in) Rhonda asked you about a common psychodynamic type of claim- “a child of alcoholics either become an alcoholic, marries an alcoholic or becomes a therapist of an alcoholic.” You responded by saying “people love those kinds of theories because people want to think they know the causes of things.” Then you went on to disagree, claiming that there isn’t much evidence to support these types of claims. At first what you said very much resonated with me, and yet I began to think about it and realized the irony in your response: you had explained people’s tendency to come up with such theories with your own cause (“people want to think they know the causes of things”), something which I doubt you’ve been able to test in a research study (though perhaps I’m wrong!) And yet what you said still resonates with me and highlights the crux of my question: isn’t there any value in intuition (without any evidence) in determining the causes of things? For instance, I think your causal explanation here is highly intuitive. (Even though an alternative explanation could have involved something not inherently psychological, like “people err because they think correlation implies causation” or something. This is not just a theoretical question for me. I currently work under a wonderful supervisor who takes a psychodynamic approach to many issues, and I am very suspicious of some his theories, but it seems that he is a great therapist. Further, I think that many people in school and in the early stages of practice (including myself) are conflicted about whether or not they wish to train further in evidence-based approaches or in a psychodynamic type of school. I think this important question is sometimes at the root of the issue. (Although psychodynamic theories are sometimes not at all intuitive.) For a practical example- something I always found intuitive is the role low self-esteem seems to play in people with inflated egos or the role it can play with those who have anger issues (In which the ego or anger serve to “compensate” for the low self-esteem). When I was working with a client who suffered in these two areas, I began by educating him about this notion (which resonated with him) and we began to address his low self-esteem. Later, however, I happened across an article claiming that this intuitive notion is not supported by research. It called into question many of my intuitions when conceptualizing cases and treating my clients. Finally, I just picked up a copy of “Feeling Great” (it’s awesome, by the way!) and I noticed you talked about the hidden emotion technique. Once we’re on the topic of evidence; do you have any evidence that this particular technique is helpful? Is there research backing such a technique? (I’m particularly suspicious of it given its psychodynamic flavor :) I apologize if you’ve addressed these questions somewhere already- I’ve only just begun to avidly read your stuff and listen to your podcast. Thank you so much! Esther David responds Hi Esther, This is an important email and if I can find the time, and may address it in an Ask David. You write: “This is not just a theoretical question for me. I currently work under a wonderful supervisor who takes a psychodynamic approach to many issues, and I am very suspicious of some his theories, but it seems that he is a great therapist.” It’s great that he is a great therapist, and it will be fun for you to learn from him. There are two caveats, perhaps. First, therapists’ views of changes in the negative feelings of their patients, like depression, are not especially accurate, so his self-report of his effectiveness may not have a lot of credibility. I have measured therapist accuracy in a study at the Stanford Hospital, and found an accuracy of only 3% in detecting changes in depression, even after exhaustive, systematic interviews with patients about how they feel. Second, most therapists have only a placebo effect, although they will strenuously insist it ain’t true! And their effectiveness is almost definitely not the result of the specific tools they are using, but other factors. Many outcome studies have been consistent with this type of conclusion. But still, learning from the wisdom of an older therapist can be awesome! With regard to the Hidden Emotion Technique, it IS a kind of modernized psychodynamic technique. I don’t think it has been studied, but I no longer keep up with research. I find it exceptionally helpful in myself (I am anxiety prone) and in about 50% or more of anxious patients. And I have found I can engage in really rewarding conversations with psychodynamic therapists when I describe this technique. I enjoy this type of dialogue, challenging our favorite ideas. Have you ever heard of the “confirmation paradox?” My memory is that if theory A predicts observation B, and you see observation B, you may wrongly conclude that theory A is confirmed. For example, the theory that the sun revolves around the earth predicts that the sun will come up in the east in the morning and set in the west in the evening. So, we do see that every day, and we wrongly conclude that we have confirmed our theory that the sun revolves around the earth. Same is true for psychological theories about the causes of depression or whatever. The problem is that your observations also confirm a large number of alternative theories that all would have predicted the same thing. You can disconfirm a causal theory with data based on an experiment or natural observation, but you cannot actually confirm any theory in science. You can only say that your data are consistent with this or that theory, and that you have failed to disprove your theory based on your observations. I tested many theories about the linkages between Self-Defeating Beliefs (SDBs), like Perfectionism, and changes in negative feelings over time in several hundred patients treated at my clinic in Philadelphia. The data was not consistent with causal linkages between SDBs and negative feelings, even though there were strong correlations between them at both time points, and even though changes in SDBs were strongly correlated with changes in SDBs. david PS You might enjoy this psychoanalysis poem by another Esther who is a member of our Tuesday TEAM training group at Stanford. GOODBYE TO ALL THAT: THE JOY OF PRACTICING PSYCHOANALYSIS No more forms, no need for technique No more brain strain week after week, Ditch those methods — fifty, a hundred, A thousand ways I might have blundered.   So long agenda, don’t mention homework Just perfect that withering shmirk. Surveys, grades, throw them away You know it’s sex, whatever they say.   Gone for good are your twelve distortions, Out with charts and their crazy proportions. Is that a purse I see before me? Nope! It’s your mother’s vagina. You think that’s a joke?   Such progress we are making you must admit Only ten years and we are ready to dip Into that complex where troubles all lie The mom you must marry, the dad who must die.   Two hundred sessions a year and each one two hundred Over ten years $400,000! I sundered… WHAT? I was…er… giving thought to your dream (And the cabbage I missed doing TEAM.)   How can you say you’re worse off than before While standing in front of Enlightenment’s door? You say you’ve awakened to find I’m a nitwit, & at last you’re done with all of this horseshit!   Goodbye, my patient, there’s the door, A pity you are so very sore. But let me say just one thing more — You really are a frightful bore.   — Esther Wanning * * * Sean asks Dr. Burns, what can you do when you are using the disarming technique and the person keeps interrupting you? I’ve recently been practicing the 5 secrets and I am still learning how to apply the techniques. I listened to many podcasts and I’m reading your books/doing the exercises. I’m a complete believer in your method! Thank you! During the disarming, if the person continues to aggressively interrupt and ask pointed questions, how do I continue to stay engaged in the conversation? I repeat the steps. I agree/try and find the truth, paraphrase the comments, along with practicing feeling/thought empathy. The person continues to interrupt, argue, blame, and ask questions to prove their point. Do I just continue to try the secrets? In the moment it seems like it’s impossible, but I stay committed. Thanks Sean David responds Hi Sean, I have often said that these abstract questions have very little value. The devil is in the details, the specific example. If you give me an example of what the other person said, and what, exactly, you said next, I will probably, or almost certainly, be able to show you what your errors were, and how you are forcing the person to keep attacking you. However, this can be painful, to suddenly see how you are causing the exact problem you are complaining about. But also freeing. So, the answer, in short, is that you are probably not using the Five Secrets correctly, but you get lots of credit for your efforts, and some feedback may help you. d PS Sadly, I never got a specific example from Sean. That is too bad, because abstract questions and answers never have much, if any, practical value or impact. All the learning is in the specific example, which becomes a mind-blowing learning experience. But, sometimes people don’t seem to “get” this message! * * * Ben asks Since exercise improves the mood of some people who are feeling down, doesn’t this prove that? Hello David! I am a frequent listener of your podcast, and am currently going through your new book, "Feeling Great". The importance of treating depression at specific moments in time, addressing self-defeating beliefs, and the death of the "self" are all topics that are of particular interest to me. I have a question for you. You make the claim that depression & anxiety always result from distorted thoughts -- that our thoughts always cause our feelings. If that is the case, what do you make of the research that shows that aerobic exercise can be an effective treatment for them? Doesn't that indicate that there could be a physical basis for some cases of anxiety & depression? I have certainly found exercise to be tremendous help for me in keeping my anxiety at bay -- a vigorous session of exercise just seems to "slow down" my mind or reduce the volume of the voice that's always chattering away in the background for hours afterward. Could people be getting more depressed and anxious because they simply don't move as much or as vigorously as our bodies have evolved to? Thank you for your amazing work and the generosity with which you share it. I've recommended your podcast to many people, and will continue to do so! Take care, Ben David responds Hi Ben, Great question. I like your critical thinking! To test this idea, we would, of course, have to measure the positive and negative thoughts of individuals who are, and individuals who are not, helped by exercise. You cannot just assume something either way. I believe that all change in moods, regardless of the treatment intervention, is mediated by a reduction in the distorted thoughts that trigger the depression. This is a testable hypothesis. Many people tell themselves things like, “Oh, I’m exercising now, this will really help me, I’m keeping up with my commitments to my health,” and so forth. I, for one, have never had a mood elevation from exercise. My daughter finds exercise very helpful. I suspect you will find a sharp reduction in negative thinking in individuals who are helped by exercise. We have to be careful about jumping to conclusions about causality. I have a mild case of sciatica, and a medication like Tylenol makes the pain disappear. Does this mean that sciatica is due to a Tylenol deficiency? I did a study with an N of 1. I asked a severely depressed man to fill out a part of a Daily Mood Log every evening. He recorded the situation, then circled and rated his feelings, and then recorded his negative thoughts and how much he believed them. Then he flipped a coin and either jogged for 45 minutes or worked on challenging his distorted thoughts for 45 minutes. In both cases, after 45 minutes he recorded any reductions in his negative thoughts and feelings. The days when he worked with the DML he experienced pronounced reductions in his belief in his negative thoughts and in his negative feelings. The days he jogged, in contrast, there were no reductions in his negative thoughts or feelings. analysis of the data with structural equation modeling confirmed that the change in his negative feelings was caused by the reduction in his belief in his negative thoughts. Just a small pilot study, and could be done on a larger group. However, the researcher would have to have a sophisticated understanding of how the DML works, and how to elicit distorted thoughts from people who are depressed and anxious. david Ben’s reply Wow! I didn't expect such a quick and thorough reply! Thank you, David. Love the Tylenol example. Such a powerful way to demonstrate the hazards of assuming causality, and also show me how easy it is to assume causality without even realizing I am doing so. Your study of the severely depressed man was ingenious as well. It gave me some good food for thought about *why* exercise might be so helpful for me -- that I can't assume that it's because I've manipulated my physiology in some way. It could very well be that I end up feeling good because I have pursued a difficult activity that I value, and thus feel as though I have accomplished something. I can see why someone who *doesn't* rely on accomplishments to feel "worthwhile" or doesn't even think of exercise is an accomplishment might not get the same boost. Indeed, there have almost *certainly* been times that I've exercised and felt WORSE afterward, but I'm mentally filtering those instances out. Like when I've gone for a run even though I was supposed to be getting dinner ready, and then the family is frustrated w/ me and hungry! ;-) I don't really get to bask in the glow of Accomplishment(tm) then! Take care, and thanks again! -Ben David responds again Hi Ben, Thanks. I ‘ve always said the thing about exercise raising brain endorphins was just something someone made up, but people wouldn’t listen to me for the most part. I pointed that human brain endorphins cannot be measured, so there cannot be any evidence all for this theory. I recently said an article where they blocked brain endorphin receptors in people who got the runner’s high. They still got the runner’s high, proving brain endorphins could not possibly be involved! People tend to believe what they want to believe, regardless of the evidence. We see this in politics and in religion in a big way, but it is true in all walks of life. david Rhonda and David

The Night My Childhood Ended, Part 2 In today’s podcast, we present the second half of the therapy session with Todd, who did personal work focused on the impact of a traumatic event that ended his childhood when he was eight. Last week, we presented the T = Testing and E = Empathy phase of the session. Today we present the A = Assessment of Resistance, M = Methods, final testing, and teaching points. A = Assessment of Resistance Todd’s goal was to be able to feel more vulnerability by the end of the session. During the Positive Reframing, we listed the positives that were embedded in Todd’s negative thoughts and feelings. My sadness shows my humanity. My sadness shows my commitment to family. I put others before me and value the time people are taking by listening to this session. I challenge myself to work on myself. My negative thoughts and feelings make me a more loving husband and parent, and a more committed and effective therapist. I love my mom and want to protect her. I have high standards. Although I feel like I was and still am “a frickin’ coward,” sharing this shows tremendous courage. As you listen, you’ll see that it was incredibly difficult for Todd to see anything positive in the fact that he was that calling himself a coward. He kept thinking that he “should” have gone in earlier to try to help and save his mother, and that this might have changed the entire trajectory of his life. At the same time, he conceded that he was just a little guy, and that his father was an incredibly frightening and intimidating figure. You can see Todd’s Daily Mood Log at the end of A = Assessment of Resistance (link). As you can see, he wanted to reduce all of his negative feelings quite dramatically, but he wanted his sadness to remain at 100%, because he wanted to be able to feel this emotion and grieve. M = Methods Jill and I tried a variety of techniques during the Methods phase of the session, including a new version of the Double Standard Technique. I played the role of the 8-year old Todd, and he played the role of himself. I verbalized all of his Negative Thoughts, “But isn’t it true that I rally was a frickin’ coward?” and challenged him to crush them. This helped Todd get in touch with his compassionate and realistic self. You can see his final Daily Mood Log. As you can see, there was a dramatic reduction in all of his negative thoughts except sadness, which fell to 80%. You will recall that his goal for sadness was 100%. There were lots of positive messages for Todd throughout the session in the chat box. There were many outpourings of love and admiration for Todd's courage and vulnerability. We sent those messages to him after the end of the session, and that was when the tears finally came. Here’s an email we received from him after the session. What an evening! I just saw the video again and I was so blown away from the amazing love and support I felt from all of you last night. I also was able to tear up a bit when I was reading all of the heart felt chats that Alex had shared with me. I would give all of you an A+ on empathy for sure. Finally, I'm so grateful to JIll and David for their compassion, and for helping me reconnect with little Todd and feel much closer to all of you. What an awesome night and group! Brandon Vance MD sent a link to a song one of his students created, and Todd responded to it: Last night, it was so awesome to listen to the musical recording that your student so beautifully shared with us. I'm not one to cry very easily, but I was so moved by the lyrics and the emotions in that song. I've been so amazed at how you continuously evolve TEAM in so many wonderful and creative ways. Kudos! Here's the link to the song if you'd like to listen! I also found it moving and beautiful. Cassie Kellogg is the performer and songwriter, and her song is called Double Standard, which is the method that proved so helpful for Todd. Some interesting information about Brandon and Cassie, as well as the words to her song, appear at the bottom of the show notes. There were also tons of positive comments about the session in the teaching evaluation at the end of the session, with overwhelming outpourings of love and appreciation for Todd. Time after time, the personal work we sometimes do while teaching seems to make the most positive emotional impact on our students. And, of course, the teaching value can be tremendous. Teaching Points 1. T = Testing is crucial. If you met Todd, you would have no idea how he feels inside, and if you were his therapist, and you did not use the Brief Mood Survey at the start and end of every session, and the Evaluation of Therapy Session at the end of every session, you would also be partially “blind” to how Todd was feeling, and how dramatically his feelings changed at the end of the session. Most therapists still are not using session by session assessment, and they are at a severe disadvantage that they are not even aware of. I am convinced that it is impossible to do great, or even excellent therapy with these, or similar, instruments. 2. Sometimes you have to slow down to speed up. During the empathy portion I made and corrected an error, with Jill's help, of jumping in prematurely with a method that fell flat. It is easy to give in to hunches and try methods prematurely, prior to doing careful and skillful E = Empathy and A = Assessment of Resistance. One good thing about TEAM is you can easily "right the boat" when it tips, and get back on track. TEAM works way better as a systematic package. Some therapists who learn about TEAM may try to "borrow" this or that M = Method, and incorporate it into their current approach, but that is generally far less effective. 3. A = Assessment of Resistance can be challenging. Positive Reframing can be quite difficult because you have to "see" something obvious that is almost invisible to the naked eye. Initially, Todd had tremendous trouble seeing any value in his self-critical thought that he was "an effing coward” when he and his older brother hid out during his parents’ brutal and terrifying fight. TEAM is not a cookbook, formulaic, treatment manual type of therapy. It requires “insight” on the part of the therapist, and the skills to lead the patient into seeing what you. therapit, (hopefully) have seen. 4. Childhood traumas can often be reversed--quickly. Another important teaching point might be that even traumatic childhood events that have totally rocked someone's world and self-esteem for decades can often be "undone" quickly using TEAM. Joy and self-esteem are possible for every human being. 5. Hopelessness is a cruel illusion. If you’re depressed, you have a deep (and misguided) incredibly painful belief that things are hopeless when they aren't. These feelings of hopelessness are common, but demoralizing at best and dangerous at worst. More about Brandon and Cassie: Dr. Brandon Vance writes: Cassie was an outstanding student of mine when I was teaching CBT last fall at CIIS in San Francisco (California Institute of Integral Studies). My final project was on sharing CBT with the public and suggested that the students could do a creative project or a paper. Cassie was inspired by the Double Standard technique personally and professionally, as she's studying to be a Marriage and Family Therapist. She wrote this song for her final project. Although she has had some experience singing, this was the first song she ever wrote (and she taught herself piano recently). I played the song just before the Feeling Great Book Club one week. and then read the words out loud in the book club. My voice cracked as I was tearing up reading them. As a musician, I am blown away at the power of the words, how well-crafted the song is, and Cassie’s singing and performance. Even the old record-like quality of the recording, with the slightly out-of-tune piano, and faint sounds of kids in the background, adds to the atmosphere! Here are the beautiful words to Cassie's song, Double Standard: You get so down on yourself Convinced you don’t need help What would you say If the reflection in the mirror Was someone you loved Would you say, babe, you’re worth it It’s okay not to be okay Would you help her up and remind her Of her strength And don’t you deserve the same grace So when you’re down on yourself Convinced you don’t need help Remember what you’d say if the reflection in the mirror was someone you love tell yourself that you’re worth it it’s okay not to be okay hold yourself up and remember all your strength you deserve all the grace so when you’re down on yourself convinced you don’t need help remember what you’d say if the reflection in the mirror was someone you love because the reflection in the mirror is someone who deserves love Thanks Todd! Thanks Cassie! Thanks Brandon! You have touched all of us! If you would like to contact Todd, you can reach him at: todd.daly@gmail.com Warmly, david and rhonda

The Night My Childhood Ended, Part 1 In today’s podcast, we present the first half of a therapy session with Todd, who describes a traumatic event that ended his childhood when he was eight. Next week, you will hear the exciting and inspiring last half of Todd’s session. My co-therapist is Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, CA, and one of the co-leaders of my weekly training group at Stanford. We are deeply indebted to Jill and Todd for making this incredible and extremely personal podcast possible. Todd hopes, and we all hope, that it will be helpful to many people around the world who are suffering, and perhaps hiding the scars from your own traumatic experiences. As we always do in TEAM, Jill and I went through T, E, A, M in consecutive order, and I will give an overview of each phase of the session. T = Testing and E = Empathy Todd started by saying: I’m uncomfortable with all the attention I’m getting right now, and I’m worried about derailing the group, since our plan was to have teaching on exposure tonight. I’m going to describe one of the worst nights of my life, when I was 8 years old. It was the last night our family lived together, and my childhood essentially ended. But I’m not looking for a pity party. When I think about that night, I feel 100% sad and shitty. My life isn’t shitty. but when I think about that night, it’s incredibly discouraging. Here’s what I’m telling myself right now: I’m more screwed up than anyone else in this group. 100% I worse than all of the others. 100% My parents got married very young, when they were 18. I was raised in the 1970’s, which wasn’t the child-centered world like it is today. My parents drank all the time. and they’ve both had lifelong challenge with addictions and mental health. In fact, my mom got arrested for a DUI just last week. I have one older brother, and we were on our own most of the time. My parents had a horrible fight one night. It was the last night our family was together. They were both drunk and screaming at each other. They began physically fighting in their bedroom, and I thought my dad was going to kill my mom. My brother and I were scared, and we hid in the bedroom and created a fort with our bunk beds. Then things got quiet, so we decided to see what had happened, and went into their bedroom. Mom was badly beaten up, her face was all bruised, and dad seem horribly embarrassed and ashamed. It was devastating, because I told myself that I should have done something to help her, to save her, and I felt, and still feel, like a frickin’ coward. I believe that 100%, and have felt ashamed every time I think about it. I feel all alone. I’m here, but I’m not here. That was the end of my childhood. I don’t like to think about it. My father moved out, and my brother lived with him. I lived with our mom. The idea at home was always, “don’t speak unless you’re spoken to.” Dad was very angry and controlling. He was angry at my mom for not taking better care of my brother and me. He was angry at life, and I’m also angry and disappointed in her for not taking better care of us. I want to be able to get in touch with my vulnerability and my emotions. Then I stop myself and say, “I’m not allowed to have these feelings.” I want to be consoled, comforted, and not be so hard on myself. Maybe I want people to feel closer to me. You can see Todd’s Daily Mood Lot at the start of the session (link). As you can see, he was incredibly upset, and had eight Negative Thoughts, and his belief in all of them was strong, with most at 100%. Next week, you will hear the dramatic conclusion of Todd’s personal work, including the A and M of TEAM! If you would like to contact Todd, you can reach him at:  todd.daly@gmail.com david and rhonda

Ask Rhonda, Matt, and David! Tips for Joy and more! In today’s Ask David, we are honored to feature Matthew May, MD, a former student of David’s during his psychiatric residency training, and now esteemed colleague. Rhonda and David are thrilled that Matt can join us, not only because he is a dear and loved colleague, but also because he is one of the greatest therapists on planet earth! Plus, he’s an incredibly gentle and compassionate man. Rhonda Asks: What is the most effective way to help a suicidal patient? Rhonda Asks: How would you teach, the technique, Thinking in Shades of Grey to therapists or patients? Brian Asks: Any tips for joy? ThisLife asks: "Could you possibly explain why Albert Elis thinks the three valid uses of shoulds are valid, and provide the source where he explain this point, if convenient?” Mark Asks: Why is trying to change a person or help fix a person's emotional problems insulting? And how can I stop this habit? Along the same lines, EJG asks, “What’s the best way to help people who don’t want any help?” Rhonda and David

The Paradoxical Nature of TEAM In today’s podcast, we are honored to feature Matthew May, MD, a brilliant and beloved colleague of Rhonda and David. Rhonda suggested the topic for today’s podcast on the Paradoxical Nature of TEAM, and Matt and I were more than excited to dive into this cool topic! We reviewed the paradoxical nature of the four components of TEAM. As you will see, each paradox requires one of the four "great deaths" of the therapist's "self," or "ego." The Paradoxes in T = Testing TEAM therapists assess how the patient is feeling “right now” in at least six dimensions just before the start and just after the end of every therapy session using brief, extremely accurate scales for negative feelings like depression, suicidal urges, anxiety, and anger, as well as happiness and marital / relationship satisfaction. These scales are like an emotional X-ray machine so therapists can see, for the first time, exactly how effective or ineffective they are in every single therapy session. You can also see exactly what happens to the patient’s feelings between therapy sessions. Therapists may make several potentially disturbing discoveries during Testing. His or her perception of how the patient feels are frequently wildly inaccurate. The therapist’s perceptions of the degree of improvement in his patients may be shocking, since the therapist will often discover that patients have not improved, and may even feel worse. These “disturbing” discoveries can be celebrated, because the therapist, if humble and open, can accept the fact that his or her therapeutic strategies are not sufficient, and that meaningful change has not yet happened. The therapist can search for and try different treatment methods that may be more helpful for each patient. Paradoxically, the therapist’s failures become golden opportunities for learning and growth every day, and your patients will become the greatest teachers you’ve ever had. This involves the first of four “great deaths” for the TEAM therapist—the death of the “self” that has expert understanding of how patients actually feel. You will discover that your perceptions are very inaccurate in many or even most situations. This discovery can transform the way you practice if you have the courage and humility to try something new! The Paradoxes in E = Empathy At the start of the session, the therapist attempts to listen and provide an empathic, compassionate connection with the patient, reflecting back how the patient is thinking and feeling and convey acceptance and warmth. But here’s what happens in TEAM. When assessing empathy with the “What’s My Grade Technique” during the session, the therapist will often / nearly always discover that you didn’t really “get” the patient. When you review your scores on the Empathy and Helpfulness Scales that patients complete at the end of every session, most therapists are shocked to see that they get failing grades from most or nearly all patients after most or nearly all therapy sessions. Paradoxically, this is a big plus because it allows the therapist to explore his / her failures with the patient in a spirit of humility and curiosity at the start of the next session. If done skillfully, this can lead to therapeutic breakthroughs as well as a significant deepening of the therapeutic alliance. But this also requires a second “great death” of the therapist’s ego, because patients’ criticisms on the feedback forms will nearly always be accurate, and often biting. If you have the courage and skill to acknowledge that truth, the therapeutic relationship can be instantly transformed. Learning skillful empathy skills, using the Five Secrets of Effective Communication, requires tremendous commitment and practice, and the “beginner’s mindset.” The Paradoxes in A = Assessment of Resistance (formerly called Paradoxical Agenda Setting) During this phase, the therapist brings the patient’s subconscious resistance to conscious awareness, and melts the resistance away using approximately 20 “resistance melting” techniques, such as Positive Reframing, the Paradoxical Invitation, the Acid Test, the Gentle Ultimatum, the Externalization of Resistance, Sitting with Open Hands, and more. During this phase, the therapist, paradoxically, does NOT try to “help” the patient, but instead assumes the voice of the patient’s subconscious resistance, helping the patient suddenly “see” why she or he actually should NOT change. Paradoxically, the moment the patient “gets it,” there will be an illumination, and the patient will suddenly lose his or her resistance and become way more open and collaborative. This what makes the rapid recovery in TEAM-CBT possible. The patient also discovers, paradoxically, that his or her symptoms, like depression, hopelessness, and feelings of worthlessness, anxiety, or rage, are NOT the expression of what is wrong with him or her, like a “mental disorder” or “chemical imbalance in the brain--but the manifestation of what is right with him or her. In other words, there are tremendous benefits hidden in every negative thought and feeling. In addition, every negative thought and feeling reveals something positive and awesome about the patient and his or her core values. These discoveries can be mind-blowing for the patient and therapist. Matt and Rhonda do an entertaining role play of a woman who is enraged with her husband, and blames him for all of the problems in her marriage. Matt beautifully illustrates (as he always does!) exactly how to “Sit with Open Hands” and transform her angry resistance into enthusiastic collaboration and a willingness to examine her own role in the problem. Matt and David also discuss an amazing concept called “therapeutic entanglement,” borrowed from quantum physics. They explain how the minds of the therapist are often connected, constantly mirroring each other during the session. So, the more the therapist becomes the resistant and oppositional part of the patient’s subconscious mind, the more the patient assumes the helpful mind an role of the therapist. This phase of the therapy involves the third “great death,” because the therapist’s “helping” or “rescuing” ego has to die. That’s because your job is to see exactly why the patient should not change, and to help the patient discover this as well. The moment the patient “sees” this, and “gets it” at the gut level, recovery will be just a stone’s throw away. The Paradox in M = Methods. At this stage, the therapist focuses on one of the patient’s negative thoughts, like “I’m a loser,” or “I’m unloveable,” or “I’m a hopeless case,” and selects ten or fifteen M = Methods to challenge and crush the thought. Methods might include Explain the Distortions, Examine the Evidence, the Paradoxical Double Standard, the Externalization of Voices, the Acceptance Paradox, and more. TEAM-CBT includes more than 100 methods drawn from more than a dozen schools of therapy. The goal is not therapeutic success, but therapeutic failure. That’s because the faster you fail, the faster you’ll get to the technique that works. And the very moment the patient stops believing the Negative Thought that’s causing his or her negative feelings, the feelings will change. This phenomenon can sometimes be dramatic, even mind blowing. But even in this process, the therapist is almost always playing the role of the patient’s negative thoughts, and the patient is the one who is arguing for change. The M = Methods involves the death of the therapist’s “expert self,” thinking that you’re going to help, rescue or save the patient with your favorite brand or school of therapy, or the exciting new method you learned in some workshop and taught by some charismatic guru. TEAM involves giving up all the schools of therapy, and the spirit of “failing joyously” using a wide variety of methods drawn from more than a dozen schools of therapy. TEAM is not a new school of therapy, but a science-based, data-driven framework for how all therapy works. And so, that’s a little peek into the extensively paradoxical nature of TEAM-CBT! What’s the point in having such a paradoxical approach to therapy? I (David) can only speak from personal experience, I love having tools that can work dramatically and quickly for the vast majority of my patients. That’s because the moment they “recover,” I “recover,” too, and we both become euphoric. So I’m highly motivated to push for rapid and dramatic changes, and this is usually (but not always) possible. I love having a form of therapy that makes patient resistance virtually impossible. I no longer have to deal with resistance. It is impossible for a patient to resist, due in large part to the Buddhist concept of “sitting with open hands.” I love empowering my patients so that they don’t have to hang around with me for months or years waiting for change that never happens. It’s exciting to put the tools for change in their hands, so they’ll know how to deal with the inevitable relapses of negative thoughts and feelings that all human beings will experience, from time to time, for the rest of their lives. Rhonda and I are convinced that Dr. May is one of the greatest therapists on the planet earth. If you have a question or would like to contact Dr. May, please check out his website at: (www.matthewmaymd.com) Rhonda and David

Ask Rhonda, Matt and David! Ask David #243 May 24, 2021 David and Ronda answer your questions about the role of hope, treating court-ordered patients, suicide threats, being a virgin, and moral scrupulosity. Guest expert, Dr. Matthew May, joins us for this fascinating podcast featuring questions from fans like you!  V3A asks: What is the role of hope? EdG asks: How would you deal with a patient who doesn’t like you or doesn’t want to come for treatment, but has been required by either an employer or the courts? Preetika asks: Recently, a client said she felt suicidal and that made me feel suicidal about anything untoward happening on my watch! I was ‘scared stiff!’ Please do a podcast if possible on therapist fears and dilemmas. Dale asks: How would you do Positive Reframing with someone who is suicidal? Miho writes: From church and from my parents, I have been told repeatedly I need to save myself for marriage thus this has been my core belief when I am dating. Although it had never bothered me before, now that I am in my last 20s it seems I have heightened anxiety and misaligned expectations when dating as literally no one around me thinks in this way, and I have been told I do not "look" like I am inexperienced. May I know which would be the best tool for combatting other people's opinions when it really does seem that their opinion is the "truth" of the world? Robyn writes: I would very much like to hear about how you treat patients suffering OCD with moral/religious scrupulosity. * * * V3A asks: What is the role of hope? Hi David, how do you fit the cultivation of hope into TEAM-CBT? Being such an important aspect of recovery, it seems to be most needed in those that most need help, creating a seemingly unwinnable situation for those people. If someone has enough hope to seek treatment, is that enough to make a recovery? * * * EdG asks: Just listened to Podcast 025 on how to relate to a patient you dislike, Very useful! What about the opposite situation? How do you deal with a patient who may have a hidden agenda, like coming to you in order to avoid a legal problem or because s/he was ordered by an employer or the courts? Thanks, EdG. That's sometimes fairly easy, and might make this an Ask David. I once told such a patient that if he wanted to work with me he'd have to have an agenda of something he really wanted to change, and he would also have to do tremendous amounts of psychotherapy homework, and that this was non-negotiable, and that he or she might prefer going to another therapist who would be more of a pushover! In my limited experience, this was very effective, and seemed to motivate the man who came to me. He did, in fact, work tremendously hard! david PS We can get Rhonda's take on it, as she does forensic work. * * * Preetika asks: Recently, a client said she felt suicidal and that made me feel suicidal about how anything untoward happening on my watch! I was ‘scared stiff!’ Please do a podcast if possible on therapist fears and dilemmas. Dear Dr Burns, Thanks for sharing your wonderful podcasts, they are of immense value. I have been using your brief mood surveys and though I found it tiresome initially, I realized its value when I I uncovered suicidal thoughts in a patient that came forth only because of repeating the mood survey each session. Further, do you think a brief behavior survey at the start of a session is beneficial to record sleep, eating, and self harm patterns is needed to assess how clients are doing in between sessions? Does it have value? Recently, a client said she felt suicidal and that made me feel suicidal about how anything untoward happening on my watch! I was ‘scared stiff!’ Please do a podcast if possible on therapist fears and dilemmas. Thanks for so many continuing insights and for making therapy feel real, Preetika Hi Preetika, Perhaps you can search on website using search function and find the podcast on suicide prevention. Then let know what you think. When you use the Brief Mood Survey and Evaluation of Therapy Session, you said it was tiresome at first. What were your scores on the Empathy Scale? Scores below 20 are failing grades. Most of my colleagues, and myself, find this anything but "tiresome," but rather dynamic and fantastically challenging. Also, what percent reduction do you see in patient's depression scores within sessions? This shows your level of skill and effectiveness. 25% to 35% reduction within a session is a fairly good benchmark of sorts. This is called the Recovery Coefficient. Have you looked at that? I find it pretty exciting, and also challenging, especially when the scores don't change, and also when they do1 Thanks for the great question. David * * * Dale asks: How would you do Positive Reframing with someone who is suicidal? Would you suggest that it says that they have a strong self-awareness of the severity of their hopelessness that protects them from more disappointments? Or perhaps a wake-up call message from there awareness of some kind? All the best Dale Hi Dale, Suicide is handled differently, in part due to the legal stipulations that make therapists guilty, and you can use the search function to find and listen to my podcasts on this topic. Thanks! David * * * Miho writes: From church and from my parents, I have been told repeatedly I need to save myself for marriage thus this has been my core belief when I am dating. Although it had never bothered me before, now that I am in my last 20s it seems I have heightened anxiety and misaligned expectations when dating as literally no one around me thinks in this way, and I have been told I do not "look" like I am inexperienced. May I know which would be the best tool for combatting other people's opinions when it really does seem that their opinion is the "truth" of the world? Hello Dr. Burns, First of all, thank you (and Rhonda!) so much for providing us with a great podcast. It has helped me tremendously and it is great to hear both of your voices. Your book "Feeling Great" is amazing as well and I just can't find enough words to express my gratitude for all that you do. I have 2 questions regarding romantic relationships and your opinion would be much appreciated if you have time. (I am a female in my late 20s) 1) I feel that I tend to associate past events to the present, for example when a guy tells me that he is busy with work, even if he is genuinely busy and there is proof, I remember the time my ex-boyfriend made that excuse to actually hide the fact that he was going out clubbing and doing drugs. It is not that I don't trust the person in front of me, but rather the feelings of anxiety from past creeps up on me due to those thoughts and makes me insecure (if that makes sense). I am not sure which tool I should use to get over this kind of thinking, as in the moment when I reframe my thoughts it works, but soon after another example would set me off again. 2) From church and from my parents, I have been told repeatedly I need to save myself for marriage thus this has been my core belief when I am dating. Although it had never bothered me before, now that I am in my last 20s it seems I have heightened anxiety and misaligned expectations when dating as literally no one around me thinks in this way, and I have been told I do not "look" like I am inexperienced. May I know which would be the best tool for combatting other people's opinions when it really does seem that their opinion is the "truth" of the world? Warmest regards, Miho Hi Miho, Thanks. I will add this to the Ask David list. It will take some time, as we have lots of great questions listed at the moment. I resonate, though, as I was raised in a religious family and told not to kiss girls, etc. which was, I think, damaging.. Sex is natural and inevitable, and perhaps best left “undemonized.” At any rate, you would need to decide on your own moral values, and then we could deal with any fears of disapproval from one side or the other. Really love and appreciate your openness. d * * * Robyn writes: I would very much like to hear about how you treat patients suffering from OCD with moral/religious scrupulosity. Dear David and Rhonda: Thank you so much for your calming, effective and often laugh-out-loud funny podcasts, filled with a generosity of wisdom. I deeply appreciate them and recommend them to others also. They have helped shape my view of CBT into something far more empathetic and human. I would very much like to hear about how you prefer to treat patients suffering OCD with moral/religious scrupulosity. I understand that exposure with response prevention is considered the standard treatment, but I don't understand how this works directly with fears about things that are unethical or immoral. For example, a deeply law-abiding person who is afraid of accidentally breaking the law ("was I speeding? I need to check if that was a police camera! what if I was doing something illegal and I didn't realise it?") or a very kind person who goes out of their way not to kill anything due to fear of consequences in the afterlife ("did I just step on an ant? I'd better check the soles of my shoes in case! I don't want to wash my hands in case it kills skin mites!") And would it change anything in your approach if the patient was someone who had had negative experiences with the law through no fault of their own (ie validating their fear)? Or who had a sincere belief that they should pray to be forgiven or purified for their perceived "sins" (a coping behavior which isn't negative in itself)? How do you even go about creating willingness in the patient to see these behaviors as problematic? It seems like it is much easier to treat for a fear of cats - it's easy to make an exposure ladder to the actual fear, it's ethical and safe to expose the patient, and the experience can ultimately be very positive - which is quite reinforcing. But what do you do when the patient is suffering from a good quality taken too far (obeying the law, refraining from killing etc.)? Obviously you can't invite them to break the law or kill things because that's not moral or ethical, so I'm assuming you can only ask them to sit with the discomfort of uncertainty? Is that just as good as working with the direct object of fear itself? Or have I missed something? I'd love it if you could talk about scrupulosity sometime! Thank you very much again. Kind regards Robyn Hi Robyn, If you like, I will include in an ask david. The short answer is one that I give every week on the podcasts—I don’t throw techniques at folks based on a diagnosis or problem. As often as I say it, people don’t seem to get it, and this is the biggest problem in our field—trying to figure out how to “help” or rescue our patients. Of course, cognitive flooding might be one of 15 or 20 methods I might use, and there are tons of others, but first one has to find out what, if anything, the patient wants, and then deal skillfully with Outcome and Process Resistance. This MUST come before trying any methods. More on this when Rhonda and I discuss your excellent question. d Matthew May MD practices in Menlo Park, California. He is on the adjunct faculty in the department of psychiatry at Stanford and practices in Menlo Park, California. Although most psychiatrists rely primarily on medications, Matt tells me that the majority of his depressed and anxious patients recover rapidly without medications as a result of his proficiency with TEAM-CBT. He is also a superb teacher and has a weekly online supervision group for mental health professionals interested in learning and refining TEAM therapy skills. You can contact him via his website. Next week, Matt will join us again in a fascinating podcast on the paradoxical Nature of TEAM-CBT! Don’t miss it! Rhonda and David

Professor Yehuda’s TEAM-CBT Israeli Initiative! Today’s podcast is the latest in a series Rhonda has created featuring people who are doing interesting and creative things with TEAM-CBT. In today’s episode, we feature Yehuda Bar-Shalom, D.H.L, TEAM CBT level 4 trainer and therapist, who will teach us all about the use of TEAM in the school system. Yehuda, who is an associate professor appointed by the Council of higher education in Israel, is the first person we know to teach TEAM to school counselors in a practical way. (We also refer you to our podcast episode 152 where we interviewed Amy Spector, MFT, who is a TEAM therapist providing TEAM therapy to “at-risk” teen-agers at a high school in the San Francisco Bay Area.) Yehuda is an educator, psychotherapist and researcher. He has served as president of Hebraica University in Mexico City, the only Jewish University in Latin America which is open to students of all religious faiths. When he became the president of Hebraica University, he adapted the psychology and wellbeing department so that it became a training program for TEAM therapists. When he returned to Israel in 2020, Yehuda’s former student Victoria Chicurel, and several others, continued the Mexico TEAM training program. Yehuda has authored seven books and almost 70 academic articles on education and society, with a focus on Jewish education, social entrepreneurship and consulting in psycho-educational settings, mostly from a CBT perspective. He has been the Vice President of the David Yellin College in Jerusalem, and the Dean of Education at the Ono Academic College. His book, Educating Israel: Educational Entrepreneurship in Israel’s Multicultural Society was published in 2006. Yehuda is married to Amira Bar Shalom, and has three children. Yehuda, who in his professional life is both a therapist, educator, and researcher, earned his doctorate in education in 1997, conducting research on applying Bion’s theory in group work with adolescents.  When he was teaching school counselors, he realized he wanted to become a counselor, so, 20 years after earning his research doctorate, he went back to school and earned a Master’s degree in school counseling, and later another Master degree in the treatment of addictions. He also studied for a two-year certificate in cognitive behavioral therapy at the Psagot Institute, where he met Maor Katz, MD, Director of the Feeling Good Institute, and one of the Psagot instructors who taught TEAM therapy. Yehuda also learned about TEAM therapy by listening to the Feeling Good Podcasts. When he started listening, he thought TEAM therapy was “like a miracle.” Yehuda then attended several of David’s TEAM training workshops, as well as on-line trainings sponsored by the Feeling Good Institute (FGI). He has also studied one-on-one with Level 5 TEAM therapist, Daniel Minte. Yehuda currently teaches at a master’s level training program for school counselors at the Ramat Gan College in Israel. He is committed to teaching TEAM to school counselors for many reasons. One is that using TEAM provides school counselors with an immediate way to create a fast connection to students. In addition, TEAM can more quickly help students who are struggling with their moods, behaviors, relationships, or habits and addictions. Yehuda emphasizes the importance of T = Testing for the school counselors, and teaches them how it helps create empathy. For example, the school counselor might say this to a new student, “Oh, I see your score on anger is such and such. Tell me about that.” Yehuda explained that school counselors are like primary care physicians. They have the immediate pulse on the student’s needs and feelings. He is training the school counselors to speak with their students using the Five Secrets of Effective Communication. He also shows the counselors how to teach the Five Secrets, so their students can use this tool in their lives. He gave an example of how a school counselor might use the Disarming Technique when interacting with a child who feels angry and wants to escape. The counselor might say, “Wow, I can see that you’re feeling really angry about being sent to me for counseling and that you want to escape! I want to escape, too!” Then the child feels understood and opens up. Yehuda is also teaching the school counselors how to identify their own distorted negative thoughts, and how to positively reframe and challenge them. Once the counselors learn these skills for themselves, they can teach them to their students so that the students can learn to challenge their own distorted thoughts. The school counselors are also learning the use of paradox, so prominent in TEAM therapy, in order to help them understand their students’ motivations about why they feel and act the way they do, and how their understanding of their students’ motivations can lead to the change. The school counselors Yehuda trains are often quite skeptical and don’t believe him or David, which is understandable. He encourages them to maintain their skepticism but do an experiment and try these tools so they can see what happens. They are often pleasantly surprised by the results. Yehuda describes the counselors he trains as humble, down-to-earth, and hungry to master new techniques that can boost their effectiveness when working with troubled students. If you want to learn more about Yehuda’s work, visit his website at: https://sites.google.com/view/yehudabarshalom Rhonda and David

Live Work with Elizabeth, Part 2 (of 2) “I’m tired of being terrified. I want to be at peace!” Last week, we brought you Part 1 of a session with a women who's been struggling with anxiety and the fear of poverty every since she was 13 years old. that included T = Testing and E = Empathy, including an empathy error that David and Jill corrected. Today, we bring you the conclusion of that amazing session! After the empathy correction, Elizabeth suddenly said: “I don’t talk about this stuff very much as an adult. I’m feeling overwhelmed in a good way right now. A sense of peace is opening up.” You can review the partially completed Daily Mood Log Elizabeth gave us at the start of the sess if you click here. Her goal for the session was to get some relief from the constant pressure she put herself under to function and to keep her practice full. A = Assessment of Resistance Together, we did Positive Reframing with her negative thoughts and feelings, asking: What does this thought or feeling show about you and your core values that’s positive and awesome? What are some benefits, or advantages, of this thought or feeling? Together, we came up with this list of the positives. They keep me moving. They are very familiar. They show I’ve got a good work ethic. They show I’m a responsible human being. They show I care deeply about my family and my business. They show I’m determined to change the family history of failure and deprivation. The anxiety protects me from failure. It has kept me alive. It has paid the bills. Keeps me independent and self-supportive. Shows I’m strong and confident. Shows my love for my daughter. You can see Elizabeth’s Daily Mood Log with her goals for each negative feeling cluster if you click here. M = Methods Next we helped Elizabeth challenge her negative thoughts using Identify the Distortions, Explain the Distortions, and Externalization of Voices, starting with her seventh Negative Thought, “I need the pressure to function,” which she initially believed 100%. She identified the following cognitive distortions in this thought: All-or-Nothing Thinking, Jumping to Conclusions (Fortune Telling), Emotional Reasoning, and Magnification / Minimization. She decided to challenge the Negative Thought with this Positive Thought: I do not need pressure to function. I have functioned many times without pressure just fine. She believed this thought 100%, and this reduced her belief in the Negative Thought to 10%. Then we did Externalization of Voices with this thought and many others. Then David suggested Cognitive Flooding. The idea is to flood yourself with anxiety by imagining whatever it is that terrifies you the most. Every minute or two you record the time, your anxiety (0 to 100), and any fantasies you are having. The goal is to make yourself as anxious as possible for as long as possible. Over time, your anxiety falls, and eventually disappears. This can be frightening, and requires some courage on the part of the therapist and patient, but it can be extremely helpful and often works rapidly. Cognitive Flooding Flow Sheet   Time Anxiety Fantasy Comment 6:34 100 I am looking at my appointment schedule, which is only half full, and the phone is not ringing with new patients   6:35 100 Only two patients are scheduled, no one is calling to inquire about therapy   6:36 110 My throat is getting tight, and I’m telling myself that other clinicians in our practice rely on me, and I’m letting them down.   6:37 Eliz can fill in anxiety ratings, perhaps I’m asking myself, “What will we do? What’s going to happen?”   6:38 Eliz can fill in anxiety ratings, perhaps My schedule is drying up. My associates don’t have any patients. Jill begins with the What-If Technique. What’s the worst that could happen? 6:39 Eliz can fill in anxiety ratings, perhaps The economy is crashing. I have to let go of my associates. This is devastating. And then what? What’s the worst that could happen? 6:40 Eliz can fill in anxiety ratings, perhaps I’m standing in my office by myself. Everyone is gone. I’m alone. No one is calling for training or treatment. And then what? What’s the worst that could happen? 6:42 50 I have to keep working alone in a dark office until I’m 80 years old. And then what? What’s the worst that could happen? 6:43 30 Now I’m 85 years old, still trying to make things worse. My husband has a heart attack and Parkinson’s Disease. Now I have to treat people for free.   At this point something unexpected happened. Elizabeth burst into tears, and said: “I’m angry because this is what I’ve always wanted to do. . . I don’t want to have to charge people for therapy. I just want to treat people for free. She said the flooding was powerful, and melted the conflict she’d been experiencing: “I want to embrace therapy, and do something for free. I love doing therapy. And my biggest fear is that I cannot do that!” David suggested doing the cognitive flooding whenever she felt a pang of anxiety about her practice. You can see Elizabeth's end-of-session Daily Mood Log if you click here. Jill suggested a homework assignment for Elizabeth after the session: You can develop a cognitive flooding script with the What-If Technique. Record it on your phone, and listen to it daily until you get bored and your anxiety no longer flares up. Here is Elizabeth’s follow-up report: I did two rewrites on the script and listen to it daily for about two weeks. The in vivo exposure was to take my schedule offline for at least two weeks and stop trying to keep it full.  I took my schedule offline until Saturday, March 13th thru Tuesday, April 6th.  I have not scheduled anyone new or additional clients during this time.  And clients have not had access to my online schedule during this time. I have gone through varying degrees of anxiety and woke up once in the wee hours of the morning to worry, but overall, there has been a significant decline in my anxiety, worry and checking to see if my schedule is full. This exposure has been very powerful! Jill added this teaching point about Cognitive Flooding: You have the patient imagine the worst thing that could possibly happen and tell it in the narrative form, so it sounds like the What-If Technique playing out...For example, someone with OCD and fears of contamination can tell the story of the worst thing that could happen... "and then I would be dirty, and then I would contaminate my child, and she would get sick, and end up in the hospital, and . . . " etc. At the same time, you also focus on the patient's negative thoughts and feelings and take anxiety ratings every minute or so. The M = Methods illustrated in the podcast include: What’s my grade? What-If Technique Downward Arrow Technique. Daily Mood Log Positive Reframing Identify the Distortions Examine the Evidence Externalization of Voices Cognitive Flooding (combined with What-If Technique) In vivo exposure and response prevention (Jill’s homework assignment for Elizabeth) After each Tuesday group, we get quantitative and qualitative feedback from the members about the quality of the teaching. You can see some of the teaching feedback for the session if you click here. Rhonda and I, and all the members of our Stanford Tuesday training group, and all of our thousands of podcast fans, want to thank you, Elizabeth and give you a great virtual hug! Rhonda and David Follow-Up I just received this lovely note from Elizabeth to report on what has happened since her session in the Tuesday group. Hello Group, Last week April 7th, my schedule went back online after being offline for three weeks.  The process was seamless, my practice did not fall apart.  The other clinician's schedule did not become empty and we did not get a bad reputation.   I no longer fear I will be 80 years old, desperate with a handful of clients and supporting my husband who has a terminal illness.  Or my daughter having to financially support us both.  Even as I write this I am smiling and laughing a bit.  I do not feel driven by the fear of financial ruin nor have I compulsively checked my schedule making sure it is full.  I have more brain space for other things. I believe I have the peace I requested in my miracle cure.  Of course, I will relapse, I already have a couple of times and I have quickly recentered. A deep heartfelt Thanks to David, Jill, and all of you who participated with feedback or witnessed my personal work. My Warmest Regards, Elizabeth

“I’m tired of being terrified. I want to be at peace!” Live Work with Elizabeth, Part 1 (of 2) This podcast features Elizabeth Dandenell, LMFT, who runs a successful treatment clinic in Alameda, California for anxiety disorders, The East Bay Center for Anxiety Relief (www.eastbayanxiety.com.). She is a certified Level 4 TEAM therapist and trainer, and also helps teach mental health professionals at our Tuesday psychotherapy training group at Stanford. We are deeply indebted to Elizabeth for allowing us to publish the very personal, dramatic and inspiring work she did that evening. I also want to thank Jill Levitt, PhD, who was my co-therapist in the work with Elizabeth. Jill practices at the Feeling Good Institute in Mt. View, California (link)  where she is Director of Clinical Training, and teaches with me at Stanford. Like most mental health professionals, Elizabeth occasionally struggles with feelings of anxiety, stress, and self-doubt, and wanted to do some personal work in a recent Stanford Tuesday group. The personal work takes courage, but is crucial to the training and personal growth of all therapists. She was hoping for help with fears that have haunted her since her father died when she was just 13 years old. She explains: I started working when I was 13 years old and that is when the pressure to make money began because my father was an unsuccessful businessman. We were all just scraping by. I started working because my father was unable to pay basic bills at times like phone and electric.  Or our car didn't always run. He was not good at running his own business and money flow was very inconsistent. I discovered when I started working that I could have some control with financial stability if I had my own money and would help out paying the phone bill occasionally. This is when the anxiety of not having enough to survive kicked in and developed the" pressure" I discussed in the podcast and in my daily mood log.. This pressure to survive has has fueled my anxiety for years. My father died from Parkinson’s Disease in a nursing home when he was 77. He wa on Medicaid because he had lost everything. I was 50 when he died. You will hear many techniques that Jill and I used during the session, including Cognitive Flooding. This is, to the best of my knowledge, one of the first times that we have captured this type of Exposure live on a Feeling Good Podcast. Combining Cognitive Flooding with the What-If Technique (pioneered by Dr. Albert Ellis) makes the confrontation with your deepest fears especially powerful.  Listening to that portion of the session will be illuminating for many therapists and patients alike, especially if you are not familiar with, or confident in, the use of exposure  in the treatment of anxiety. Elizabeth’s anxiety was triggered by an exercise we did called “No Practice” in one of the David and Jill workshops for mental health professionals. Essentially, you practice saying “no” to someone who is pressuring you and making unreasonable demands on you. But in Elizabeth’s case, and perhaps for you, too, those demands are internally generated. If you click here, you can see the partially completed Daily Mood Log that Elizabeth brought to the session. T = Testing We began our session by reviewing Elizabeth’s scores pre-session scores on the Brief Mood Survey. The scores indicated only mild anxiety and minimal anger, but these scores probably do not reflect the intensity of the anxiety and terror she often feels. We then went on to: E = Empathy Elizabeth said, “That workshop exercise (“No Practice”) got me thinking about an unresolved issue I’ve been struggling with my entire life.” She explained that I’m doing too much in my life. I complain and then I take too much on and get overwhelmed. I fill my plate too much, and I tell myself that my patients need me, so I’m always taking on new patients to keep my schedule full . . . At times I get really anxious and don’t feel competent or confident. Who I am today is due to constant pushing, pushing, pushing, and never letting up. She explained that the problem started when she was 13: We didn’t have much money, and my father died penniless, in poverty in a skilled nursing facility. I’m always pushing for fear of meeting the same fate, telling myself that if I slow down I might not have enough money for my daughter’s college education, or for our retirement. I work so hard I was once even treated for adrenal fatigue. But my husband and I are not in any financial danger now, and things are fine, and I’d love to have time for more walks, for more meditation. But I’m terrified of slowing down. We did the What-If Technique to explore Elizabeth’s fear of slowing down. What was at the root of her fears? David: What would happen if you slowed down? What are you the most afraid of? Elizabeth: We might not have enough for my daughter’s college and for our retirement. David: And then what? Elizabeth: Our daughter would have to take out student loans. David: And if you did not have enough for your retirement, and your daughter had to take out student loans, what then? What are you the most afraid of? Elizabeth: My father’s life collapsed at the end, and he ended up in a skilled nursing facility with nothing. (tears) Jill pointed out a belief at the root of Elizabeth’s fears. “If I slow down, we won’t have enough money for survival. This fear has been haunting and driving me since I was 13.” Elizabeth said it felt unjust, and that she was angry that she could not take a break without feeling a sense of panic. She said, “it’s all about family values. I wish the work ethic hadn’t been driven into me so hard.” She said she’s struggled with constant worries about money, and wondering whether she can pay her bills ever since she was 13. She said, “It’s not about having fancy things—that doesn’t interest me. It’s all about survival.” Although Elizabeth and her husband are doing really well, and her treatment center is doing really well, she constantly worries, keeps her schedule more than full, and cannot say no to a new patient. She gives herself the message that she should be working longer hours, and that she can work overtime to make room for every new patient. She said, “For years I’ve wanted not to be so overwhelmed, and I’m still stuck with so much on my plate. . . ‘I’m tired of being terrified and want to be at peace. I want to learn to let go of this constant fear, but I don’t know if I can let it go. I want to feel differently, and not just do differently. “I want to be at peace with my business. I want the freedom to say yes or no. I want the freedom of choice. “If I have a day off, I don’t know what to do. It feels weird. My greatest fear is ending up in a nursing home on Medicaid, like my father.” I decided to explore this fear once again, using the Downward Arrow Technique. David: And then what would happen? What would that mean to you? Elizabeth: My daughter would see me and realize she would have to support herself. David: And then what? What would that mean to you? Elizabeth: That would mean I was worthless. (tears) That would mean I was not enough. And then I’d be rejected. Now I’m feeling so ashamed! (more tears) At this point, we summarized what Elizabeth and been saying and feeling, and asked her to grade us on our empathy so far. Would she give us an A, a B, a C, a D, or what? This “What’s My Grade” technique is powerful and helpful, but a bit intimidating for the clinician. Elizabeth said she’d give us an A- or B+. That’s not bad, but it is really a failing grade, because we’re aiming for an A. When this happens you can ask, “What am I missing?” Elizabeth explained that we’d done a great job on the thought and feeling empathy, but she did not feel as much warmth and acceptance as she was hoping for because she was feeling very ashamed about her story Jill reminded us of the need to include “I Feel” Statements to our empathy (my bad), and then we shared our feelings of sadness and admiration for Elizabeth, and quickly got an A. As a teaching point, your perceptions of how empathic you are, if you are a therapist, will not be accurate. That’s why the “What’s My Grade” technique can be so valuable. When you fall short, the patient will tell you why, and can easily make a correction and greatly enhance the therapeutic relationship. Superb empathy is desirable, and necessary if you want to do top-notch clinical work, but it won’t cure much of anything. So we’ll need something more! Next week you will hear the amazing last half of the session, starting with A = Assessment of Resistance and then going on to M = Methods, and end of session T = Testing. In next week's podcast, you'll hear the final half of Elizabeth's session and, if you like, you can also listen to some of the Q and A from the participant's in the Tuesday group who watched the session live. Rhonda and David

239: Ten Days to Self-Esteem, Featuring Dawn O’Meally Dawn O’Meally is a licensed mental health professional from Westminster, Maryland who purchased my book, Ten Days to Self-Esteem workbook (link) as well as the Ten Days to Self-Esteem Leader’s Manual for at a workshop she attended in 2002. This is a 10-class self-esteem training program for patients and the general public. The groups can be led by a therapist or lay person. This book was the basis of a large and successful treatment program at the hospital where I practiced in Philadelphia. Dawn described reading the books and telling herself, “I can do this!” Since that time, she has conducted roughly four Ten Days groups per year. The improvement in her patients has been phenomenal, due, in large part, to her spark, creativity, and gift for teaching and inspiring individuals struggling with depression, anxiety, and low self-esteem. In the podcasts she takes us through the first seven steps of the ten-step program, and reads testimonials from patients like Julie who wrote: “I had many WOW moments. This book is my bible!” If you are interested in setting up a similar program in your area, feel free to contact Dawn at dao@tcc4change.com. I think it is fair to say that today’s podcast is electrifying, and filled with the same excitement that Dawn brings to her patients! Dawn describes herself as a little like Miss Frizzle with her Magic Schoolbus. I’m not personally familiar with Miss Frizzle but it does sound like fun, exciting, and creative, three strong characteristics of Dawn. She describes how she makes patients accountable, requiring a $50 deposit they can earn back by coming to groups on time and doing their homework (HW). As a group, they also do a Cost-Benefit Analysis (CBA) on the Advantages and Disadvantages of doing the HW, and review the list of really GOOD reasons for NOT doing the HW in the book, with each member ticking off the ones that resonate with their own thinking. She said some of the most popular ones are: I’m afraid of what might happen if I DO change. I believe that others are to blame for my problems, so why should I have to change? I don’t trust Dr. Burns! I’m not convinced the exercises in this book will really make a difference in my life. Dawn described several of the “steps” in the group, including the exciting steps on “You FEEL the Way You THINK” and “You can CHANGE the Way You Feel.” She said that members found the lesson on healthy vs unhealthy negative feelings illuminating, and the lesson on the Acceptance Paradox was mind-blowing. The group trains participants in 15 techniques for crushing distorted thoughts, and some of the popular ones include the CBA, Examine the Evidence, the Double Standard Technique, and the Acceptance Paradox. She described the feared and famous “Mirror Method,” where patients pass a mirror around the group and each one has to look into it and verbalize his or her negative thoughts, like “I’m a failure,” and “I’m the worst mother on the planet.” Then they have to talk back to that thought, using the second person, “You,” as they talk to themselves in a more realistic and compassionate manner. She also does the T = Testing at each group session, tracking changes in depression, anxiety, and relationship satisfaction and sees significant reductions in scores on the mood tests by the end of the program. She also gives each participant a “report card” at the end of the program so they can see how much they progressed. Participants FEEL so much better! At the start of the group she tells participants, “If you attend the groups and do the exercises in the book, you WILL change. This material can’t not have a huge impact on your life.” She said that at the end of the ten sessions, the participants see that this really did happen. She emphasized that she greatly prefers treating people in groups, but calls them “classes” due to the stigma of “group therapy.” I, David, strongly agree, as this has been my experience as well. With a skillful group leader, and great material, magic becomes possible! Dawn has done much more, creating follow-up groups for interested patients, as well as a new program based on my new book, Feeling Great (link), so we hope to have an encore appearance from this bubbly and brilliant woman! Rhonda and David

238: Feeling Great Book Club Featuring Drs. Sharon Batista and Robert Schacter In today's podcast, Drs. Sharon Batista and Robert Schacter describe their visionary 16-week Feeling Great Book Club for mental health professionals that we mentioned in a podcast several months ago. The group was a great success, and I am super thankful to them for creating it! Sharon described how the group came into being. She’d been looking forward to Feeling Great and ordered the hardbound and the audio version as well. But she found, like so many mental health professionals, that it is difficult to keep up with career and family, and sent out a post to colleagues suggesting a possible book group to make the process of learning easier. Bob wrote back and said, “What a brilliant idea! Let’s do it!” Sharon and Bob reported that the more than 40 therapists signed up for the Book Club, which consisted of 90-minute sessions every other week. The participants ranged in experience from Level 1 to Level 4 certification in TEAM-CBT. Sharon explained that “People liked learning the parts of TEAM piece by piece. Being assigned to read 1 chapter per week gave them enough time to read and digest the material in small chunks. And people had a myriad of questions at every group.” Sharon and Bob graciously said that “a highlight for the group was the time David attended and generously gave us over two hours for Q and A.” For me (David) it was also a peak experience. Due, in part, to my narcissism, I just love answering questions, and they asked tons of really good ones! The other phenomenon they described was that “we became a group. It was comforting to see each other every two weeks with a common purpose and sense of community. People felt the group was relaxed and said they gained more understanding than from the training groups they’d been in. People were relieved to discover that they weren’t the only ones who thought TEAM-CBT was very complex.” Sharon added; “As therapists, we face lots of challenges and sometimes make mistakes. The participants got a lot of support and engaged in a process that involved learning and personal growth.” The questions from book club members began with clarifying the descriptions of the ten Cognitive Distortions. People asked questions like these: What is the difference between Overgeneralization and Mental Filtering? Why is a Should Statement a cognitive distortion? Why do some methods work better than others for various distortions? How do we know which ones to use? What is Unconscious Resistance? Why does the therapist need to become the voice of that resistance? What do you do when nothing seems to be working? Can you explain how the Magic Button leads to the “Switch” that makes someone decide to get better. How do you show empathy to someone who is suicidal? Can you explain the Death of the Ego? (This was a big question) When you are dealing with the spiritual side, how do you take the path of acceptance? What is the path of acceptance? What is the difference between a low-level and high-level solution? How can you be happy if the negative thoughts are true? How can you do TEAM-CBT when only 50-minute sessions are possible? Tell us what Enlightenment is! A major question was: Why do some people seem to not want to get better? How do you figure out what the resistance is, and how do you work through it? We shot the breeze about some of these questions in today’s podcast. If you would like to start your own Feeling Great Book Club for therapists or for lay people, and need more information, feel free to contact Sharon or Bob. Sharon M. Batista, M.D., FAPA, FACLP, FAMWA Medical Director, Balanced Psychiatry of New York  (212) 869-0515 drbatista@balancedpsychiatry.com Rhonda and I want to thank both of them and send them a big virtual hug!

Podcast 237: The Gentle Ultimatum: Can We Make Our Patients Accountable? April 12, 2021 At the top of the podcast, Rhonda reads several beautiful and thoughtful comments from listeners like you. One was an enthusiastic listener who found us on YouTube and wondered why we don’t have vastly larger audiences, since the quality of what we offer is not only free, but it beats out all the other “self-help gurus” by a large margin. Thanks for that. We are not experts in market and could use all the help we can get. So if you can spread the word for us, we’d appreciate it! David announced that his next workshop with Dr. jill Levitt will be on May 16, 2021, featuring David and Dr. Jill Levitt working with two audience volunteers who are struggling with depression and anxiety. Link to Registration Information It should be dramatic, inspiring, and profoundly educational, so you can see how TEAM-CBT really works in a live and spontaneous setting with no role-playing. This will be the real thing! One of the unique features of TEAM Therapy is the Gentle Ultimatum. At the beginning of therapy, we tell patients what will be required of them, and how the therapy works, if we accept them as patients. That way, they can make an informed decision about whether or not they want to work with us. This table illustrates what they’ll be asked to do. Problem What the “Gentle Ultimatum” involves Rationale Depression Psychotherapy homework David’s published research indicates that psychotherapy compliance has massive causal effects on recovery from depression. Anxiety Exposure Extensive research shows that Exposure is effective in the treatment of all forms of anxiety. Clinical experience indicates that full recovery from depression is difficult, if not impossible, without exposure. A Relationship Problem Giving up blame and focusing on your own role in the problem Research and clinical experience indicate that blame is probably the main cause of troubled relationships.   In the podcast, David and Rhonda discuss the rationale for the Gentle Ultimatum, as well as how to do it skillfully, and when. David describes his own reluctance to make patients accountable during the first seven or eight years of his practice, and what happened to change his mind, and how that led to the emergence of TEAM-CBT. David also describes the correct and incorrect way of presenting this to patients at the initial evaluation in a kindly, collaborative way. This requires therapist integrity, skill, and compassion. You cannot simply issue a crude “my way or the highway” demand. David also describes the Concept of Self-Help Memo that he created and began sending to patients prior to their first visit. The memo explains the rationale for requiring psychotherapy homework, briefly describes the ten most common forms of homework, and asks patients if they are willing to do homework if accepted into the clinical. The memo also asks how many days per week they’ll agree to, how many minutes per day, and how many weeks she or he will keep it up. The memo concludes with a list of “35 GOOD Reasons NOT to do Psychotherapy Homework,” and patients indicate how strongly they agree with each one. David illustrates how he discusses the memo, and the topic of homework, with new patients. David compares the Gentle Ultimatum with what happens when you go to the doctor with a broken leg. He or she might say you have to get an X-ray, and then we’ll give you a cast. If they patient protests and says that she or he is against X-rays and casts, and wants to be treated with “talk therapy,” the doctor would politely decline and explain that s/he is using a medical model of treatment, and that “talk therapy” is not offered for broken limbs. David and Rhonda explore the fairly intense resistance of many, and perhaps most therapists to making patients accountable. Rhonda describes her own inner fight about this, and how she had to terminate a patient recently because s/he refused to do homework, and opted for pure “talk therapy” from another therapist instead. The table above indicates that if the patient is struggling with anxiety, Exposure is the focus of the Gentle Ultimatum. If the patient wants effective treatment, Exposure will be required, and not an option. If, in contrast, you want help with a relationship problem, like a troubled marriage, you will have to agree to stop blaming the other person, and focus on pinpointing your own role in the problem, which can be immensely painful and humiliating. But it’s also liberating, because when you change yourself, instead of blaming the other person, you can transform trouble relationships into loving ones. Rhonda points out a potential conflict of interest with TEAM-CBT and the Gentle Ultimatum. It can lead to such rapid recovery that therapists need a large flow of patients. David mentions that one of the therapists in Rhonda’s FeelingGreatTherapyCenter.com, Sunny Choi, has this exact problem. His patients are getting better so fast he can’t keep his practice full. David urges potential patients to contact him, if interested, since Sunny is not only remarkably skillful, but he has a big heart and low fees, with a sliding fee scale, too. Thanks for listening today! Rhonda and David

Upcoming Workshops The Cognitive Distortion Starter Kit With David Burns, MD A One-Day Workshop on May 5, 2021 Click here for more information including registration! 8:30 AM to 5:00 PM West Coast Time: 7 CE Credits   Bringing TEAM-CBT to Life in Real Time Two Live Therapy Demonstrations with Drs. David Burns and Jill Levitt REGISTRATION CLOSES AT 5:30 PM PACIFIC TIME ON SATURDAY 5/15/21. NO EXCEPTIONS. Live Online Workshop with David Burns, MD and Jill Levitt, Ph.D. Click here for more information including registration! May 16, 2021 | 7 CE hours. $135 8:30 AM to 4:30 PM West Coast Time   Binoy asks: How does one know that a thought is a good one or a bad one? Or put in another way, how do I know if my fortune telling thought is really a fortune telling one? What is the basis? Binoy also asks: Is there something called “objective truth” that we can all agree on? Kristina asks: I have been labeled codependent in therapy. Is it a true label? . . . Do you believe in highly sensitive or empathetic people that can feel others energy? Fabrice asks: What do you think about this definition of the “self?” Don asks: Is TEAM as effective as you say? Binoy asks: I live in an Arab country and some of the things on your list of Shame-Attacking Exercises could get me arrested. Is there a better way to overcoming anxiety? * * * Binoy asks: Hi David, I just listened to podcast 079: “What's the Secret of a "Meaningful" Life? Live Therapy with Daisy." One of the questions that came across my mind is, how does one know if a negative thought is a good one or a bad one? Or put in another way, how do I know if my fortune telling thought is really a fortune telling distortion? What is the basis? Hi Binoy, thanks! Excellent question I might address on a future Ask David podcast. However, I would need you to give me a specific example of a thought you want help with. Specifics typically lead to illumination, whereas abstract thoughts sometimes lead to endless pontification. Binoy also asks: “Hi David, I did listen to the podcast #20 on “The Truth About Antidepressants.” I wish everyone agreed that there is something called objective truth. This is a question about truth or the existence of objective truth. Is the popular ideology that there is nothing called objective truth (everything is relative) correct? How can we talk about truth in a way that will help us be on the same page? So, I hope to hear from you again! Hi Binoy, this is also an abstract question, best answered through specific examples. For example, I can explain the concept of controlled outcome studies to test a drug against placebo, but even there you can find lots of ways to challenge any scientific study. We can also talk about distorted negative thoughts that trigger negative feelings like depression and anxiety. These thoughts are not really true. but we always focus on one specific thought at a time, and only from someone asking for help. I do not pontificate about “truth” in some abstract sense! All the best, david * * * Kristina asks: I have been labeled as codependent in therapy. Is it a true label? Hi Dr. Burns, Thank you so much for all your services and help that you offer Dr. Burns. It has been life changing and I’m just starting to help myself out of this anxiety and depression. I wanted to ask how you feel about the terms, codependency and boundaries. I have been labeled codependent in therapy and is it a true label? Do you believe in highly sensitive or empathetic people who can feel others’ energy? Thanks again for all you do! Thank you, Kristina   Hi Kristina, I had to look up the term. According to dictionary.com, someone who is codependent “is in a relationship in which one person is physically or psychologically addicted, as to alcohol or gambling, and the other person is psychologically dependent on the first in an unhealthy way.” David and Rhonda can mention: the “codependency” and compulsion to “help” or “rescue” that often gets therapists into trouble with patients. This is a kind of addiction that therapists have, and is the main cause of therapeutic failure. that I work with specifics more than labels. For example, if a patient wanted help with “codependency,” I would ask him or her to describe a specific time on a specific day when this seemed to be a problem. Then I’d figure out what was going on, and find out if it was an individual mood problem or a relationship problem. After empathizing, I would find out what, if anything, the patient wanted help with, and then I’d bring the resistance to change to conscious awareness. My research on empathy indicates that even therapists are not accurate in sensing how their patients feel. The same is true, I believe, of the general public. People vastly overestimate their capacities to understand how others are thinking and feeling, and this is super easy to demonstrate with simple experiments using rudimentary statistical analyses. David * * * Fabrice asks. What do you think about this definition of the “self?” Hi David & Rhonda, Start with this: When I refer to my "self," I am speaking of the sum of my experiences and the trails they have left in my mind, my body, and my life circumstances, as well as the material things that are associated with me, beginning with my body, symbolized by the name printed on my ID card. This "self" has certain characteristics, including past actions, habits, patterns, qualities, flaws, etc. So, the first question is, how can you say that this "self" does not refer to anything? I know very well who I am, and I am distinct from any other "self" that presents him/herself to me. The second question is, based on the previous definition, why can't I pass judgment on the different attributes of that "self"? If that self has never been able to solve a linear equation, can't I call it "bad at math?” If that self almost always turns in its assignments after the deadline, can't I call it "slow" or "procrastinating?” And so on. I agree that passing negative judgment on a self can lead to that self having some unpleasant emotions, but that doesn't mean that those judgments are meaningless. I suspect that some listeners were turning over thoughts like these in their minds. I hope that gives you something to sink your teeth into. I'll try to be more specific about future episodes. Take care, Fabrice Nye Hi Fabrice, Thanks! When I get time to redo the deleted chapter on the “self” from Feeling Great, I can perhaps include these questions, although I did pretty much cover them in several of the later chapters in Feeling Great on the impossibility of judging the “self,” as opposed to things we think, do, or say. My problem is that people don’t “get” or “grasp” what I’m trying to say. Below, you seem to think I believe the “self does not exist,” and you have some excellent attempts to define it and prove that it does exist. At least that’s my take on it. My position is radically different. To me, the statement “the self does not exist” and “the self does exist” have no meaning. The statement, “I don’t know if the self exists” also has no meaning to me. This is language that is “out of gear,” so to speak, as Wittgenstein might say. You can press on the accelerator all you want, but the car won’t move forward when it is not in gear. But most people, nearly everybody in fact, have tons of trouble grasping this. You probably “get it,” I don’t know! I am just referring to your email, where you say the self is such and such. Nouns do not always refer to “things” that could “exist” or “not exist.” Still, when I say this, it goes in one ear and out the other, I’m afraid! And that was why Wittgenstein was intensely lonely and frustrated, and often depressed, and perhaps why he never attempted to publish anything during his life. You can certainly say, “I’m not very good at math. In fact, I’m below average at math.” This means that your math skills are below average. Does it also mean that your “self’ is below average? Many of my skills and attributes are below average, but that does not upset me or threaten my feelings of self-esteem for two reasons: I don’t believe that my worthwhileness as a human being depends on anything. I don’t believe that “worthwhileness as a human being” has any meaning. I don’t believe the statement, “the self exists,” has any meaning. What would it be like if “the self” didn’t exist? What are we actually talking about? But if I judge my “self” to be “inferior” or “worthless” or “below average,” that type of self-critical thinking can cause a lot of emotional pain, and can, in extreme cases, even lead to suicide, thinking that “I am not good enough.” david I asked Fabrice if he wanted to comment on my response above, and if I should include it in the show notes. He gave a really cool answer: Hi David, Yes, you can absolutely include it. From your response here, you ought to make it clear that your point is that the language is not meaningful, therefore the word, "self," is not meaningful. But you may need to delve deeper into this. If you do that, you're going to end up at the same place the Buddha ended up when he discovered the ultimate emptiness of things. Of course, he didn't talk about "things," since that's meaningless too, just emptiness. Fabrice Nye By the way, you may enjoy Fabrice’s new podcast. Here’s the link: https://podcasts.apple.com/us/podcast/peace-at-last/id1496573038 The following email might also help. Hi Rhonda, Here is the other Ask David with the remainders from our last one. If we use this one, let’s please be sure to include your through about your “self” as “a mom,” “a psychologist,” and so forth, and how I responded to it, as I thought that was really helpful. We can judge and talk about what we DO, and not what we ARE. We can use the word, “self,” in a variety of ways that are meaningful. For example, Behave yourself. This means stop behaving badly. Just act like yourself on the date. This means don’t try to impress your date. Instead, show an interest in him / her. Why you write, try to tune I on your true “self,” and stop acting so fake. This means you need to change your tone of voice when you write. Share more of your feelings and vulnerabilities. All these uses have specific meanings. They are not metaphysical or philosophical claims, just attempts to influence someone’s thinking, feelings, or behavior. “Self” is just a sound that comes out of your mouth. It is not an esoteric or metaphysical “thing” that could “exist” or “not exist.” Aristotle thought that nouns were descriptions of “things” that existed in some ideal alternative reality. For example, he thought that tables are just imperfect examples of some perfect essence of “tableness” that exists somewhere. This erroneous view of language gave rise to most of the problems in philosophy, as well as most of our emotional problems of feeling we have a “self” that isn’t important, or isn’t worthwhile, or isn’t good enough, and so forth. d * * * Don asks: Is TEAM as effective as you say? Hi Dr. Burns, I feel compelled to say, with the greatest respect and affection, that the very concept of successfully treating my lifelong battle with depression, anxiety, and ocd within a few hours seems, at face value, far too good to be true! Is it really possible? I've endured countless disappointments and treatment failures from many, many therapists, all of whom wasted months or even years of my time, essentially to no avail. Tell me again: Is short term treatment, as described, as potent as TEAM promises. It's just so hard to believe! DBs Comment: Don went on to describe chronic severe mood problems and recent intense feelings of anxiety due to medical problems in his family. Hi Don, Good questions. Here are some thoughts. Effectiveness depends on the skill of the therapist, and TEAM is challenging to learn. I’ve been at it for more than 40 years, and have used T = Testing at every session with every patient. This has been my greatest teacher—my patients. Some of my students have achieved high levels of skill, and they are the ones who have put in tremendous effort to learn. There are not yet many of them, sadly, and that’s why I’m working on an app. . . . So I can make these tools available to large numbers of people who are suffering. We will be starting a new beta test in a few weeks. It is in progress, and very labor-intensive to develop, but if it works, it will be fantastic. An inexpensive way to find out if TEAM is for you, and you have perhaps done this already, would be to read Feeling Great and do the written exercises while reading. Then you’ll find out if you like the new methods, and if they are helpful for you. I assume you’ve already read Feeling Good and done the exercises. Is that correct? The results I report are the results of my work with patients, using TEAM. I only report truthful things, and don’t fabricate results! I am analyzing a huge data base of thousands of TEAM therapists at the Feeling Good Institute, but it is a naturalistic study, and interpreting the results is challenging for a variety of reasons. The mean reduction in depression scores in a large number of severely depressed individuals in four or five sessions was 59%, which is excellent. It is little bit hard to interpret that result because when patients recover, they drop out of treatment, so the mean depression score in the data you analyze at any session is the mean of those who are still in treatment who have not yet recovered. Therefore, the analysis is potentially biased in a negative direction, if you see what I mean. My published research shows that psychotherapy homework is crucial to success. Some patients are strongly opposed to doing homework, and they are likely served better by therapists who do not believe in the value of psychotherapy homework. The rapid recovery I see is in the treatment of depression and anxiety. Relationship problems are much more challenging to treat due to the intense resistance people have to looking at their own role in a problem instead of blaming others. Habits and addictions can be slower and more challenging, too, since the temptations to give are so pervasive and powerful. Thanks! I hope this information in helpful for you. Here’s an afterthought. Sometimes when people ask me if this will really work, they are actually skeptical or even annoyed, and expressing resistance or a lack of enthusiasm for the treatment techniques I have created. I do not try to sell patients on anything, and feel strongly that people should find an approach they are enthusiastic about, even if it is radically different from the methods I have developed! I strongly applaud skepticism and critical thinking, but it is also true that trust and TEAMwork are vitally important dimensions of successful treatment. If a patient is putting up a wall and resisting, that must be dealt with first before there is any chance for success. The approach to resistance is radically different from answering questions as I am doing here. I hope that makes sense! Here’s the type of thing I’m saying, or trying to say. If you’ve been burned in the past, and had negative therapeutic experiences, it would make sense that you’d be reluctant to trust, or to hope, or to collaborate, for fear of being let down yet again. I would want to bring this issue to conscious awareness at the start of therapy with anyone who has strong feelings of skepticism, and anyone who is saying “prove it to me” when we start therapy. Almost all the patients I’ve treated have had months, years, or decades of failed therapy in the past. But that’s not so crucial. The crucial question is, can we work together with some trust and enthusiasm and teamwork? And are you willing to do what will be necessary for a positive outcome? This might include doing regular psychotherapy homework, being willing to use Exposure techniques for anxiety, like OCD, and so forth. Lots of people don’t want to do homework or use exposure, and they may have other objections to the treatment, which I honor. I don’t try to persuade or twist arms, since those approaches are doomed to failure. Not sure if this makes sense, or if I’ve expressed my thinking clearly. david * * * Binoy asks: I checked the list of shame attacking exercises you have suggested for social anxiety. I live in an Arab country. Some of the things on the list could get me arrested. Is there a better way to overcoming anxiety? Hi Binoy, Perhaps you can tell me what Shame Attacking Exercises would get you arrested! Since I’ve listed more than 100, perhaps you could choose ones that will not get you arrested! In addition, I never throw techniques at people based on a diagnosis or problem, but work systematically using T, E, A, and M. In addition, I use four treatment models, and more than 50 techniques, when I am treating any form of anxiety. There is a free anxiety class on my website. Check it out!  

235: Anger in Marriage Several months ago. a professional dancer named Brian emailed me with an Ask David question on how to deal with anger in marriage using the Five Secrets of Effective Communication. I was pretty excited because anger in marriage is a problem nearly everyone can identify with, and something we all need some help with! Brian and his family Brian said that he and his wife, Michelle, have been married since 2009, and while he loves Michelle a great deal, their relationship runs hot and cold, with frequent angry clashes. I asked Brian for a specific example, including a partially filled out Relationship Journal (RJ), so I could get some details on what his wife said to him, and what, exactly, he said next, during one of their conflicts. Brian and his wife, Michelle The analysis of this exchange will provide us with a crystal clear example of the type of problem they are struggling with, along with the opportunity to pinpoint the specific errors Brian is making in responding to his wife’s criticisms. In the example he sent, she said that he wasn’t doing enough to help put the kids to bed one night, and he responded by saying nothing. He analyzed his response with the EAR technique from my book, Feeling Good Together. By ignoring her, it was obvious that failed on E = Empathy (he did not acknowledge how she felt), and A = Assertiveness (he did not share his feelings), and on R = Respect (he did not express any warmth, respect, or love for her.) He was able to see that this response will make the problem worse and force her to keep criticizing him. When he ignores her, she feels even more hurt, ignored, abandoned, and unloved. As a result, she’ll keep criticizing him since he hasn’t yet listened or “gotten it.” So although he feels like an innocent victim, he’s actually the secret creator of his own interpersonal reality. In other words, he forces her to do the very thing he’s complaining about. That’s the purpose of the Relationship Journal (RJ) —to help you see your own role in a conflict. It’s an amazing but pretty painful tool that’s potentially liberating. At my urging over the past several months, Brian worked really hard studying the Five Secrets of Effective Communication (LINK) and doing the written exercises in Feeling Good Together. After a rocky start, with some notable failures in his attempt to improve his interactions with his wife, he slowly began to “get it,” and their relationship began to improve a lot. Brian joins us today to describe his journey, and share his excitement about my first book, Feeling Good, as well as Feeling Good Together. I am really proud of what Brian has accomplished through commitment, practice, and hard work, as well as his courageous willingness to look at his own role in the problem. This is nearly always painful, and requires the “great death” of the “self,” or “ego.” During today’s podcast, we practiced with the “Intimacy Exercise.” This exercise can help you improve your skills with the Five Secrets. Here’s the way it works. To get things started, either Rhonda or David will play the role of Brian’s wife, and Brian will play the role of himself. We will criticize Brian in the way his wife sometimes criticizes him, and then he will respond, using the Five Secrets. For example, she recently said: “When I was on the phone with my best friend, you were rude and selfish, and making too much noise with the video you were creating.” Then he responded and we gave him a grade, and pointed out what he was doing right and what he was doing wrong that needed improvement. If you check your ego at the door, this can be a great, but challenging, way to learn! Brian gave himself a C on his response, which you’ll hear in the podcast, and Rhonda agreed. She also gave him a C. I gave him a B, as I thought he did some pretty cool things while making several errors. Here’s where he needed improvement. His use of the Disarming Technique needed upgrading. He didn’t strongly and directly endorse the truth in his wife’s criticism. For example, he might say something like this: “You’re right, I was being insensitive and selfish, and I’ve done that to you so often over the years.” His response would benefit from the inclusion of some “I Feel” Statements,” since it sounded a bit mechanical. For example, he might say, “I feel really sad and ashamed to hear you say that I was selfish and insensitive, because you’re absolutely right, and I love you so much.” There was no Stroking, and I included one way to do this in the “I Feel” response I just described. His Thought Empathy was good, but there was no Feeling Empathy. In other words, he did not mention how sad, hurt and angry his wife might be feeling. He did not finish with a sound use of Inquiry that would invite his wife to open up even more. For example, he could end by asking her to tell him more about how she feels when he’s being insensitive and selfish, and how hurt, angry, and lonely she might feel. Brian was non-defensive and open to this feedback. Then we did role reversals to give him the chance to try these new approaches and boost his grade. Here’s a comment he wanted me to share with you: Learning and implementing the 5 Secrets of Communication literally helped to save my marriage. The breakthrough came for me when I was really able to grab hold of Feeling Empathy, and really delve deep into understanding how my actions hurt my wife. This was one of the hardest challenges I've ever had in my life but the deeper I got into my wife's heart and mind, the more my anger dissipated and was replaced by empathy, warmth and love for my wife. I am no expert by any stretch of the imagination and in the podcast, both Rhonda and David went over some really cool role play to help sharpen my skills in the 5 Secrets. My hope is that by sharing my story it will help to provoke some helpful thoughts in the listener to help them continue to grow in their relationships. Brian Brian also said that he is a Christian, and loves Jesus, and that one thing he appreciates about the Five Secrets is that it is deeply connected to Christian teachings. For example, here’s a quotation from Matthew 7:3: “And why beholdest thou the mote that is in thy brother's eye, but considerest not the beam that is in thine own eye?” I strongly agree with Brian’s take on this, and believe that the Five Secrets of Effective Communication can be viewed as both a psychological and a spiritual tool. I would add that the Five Secrets, as well as all of the techniques in TEAM-CBT, are compatible with most if not all religious traditions. I have often said that the moment of profound change—the moment you recover from anxiety or depression, for example—will nearly always have a spiritual meaning, but the details of your interpretation will depend on your religious or philosophical upbringing. I like to emphasize this because my father was a Lutheran minister, but he seemed pretty suspicious of psychiatrists, thinking that psychiatry and religion were inherently at odds with one another. Some deeply religious people have seen me, as some kind of pariah, or enemy of religion. When I lived in Philadelphia, I went to Lancaster, Pa, on ten consecutive Saturday mornings to teach CBT at a beautiful religious hospital there. I enjoyed teaching their staff a number of new techniques for treating depression. They told me that one of the local evangelists had a Saturday morning radio show, and that whenever I came to town, he would say, “the snake has returned to Lancaster” on his show! I think it is because I quoted the Buddha on something, and some of the more conservative folks didn’t take kindly to that comment! I guess they thought that the Buddha was the same as the devil! I see religion and psychotherapy, in contrast, as synergistic. Although all of my work is totally secular, and based on research and clinical experience, the overlap of TEAM-CBT with all religious traditions is clear and unmistakable. I love it when clergymen, rabbis, or imams attend my workshops and point out the common grounds with what I’m teaching and their theological beliefs. We did more role playing during the podcast, as Brian also wanted to focus on his feelings of insecurity resulting from relentless self-critical thoughts, like, “I suck at dancing, so I’m worthless”. We used THE Externalization of Voices along with the Acceptance Paradox, the Self-Defense Paradigm, and the CAT (Counter-Attack Technique) to challenge his negative thoughts. We also used Positive Reframing to reduce his resistance to giving up his self-criticisms. We did a number of role plays with role reversals, just as we’d done earlier when practicing the Five Secrets. Brian was incredibly fun to work with, and Rhonda and I developed great affection and admiration from him. We’ll try to post some follow-up, too, once Brian has had the chance to listens to the audio with his wife We can perhaps get her responses to the show and include them in the show notes. There were at least two keys to the rapid progress Brian has made learning to use the Five Secrets of Effective Communication with very little input from me. He is very much in love with Michelle and intensely committed to improving their relationship. He has high standards and is willing to put in the work that is necessary to master the Five Secrets of Effective Communication, not only in his interactions with his wife, but also with people in general. He has also been willing to put in the work to learn to change the way he thinks and feels, so he can modify his internal dialogue as well as the way he communicates with others. Your internal and external dialogues will often fuel each other. You know that Brian is a professional dancer. Can you guess what he does for a living? I was surprised and delighted to learn that Brian runs a Break Dance School in Long Beach, California, for children, teens, and adults. Here is the link in case you want to contact him or sign up for some awesome break dance classes! Webreakdance.com Instagram.com/Webreak Here are some awesome video links you can watch: Webreak Soul Evolution Crew Performance: https://youtu.be/M4FzENnYXj4 Brian Breakdancing Solo: https://www.instagram.com/tv/CHjr8yXhGk7/?igshid=1341ipmr311ho

Announcements / Upcoming Workshops March 24, 2021 Feeling Great: A New, High-Speed Treatment for Depression and Anxiety. A One-Day Workshop by David Burns, MD. sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration!   April 7, 2021 Bringing TEAM-CBT to Life in Real Time, by David D. Burns, MD. A Half-Day Live Therapy Demonstration Sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration! * * * Podcast 234: How To Deal with Whiners and Complainers In today’s podcast, we bring to life two of the earliest CBT techniques I developed way back before I wrote Feeling Good: The New Mood Therapy. The are: The Anti-Whiner Technique The Anti-Heckler Technique they are both based in two of the Five Secrets of Effective Communication: The Disarming Technique: You find truth in what the other person is saying Stroking: You find something positive to say to the person In addition, if appropriate you can include Feeling Empathy, especially in the Anti-Whiner Technique. This means that you acknowledge how the other person is feeling The Anti-Whiner Technique Most of us know someone who tends to whine and complain a great deal, and you might have noticed that when you try to help them, cheer them up, or give them some advice, their whining and complaining just escalates, so you end up secretly frustrated and annoyed. If you’re tired of this pattern, you might want to try the Anti-Whiner Technique, which can be incredibly effective, but it’s anti-intuitive. You simply agree with the person who’s complaining, and give them a compliment. Rhonda and David will illustrate this with complaints like these: Nobody cares about me! I never get to do what I want to do. Nobody likes me. I never get invited anywhere. I never get to do anything fun. I’ve tried everything and nothing seems to help. All the doctors just seem to care about themselves. Nobody listens to me! Life is unfair. People only care about themselves I have to do everything for myself. Nobody helps. I can’t hear very well, my sight is deteriorating, and I’ve got hemorrhoids! What can I do? Preparation H doesn’t help at all! My students just don’t listen. This younger generation is totally screwed up! Nothing helps! I’m depressed all the time. I’ve tried everything. No one every said one kind thing to me! I’ve got so much to do, but I just can’t get started, and everything just keeps piling up! The Anti-Heckler Technique I love treating public speaking anxiety because I used to struggle with this problem myself, but now I totally love public speaking. One of the many reasons that people fear public speaking is because they’re afraid someone in the audience will become critical or hostile, or ask them something they can’t answer. The Anti-Heckler Technique is fairly easy to use, and works like a charm if done skillfully. It’s similar to the Anti-Whiner Technique we just illustrated. Just make a list of hostile things that the audience member from hell might say during your talk, or during the Q and A period, and then respond with the Disarming Technique plus Stroking. Rhonda and I will illustrate this with these kinds of critical comments. You’re full of shit and you know it! What you’re saying isn’t true and doesn’t make sense. You’re a total fraud and a fake. You're not supposed to say that. You talk too fast. You are confusing. You don't know what you're talking about. You are not following the outline you gave us. It's too cold, too hot. You're wrong about that. You are quoting outdated research that's been debunked already. I didn't like it when you made jokes. You don't know enough to teach this class. You're disorganized, incomprehensible, and boring. You always call on the same people in the audience, you play favorites. Rhonda and David also explore why it is so hard to use these techniques in our personal and professional relationships, and why we lapse into adversarial defenses when we could collaborate with others in the spirit of mutual exploration and learning. Most of it has to do with the idea that we have a “self,” or “ego” to defend! As the Buddha so often said, “Selves are cheap. Selflessness is dear!”

Phillip with his brother, (Paul), his mother (Maureen) and Ladybug (Labrador). Phillip Lolonis joins us again with vital information we forgot to explore in his first podcast two weeks ago. Phillip's interest in the treatment of schizophrenia stemmed from his relationship with his brother, who suddenly and unexpectedly developed schizophrenia when he was 19 years old. and Phillip was 26, One of his motivations to become a therapist was his anger and disillusionment with the treatment his brother received that was medication focused and somewhat formulaic. Phillip thought the impact was somewhat detrimental. In today's podcast, we explore how to use the Five Secrets of Effective Communication, and especially the Disarming Technique, in interactions with individuals with schizophrenia. This can be difficult and challenging, because many of the things the patient says are delusional and can't possibly be true, like "I know you're plotting against me!" And yet, as David points out, if you listen to the "music" behind the words, you will see that the individual is saying something that's absolutely true. He or she is just expressing feelings in a symbolic manner. And if you find the truth in what the person is saying, he or she will nearly always calm down and feel heard and respected. Rhonda, Phillip and David demonstrate this in role-playing, using statements like "You're against me!" David recalls his treatment of an angry young university student with severe paranoid schizophrenia who responded beautifully to Dr. Stirling Moorey, a (then) visiting medical student from London who was doing cotherapy with David so he could learn the then-new cognitive therapy. Stirling used the Disarming Technique when the young man insisted that the police were trying to prevent him from seeing John the Baptist who had secrets about the spiritual human of the human race. When Stirling expressed interest and found truth in what the young man was saying, there were immediate and dramatic results. David described this interaction in his first book, Feeling Good. Phillip said he's experienced similar things with his brother, and that this new way of communicating has been helpful. Rhonda commented that we've had many podcasts recently on the Five Secrets of Effective Communication. These techniques are very challenging to learn, for technical and human reasons, but incredibly rewarding if you're willing to learn them and let your "ego," or "self," die. Phillip asked us to add these comments to the show notes:  I'd like to add that the place that has been a godsend for my brother and our family is called the Putnam Clubhouse he regularly attends but not during covid,  it's tough on everyone especially the severely mentally ill, in terms of isolation.  They do have zoom meetings and come by members' homes to deliver food and goodies during covid.   It's a place that provides socialization, work, gatherings with music/poetry and outings like going to a baseball game. They are part of a larger organization world wide.  This is the link to the Clubhouse in Contra Costa County. and this is the link to the international Clubhouse for the severely mentally ill            Rhonda asked me the question if have I ever been afraid of my brother. That was a good question, Rhonda and I didn't answer very well. Only once in the 20 years of my brother's disease have I been afraid of him.  People judge my brother as potentially violent when in fact he’s terrified daily because of the violent voices towards him he hears.  My brother is stigmatized by the world as dangerous when the facts state that most people with schizophrenia are preyed upon, like my brother has been over the years---people taking his money, people crossing the street to avoid him, people calling the police on him, etc.  When he is upset or angry, and I respond with 5-Secrets, especially a strong  "I Feel" Statement, his rage softens immediately. Your question itself, "was I ever afraid?" is a misnomer. Here's a better question: Is my brother afraid? Yes, every day he's afraid of being misunderstood, stigmatized, hospitalized by the police (5150) but mostly he is afraid of the voices hurting him. And my mother and I are afraid someone will eventually hurt him, or he will take his own life because he has stated that he has done enough over the years to defeat the voices but they won't go away.  So at times he feels hopeless.

  Announcements: Feeling Great Book Club We're excited to announce a Feeling Great Book Club for anyone in the world, supporting people in reading and learning from David Burns' powerful and healing TEAM-CBT book Feeling Great with questions and answers, exercises and discussions in large and small groups. It will meet online for an hour at a time for 16 weeks on Wednesdays starting March 17 at 9am and 5pm Pacific Time - which should allow for fairly reasonable hours from anywhere in the world. Note that the group is intended to provide education but NOT therapy or treatment. Cost is 8$ per session paid in advance, but people will be able to pay whatever they can comfortably afford and no one will be turned away for lack of finances. The group will be primarily led by Brandon Vance, a psychiatrist who is a level 4 TEAM therapy trainer who has studied with David Burns since 2011. Please go to https://www.feelinggreattherapycenter.com/book-club to find out more and to register. Your Book Club Teacher: Brandon Vance, MD Upcoming Virtual Workshops February 28, Self-Defeating Beliefs: How to Identify and Modify Them, a one day workshop for mental health professionals. 7 CE credits. Featuring Drs. David Burns and Jill Levitt, sponsored by FGI, Mt. View Click here for more information including registration!   March 24, 2021, Feeling Great: A New, High-Speed Treatment for Depression and Anxiety. A One-Day Workshop by David Burns, MD. sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration!   April 7, 2021, Bringing TEAM-CBT to Life in Real Time, by David D. Burns, MD. A Half-Day Live Therapy Demonstration Sponsored by Jack Hirose & Associates, Vancouver Click here for more information including registration!   Today's Questions Brian asks: Can negative thoughts lead to high blood pressure? Thank you Jim asks: I’m having panic attacks! What should I do? Adam asks: Shouldn’t we get rid of the terms, “Positive Thoughts” and “Self-Defeating Beliefs?” Phil asks: Hi David and Rhonda! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions? Nandini asks: How do I get your Decision-Making Tool for help with habits and addictions? A man from France asks: After listening to Podcast 003: E = Empathy — Does It Really Make a Difference?: “How do we do when the person, we are having a conversation with does not feel comfortable in sharing his/her feelings and thoughts, or does not know how to deal with feelings and thoughts when hearing them? Thomas asks: What would you say to a person who wants more ego strength.? * * * Brian asks: Can negative thoughts lead to high blood pressure? Thank you Thanks Brian. I don’t know the answer to your excellent question. One big problem is that much, if not all, of this type of research is of pretty poor quality. When I review research articles, my focus is not on “what are the implications of these findings,” but rather on “what are the flaws in this research study?” Usually, the flaws are so severe, at least to my way of thinking, that the findings are not worth interpreting. I apologize for this answer, as it is way less exciting than speculation! On minor point would be that if you believe negative thoughts, you will experience feelings like depression, anxiety, anger, and so forth. So the real question would focus on whether elevations in negative feelings are associated with increases in blood pressure. One common phenomenon is that some people get very anxious when their blood pressure is measured, and this, it appears, can lead to temporary blood pressure elevations. So, sometimes the doctor or nurse will ask the patient to sit quietly for a little while, and will then repeat the blood pressure measurement. So, it might be the case that people who are more prone to feelings of anxiety would have more fluctuations in blood pressure. But the question then might be—are these temporary fluctuations associated with generally elevated blood pressure? I don’t think they are, but I’m not up on the latest thinking on this topic. david Brian adds: David Burns Last night, I was having stressful thoughts about family and I checked my blood pressure and it was way up, so I think it does. 🙂 Cool, nice research! You can also see if changing those thoughts and feelings leads to a reduction in BP! d Dr. Burns i did and my stress lowered and so did my blood pressure Way to go, Brian! Kudos! david * * * Jim asks I’m having panic attacks! What should I do? Dear Dr. Burns, I recently bought copies of Feeling Good, Feeling Great, and The Feeling Good Handbook, and studying them has been remarkably helpful so far. Thank you for writing them! I hope this is not too forward, but I am struggling with one immediate difficulty: within the past two weeks, I have had two panic attacks that brought on heart palpitations, and it's created a cycle of anxiety that I can't seem to break. My central issue is that I can't seem to isolate a thought that brings on the initial feelings of worry (followed by flushing of the face and then skipped heartbeats) The first attack happened in the car after visiting a store, and the second happened while waiting on line at a store. I have seen a cardiologist, and so far all my blood work and EKGs have come back normal. Whatever help you can give or resources you can share would be sincerely appreciated. Thank you, Jim David responds by emphasizing: My book, When Panic Attacks, will give you great tools for understanding and overcoming panic. I use four models in treating all forms of anxiety, including panic: the cognitive model the hidden emotion model the motivational model the exposure model You can find podcasts that detail all of these approaches. I describe the kinds of thoughts that typically trigger panic, and how to defeat them! * * * Adam asks: Shouldn’t we get rid of the terms, Positive Thoughts and Self-Defeating Beliefs? I have a few questions about some of the Semantics on the Daily Mood Log and the Self-Defeating Beliefs list: On the Daily Mood Log, there is a section for positive thoughts. My understanding is that the goal isn't necessarily to think positively, but instead to correct distortions so that the person is thinking realistically. A lot of the thoughts I hear reframed on the podcast aren't necessarily positive, but instead capture a more realistic or balanced perspective. If I'm understanding correctly, positive thinking may actually cause your thoughts to be distorted in the opposite direction. My experience has been that often times when you speak with people about positive thinking, they will end up in the territory of positive distortions. I'm wondering what you would think about calling this column 'Realistic Thoughts'? One of my favorite tools that I've used both for myself and for my clients is the list of Self-Defeating Beliefs. So often when I use the "Downward Arrow" technique with a client, it leads to one of these beliefs, and it is really helpful to have clients identify the beliefs on their own accord. With that being said, one thing that I personally feel some reservation about is calling the beliefs "Self-Defeating." Similar to positive reframing, it often seems like the goal of these beliefs is to protect the person or give them some benefit, and that the side-effect of that protection is the self-defeating part. For instance, being perfectionistic may be intended to protect people from criticism (protective and helpful), however never allows them to see that it's okay to make mistakes (unhelpful and self-defeating). This is often revealed through the cost-benefit analysis, and I like the idea that the individual gets to decide if the belief is self-defeating or not after the CBA. In that way, I wonder if calling them "Self-Defeating" from the start may bring up resistance, as it assumes the belief is more unhelpful than helpful before the client has really done the work to decide that. I've had a harder time thinking of another name that captures this, but I'm wondering what you think about the term possibly leading to resistance? As always, I appreciate the effort that you and Rhonda have put into the podcast and I'm looking forward to what you have to offer in the next year! Be well, Adam Holman, LCSW, SUDS Hi Adam. Thanks for your ideas! I’m kind of sticking to the current wording for many reasons. One problem is that any terms you might suggest will have tons of positive and negative aspects, and the art is in the delivery of the therapy, and not so much in the names of things. I have not run into any resistance with SDBs, but rather enthusiasm from most (nearly all) folks. Still, your ideas are all correct. SDBs have huge positives, absolutely. In Philadelphia, we started with “Automatic Thoughts” and “Rational Responses,” which were Beck’s terms. However, 25% of the patients at our inner city hospital had not made it through the fifth grade, and they found these terms intimidating. But they DID understand Negative Thoughts and Positive Thoughts! People used to think the term “psychotherapy homework” was aversive and people would be more compliant ii if we changed the name to “self-help assignments.” But the name was NOT the issue, motivation was the issue, and the term “psychotherapy homework” is actually way more useful, as it lets the patient know what will be required if they want this type of treatment. If they do want a form of therapy that requires “homework,” then I am not the therapist they are looking for! Semantics are important, and different people will perhaps want their own words and terms for things! Sincerely, david * * * Phil asks: Hi David and Rhonda! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions? Hi Dr. Burns, First of all I want to wish you and Rhonda a very Happy New Year. We are off to a rocky start, but things will get better soon! I loved the podcast on jealousy and anger as it really showcased a ton of TEAM techniques and tools. I had a question that perhaps you'd be willing to answer. Or not! Is it necessary to write out the distortions in your DML or would you get the same benefit by just plowing through with positive thoughts, realizing that your negative thoughts contain loads of distortions. At least mine do! Obviously writing down the distortions will certainly reinforce the fact that you can pinpoint the distortions at hand, but will it make a big difference either way? Also, way back when I requested and received a few free chapters in your new Feeling Great book and received the chapter on the Decision-Making Tool which I thought was terrific. I can't for the life of me find the email/link which contained the blank Decision-Making Tool but if you could direct me to find it I would very much appreciate it. I knew you said you were planning an App for it so perhaps that's where it might reside. I loved working with you, Jeremy and Alex on the Beta Testing. It was a lot of fun and if there is any more way I can help out, let me know. Keep up the great work! Phil McCormack (Philomablog!) Thanks, Phil, Identifying and explaining the distortions is a great help to many. But if you’re super experienced, you can often take short cuts! When you’re doing this for the first time, it is necessary to write them down, however. David * * * Nandini asks: How do I get your Decision-Making Tool? Hi Nandini, The free chapter(s) offer is at bottom of the home page of my website. d * * * A man from France asks, after listening to Podcast 003: E = Empathy — Does It Really Make a Difference?: “How do we do when the person, we are having a conversation with, does not feel comfortable in sharing his/her feelings and thoughts or does not know how to deal when hearing them? Hello Dr. Burns, Many thanks for this podcast. It's been really helpful. And I do agree that practicing the 5 key of Effective Communication is extremely important. I would like to have your opinion with regard to the 5 Key to Effective Communication. I had a really mild argument with my teenage 17year-old son, last night. I bought him an M size jacket instead of an S size. When I asked him if the jacket suited him, he replied "why don't you ever listen to me! I asked you to get me an S size, but still, you buy me an M size! I replied I got him an M size because the website warned that the clothing size fit small. Then he went back to his room... whereas, I, ran to my Relationship journal and started to work on this little argument I sure did feel bad, and worthless as I wasn't able to get him what he requested. I decided to use the 5 key to Effective Communication and did my best to include the 5 steps, and when I expressed my feeling with regard to what he had said, he snapped right back at me saying "oh, stop acting as if you were a victim there ! Though it is very difficult to express my feelings (as I was taught from childhood to hide them/put them aside), I also can understand how difficult it can be, to hear someone expressing his/her feelings. My son was able to hear the empathy I had towards his thoughts and feelings, but was not ready to hear how I felt about my feelings. Where did I do wrong? How do we do when the person, we are having a conversation with, does not feel comfortable in sharing his/her feelings and thoughts or does not know how to deal when hearing them? Your insights would be greatly appreciated. Warm regards, From France Hi man from France, Send me your Relationship Journal and all will be revealed. That’s the only way to get a handle on the errors you made in the interaction. Thanks! David In the podcast, I emphasize the role of blame in relationship problems. The man in France appears to be blaming the other person for not being comfortable sharing feelings, but in my experience, we are creating the problems in our relationships, and the answer is to examine your own errors. Read Feeling Good Together and do the written exercises if you really want to learn. * * * Thomas asks: What would you say to a person who wants more ego strength.? Thanks Thomas! I would say, “what time of day would you like it,” and ask them to fill out a Daily Mood Log for that moment of insecurity! I focus on specificity, and avoiding big words and abstract concepts. d

This is the first of two podcasts featuring Phillip Lolonis, LCSW, who works with Rhonda at her new FeelingGreatTherapyCenter.com. Some of you may remember my descriptions and photos of my Sunday hikes for people in our training groups for the past ten years. Here's a photo from one my last hikes before the pandemic. Phillip is the one in red in the back row.  I hope to resume the Sunday hikes as soon as people are vaccinated! In today's podcast, you'll meet Phillip Lolonis who has transformed TEAM-CBT hiking therapy into a high and exciting art form on the California trails near Mt. Diablo. Phillip is a licensed clinical social worker and Level 3 TEAM therapists who is a member of Rhonda's new Feeling Great Therapy Center in the East Bay. He describes his love for "nature therapy" and pointed out that the Buddha experienced enlightenment when meditating under a tree. Phillip describes growing up on a farm and feeling at peace and profound connection with nature as he watched his father working in the fields. He said that his ancestors were all farmers in Greece for hundreds of years. Phillip first started "hiking therapy" when he was working with groups of individuals suffering from schizophrenia. One day, he decided to take his group out for a hike in the hills behind the hospital, and noticed the peacefulness and relaxation the patients experienced while hiking, and see the views of the San Francisco Bay from (describe the location at the top of the hike.) He said the patients seemed to experience much less of the internal, distracting stimuli that interfered so greatly with their attempts to connect with others. All of his patients complete David's Evaluation of Therapy Session after each session. This tools encourages patients to rate the therapist's empathy and helpfulness and describe what they liked and disliked about the session. Phillip works with a wide range of individuals, and says that whether they are 10 years old suffering from shyness, or executives from a tech companies who are facing burnout, they often say that they feel more open, honest and willing to go deeper when hiking in nature, than when they are being treated back in his office or on zoom. He pointed out that these days, a great many individuals coping with mental illness end up being "treated" in jails, which are frightening and actually intensify the symptoms of schizophrenia. Phillip has a special tenderness and compassion for individuals with schizophrenia because his younger brother struggles with this affliction. However, his "hiking" therapy is not limited to individuals with schizophrenia, but adults and families with the full range of emotional challenges, such as depression and anxiety. He explained how he integrates the four elements of TEAM: T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods while hiking with his patients / clients. He also discussed some of the ethical considerations, and how to gently create boundaries so that his patients will understand that this is a professional relationship in a natural setting. Phillip is convinced, and probably right, that a beautiful and peaceful outdoor environment actually facilitates treatment and speeds recovery. Here are some photos from his hikes. just to give you an idea of what his special "office" looks like. It's a bit different from the analyst's couch!       Take a look at this incredibly cute video of "talking turkey" on one of his hikes! [videopress McaWCx7u]

Ask David: Questions on self-esteem, recovery from PTSD, dating people with Borderline Personality Disorder, recovery on your own, and more! Jay asks: Is psychotherapy homework still required if you’ve recovered completely from depression in a single, extended therapy session? Is Ten Days to Self-Esteem better than the single chapter on this topic in Feeling Good? Are people who were abused emotionally when growing up more likely to get involved with narcissistic or borderline individuals later in life because the relationship is “familiar?” Many patients can read your books and do the exercises and recover on their own. Is a teacher or coach sometimes needed to speed things up? Is it possible for a person to become happy WITHOUT needing anyone else if they have had depression in past and/or PTSD? Also, how would Team-CBT address treating PTSD? PTSD can involve a person having multiple traumas. * * * Is psychotherapy homework still required if you’ve recovered completely from depression in a single, extended therapy session? Thanks, Jay, I will make this an Ask david, if that is okay, but here is my quick response. Although many folks now show dramatic changes in a single, two-hour therapy session, they will still have to do homework to cement those gains, including: Listening to or watching the recording of the session Finish on paper any Daily Mood Log that was done primarily in role-playing during the session. In other words, write the Positive thoughts, rate the belief, and re-rate the belief in the corresponding negative thought. Use the Daily Mood Log in the future whenever you get upset and start to have negative thoughts again. I also do Relapse Prevention Training following the initial dramatic recovery, and this takes about 30 minutes. I advise the patient that relapse, which I define as one minute or more of feeling crappy, is 100% certain, and that no human being can be happy all the time. We all hit bumps in the road from time to time. When they do relapse, their original negative thoughts will return, and they will need to use the same technique again that worked for them the first time they recovered. In addition, they will have certain predictable thoughts when they relapse, like “this proves that the therapy didn’t rally work,” or “this shows that I really am a hopeless case,” or worthless, etc. I have them record a role-play challenging these thoughts with the Externalization of Voices, and do not discharge them until they can knock all these thoughts out of the park. I tell them to save the recording, and play it if they need it when they relapse. I also tell them that if they can’t handle the relapse, I’ll be glad to give them a tune up any time they need it. I rarely hear from them again, which is sad, actually, since I have developed a fondness for nearly all the patients I’ve ever treated. But I’d rather lose them quickly to recovery, than work with them endlessly because they’re not making progress! People with Relationship Problems recover more slowly than individuals with depression or anxiety for at least three reasons, and can rarely or never be treated effectively in a single two-hour session: The outcome and process resistance to change in people with troubled relationships is typically way more intense. It takes tremendous commitment and practice to get good at the five secrets of effective communication, in the same way that learning to play piano beautifully takes much commitment and practice. Resolving relationship conflicts usually requires the death of the “self” or “ego,” and that can be painful. That’s why the Disarming Technique can be so hard for most people to learn, and many don’t even want to learn it, thinking that self-defense and arguing and fighting back is the best road to travel! * * * Is Ten Days to Self-Esteem better than the single chapter on this topic in Feeling Good? Yes, Ten Days to Self-Esteem would likely be a deeper dive into the topic of Self-Esteem. It is a ten-step program that can be used in groups or individually in therapy, or as a self-help tool. There is a Leader’s Manual, too, for those who want to develop groups based on it. * * * Are people who were abused emotionally when growing up more likely to get involved with narcissistic or borderline individuals later in life because the relationship is “familiar?” I was involved with a woman with Borderline Personality Disorder, and it was exhausting! Why was I attracted to her? Thank you for the question, Jay. Most claims about parents and childhood experiences, in my opinion, are just something somebody claimed and highly unlikely to be true if one had a really great data base to test the theory. We don’t really know why people are attracted to each other. Many men do seem attracted to women with Borderline Personality Disorder. Perhaps it’s exciting and dramatic dynamic that they’re attracted to, and perhaps it’s appealing to try to “help” someone who seems wounded. Good research on topics like this would be enormously challenging, and people would just ignore the results if not in line with their own thinking. Our field is not yet very scientific, but is dominated by “cults” and people who believe, and who desperately want to believe, things that are highly unlikely, in my opinion, to be true. I do quite a lot of data analysis using a sophisticated statistical modeling program called AMOS (the Analysis of Moment Structures) created by Dr. James Arbuckle from Temple University in Philadelphia, someone I admire tremendously. This program does something called structural equation modeling. In the typical analysis, the program tells you that your theory cannot possibly be true, based on your data. If you are brave, this can lead to radical changes in how you think and see things, especially if you are not “stuck” in your favored theories. But this type of analysis is not for the faint of heart. All the best, David Here is Jay’s follow-up email: HI Dr. Burns, As you know A LOT of people attribute their present problems (depression / anxiety / relationship conflicts / addictions) to their "abusive" or "toxic" relationship with their parents. It is interesting that it seems some people internalize negative beliefs about themselves based on what their parents said to them on a consistent basis. But it seems you are saying the data does not support that theory. Jay Thanks, Jay, I’m glad you responded again. There may be some truth to those kinds of theories. We know, for example, that abused or feral cats often have trouble with trust. So, we don’t want to trivialize the pain and the horrors that many humans and animals alike endure. At the same time, people are eager to jump onto theories that “sound right” to them and serve their purposes, and most of these theories are not based on sound research. Here are two examples from my own research. I tested, in part, the theory that depression comes from bad relationships, and also that addictions result from emotional problems. I examined the causal relationships between depression on the one hand and troubled vs happy relationships with loved ones on the other hand in several hundred patients during the first 12 weeks of treatment at my clinical in Philadelphia, and published it in top psychology journal for clinical research. (will include link) That was because there were at the time two warring camps—those who said that a lack of loving and satisfying relationships causes depression, and those who said it was the other way around, that depression leads to troubled relationships. And the third group said it worked both ways. My study indicated that although troubled relationships were correlated with depression, there were NO causal links in either direction. Instead, the statistical models strongly hinted that an unobserved, third variable had causal effects on both simultaneously. This is the only paper in the world literature that I am aware of that has tested the causal links between intimacy and depression, but because the results did not satisfy anyone, the paper is rarely or never quoted, and did not seem to influence those who were advocates of one or the other theories. As they say, wrong theories die hard. Here’s the reference: Burns, D. D., Sayers, S. S., & Moras, K. (1994). Intimate Relationships and Depression: Is There a Causal Connection? Journal of Consulting and Clinical Psychology, 62(5): 1033 - 1042. I also looked at the causal links between all kinds of emotional problems and all kinds of addictions in 178 or so patients admitted to the psychiatric inpatient unit of the Stanford Hospital. I was unable to confirm any significant causal links between depression, anxiety, loneliness, anger, and so forth and any kind of addiction (overeating, drugs, alcohol, etc.) The only possible causal link I could find was a small causal link of depression on reducing the tendency to binge or overeat. This was a secondary and unpublished analysis of data I collected in validating my EASY diagnostic system. I don’t mean to encourage insensitivity to suffering or and I don’t want to stop or stifle creative thinking about the causes of depression and anxiety and addictions. I simply want to emphasize that the causes of depression, and most other emotional problems, are still totally unknown. That is a very simple statement, but it seems to me that most folks don’t “get it,” or don’t want to hear it. Maybe we all want to explain things, or blame others, or think of ourselves as “experts,” or perhaps we feel uneasy with thinking that we don’t yet know the causes of most psychiatric problems, like depression and anxiety or troubled relationships. It may be comforting to think we do know the causes of negative feelings or human conflict. This is my thinking only, and I’m often off base! Tell me what you think. David

Today’s emotional and inspiring podcast features Mary Stockton, an Level 3 certified TEAM therapist living in Ohio and her daughter, Elizabeth Stockton Perkins, who is 19 years old and a sophomore at Vassar College. They give testament to how the Five Secrets of Effective Communication have transformed their relationship as mother and daughter, as well as their relationships with others. Mary said that the Five Secrets changed her life personally and professionally, and that the tools have been “life-changing.” Mary was first introduced to the Five Secrets of Effective Communication when she attended one of David’s training workshops in 2002 entitled, “And It’s All Your Fault!” However, she did not really dive in and use the techniques until 2017 when she received additional TEAM-CBT training from Rhonda, Jill Levitt, Daniel Mintie, Matt May, and Thai-An Truong. Mary introduced Elizabeth to the Five Secrets when Elizabeth was a junior in high school, and Elizabeth began to use these tools with friends and also in her baby sitting. Mary said it has transformed their relationship, because previously she had been addicted to “helping,” rescuing, advising and problem solving, habits which often prevent closeness in relationships. David pointed out that many if not most mental health professionals, including many reading this at this moment, have been trained in these misguided “helping” methods, and are not even aware of it, or how unhelpful that “helping” can be. The relationship between Mary and Elizabeth is wonderful testament to the power of the Five Secrets. Mary said that using the Five Secrets in their relationship provides them with a wonderful framework that they share and enjoy. Elizabeth said they have zero other-blame or self-blame in their relationship, and that they routinely get a fun, positive charge from the Five Secrets. Elizabeth discussed a distressful situation when Mary responded to her using the Five Secrets and she felt supported, comforted and empowered. She was struggling with negative thoughts and feelings about her body image, telling herself on the one hand that “I should be bird boned and be a size 2 and be super skinny,” while at the same time telling herself, “I should be a strong feminist and not give in to these societal messages about what a woman should be like.” Because her mom relied on the Five Secrets of Effective Communication and other TEAM skills, Elizabeth suddenly found that she could open up about feelings she'd been hiding, and their relationship changed dramatically. Elizabeth suddenly found that she could open up about feelings she’d been hiding out of a sense of shame, and felt love and accepted. She said that “mom was the first person I’d been able to open up with. I felt relief that I didn’t have to defend myself.” Elizabeth cried when she described the gratitude she felt when she had the chance to be open and accepted, especially when she described her concern about being a good role model for two younger friends. They also described how Mary used the TEAM process of Empathy, Positive Reframing, and Methods like the Externalization of Voices and Survey Technique to help Elizabeth escape from the self-critical thoughts that had trapped her. It was a beautiful experience just to witness the joy and love in their relationship. They also described a program on the Five Secrets that they presented for other teens and families. We explored how one might use the Five Secrets when interacting with someone on the other side of the political divide who is angrily proclaiming political views that are sharply different from, and opposed to, your own. This is a huge problem in our country right now, with so much focus on blame, labeling others, and wanting to proclaim and insist on your own “truths.” I have not done this podcast justice in my show notes. You’ll have to listen to “get it.” Mary, her elegant daughter Elizabeth, and the always wonderful and delightful Rhonda really hit it out of the park today. I deeply appreciated being included in this terrific experience, and hope you also enjoyed it! David

In today’s podcast, we focus on a request by Tommy, a podcast fan who asked for a podcast on how TEAM evolved from traditional CBT. So here it is! Hi Dr. Burns, I hope you're doing well! I just recently completed Feeling Great and found it incredibly helpful. I found the technique chart that offered specific techniques for each distortion to be incredibly valuable and I've incorporated it into all my Daily Mood Logs. I've also listened to every podcast and have been already exposed to nearly all of the content within the book, but the book did such an elegant job of simplifying everything and putting it into context. I've already gifted it to several family members and am eagerly awaiting the audio version so I can gift it to my grandfather, a psychodynamic therapist of 30 some odd years who's vision impaired. I think he'll really get a lot out of it! Beyond the well-deserved praise, I'm emailing because I just listened to your post recent podcast episode (222) with Dr. Barovsky and you asked for any suggestions the audience might have concerning future episodes. There were two things that you mentioned that made me think an episode on the evolution of TEAM might be really cool and insightful. You mentioned that TEAM was specifically developed to deal with borderline personality patients that you saw at PENN and you also described an interaction with a stranger in California who approached you that inspired the concept of fractal therapy (at least that's how I understood that interaction). I think it would be incredibly interesting if you gave a sort of chronology of TEAM and what problems some of the core components were intended to solve. Obviously, I wouldn't expect you to go through every technique. But some insight into how you came up with positive reframing, the magic dial, perhaps uncovering techniques, and whatever else you'd be willing to share. Besides being interesting, I think it would be valuable because it would provide greater insight into the TEAM processes through demonstrating how it's overcome some of the obstacles that traditional CBT was unable to overcome. Dr. Mark Noble's chapter in Feeling Great led me to think quite a bit about this, particularly where he described how TEAM is really the ideal therapeutic structure from a neurological standpoint. Certainly you didn't just stumble into TEAM and I for one would find anything you'd be willing to discuss on this topic really interesting! Thank you again for everything you do. Best, Tommy Hi Tommy Here are some historical highlights in my thinking. In the podcast I will describe them and dialogue with Rhonda, but in no particular order. Thanks for the great suggestion, and hope you enjoy the podcast. Rhonda also mentioned how the empathy piece evolved, and we discussed that! Psychotherapy homework: Early research and clinical observations on psychotherapy homework and recovery from depression; how I published research on this topic and decided to make patients accountable. Helping: The man who I called at home twice every time he called me with some emergency one weekend, and my conversation with Dr. Wendy Dryden from England. The beauty of depression: The businessman who thought he was responsible for the death of his stepson. The universal importance of Positive Reframing: The time jill said she wished we’d done positive reframing during her session. Fears of therapists that keep them stuck: My observation through supervising psychology and psychiatry graduate students, as well as teaching workshops, how really hard it is for the vast majority of therapists to give up because of their addiction to helping and their intense fears of making patients accountable. Suddenly understanding “resistance.” The meeting of the Stanford voluntary faculty on teaching, and I mentioned making the concept of “resistance” more understandable for the psychiatric residents. They didn’t seem interested, and then I found the answer in a dream. Creating techniques with more “oomph:” The first method I created, Externalization of Voices, how this was inspired by my experiences in psychodrama marathons when I was a medical student. Giving up on “non-specific” techniques: The elderly depressed man who ran up to 12 miles a day. Therapeutic Empathy: What I learned from Stirling Moorey, and how I set up an empathy training program along with a scale to assess empathy after every therapy session. Rhonda and David

Many of you will recall one of our most popular and amazing podcasts of all, the recording of the live therapy with Michael at the Atlanta intensive last year. In today’s recording, which was recorded for a different purpose, Dr. Michael recalls his entire experience that day, with many teaching points. Although I was AT the Atlanta intensive doing the therapy, with the help of my co-therapist, Thai-An Truong, I was fascinated and enlightened by this interviews because: Michael was incredibly warm, genuine and openness. The summary shows clearly and exactly how TEAM therapy works. He recounts not only his recovery, but also how was unexpectedly catapulted into what, by my understanding, is best described as “enlightenment.” Or something awfully darn close to it! He reminds us that even after one has recovered and experienced “enlightenment,” we are still human and never immune to the occasional return of negative thoughts and feelings of insecurity and self-doubt, which are now, for Michael, short-lived! I just got Rhonda’s response after she listened to this recording for the first time. Here’s what she said: I forgot to tell you that I listened to the 30-minute recording of Michael's reflections and I loved it. I think it would be a great podcast. He did a wonderful job summarizing the work, and how it impacted him at various stages. I liked how he included his skepticism and his awe in recovery. Warmly, Rhonda and David PS Rhonda and I are convinced that successful personal work is a necessary part of therapist training. When you’ve done your own work, you are no longer just a “technician,” but a healer, because you can tell your patients, “I know you feel because I’ve been there myself, and I know how painful and lonely that can be. And I’m really excited to show you the way out of the woods, too, so you can get back to feelings of joy and self-esteem, so you can wake up in the morning and say that’s it’s GREAT to be alive!”

We have not had the chance to do a really good podcast on the Five Secrets of Effective Communication recently, so Rhonda and I jumped at the chance to do a podcast with a local executive we will call “Valentina” who is facing a severe challenge. How can she respond effectively to a ton of her colleagues who responded critically and angrily to one her first emails since being place in a top leadership role at work? They said that her email was harsh and accusatory, and sounded adversarial and provocative, and didn’t give a feeling of partnership or appreciation for all the hard work they were doing. Yikes! That’s pretty tough. And yet, my philosophy—in therapy, in family conflicts, and in work settings as well—is that your worst failure can often be your greatest opportunity in disguise. Is this true? Or just pie in the sky? Rhonda and I do a lot of role-playing and role reversals to (hopefully) show Valentina how to transform a humiliating professional failure into an enormous success. We’ll let you know how it works after we get some feedback from Valentina. We are both deeply indebted to Valentina for her courage in allowing us to talk about a problem that most of us encounter from time to time. I often receive harsh criticism, so I know how anxiety provoking it can be, especially when the criticisms come from authority figures! Valentina was wonderful to work with, and said she felt happiness and a sense of peace at the end of the podcast. It was great to see that! Let us know what you think about today’s podcast, and your own philosophy of how to respond to criticism skillfully and effectively. We alluded to, but did not delve deeply, into the opposite philosophy of arguing, defending yourself, and never apologizing. We’ve seen a lot of that in the past year on the evening news every day. Did the approach we modeled on today’s show seem inspiring and awesome? Or foolish and self-defeating? Thanks for listening! We hope you enjoyed today’s podcast and maybe learned something useful. For more information on the Five Secrets of Effective Communication, you can check out my book, Feeling Good Together, available in paperback on Amazon. Warmly, David and Rhonda

At the start of today’s podcast, we got an update on the Feeling Great app from Jeremy Karmel. We are looking for one or more programmers who might like to join our project. Our goal is to create the first electronic tool that can outperform human therapists, and some super promising preliminary data suggests we may be on the right path to make this happen. We are looking for talented engineers and designers who would share our passion for this incredible dream. If you are interested, contact Jeremy@FeelingGreatapp.com Today we are joined by our beloved and brilliant colleague, Dr. Jill Levitt to ask two questions: Can the “self” be judged? Does the “self” exist? We got quite a bit of positive feedback to a recent Ask David Podcast that included a question about Buddhism, but people said they wanted more on the topic of the “great death” of the self. Bottom line was this: You can judge your own or someone else’s specific thoughts and actions, but you cannot judge your (or somebody else’s) “self.” The question, “does the ‘self’ exist,” is meaningless. The goal of therapy is not to get promoted from the “worthless” to the “worthwhile” category, but to reject these categories as having no meaning. David argues that it is impossible to feel depressed without the distortions of Overgeneralization and Labeling—that where you jump from a specific flaw or problem, like getting rejected by your boyfriend to some abstract label or judgment, like thinking you are “unloveable.” We also used the real-life example of David responding to criticisms that he was too harsh with Steven Hayes on Episode 220. We show how TEAM therapy works, and illustrate several techniques for crushing the Negative Thoughts that lead to the painful negative thoughts that including Overgeneralization and Labeling, including: Empathy Positive Reframing Externalization of Voices Be Specific Acceptance Paradox Feared Fantasy We also focused on the concept of “laughing enlightenment,” a key Buddhist concept, along with the “great death” of the self. When you lose your “self,” you actually lose nothing, because there was nothing there in the first place. This is a kind of cosmic joke. But you inherit the world and gain liberation from your suffering, along with great joy, and of course, sadness as well. We also summarized the thinking of Ludwig Wittgenstein, arguably the greatest philosopher of all time, and how his sudden insight when a soccer ball hit him in the head transformed the history of philosophy. He was an extremely lonely man who had numerous episodes of depression, and never attempted to publish anything when he was alive, because only a handful of students and colleagues could understand what he was trying to say. This was intensely frustrating to him, because his message was so simple, clear, and basic—and yet the great philosophers could not grasp it. The Buddha had the same problem. The book, Philosophical Investigations was published in 1950, right after his death. It is just a series of numbered paragraphs, or brief comments, on different everyday themes, like bricklayers, string, games, and so forth. It is was based on a metal box they found under his bed, which contained notes from his weekly seminars at Cambridge. Many people, including myself, consider it as the greatest book in the history of philosophy, and think of Wittgenstein as the man who killed, or ended, philosophy. According to Wikipedia, the famed British philosopher, Bertrand Russell, described Wittgenstein as "perhaps the most perfect example I have ever known of genius as traditionally conceived; passionate, profound, intense, and dominating." Although Wittgenstein did not focus emotional problems, his solution to all the problems of philosophy is very similar to cognitive therapy. Here is the parallel: You don’t try to solve the classic “free will” problem. Instead, you see through it and give it up as nonsensical, as language that's "out of gear," so to speak. Once you “see this,” and understand why it is true, it is incredibly liberating. But it can be a lonely experience, because you suddenly “see” something super-obvious that seems to be invisible to 99.9% of humans. It's as if you had a "third eye," and could see something incredible that people with only two eyes cannot see. By the same token, when you suddenly “see” that the idea that you have a “self” which could be “superior” or “inferior” is nonsensical, it is also incredibly liberating. This, in fact, is the cognitive therapy version of spiritual “enlightenment.” And that's also one of the goals of the TEAM-CBT that my collegues and I have created. Jill, Rhonda, and David

Podcast 224 Ask David January 11, 2021 Ask David featuring more challenging and interesting questions. Josh asks: What are the most effective types of psychotherapy homework assignments? Hassam asks: How would you treat my severe OCD? Exposure doesn’t seem to be working! And Joe asks: Would you say that the secret to overcoming OCD is willpower? Ted asks: Does any psychiatric disorder result from a chemical imbalance in the brain? Brian W. asks: Burns, could you do a video on how to use CBT for stress? Thanks. Clarity asks: Is it too late to be a beta tester for your app? Simon asks: Is there a podcast that you can recommend for general depression, and how to find out what is wrong? Stephanie asks: My patients don’t recover as rapidly as your patients. Am I doing something wrong? I’m feeling a lot of anxiety and self-doubt! * * * Josh asks: What are the most effective types of psychotherapy homework assignments? Hi David, thanks for all your work. It has been very helpful. You mention That doing homework is essential to recovery from anxiety and depression. Any homework you recommend? I am going to buy a few of your books and have the worksheets from the Neil Sattin podcast. Anything else that will benefit? Josh Hi Josh, It depends on the type of problem you are working on. I can work up an answer, perhaps, if you want to tell me! I did not hear from Josh, but Rhonda and I summarize the best kids of psychotherapy homework for: depression anxiety relationship problems * * * Hassam asks: How would you treat my severe OCD? Exposure doesn’t seem to be working! Hi David, I love your work on the podcast. I have not yet found a copy of any of your books in Lahore (where I live), but I have grown to understand your philosophy through your podcasts. Episode 162 disturbed me a little. I suffer from severe OCD and its cousin, depression. And the "high-speed cure" in the title really attracted me. But I had buyer's remorse. Why? Because it does not work like that for most people. The guest on your show, had a few exposures, and BAM, cured. I have tried exposure many many times, and it very minimally helps in lowering the threat of the obsessions. I feel that this was a Magic Pill kind of account, and at the risk of judging a person's pain, I think your guest had a relatively mild (as compared to me) OCD. I would really love it if you could talk about Pure OCD (the type I have), and how it can be resistant to exposure. The intrusive thoughts/obsessions continue to be extremely, EXTREMELY, painful. This "high speed cure" idea seems dismissive of the seriousness of my condition. Please keep up the great work. And I hope to read your books one day. Thanks Hassam (Therapist in training) Thanks Hassam, sometimes, therapy is much harder, as you say! Good point. I often get slammed when I present patients who recover rapidly, especially patients who have had incapacitating symptoms for years or even decades of failed therapy. This is disappointing to me, as my goal is to bring hope to people that rapid and meaningful change IS possible. To be honest, I don’t like it when I get slammed for presenting cases of rapid recovery. Some people think I am a con artist! Yikes! Of course, everyone is different, and some people will be more challenging to treat. One thing I learned when I was in private practice is that you can never tell ahead of time who will recover rapidly and who will take much more time. I’ve had patients I thought would be super easy to treat who responded much slowly than I predicted, and many who I thought would be nearly impossible to treat who responded almost overnight. You’ve mentioned that exposure has been of limited value for you. I totally agree and saw that early in my treatment of anxiety that exposure alone is often quite ineffective. That’s why I argue so strongly that exposure is not a treatment for OCD or for any form of anxiety. It is just one tool among many I use in the treatment of anxiety. I use four very different treatment models with every anxious patient: The Cognitive Model The Motivational Model The Hidden Emotion Model The Behavioral (Exposure) Model Unless you understand and use all four models, the prognosis might be somewhat guarded, as you’ve discovered. In contrast, when you use all four strategies, your chances for success increase tremendously. For example, prior to using Exposure in the episode you listened to, I spent about 25 minutes with Sara using the motivational and cognitive models, which really helped. Focusing on one method alone will often not be terribly effective, especially if you’re looking rapid, complete, and lasting recovery. However, occasionally one method will work, so therapists and patients alike get focused on some single approach they’ve learned, thinking they’ve found “the answer.” There’s a great deal of information on the treatment of anxiety disorders using these four models on my website, www.feelinggood.com. I often urge listeners to use the search function on my website, and everything will be served up to you immediately. You can learn all about these four powerful models. In addition, if you were looking for more techniques, you might want to take a look at my book, When Panic Attacks, which describes 40 potent anti-anxiety techniques. You can order it from Amazon. My psychotherapy eBook, Tools, Not Schools, of Therapy, might also be helpful for therapists who want to learn more about the treatment of depression and anxiety with TEAM. It is an eBook, and order forms are available on my website, www.feelinggood.com, in the resources tab, and also in my store. Thanks for your excellent question! david And Joe asks: Would you say that the secret to overcoming OCD is willpower? In reply to Joe. I use four treatment models in the treatment of all anxiety disorders, including OCD. Certainly, the willingness to use Exposure is required, but Exposure is only one of many helpful methods for OCD. You can search for anxiety treatment on my website, and you’ll find many good podcasts. Also, there is a free anxiety class on my website. My book, When Panic Attacks, is another great resource with more than 40 techniques to combat all forms of anxiety, including OCD. You can find all my books on AMAZON, or on the books page on my website. david * * * Ted asks: Does any psychiatric disorder result from a chemical imbalance in the brain? Hi Dr. Burns, It says in your book, When Panic Attacks, p. 49, 3rd paragraph, you said that there's not a shred of evidence that there's any chemical imbalance for any psychiatric disorder. Does that include schizophrenia or bipolar or OCD?  Haldol works for me for schizoaffective....controls dopamine in brain? Ted Hi Ted, There are likely one or more biological factors that contribute to schizophrenia as well as full blown bipolar disorder (with true manic episodes.) We do not yet know what those causes are. However, the brain is not a hydraulic system of chemical balances and imbalances, or perhaps more like a supercomputer. I am not aware of any neuroscientists who believe in the crude “chemical imbalance” theory. We simply don’t know what the causes are. Meds can definitely help with the symptoms of schizophrenia and mania as well. This tells us nothing about causes. Aspirin can help with a headache, but headaches are not due to an “aspirin deficiency” in the brain. Computers often crash, but I’ve never heard of a computer problem that was caused by a “silicon imbalance” in the chips. Hope that helps. Psychotherapy can definitely help with feelings of depression and anxiety, but is not a cure for schizophrenia or mania. I would hate to have to treat any psychiatric problem with drugs alone! I like to treat humans, not “diagnoses,” but it can helpful to be aware of diagnoses like schizophrenia, or schizoaffective, or bipolar I, for example. Hope that is helpful! And just my thinking, too, not “written in stone.” david * * * Brian W. asks: Burns, could you do a video on how to use CBT for stress? Thanks. Hi Brian, Thanks! One point is that people are often looking for “formulas” or general solutions to buzzwords like “stress.” The key to TEAM is to focus on one specific moment, and to work with it in an individual way, never using non-specific solutions like exercise, meditation, deep breathing, dietary changes, and so forth. But as you can see, this is tough for many people to grasp. The failure to understand the importance of specificity is one of the big problems in our field, and it is a problem for therapists and patients alike. There are no very good solutions in the clouds of abstraction, because we are all unique. I asked Brian for specific examples, and he wrote: “Work pressure, obnoxious bosses, nagging family members, drug addicted family members, and inability to pay bills are a few.” I responded, Thanks, these are all totally unique with different solutions. Perhaps you can focus on one and provide a couple details. david Brian responded, Thanks. Whichever one you think is best. Stressful thoughts. Also how to change stressful thoughts when they're automatic. Hi Brian, There an infinite variety of "stressful thoughts," and they all have unique, non-overlapping solutions. Could you tell me about one thought you had at one specific moment? david During the podcast, I made some additional comments on dealing with stress using TEAM: Stress is a fairly non-specific word for feeling upset or distressed. I like to use and measure specific emotions in my patients, like depression, anxiety, guilt, shame, inadequacy, hopelessness, frustration, anger, and so forth. But for some people, “stressed” may be more acceptable than words like “depression,” which may carry more stigma. However, there is a somewhat specific meaning to stress, which means overwhelmed by having too much to do and not enough time to do it all. This can sometimes result from taking on too much, and having trouble saying no. Reasons for this difficulty being assertive include: Conflict Phobia Excessive Niceness Submissiveness / Pleasing Others Fear of missing out on something cool and exciting to do NY TV story on “stress” and my ten distortions General tools for dealing with patients who feel “stressed out.” Daily Mood Log Relationship Journal Brief Mood Survey You can take a thought on a DML and do a downward arrow—you will typically come to several common Self-Defeating Beliefs, such as Perfectionism Perceived Perfectionism Approval Addiction Submissiveness Worthlessness schema Conflict Phobia / Anger Phobia Superman / Superwoman Specific Tools Positive Reframing “No” Practice * * * Clarity asks: Is it too late to be a beta tester for your app? Hi Clarity, Thanks! You can sign up at www.feelinggood.com/app * * * Simon asks: I have a question for you. I am very depressed at the moment, and I don't know what is wrong, or I have difficult to find out what thought is giving me the down-feeling ☹ Is there a podcast that you can recommend for general depression, and how to find out what is wrong?Thanks for the sooooo great in inspiration. Thanks Simon. I will include your question in an upcoming Ask David, but here’s a start. Focus on one moment you were upset, and tell me how you were feeling and thinking at that specific moment, and record the information on a Daily Mood Log. If you listen to live therapy on the Feeling Good Podcasts, or read one of my books, like Feeling Good or Feeling Great, you will get a step by step introduction to TEAM therapy. Thanks! d PS There is at least one podcast on how to identify your negative thoughts and generate a Daily Mood Log. You can use the search function on the website to find those or podcasts on any topic, but here’s the link since the search function is not working properly at the moment so I’ll have to fix it. (https://feelinggood.com/2018/03/05/078-five-simple-ways-to-boost-your-happiness-5-you-can-change-the-way-you-feel/) PS PS I want to thank Simon for creating time codes for all 50 techniques on podcasts 93 (https://feelinggood.com/2018/06/18/093-fifty-ways-in-fifty-minutes-part-1/) and 94 (https://feelinggood.com/2018/06/25/094-50-methods-in-50-minutes-part-2/) entitled, “Fifty techniques in fifty minutes.” His time codes allow you to find the description of any techniques of interest. * * * Stephanie asks: My patients don’t recover as rapidly as your patients. Am I doing something wrong? I’m feeling a lot of anxiety and self-doubt! Hi David, I hope this is the right address to which to send an "Ask David." I am a huge fan of your work and cannot thank you enough for making your therapy techniques so accessible. And thank you for taking audience questions! I am in the process of learning TEAM and notice myself getting more skilled, slowly but surely.  There are times I hear you help patients recover in a single session. So far, I have not found myself able to help patients that quickly. I've felt disappointed about this, and it's led to anxiety and self-doubt ("I need to learn TEAM faster so I can help my patients as quickly as possible," "This should be happening quicker."). I am wondering how logical it is for me to expect myself to help patients recover in a single session. Is it reasonable to assume I may have to practice TEAM for some time and go through several training experiences before I can help patients change that quickly? Thank you again!! Stephanie David and Rhonda discuss ways of improving over time and reducing the pressure on yourself if you are a therapist.

The Jealousy Addiction! What Can You Do When Good Things Happen to Bad People? Hi podcast fans! Thanks for your wonderful support in 2020. You helped us hit our three millionth download. I wanted to give a shout out to my fantastic hostess, Dr. Rhonda Barovsky, who has brought magic to the Feeling Good Podcast! This is our first podcast of 2021. It is a really good one, I think. A tremendous amount of work has gone into it, both in the weeks prior to the podcast, as well as in the creation of the detailed show notes for those who want to study and understand exactly how TEAM therapy works for the thorny and almost universal problems of jealousy and anger. Much violence in the world, especially in couples, results from these feelings. I want to thank Bridget for her tremendous courage in giving us all this wonderful gift to kick off the new year! For therapists and therapy students, this show, with the show notes, should be a rich source of learning. David And, I, Rhonda wants to thank Dr. Burns for the incredible contribution he has made to the field of mental health treatment and for the honor of being part of the Feeling Good Podcast! Rhonda Bridget asks: Can you help me with my feelings of intense jealousy? Hello David & Rhonda, I’ve had this issue for a while now, and I’m wondering if others deal with it as well. If I find out that someone I dislike has something good happen in their life, I get extremely upset, frustrated, angry, jealous, & resentful. It will eat away at me, sometimes for weeks. The thing is I’m happy with my life & wouldn’t actually want to trade places with these other people, but it’s like just the fact that they get to be happy when they are a “bad person” & don’t deserve it upsets me. By “bad person” I mean people who are manipulative, liars, cheaters, etc. I’ve always been a person who is big on justice. I don’t want to focus on these other people anymore. I don’t want to care. Any help would be greatly appreciated. Thank you, Bridget David's Comment I was pleased to receive this email, as jealousy IS a big problem, and one I have not focused on specifically in my books or podcasts. I exchanged several emails with Bridget who graciously gave me permission to feature her work in today’s podcast. When people share their vulnerabilities openly, it is a gift to the rest of us, since the teaching and learning potential is great. In addition, most of us feel close to people who open up and share the inner feelings and insecurities that most of us hide. This is an action that requires great courage, and often results in even greater rewards. Bridget is also interesting because some fans have criticized me for featuring mental health professionals when I’m doing personal work. I do that because I’m no longer in private practice, and do not carry liability insurance. When I do personal work with therapists, it is in the context of their training, and is not considered an ongoing therapeutic relationship. But today, I have decided to bring you some really challenging work with someone who is not a therapist, but a married woman who works as a product manager for a high-tech company. Of course, I have disguised her identity. The emotions she is asking for help with, jealousy and anger, are the toughest emotions to challenge, far harder than depression or anxiety. That’s because the thoughts that trigger depression and anxiety involve Self-Blame and self-criticism, so you tend to feel worthless or inferior. Crushing self-critical thoughts leads to relief and joy. But the thoughts that trigger jealousy and anger typically involve Other-Blame and other-criticism, which is far tougher to defeat, because blaming others can be associated with exciting feelings of moral superiority. (You will notice below that I am embedding the PDFs of Bridget's work in the show notes, as opposed to linking to them as I usually do. Let me know which format you prefer. Thanks! david) STEP 1: Record your negative thoughts and feelings at a specific moment Here was my response to Bridget: Thanks, Bridget! On the attached DML, fill out the event, circle and rate emotions, and record and rate belief in negative thoughts. Scan back to me, and then I'll have further instructions. d Hi Dr. Burns, Here is my DML. Thanks! Bridget's DML at the beginning of the intervention. Notice that the belief in the NTs are all high, and the negative feelings are intense. STEP 2: Positive Reframing Hi Bridget, You’re moving fast! Way to go! Great example! Now list answers to these two questions about every category of negative feeling. What does this negative feeling show about you and your core values that’s’ positive and awesome? What are some benefits, or advantages, of this negative feeling? You can also do this with a couple of your negative thoughts. david Hi Dr. Burns, Some of these were difficult to find positives, but I do truly believe everything I wrote. This is Bridget's Positive Reframing Table. The items in caps were suggested by David, and she endorse these as well. Hi “Bridget,” You did great work on Positive Reframing. I have added several more things in caps in the right-hand column. Delete or edit that are not valid or don’t ring true. Would love to see your edited version. Once you are done, use the % Goal column at top of emotions table to do the following. Imagine you had a Magic Button, and if you pressed it, all your negative thoughts and feelings would vanish, and you’d be euphoric with no effort. However, all these benefits and beautiful things about you would go down the drain at the same time. So, answer this question: Why in the world would you want to do that? Then, answer this question for each negative feeling: “Given that there are many genuine benefits of this feeling, would there be some level I could dial this feeling down to if I had a Magic Dial? For example, my unhappiness is at 100%. Would there be some ideal level of unhappiness that would be less painful, but would still allow me to have the benefits and positives associated with this feeling? Would 40% be enough, for example? Or maybe even 20%” If this makes sense, fill in the %Goal column for each negative feeling. Thanks! david STEP 3: Magic Dial Hi Dr. Burns, Thank you! I actually really liked & agreed with everything you added. Those all seem true to me, so I left them on there and did not change it. I put in percentages for my goals on the daily mood log. I think it's good to keep quite a bit of those feelings after seeing the benefits. Bridget's DML with Goal column filled it  STEP 4: Positive Thoughts Hi Bridget, Perfect, and you are moving fast. So cool! Now I want you to choose one thought to work on first. Identify the distortions in it with abbreviations in the Distortion column. Then see if you can generate a positive thought with the help of the attached booklet, which is for your eyes only. Please do not send to anyone!  It is written for therapists but will be great for you, too, hopefully! Please note the Necessary and Sufficient Conditions for an effective and helpful Positive Thought: It has to be 100% true. It has to reduce your belief in the Negative Thought. Reach out if you need help or if something isn’t clear. david Hi Dr. Burns, I was able to reduce the belief in the thought to 50%. Just because she lives in a nice house in a warm location doesn't mean that's guaranteed happiness. There's a lot of factors involved that could change at any moment. Bridget's DML with first Positive Thought. As you can see at the link, she believes the PT 100%, and this reduced her belief in the NT to 50%. Hi Bridget, Well done! If 50% is low enough, we can move on to another thought. Another distortion in the thought is Mind-Reading, since our assumptions about how other people feel are rarely valid. My research has shown that shrinks cannot even know how their patients feel, even at the end of a therapy session. So, we don’t actually know how she feels most of the time, or at any specific time. In addition, you are saying that it’s unfair that people with poor character can have lots of money and nice things, and this is a source of anger. That’s the “should” telling yourself this “should not” happen. It is so EASY and ENTICING to feel this way. And we certainly see lots and lots of ugly, repulsive, mean-spirited people with tons of money and stuff! It’s unfortunate. Albert Ellis used to point out that we may not like certain things, but it’s not true that they “should not” happen. For example, we don’t like the fact that our cats like to capture, play with, and kill little creatures. But it’s not true that they “should not” do that because it’s their nature. For myself, I’d rather hang out with people I like and respect and feel comfortable with, as opposed to these “hot shot” types. I’ve treated some very wealthy narcissistic individuals, one in particular, and it was incredibly unpleasant. I had no longing at all to live his lifestyle—in a mansion in Southern California filled with priceless antiques and stuff—but miserable relationships with other people he was trying to control since it seemed like his only thing—brag and try to manipulate people. I prefer people who are more on the humble side! Just some babbling. If 50 is good enough—since there IS truth in the thought, time to tackle another. You’re doing great! david Hi Dr. Burns, I worked my way through all my negative thoughts, & I ended up surpassing all of my goals for my negative emotions. Some of the thoughts were hard to challenge. I think the "shoulds" do get in the way a lot for me. And I also do a lot of fortune telling I noticed. I did some cognitive flooding and imagined her being hand fed grapes by the pool, her husband telling her how wonderful she is, her saying "I just love my life", and it all seemed so ridiculous then. There's no way that's how the majority of anybody's days are. I feel much better about it now. Let me know if you have any other thoughts. Bridget's completed DML Notice that she believed all of her PTs 100%, and there was a nice reduction in her belief in the NTs, along with a reduction in her negative feelings.  But was this enough? Had we gone far enough. Only Bridget can answer this question! Hi Bridget, This is fantastic, thanks! Can I use all this great work in an Ask David? We might record it Friday, tomorrow. Are you satisfied with where you’re at now? If you want to bring feelings down further, we can attack a couple of the thoughts that are still at 50%, but not necessary. The question will be how many of the negative feelings you want to retain, and it’s cool that you have surpassed your goals! Very cool, and might be helpful to others. let me know if you give permission to use this personal but terrific material in a podcast. Tons of jealousy in the world! David Hi Dr. Burns, Yes, you can definitely use everything we did here. I think it will help others. I think I’m ok with leaving the thoughts at 50% for those 2. Bridget STEP 5: Additional Methods Hi Bridget, While jogging, I realized that I forgot to comment on your creative use of flooding. I had thought of that also as another useful technique, and there you went and did it before I had the chance to suggest it! You are probably the first person in the world to use flooding for jealousy—usually it is for anxiety, as you likely know. I’ve attached a flooding flowsheet if you do more. The goal would be to see if you can work your jealousy up to higher and higher levels, and keep it as high as possible. I also thought of a ton of additional techniques we could use in challenging any of your negative thoughts, like the Individual and Interpersonal Downward Arrow, to get at the core beliefs underneath the jealousy, and lots more cool techniques. But we may not need any more techniques! Like scheduling time each day to make yourself as jealous as possible, say for one minute, or five minutes, or whatever. I was also curious about your prior experiences with this woman. I’m sure there’s a story behind your negative feelings David Hi Dr. Burns, I actually haven't ever met this woman personally. I guess I've seen her as the enemy ever since I started dating my husband. I saw all their old pictures on Facebook & messages between them, & I had this intense rage about it. My husband told me that she had not been faithful to him throughout their entire relationship, but he kept sticking it out with her. So anyways, I had this intense desire to find out more information constantly. I was looking her up online all the time, trying to find out more. It was an obsession at times. At first I thought I just needed to know what it was about her that he liked so much that he was willing to be with her all those years despite everything she had done. Eventually I realized I was doing it to prove to myself that she was not better than me, that her life was not better. But then it's like I was finding out the opposite. I found out about her marrying into that rich family, saw pictures of her and her husband traveling the world together, then buying this big beautiful home. I was filled with jealousy and rage. I thought here she strung my husband along for years and stole his prime years from me, and now she's living it up! Never paying the price. So yeah I suppose that's the long back story behind it. Wow thanks, Bridget, I really appreciate your candor! It all makes sense now. I’m so sorry she has been haunting you and making your life unhappy at times. She sounds, to me, like a pretty unhappy person, bitter and tortured and maybe trying to impress people with her “things.”. Not my kind of folk at any rate! When I was in grammar school, someone asked me if I was going to any Halloween parties, and I said I hadn’t been invited to any. I told my mother, if memory is correct, and she said why don’t I have a Halloween party? So, the next day at school I said if anyone hadn’t been invited to a Halloween party, they can come to my Halloween party. I had an older sister who helped prepare it to be this really neat party, but I didn’t know if anyone would come as I didn’t feel like I was one of the “popular” people. I might have been more of an intellectual nerd or something like that, and I wasn’t very attractive. But I was really happy when practically the whole class came, and we had the best party ever. Ever since then, I think I’ve kind of preferred the “unpopular” people, and to this day it is the same. I have tons of friends I totally love in low places. Anger and jealousy are, to my way of thinking, by far the hardest emotions to get rid of. It can be done, as you’ve shown, but it ain’t always easy. And what you’re doing totally rocks! Kudos! It was hard for me to shake it in the early days of my career. Now, these emotions never bother me, although I am joyfully angry from time to time! And thanks, too, for such rapid responses! I love the humorous imaging you created of her sitting around the pool being fed grapes, exotic wines, and rare chocolates by her dutiful slave husband, and perhaps a couple servants as well! Happy Thanksgiving, and thank you for giving of yourself!! David Hi Dr. Burns, That is a great story. I hope I can one day rid myself of those emotions like you were able to. I really appreciate you taking the time to work with me & spend so much time on this issue. I am just so grateful! I look forward to the podcast. Happy Thanksgiving! Hi Dr. Burns, Thank you! I actually got the idea by using that cheat sheet for the recovery circle from your new book Feeling Great, which by the way I love. It's like the Bible of cognitive therapy. I have so many spots bookmarked and go back to it all the time. I did the Downward Arrow technique, & it helped reduce my beliefs in the thoughts even more. I don't think that I made the wrong choices in life just because I have to work hard to get by. If I had made other choices, then I might never have met my husband or adopted my cats or maybe I would've never even discovered your books and connected with you which changed my life. I was able to reduce my belief in the thought "It’s not fair I have to work so hard just to get by" to 20%. For my other thought "She gets to live this happy life after how she’s manipulated and treated people poorly for years" I also did the Downward Arrow. That made a big difference as well. Just because she is happy doesn't mean that me doing the right thing has been for nothing. I'm glad I can confidently say I believe I'm a good-hearted, caring person. Her happiness will never change that about me. That thought is also now reduced to 20%. I'm feeling pretty dang good right now! I think I will take your advice and continue to do the cognitive flooding a little each day until the thought has no merit anymore. Link to her downward arrow work Hi Bridget, Thanks for all the positive feedback and hard work. I have more ideas, a lot more actually, if you want to push things further at some point, but doesn’t hurt to take a breather when you have climbed to the top of a mountain! Warmly, david Hi Dr. Burns, I’m always open to more ideas to try. Wouldn’t hurt. Maybe I could even get my belief in the thoughts to 0 eventually. * * * I offered to send Bridget a copy of my video, “Overcoming Toxic Shame,” since she was feeling some shame about carrying this burden alone. * * * Hi Dr. Burns, Yes, you are the only person I’ve ever told this to. I definitely fear being judged & rejected in this situation. I feel like I shouldn’t care so much what everyone else is doing in their lives & just focus on my own life. I feel ashamed & embarrassed of my online stalking too. The thing is that when I “play detective” & find out new information about her online I get this sort of high off it. It can be exciting, but then it always just ends up leading to me feeling bad about myself. So, as you can see there are advantages & disadvantages to doing it. I have done online stalking with other people too & told my husband about it when I would find out something upsetting or just interesting information. Sometimes he would make a face & say why would you be looking them up. And then I’d feel ashamed. I just feel like he does not approve of that behavior, & I can’t blame him. If the roles were reversed, it might make me a little suspicious of his intentions. Maybe even a little concerned. I do have a DVD player & would be very interested in seeing that video you mentioned. STEP 6: A New Idea: Is this actually a habit / addiction? Hi “Bridget,” Your video is ready for shipping, and the next mail package pick up at our house will be tomorrow or Wednesday. It will come express mail, so you should get it later this week. I had one other thought. If your habit of checking up on people gives you a high, but also leads to negative feelings, one could view this problem in the context of habits and addictions. You would have to think about that and see if it is valid or not. I don’t know for sure. But if it is, then abstinence might be helpful, too, since continually re-engaging with your checking up on people might keep fueling your feelings of jealousy. So, giving up this habit might be a price you’d have to pay to escape completely from this problem. Again, just speculation. At any rate, two chapters on habits were not included in my new book due to length, but they are available for free on the home page of my website. It offers one unpublished chapter, but there are actually two. If you are interested in this approach, download the chapters and see what you think, and maybe do some of the written exercises like the Triple Paradox, for example, and let me know what you think, too! Sincerely, David Hello Dr. Burns, I read the extra chapters, and they are great. It's too bad they couldn't have been included in the book because I bet they would help so many people. I did all of the exercises & found them very helpful. I especially loved using the decision-making tool for this. I would never think to compare disadvantages of 2 situations like that. I was actually surprised at how much of a "slam dunk" the option of "stop checking up on people entirely" was. I didn't expect that. I want to change because I'm tired of comparing myself & my life to other people. I also don't want to sit around waiting for justice then getting upset when the opposite happens. I spend too much of my free time thinking about these people I don't even like. I'm letting them win by caring. I also don't want to feel like I'm keeping secrets from my husband. The less I know, the better. All signs point to stopping the behavior. I just hope I can do it! Attached are the exercises I did. Would love your thoughts/feedback. Bridget You can link to Bridget's Triple Paradox and work with the Devil's Advocate tool. If you're interested, you can also review her work with the powerful Decision-Making Tool that I created 40 years ago. For more information, you can download the two free unpublished chapters on Habits and Addictions that I omitted from my new book, Feeling Great, due to length. You will find those chapters for free on the homepage of my website, www.feelinggood.com. Hi Bridget, Forgot to write back, I thought all your work was awesome! Incredible. Thanks, and kudos!! Hope you got or soon get the Melanie video. Apology for slowness. We adopted an incredibly 6-year old cat at the Humane Society, but ran into some temporary complications and now all is well. Plan to integrate her with our 3-year old feral cat, Miss Misty, at the end of a week keeping them separated. The new lady is a purring machine! Her owner died, and then she was adopted and returned, so she is terrified that she’s not “good enough” and fearful that we’ll send her back. We are totally in love with her, but had to take her back for a check-up for ring worm as the Humane Society called and said she had an accidental interaction with a ring worm cat. But they didn’t find anything. It was super-traumatic, since we had to put her back in the carrying cage, and she was desperate, thinking we were returning her. It was heart breaking, once of the worst experiences of my life! But now she’s back with us and looking forward to meeting her new “sister,” Miss Misty. Fortunately, she gets along really well with other cats. But we don’t know about Miss Misty! David Hi Dr. Burns, Aww poor kitty! That is so awesome you decided to take in another cat. I love how passionate you are about them. I loved your story of Obie in your book and how you dedicated it to him. I could really identify with it. We took in a feral kitten this past fall, and it went from him running away from us if we were within 10 feet of him outside to him being a permanent inside cat. Just last night he hopped on the couch next to me and laid on me purring while I put my arms around him like a teddy bear. It was so special! I haven't gotten the Melanie video yet, but I will definitely let you know once I receive it and watch it! -Bridget Hi Bridget, Thanks! Congrats on your kitten! Heaven! d Commentary Here are my random comments / observations. Bridget got a really rapid and fairly dramatic response. This was due, in large part, to the fact that she did all of her homework, and she did everything right away. When I worked with individuals when I was I private practice, doing homework was required, not optional. Many people want to just come and talk to their shrink once a week, but, at least in my experience, this has never once been effective. Bridget was motivated. She asked for help, and worked hard to get that help. Motivation is the key to overcoming depression, anxiety, relationship problems, and habits and addictions. Most religions have the concept of “ask and ye shall receive.” Without the asking, there will be little or no “receiving!” Bridget conquered two of the most challenging of all emotions on her own. I did provide some guidance via email comments, but she did the heavy listing. Over time, new insights develop. Therapy and self-help are fluid in this regard. The idea that this problem could be viewed as a habit or addiction suddenly popped into my mind and clicked, and provided another powerful tool for defeating this problem. Rigid formulaic treatment is less effective, but many therapists and many people in general are looking for “formulas” and secrets of overcoming this or that problem. Methods and tools are great, but formulas leave a lot to be desired. I don’t think that Bridget’s response was any slower than when I do live personal work sessions with therapists. It took longer, since we had to exchange a series of emails. But the total contact time was still in the range of an extended (two hour) therapy session. This demonstration may not satisfy the doubters, but it might at least help a little. The effective ingredient is TEAM, applied systematically with warmth and compassion. I am incredibly indebted to Bridget, and hope you also appreciate her brave contribution! It is not easy to bare your soul to the world, but the world deeply appreciates this type of openness, because most of us suffer in secret, adding loneliness to the equation. When you open up, your worst part sometimes gets magically transformed into your best part. It is a little like emotional alchemy, turning your emotional mud into gold! I hope you enjoyed today's podcast, and a got a feel for how a TEAM therapist might treat someone struggling with intense jealousy and anger. These are topics not often discussed in the psychotherapy world, so hopefully this podcast will be a useful contribution to a challenging topic! Rhonda, Bridget, and David

Podcast 222 Ask David December 28, 2020 Ask David featuring five challenging questions. Jay asks: How do you treat individuals with personality disorders using TEAM-CBT? Jeff asks: Can you talk more about the “great death” of the therapist’s “helping” or “rescuing” self? This was really helpful to me! Darkmana asks: Hey David, are there any books about Buddhism you would recommend? I can see you’re a fan of it from Feeling Great! Angela asks: What’s a perfect score on your empathy test? Margaret asks: What can you say to a patient who doesn’t want to push the Magic Button? * * * Jay asks: How do you treat individuals with personality disorders using TEAM-CBT? Dr. Burns Have you considered doing a podcast on using TEAM-CBT or CBT for Borderline, Narcissistic and Histrionic Personality Disorders? The interesting thing is those with personality Disorders seem to blame everyone and everything for their problems but themselves Also, what if anything could individuals do to not get attracted or quickly eject when they encounter these folks. One theory is that folks with abusive or neglectful parents are vulnerable. Because the chaos and drama is familiar. I think many therapists avoid folks with pd no? Particularly patients with Borderline PD. It's interesting in that kids have years of relating to parents with personality disorders. So how would TEAM-CBT help? Just curious what your experience and Rhonda too Jay Rhonda and David talk about how TEAM-CBT developed out of David's treatment of large numbers of individuals with Borderline Personality Disorder, and what some of the treatment strategies are. * * * Jeff asks: Can you talk more about the “great death” of the therapist’s “helping” or “rescuing” self? This was really helpful to me! Hi Dr. Burns, I loved what you've taught on the death of the selves - and recently read the Four Great Deaths of the Therapists Ego in your new book, Feeling Great. One part that I found so helpful was the death of "The Helping, Rescuing Self." I think I've believed that's my purpose. That's why I'm there. I'm there to "help" the client feel better and live a full, rich, meaningful life. That's something I've struggled with - because if I'm not there to help, what am I there for? And if I don't FEEL like I've helped, then I've failed the client. I'd love to hear this concept expanded on. I think many therapists, coaches, etc. would benefit from seeing how they can work with clients without thinking they have to help or rescue them. Thank you, Dr. Burns. P.S. Your new book is a goldmine. Enjoying it immensely. * * * Darkmana asks: Hey David, are there any books about Buddhism you would recommend? I can see you’re a fan of it from Feeling Great? Hi Darkmana, Thank you for your question. I'm sure there are many great books out there, but I have never studied Buddhism or read anything about it. I just sort of make things up! David will tell his Buddhism story when eating in a noodle house with his son Erik. Rhonda has invited the Dalai Lama to appear on a Feeling Good Podcast. It seems like a long shot, but it would be delightful to have the chance to chat with him, as there is so much overlap between Buddhism and TEAM-CBT! I would guess that he likely has a good sense of humor, since humor and laughter can be such great ways of grasping certain ideas and achieving enlightenment. I have heard that the Buddha talked about the “Great Death” of the self. In Feeling Great, I talk about four “great deaths” that correspond to recovery from depression, anxiety, relationship problems, and habits and addictions. I’d love to hear the Dalai Lama’s thoughts about this. There may be large numbers of “Great Deaths,” I suspect. To me, “reincarnation” is something that happens when we are alive, and not something that happens after our bodies die! However, I think most Buddhists might fiercely oppose my thinking in this regard. I think that “literalism” is one of the problems with most organized religions. Stories that are intended to convey wisdom and insight are taken as literally true. * * * Angela asks: What’s a perfect score on your empathy test? Hello David, In the weekly practice group that I host, the question came up today “what does Dr. Burns mean by no less than 20?  Is it the first section titled “Therapeutic Empathy” which is 20 points total, or the entire survey which is 20 questions? Warmest blessings, Angela Poch, RPC-C Hi Angela, Thanks, yes that is correct. 20 on the empathy scale is the lowest passing grade. A score of 19 and below indicate some significant failure in the therapeutic relationship / empathy. Since we are hoping for failure, I try to make failure as easy as possible! That’s part of my “anti-perfectionism” philosophy. I encourage the four “great deaths” of the therapist’s ego, and this is the first of the four deaths. * * * Margaret asks: What can you say to a patient who doesn’t want to push the Magic Button? Hi Dr. Burns, I attended your intensive in Atlanta and am working on my level 3 certification. TEAM CBT has transformed my life personally and transformed my practice professionally. I will be forever grateful to your hard work and dedication in developing this approach. My burning question is about the magic button / magic dial. After the positive reframe, when we ask, " With all these awesome things your negative emotions show about you and all the benefits you get from them, why would you want to press this button?"  Ninety five percent of the time my clients argue for change and that is great. My problem is when they say, "I guess I wouldn't want to press that button."  I feel like I am cheating them by not offering the magic dial. It seems like all or nothing thinking. If you press the magic button, "all" of these positive things will go away. They never get the chance to even learn about the magic dial and then may never get the chance to learn about cognitive distortions and all of the other cool methods you and others have created. My clients always benefit from the positive reframing. How much do they have to argue for change? How critical is this? Maybe I am thinking about this all wrong. I can really use some guidance. Thank You so Much, Margaret McCall I just realized my pun with "Burn"ing question- that was not intentional, lol Hi Margaret, Great question! Will add it to an Ask David. Quick answer: you can agree that it is not a good idea to press the Magic Button,  and ask them what their NTs and feelings show about them that is positive and awesome, and also ask them why they might NOT want to push the Magic Button, and then once again paradox them. All you have to do is say “Good thinking. Let’s list all the really GOOD reasons NOT to press that button.” Then you go right into Positive Reframing, followed by the Magic Dial. Also, if they do not want help, which is often the case with relationship problems as well as habits and addictions, you can just ask if them if there is anything they DO want help with! It is not my job to persuade the patient to work on something. It is the patient’s job to persuade me to help him or her! Rhonda and David

Podcast 221 Ask David December 21, 2020 Today’s Ask David features five challenging questions submitted by listeners like you! Sumaya asks: I recently bought Feeling Great and can’t find the chapters on Habits and Addictions in the book. Could you please clarify? Jay asks: Can you provide more specific information on the contrasts between Feeling Good, The Feeling Good Handbook, and Feeling Great? Rizwan asks: How would you use the Five Secrets to respond to a truly irate patient? Casey asks: How do you treat resistant autism patients with All-or-Nothing Thinking? Debby asks: What’s your definition of a violent person? Today’s podcast begins with season greetings for people of all (or no) religious faiths. Rhonda reads a moving email submitted by a listener who was helped by the recent two-part Sunny series on the Approval Addiction. David gives a plug for his upcoming workshop with Dr. Jill Levitt on “Defeating the Beliefs that Defeat You and Your Patients” on February 28. 2021 (include link.) We also give a shout for Sunny’s recently opened private practice, which offers super rapid treatment and a user-friendly fee schedule. Sunny can be reached at: Sunny Choi, LCSW sunny@bettermoodtherapy.com Better Mood Therapy rhonda's exciting new Feeling Great Treatment Center is now open for business as well. She can be reached at rhonda@feelinggreattherapycenter.com. And now—your cool questions! * * * Sumaya asks: I recently bought Feeling Great and can’t find the chapters on Habits and Addictions in the book. Could you please clarify? David explains that the two “lost” chapters on habits and addictions are available for free on the homepage of www.feelinggood.com. I had to cut about ten chapters from Feeling Great due to length, but put them on the homepage since the techniques for treating habits and addictions are new, innovative and powerful, and may help some folks. * * * Jay asks: Can you provide more specific information on the contrasts between Feeling Good, The Feeling Good Handbook, and Feeling Great? Dr Burns Is it possible for you and Rhonda to do a podcast about Feeling Great book and Feeling Good and Feeling Good Handbook? I sat down to hear the similarities and differences and target audiences etc. Very in depth etc but podcast 213 seemed to me to get derailed into the four ego deaths of the therapist and the four ego deaths of the patient. I am not minimizing the value of discussing Ego deaths. But it seems like you never really addressed the similarities and differences in the three books. One thing I have not heard you discuss is that powerful section in Feeling Good on preventing setbacks. Love addiction etc. Addressing the core beliefs that trigger recurrent depression in some people. Also the expectations of doing a two-hour session vs doing the daily mood log for 15-20 minutes per day over a few months ( in the Self Esteem section of Feeling Good.) I thank you Sincerely Jay Thanks, I DO meander! Both a curse and a blessing, as my mind works like that, with new ideas popping in all the time. First, here are the differences between the three books: Feeling Good is a beautiful presentation of the basics of cognitive therapy, including how to crush distorted thoughts and modify self-defeating beliefs like the Achievement, Love, and Approval Addictions, as well as Perfectionism and Perceived Perfectionism. The books focuses on depression, including suicidal urges. This book was published in 1980 and has sold more than 4 million copies worldwide. It has received a number of awards and has been named the top depression self-help book, from a list of 1,000 books, by American and Canadian mental health professionals. The Feeing Good Handbook has more exercises and a broader range of topics, including depression, anxiety, and relationship problems, as well as a special section for therapists on how to help challenging, difficult patients. This book was published in 1988 and has sold roughly two million copies. Feeling Great was published in September of 2020. It updates all the tools and techniques in the prior two books, but also includes powerful new techniques to overcome therapeutic resistance. It also includes a section on more spiritual (but still practical) techniques, including the four “Great Deaths” of the self. Feeling Great has a special section on how to crush each of the ten cognitive distortions, plus many real case examples with links to the actual therapy that you can hear online in my Feeling Good Podcasts. This is important because some readers may not believe that people with chronic and severe depression and anxiety can recover more or less completely in a single, two-hour therapy session. Toward the end there of Feeling Great there is a special chapter by the famed neuroscientist, Professor Mark Noble from the University of Rochester, on how TEAM quickly modifies specific circuits in the brain to achieve ultra-rapid recovery. The stance of the therapist has changed significantly in Feeling Great, as compared with the earlier books. Instead of trying to “help,” the therapist becomes the voice of the patient’s subconscious resistance, and makes the patients aware that their symptoms of depression and anxiety are not the result of what’s wrong with them, like a “chemical imbalance in the brain,” or a “mental disorder” described in the DSM, but rather what’s right with them. And the moment the patient suddenly “sees” this, recovery ill be just a stone’s throw away. Feeling Great was based on 40 years of research on how psychotherapy actually works and more than 40,000 hours of therapy with depressed and anxious individuals, including many with severe and chronic problems. TEAM is not a new school of therapy, but a structure for how all therapy works. * * * Rizwan asks: How would you use the Five Secrets to respond to a truly irate patient? Dear David I suggest one imaginary statement from an irate patient: “Your therapy is not working. In last one year I paid you $1500. And I am nowhere near completing the therapy successfully with you. I am broke. I can’t pay you anymore. I need to quit. How you could you do such a thing to me?” How would a therapist reply to this using 5 secrets? Rizwan David and Rhonda emphasize the importance of session by session testing so this unfortunate situation does not develop, and role play how to respond effectively using the Five Secrets. The importance of the Disarming Technique is highlighted, and training methods are illustrated, along with the philosophy of "learning through failure" or "joyous failure." * * * Casey asks: How do you treat resistant autism patients with All-or-Nothing Thinking? I am a behavior support specialist working with people with Autism, all across the spectrum of the diagnosis, as well as with people with intellectual disabilities, cerebral palsy and down syndrome. Not to be confused with an ABA therapist, I am more of a traditional therapist who uses eclectic strategies and methods to help the people I support. I also work mainly with adults because, sadly, the system often forgets them and they do not have as many services as children. Because I work on helping people change their behavior, it is a logical conclusion that I have to help them work to change their thoughts first. Thankfully my graduate school program was very CBT focused (Go IU School of Social Work!). Since then I have found your podcasts and books immeasurably helpful in enhancing my practice and use the methods you teach whenever possible. When working with people with Autism I often run into All or Nothing thinking, catastrophizing, and unfortunately a lot of treatment resistance because most of the people I support are “Involuntary” clients who have been sent to therapy by their family members. I have two questions: First, what is the most powerful method for defeating All-or-Nothing Thinking? Second: I know you talk a lot about agenda setting to combat treatment resistance. How do you balance the wishes of the parents (or guardians) vs. the willingness on the part of the patient to change? I struggle with this daily and could use some advice. Thank you and Rhonda so much for the amazing podcast, the books, and the wealth of information about TEAM-CBT. I have also attended several of your trainings and plan to attend more this year because our annual conference was cancelled, so I’m left to get 10 CEUs on my own and your trainings have been very helpful in fulfilling this need! Also, Rhonda: You are amazing and I hope you know it! Casey P.S. I also promoted you a lot on my Instagram channel @passionplanhappiness when I did a series on unhelpful thinking styles. I couldn’t find an Instagram page for the podcast so I just mentioned it by name. Do you have an Instagram channel? Hi Casey, Thanks, I can include this in an Ask David, and you might also want to try out one of the introductory 12 week TEAM classes sponsored by FGI, feelinggoodinstitute.com, as a lot of practice is usually needed to grasp and implement techniques and ideas that might seem simple. I do not ever treat people against their will, who are involuntary. This is not treatment in my opinion, and is rarely or never effective. However, I would offer to treat the parents if they wanted help with parenting skills for the child. Also, you might want to check out the podcast on the best techniques to treat AON! Use search function on my website. All the best, david David D. Burns, M.D. David and Rhonda talk about techniques to combat All-or-Nothing Thinking as well as how to set the agenda and sit with open hands with patients who are in therapy involuntarily. * * * Debby asks: What’s your definition of a violent person? Hi Doctor Burns, I have a question on what you consider a” violent person” to be. For example, If someone feels like punching someone out, doesn’t does that make them a violent person just for feeling it? I would say no because they never acted on it. Debby Hi Debby, You may be trying to define something that does not exist. Violent urges exist in varying degrees at varying times in all human beings. Violent thoughts, feelings, urges and actions exist. But a “violent person” does not exist. My thinking only, and many will undoubtedly “violently” disagree, and not even comprehend, perhaps, what I am saying. Humans have a dark side, and the extent is on a bell-shaped curve. The denial of the dark side is arguably worse than the dark side, since violence is generally carried out in the guise of some religious principle, or some kind of “truth.” david Hope you enjoyed today's podcast! Rhonda and David

Today’s podcast features Dr. Steven C. Hayes, the founder of ACT (Acceptance and Commitment Therapy), and author of 46 books, including his most recent book, The Liberated Mind, which is available on Amazon. We are joined by Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, California. Dr. Hayes began by describing ACT, a form of psychotherapy aimed at increasing something he calls “psychological flexibility.” He defines psychological flexibility as the ability to stay consciously in contact with the present moment, including the difficult thoughts, feelings, memories, and bodily sensations you may be experiencing. At the same time, you direct your attention toward actions and behaviors based on your personal values. I think it is fair to say that Rhonda, Jill and I had a more than a little difficulty understanding what Dr. Hayes was saying at times throughout the interview, particularly when he was describing the six dimensions of his concept of psychological flexibility. This is unfortunate, because Dr. Hayes has a great personal story to tell, and he has done a tremendous amount of interesting and important research as well. Dr. Levitt did a tremendous job in tracing some overlap between ACT and TEAM in several areas. One is the idea that feelings like depression, anxiety, shame, and even anger are not bad but are actually good. These feelings can be telling us things that are tremendously valid and important about our core values as human beings. In TEAM, we call this Positive Reframing. Another overlap between ACT and TEAM-CBT has to do with what Dr. Hayes calls “cognitive defusion,” a concept that has to do with the capacity to realize that your negative thoughts, like “I’m a loser,” or your anxious thoughts, like “I’m about to go crazy,” are simply thoughts, and not statements that are literally true. This is consistent with one of the goals of TEAM-CBT, which is to recognize that these kinds of thoughts are nearly always distorted, and the moment you stop believing them your negative feelings will diminish or disappear. ACT suggests that you need to simply “defuse” from your thoughts, while TEAM-CBT utilizes many techniques to help you crush the distorted thoughts that trigger negative feelings, since everyone is different, and you can rarely predict which approach will be effective for a particular individual. I sadly have to confess that after this face-to-face interview with Dr. Hayes, I still have extremely limited understanding of ACT, and apologize that I can’t be a more effective translator of his many excellent ideas and methods! A touching moment came at the end of the interview when Dr. Hayes spoke about his own journey into a dark place in 1981, and why the ineffective therapy that he received at that time inspired him to create ACT. We all felt really close to him at that very human and vulnerable moment. If you would like to contact Dr. Hayes, you can reach him at stevenchayes@gmail.com or visit his website at www.stevenchayes.com. You can also link to his new book A Liberated Mind. Thanks for joining us today! Rhonda, Jill, and David

Today’s podcast features a most unusual and incredibly inspiring guest, Dr. Cai Chen. Cai is a fourth-year general psychiatric resident at the University of Texas Health Science Center in Tyler, Texas. He’s also currently enrolled with Mike Christensen’s “Live Online CBT Training Courses for Therapists.” Cai has told me that Mike Christensen is a “friggin’ amazing teacher” and that everyone who is interested in starting their journey in TEAM owes it to themselves to take his class. My first contact with Cai was an email he sent me after listening to Podcast #187 on the live work I did with Dr. Michael Greenwald and Thai-An Truong at the Atlanta intensive about a year ago. Cai wrote: Hi David, Michael, and Thai-An, This podcast episode helped me truly change my life. I thought I had things figured out before, but man! The work you three did that day crystallized my own social anxiety issues and gave me the courage to finally do some very hefty self-disclosure. I was in tears throughout the podcast and well after even waking up in the middle of the night crying, knowing that I had to do the exact same thing that Michael had done. So I finally told all the people I knew on social media that I struggled with social anxiety and that my deepest fear was my negative feelings inconveniencing people, hurting them, and showing how I was being selfish by taking the spotlight. I also told everyone how all of these fears led to a lifetime of loneliness, rejection, and helplessness. I cried writing it all out because it finally felt like I was letting all of that go for the first time in my life. The response I received from so many on social media, including people I hadn't heard from in years, was astonishing and so supportive! My social anxiety was completely shattered! Now I see the truth: that our feelings are an expression of our humanity and the most honest, loving thing to do is to share them with people! I'd be damned if I'm going to tell myself anymore that my negative feelings "inconvenience" or "hurt" people. Screw whether I'm being "selfish"! I finally understand what you mean, David, that the problem was NEVER that I have been inconveniencing, hurtful, or selfish. It's that I'm telling myself that these things about me are WRONG and that I SHOULDN'T be that way. I share my feelings all the time now! The constant feelings of nervousness/unease, OCD, and panic attacks I had before are gone 99% of my days! I feel more human and myself than I've ever felt for the last 20 years. You should call it "re-learning how to be human" therapy! God bless you David, Thai-An, and of course yourself Michael! I'm truly in your debt, Michael. You're my own personal hero and I wish I was there at the intensive to give you a big hug! I'm grateful, honored, overjoyed, and just so happy for the help you've all brought me it's making me tearful again. I love the work you've done and I love you all! I'll remember this for the rest of my life. Regards, Cai Today, Rhonda and I were thrilled to meet with Cai face to face for the first time to get an update on what’s happened since that time. Cai emphasized that his intense feelings of depression, anxiety, crippling shyness and loneliness have vanished because of the intense effort he put in learning and using TEAM-CBT entirely on his own. He described how he first became acquainted with the podcasts. He felt a lack of clinical training in his residency program on how to do psychotherapy, so did a google search for therapy training, and came up with two podcasts, one of which was ours. So, he flipped a coin and the Feeling Good Podcasts won. He listened to the first podcast on measurement and testing, and said he was immediately excited about testing the idea that you could see exactly how effective or ineffective you were in every session with every patient. He was also excited by the idea that rapid changes in depression and anxiety really are possible, and that long term treatment is often not necessary. He describes his determination to use TEAM-CBT in his clinical work, after a tremendous amount of practice based on what he’s been learning in the Feeling Good Podcasts. He stressed: The importance of T = Testing, and how helpful and challenging it was at first because, as I had predicted, he initially got failing scores on the Empathy and Helpfulness scales from nearly all of his patients. But this led to opportunities to deepen his relationships with them while processing their feedback from the previous session. He said that he was initially embarrassed about handing his patients the Brief Mood Survey and asking them to fill it out before and after each session. This was helpful, but very challenging, both from a technical and emotional perspective, since it was painful to have to view his failures. I mentioned that it has been the same for me, and described a recent extreme failure with a patient who was livid with me after a session I had thought was great. But talking it over with that individual subsequently led to a tremendous breakthrough, confirming the idea that “your worst therapeutic failure is often, or always, your greatest therapeutic success in disguise.” Of course, you have to have the willingness and skill to talk it over with your patient in a respectful, non-defensive, and genuine way. My patient’s Achilles heel was perfectionism and a fear of anger. I believe it was helpful to her to see that it was absolutely okay to be angry with me, and to express feelings that she so often avoided, and to see that my failure did not have to be “awful,” but presented genuine opportunities for growth and a deepening of our relationship. Cai also emphasized the value of the Five Secrets of Effective Communication, since these tools showed him HOW to be empathic with his patients. Prior to that, he thought that empathy was something you just kind of acquired spontaneously, on your own. He also said he now realizes the incredible importance of doing your own personal work if you are a therapist. Cai was so determined to learn and to do his own personal healing that he did tons of Daily Mood Logs, every time he was upset in fact. He also did many Relationship Journals to improve his skills with the Five Secrets of Effective Communication, and even role-played with himself! He unearthed many of his own Self-Defeating Beliefs with the use of the Downward Arrow Technique, including Perfectionism and the Achievement and Love Addictions, as well as the Conflict and Anger Phobias, as well as a kind of underlying “worthlessness” schema, thinking of himself as an inherently “useless person.” Cai described his struggles with shyness, described in his email above, and identified with one of my podcasts about a young man I treated for shyness who “froze” with anxiety when in line at a Safeway store and seeing an attractive young lady checking groceries who seemed to be looking at him and smiling. Similarly, Cai froze when seeing a cute young lady and similarly felt “mortified.” He describes how he overcame his own shyness, and how he did the “What-If Technique,” while working on a Daily Mood Log, and discovered his belief that “If I open up to people about my feelings, I’ll just be wasting their time.” He decided he also had to take action, and begin forcing himself to use Self-Disclosure with strangers, as well as all the people he knew on social media, plus patients, and colleagues, telling them about his shyness instead of hiding it. He says that the positive responses he got blew his mind. He can now share his honest, vulnerable feelings with complete strangers in public and talk with them without shame or anxiety, something he never thought would be possible in the last 20 years. He also described using a two-and-a-half-hour TEAM CBT session with a woman with decades of failed treatment for incredibly severe depression, including several series of electroconvulsive therapy that had minimal effects. Althought the shock therapy worked for several months, she relapsed when she remembered why she was depressed and became miserable again). But when he did Positive Reframing, she was astonished to realize for the first time that her symptoms were actually the expressions of what was most awesome and beautiful about her, and when he used the Externalization of Voices during the M = Methods portion of the session, her symptoms not only disappeared completely for the first time, but she became euphoric. He described this personal rule: anytime he becomes upset: He immediately does a Daily Mood Log or Relationship Journal ASAP, and sometimes spends two to three hours a day doing this. He would also stubbornly skip out on meals to finish a session with himself, something he doesn’t recommend other people do! I am in awe of his commitment, not only to defeating his own demons, but also to learning to become, not just another “shrink” who prescribes drugs, but a true “healer.” Of course, Rhonda and I were pretty happy when he described the free assets on feelinggood.com, especially the podcasts, as “freaking amazing!” He mentioned how convinced he is that with dedication, time, the courage to face a lot of pain, and a lot of homework, anyone can learn how to heal themselves and better heal other people through TEAM just with the podcast and other self-learning material. He feels strongly that this is the case even if you don’t have access to any readily available teachers or trainers in your immediate area. At the end of the podcast, to bring his story to life, he shared three of his negative thoughts after seeing a woman’s new relationship status on Facebook. At the time, he previously believed all three thoughts 100%, but now no longer believed them at all. This proves that I’ll never find anyone special. There must be something inherently wrong with me because I haven’t found a lifelong partner. There’s no point in trying anymore because I keep screwing things up. I’m sure that many of our listeners, including maybe you, have had thoughts like this at some time in your life! We demonstrated Externalization of Voices, using his first thought, and Cai blew it out of the water. This was his response: “This one’s a real tear-jerker for me. I dated someone a couple of months back and it was one of the best moments of my life. It didn’t last long, but I really loved her. She wasn’t special, but that’s the exact reason why I loved her.” And then, when thinking back on the women he loved, he said, “none of them were special, but I loved all of them tremendously,” and broke into tears—showing us the beautiful and awesome human being he is. Cai was so inspired by this short session that he went back to his Daily Mood Log and came up with some more killer, emotional responses. For another of his negative thoughts “Everyone else is succeeding more than I could ever hope to”, he responded: “It’s not in my interest to believe in success and accomplishments anymore. To live is to fail because being human means being defective, flawed, and imperfect. We’re all human and we’re all failing fantastically every day. It’s time for me to join the rest of the human race by letting my success and accomplishments die. Luckily there’s not very much there so I don’t think it will be too painful to let it all go.” He mentioned how this brought on a lot of tears as well because it finally felt like he could let go of what he “needed” and still be ok. Hey ladies, I’m going to post his photo with this podcast! Go for it! This incredible young doctor is—believe it or not—available! Cai (Dr. Chen) plans to start his clinical practice in Dallas next summer following his graduation. He plans to be certified in TEAM-CBT, and will join one of our weekly free training TEAM-CBT training groups. If you would like to contact Dr. Chen, you can do so at: fontatlas42@gmail.com or cai.chen@uthct.edu. David  and  Rhonda

Do Negative Thoughts or Hormones Cause Postpartum Depression and Anxiety? And What’s the Best Treatment? TEAM-CBT or Pills? We begin today’s podcast with a lovely endorsement, and an announcement that Rhonda’s new free Wednesday TEAM therapy training group will be open to therapists from around the world and will start on December 2, 2020 at 9 to 11 AM west coast (pacific) time. Rhonda will have many fine trainers working with her, including the incredible Richard Lam, and the magnificent Leigh Harrington, to make your training experience stellar. If you are interested, contact Rhonda right away, as slots will be strictly limited. You can also fill out this form to confirm your interest! Today, Rhonda and I are proud and excited to interview our brilliant and delightful guest, Thai-An Truong, from Oklahoma. Thai-An is an accomplished TEAM Therapist (the first in Oklahoma) and popular TEAM trainer for therapists who want to learn about these new techniques. Thai-An, her husband, and two children on Halloween, the day after this podcast was recorded. Her daughter was born earlier this year. Thai-An’s niche is unusual and extremely interesting—she specializes in the treatment of women with post-partum depression with TEAM therapy, and usually without medications. This is extremely interesting since the world is currently focused on the belief that post-partum depression is a 100% biological disorder that results from hormonal changes, needs treatment with medications, and typically requires a year or more of treatment before improvement can be expected. Of course, this message can unfortunately function as a self-fulfilling prophecy. And is it even valid? No, says Thai-An. Although she sees a role for medications in some women with severe post-partum depression and anxiety, she says that the vast majority of the women she treats recover quickly without drugs. I was so happy to hear this, since my experience has been the same. In fact, Chapter 2 of my new book, Feeling Great, features my treatment of a woman struggling with severe post-partum depression who recovered in a single TEAM therapy session. Thai-An begins by describing her own horrifying and totally unexpected battle with post-partum depression after her first child was born 4 ½ years ago. She had a wonderful pregnancy and was excited about the prospect of giving birth to her daughter, but immediately after delivery, “it suddenly felt like the rug was pulled out from under me.” She went into a state of self-loathing and struggled with extreme depression and anxiety. She says, “I could barely sleep, woke up in a state of panic, and wondered ‘can I feed my baby?’” It got so bad that Thai-An began to think that her family and daughter would be better off without her. She said, “I even asked my mother if she’d be willing to raise her.” I felt incredibly sad to hear that, and I could barely even grasp the intensity of her suffering. The suffering of extreme depression is almost beyond human understanding, especially if you’ve never been there yourself. Thai-An was treated with medications, including antidepressants, but they didn’t help and made her more anxious. Then was told that these side effects are “expected” and advised to “wait it out.” She said, “I saw how devastating post-partum depression is—it robs you of joy.” They told me it was biological. One theme of Thai-An’s depression was her belief that moms are supposed to bonded to their children and loving at every moment, so “I asked myself, ‘did I make a mistake? Am I a monster? Why don’t I feel that way?’” Fortunately, Thai-An recovered after 3 months, and decided she wanted to work with other mothers with similar problems. She now has a thriving practice in Oklahoma. Rhonda asked how other doctors view her work, since Thai-An’s treatment approach—TEAM—is so radically different from current treatments that emphasize biology. Thai-An said the doctors have become extremely supportive when they see fabulous results in the patients they refer to her. Thai-An emphasized several components of TEAM-CBT that have been especially helpful to the women she treats. Positive Reframing. She says that this method is super powerful. Traditionally, woman are told (and think) that they need to “calm down,” but this makes the symptoms worse, especially the anxiety. Positive Reframing, in radical contrast, honors their negative feelings, and the effect is often “mind-blowing.” She says, “It heals a lot of the symptoms” Anxiety is even more common in post-partum depression than depression, including OCD symptoms. For example, many women have horrific intrusive thoughts that their child may suffocate, or that they’ll throw their child down the stairs, or other gruesome scenarios that they try to control and suppress. Of course, that never works and always makes the symptoms worse. Exposure, techniques like Cognitive Flooding—leaning into the fantasies and surrendering to them—can often be rapidly curative, but requires great courage on the part of the therapist, as well as the patient. Sadly, 80% of American mental health professionals avoided Exposure, wrongly thinking it will be “too dangerous” or that the patient is “too fragile.” Therapists like Thai-An, with expertise in Exposure and the courage to use it, are treasures, or “healers,” because they can often cause almost unbelievably rapid recovery and freedom from horrific fears. The Hidden Emotion Model. Nearly all anxious individuals are overly “nice,” and often suppress forbidden negative feelings, like feeling angry or annoyed. Bringing the hidden feelings to conscious awareness, and helping the patient express them, using the Five Secrets of Effective Communication, can also have fantastic and rapid healing effects. I, David, resonated with all of these themes, having seen nearly identical scenarios in many patients I’ve treated with post-partum depression, as well as their husbands or partners. Rhonda and I both share Thai-An’s enormous enthusiasm for TEAM-CBT, and greatly admire her incredible dedication to healing. Thai-An said that although post-partum depression is a bit more common among African-Americans as well as poor and underprivileged populations, it really affects everyone from a wide variety of social and economic backgrounds. No one is immune to this debilitating and demoralizing disorder. Thai-An emphasized that while hormones may play some kind of role, the real and surprising culprit is perfectionism, and the expectation that things should or should not be a particular way. In other words, telling yourself that “I should not feel angry or sad,” and “I should be flooded with love and joy,” can set you up for a painful fall. These are the unrealistic expectations that trigger intense feeling of inadequacy, anxiety, and worthlessness, not only in women with post-partum depression, but all of us. I can attest to that personally! Thai-An emphasized that recovery is not just a psychological phenomenon, but involves a deep and spiritual transformation of the patient. I definitely resonate with this theme. Thai-An attributes her fantastic therapy skills to her many mentors—teachers she’s learned from at the Feeling Good Institute (FGI) in Mt. View, California, including Matthew May, MD, Angela Krumm, PhD, and many others. But she especially wants to honor her hero and mentor, Mike Christensen, who teaches introductory TEAM-CBT classes at the FGI. I want to second that, since I also love and admire Mike, and all of our amazing teachers and colleagues at the FGI. Thai-An’s parents emigrated from Viet-Nam, a culture where psychiatry and psychology are practically unknown. Thai-An was “supposed” to go to medical school, but found psychology classes way more interesting than pre-medical classes. But her mom didn’t understand. She said, “Are you going to sit around and talk to crazy people al day?” Fortunately, Thai-An stuck to her guns and went to graduate school in a mental health field rather than medical school, and the rest is history. We are SO LUCKY to know Thai-An. She is a diminutive and beautiful woman with the brain and heart of a giant! Rhonda and I both feel extremely honored to have her testimony on today’s podcast! If you would like to contact Thai-An for training, please visit TEAMCBTTraining.com. If you are in Oklahoma and looking for treatment, you can contact Thai-An at LastingChangeTherapy.com. Thanks for tuning in today. Next week, it looks like we’ll have another amazing guest, Cai Chen, who will also blow your mind. Warmly, David  and  Rhonda

Today's Ask David features four terrific questions. Kevin asks: Why is the concept of worthwhileness and worthlessness so important to people and their emotional health? Vallejo asks: Does the statement, "WHY AM I ALWAYS THE LAST ONE TO FIND OUT ABOUT ANYTHING?” correspond to overgeneralization, or self-blame? I’ve been listening to the early podcasts on the ten positive and negative cognitive distortions. David P asks: Do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log? Harvey asks: I don’t see how Positive Reframing actually contributes to the therapy. Kevin asks: Why are the concepts of worthwhileness and worthlessness so important to people and their emotional health? Hi David, I have a quick question about the concept of being a worthwhile human being. Suppose a person believes they are unconditionally worthwhile, what are the implications of this? Why are the concepts of worthwhileness and worthlessness so important to people and their emotional health? Best Regards, Kevin Hi Kevin, Thanks! That’s a very important question. However, it is abstract and philosophical. I have found that philosophical discussions tend to go on endlessly with resolve. In contrast, when someone asks for help with a specific moment when she or he was upset, then I can usually show that person how to change the way she or he is feeling. And when that happens, the person generally suddenly “sees” the solution to some very profound philosophical or spiritual questions. All that being said, I’ll take a crack at it. The goal of TEAM therapy is not to go from thinking that you’re a worthless human being to thinking that you’re a worthwhile human being, but to give up these concepts as nonsensical. Specific activities, talents or thoughts can be more or less worthwhile, but a human being cannot be more or less worthwhile. We can judge specific events, actions, and so forth, but not humans. At least I am not aware of how to validly judge a human being, or a group of humans. We can only judge their actions, attitudes, thoughts, and so forth. Unconditional self-esteem is definitely better than conditional self-esteem, since you don’t have to be perfect or a great achiever or a great anything to be “worthwhile,” but you are still focused on being "worthwhile." I'm not sure what that means, but there is a downside, to my way of thinking. If you think you are worthwhile because you are a human being, does that mean that you are more worthwhile than animals? Lots of people abuse animals, hunt animals, and so forth, which many people find immensely disturbing. These are some of the consequences of thinking that animals are less worthwhile, for example. Not sure that helps, but like your line of questioning! David Kevin follows up: What is the implication then of giving up these concepts at all? I assume that thinking that you have unconditional worthwhileness because you are alive or to drop these concepts entirely have the same emotional implications for people. What are these implications? For example, if I think that worthwhileness and worthlessness are meaningless concepts, so what? What’s the point? What do I gain? Hi Kevin, Let me start by saying, once again, that I am not an evangelist spreading the “gospel,” so to speak. My goal is simply to help people who are struggling with feelings of depression, anxiety, and self-doubt. So, if your way of thinking about things is working for you, there’s no reason to change. But my focus is always on someone who is suffering, and that’s where these concepts can sometimes be important. I can tell you what I gained by giving up the idea that I could be, or needed to be “worthwhile” or “special.” I gained a great deal of joy. It was a lot like escaping from a mental prison. It freed me to find incredible joy in the “ordinary” events of my daily life. It also freed me from fears of “failure” or not being “good enough.” Depression always results from Overgeneralization--you generalize from failing at something specific to thinking you are a failure as a human being. Without Overgeneralization, I think it is safe to say that it is impossible to be depressed. For example, if you measure your worthwhileness based on your achievements and success, you may feel excited when you succeed and devastated or anxious when you fail, or when you are in danger of failing. I'm not sure if this addresses your excellent question! A young woman told herself that she was "unloveable" when she and her boyfriend broke up after two years of going together. Can you see that she thinks she has a "self" that can be "loveable" or "unloveable?" This thought was very disturbing to her, as you might imagine. Relationships do not break up because someone is "unloveable," but because of specific factors or events that drive people apart. Once you zero in on why the relationship failed, or more correctly, why the two of you broke up, then you can pinpoint the causes and learn and grow so you can make your next relationship even better. There are tons of specific reasons why people break up! But if you think that you’re “unloveable,” or tell yourself that the relationship was “a failure,” then you may get stuck in a morass of negative feelings. But it’s not even true that the relationship was a failure.” That’s All-or-Nothing Thinking, since all relationships are a mixture of more or less successful aspects. You could even tell yourself that a “failed” relationship was a partial success, since you successfully learned that this isn’t the person you’re going to spend the rest of your life with. What’s in it for you to give up Overgeneralization and All-or-Nothing Thinking, as well as the concepts of being a “worthwhile” or “worthless” human being? That’s a decision each person can make. There are benefits as well as problems with these ways of thinking. For example, let’s say you’re depressed and think of yourself as “defective.” This is a common negative thought, and it is based on the idea that a human being could be more or less worthwhile, or thinking that your "self" can be judged or rated. So, you could do two Cost-Benefit Analyses. First, you could list the advantages and disadvantages of thinking of yourself as a “defective” human being. Then balance the advantages against the disadvantages on a 100-point scale, assigning the larger number to the list that seems more important or desirable. Second, you could list the advantages and disadvantages of thinking of yourself as a human being with defects, and once again balance the list of advantages against the disadvantages on a 100-point scale. This is just a subtle change in semantics, but the emotional implications can sometimes be pretty powerful. As I mentioned at the top, philosophical debates are just debates. Fun, perhaps, but not terribly useful. I’m more interested in magic, or miracles. That’s what happens at the moment of profound change, which can ONLY happen by focusing on one specific moment when you felt upset and needed help. When you do that, everything becomes radically different, and real change can occur. And at that magic moment of change, the solutions to all of the problems of philosophy will often suddenly become crystal clear. Or, to put it differently, the philosophical debates will suddenly become, without meaning to sound harsh, almost a waste of previous time. Our current semi-feral cat loves my wife, but is only starting to trust me, so I’ve been working at gaining her trust and learning to understand her non-verbal and somewhat complex efforts to communicate. Yesterday she roller over on her back and stretch out her front and back paws to expose her tummy to the max, and she let me pet her tummy for quite a long time, purring loudly the whole time. I don’t care if she’s “worthwhile,” or if I’m “worthwhile,” and have no idea what those terms could even mean. But petting her tummy—now, that’s something that’s REALLY worthwhile! david Hi David, You and Albert Ellis are my heroes. Without your books, I always wonder what path I would have taken in life! Thank you. I had a quick question about self-acceptance. One of the reasons I feel that I’m fully unable to embrace it (and I think this is common) is that I’m afraid that I will lose out on motivation to work hard towards my goals. I think this partially true because my conditional self-esteem has caused me to work hard on a lot of things including CBT! Do you have any good ways to combat this exact notion, that if I accept myself I will simply become complacent and therefore I can’t? Looking forward to Feeling Great! Best Regards, Kevin Hi Kevin, There’s a lot of truth in what you say. Early in my career I also had a tendency to base my self-esteem on my achievements and productivity, both in my research and in my clinical work as well. I did accomplish quite a lot, but things were a bit of a roller coaster. When I thought I was doing well, I felt terrific, but when I thought my research was failing, or when I was stuck with a patient, I got quite anxious and frustrated. These feelings didn’t always foster positive outcomes. Now I no longer feel that my “worthwhileness” as a human being depends on my successes. In fact, I don’t even have the concept anymore. Now, I think my writing skills are very good, especially my skills in explaining complex ideas in fairly simple terms. But I do not think this makes me “more worthwhile.” Sometimes my writing, or my interactions with people, or my jogging, and many other things I do aren’t very good. But I don’t think these problems and flaws make me any less “worthwhile.” Take our little adopted feral cat, Miss Misty, that I mentioned in my last email. Misty does not care how “worthwhile” I am. However, she’s totally delighted if I pet her, let her out in the back yard to explore, or give her a piece of cat candy, or if I play with her. She is enlightened because she judges what I “do,” not what I “am.” Will you become less productive or unmotivated when you give up these concepts of “worthwhileness?” That has not been my experience. I am the busiest and most productive now than at any previous time of my life. I’m now 78, and life is a ball. I have tons of fabulous colleagues to collaborate with and we’re working on all kinds of super-exciting and challenging projects. When we don’t have “selves” that we need to protect, or feelings of “worthwhileness” that we need to defend, we can listen to criticisms and collaborate without feeling threatened, and use the information to improve what we’re doing! Hope that makes sense! david * * * Vallejo asks: Does the statement, "WHY AM I ALWAYS THE LAST ONE TO FIND OUT ABOUT ANYTHING?” correspond to overgeneralization, or personalization cognitive distortion? I’ve been listening to the early podcasts on the ten positive and negative cognitive distortions. Hi Vallejo, Rhetorical questions are technically not considered Negative Thoughts because they contain no distortions. However, this question is actually a Hidden Should Statement, and a great example of Other Blame as well. You need to change rhetorical questions into statements, like: “It’s unfair that I’m always the last one to find out about anything. This shouldn’t happen all the time!” And, as you point out, it is also a gigantic Overgeneralization. Thanks, Vallejo! On the podcast, David will talk about some of the rules for generating Negative Thoughts. * * * David P asks: Do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log? Dr. Burns, I'm a big fan of your work, and have now finished "Feeling Great" and loved it. I know you approach depression from a clinical background, but do you think there is anything to be gained from a daily gratitude log, to go along with the daily mood log? It seems like my negative thoughts are automatic, and I have to work to counter them. Maybe, if I have to force myself to think of a few things I really am grateful in my life, instead of only focusing on countering the negative automatic thoughts, it would be beneficial? Also, is there a role for altruistic volunteering in alleviating depression? Thank you. david p Hi David P, Anything that works for you is strongly recommended. I do a lot volunteer teaching, and also treat therapists and students for free, and i enjoy that a great deal! So go for it and let me know if it is effective! I often feel grateful for a lot of things, and people, and animals, like our cat, who "almost" loves me! As for me, I never use non-specific, formulaic approaches that one practices over time, hoping some good will come from it. So I never prescribe meditation, a daily gratitude log, prayer, aerobic exercise, dietary considerations, vitamins, and so forth. You can do these things if you like, but they are not “therapy” to my way of thinking. I only use specific techniques to crush a patient’s unique negative thoughts of dysfunctional ways of communicating with others during conflicts. Therapy is a lot like learning to play the piano, or going to a tennis coach to improve your game. Specific practice is needed, not prayer, gratitude journals, or the like. And my focus is on high speed, total and lasting change right now, if possible. david * * * Harvey asks: I don’t see how Positive Reframing actually contributes to the therapy. Hi Dr Burns: Thank you for this great podcast. I was particularly impressed by and related to the idea of “Beating Up On Yourself.” I think it is so easy to fall into that trap. My question is that I don’t see how the positive reframing aspect of TEAM actually contributes to the therapy. Once you did the reframing with Neil, you didn’t seem to go back to it. So why is that a necessity thing to do? I understand that the positive side of negative thoughts could cause resistance to give up the negative thoughts, but that didn’t seem to be dealt with. Thank you so much for these podcasts and I have just started to read “Feeling Great”. Maybe you go into the positive reframing aspects and benefits more in the new book. Thanks, Harvey. Hi Harvey, The session you are referring to was a while back, but by memory my thinking was that the Positive Reframing was not a particularly powerful tool for Neil, and I think he thought that also. It is not the case that any one tool--and I have created / learned more than 100 methods--will be effective for everyone. That's why it's so great to have a huge palette of tools and techniques, so you can find the path forward for many patients, and not just a few! Some people think that if a technique is not helpful for one patient, then it is no good. Some people also think that one technique, like meditation, or exercise, or medication, should be "the answer" for everyone. My experience is radically different, and it is hard for me to even comprehend how people can get sucked into some of these notions--but they do! Positive Reframing is one of the great breakthroughs in TEAM-CBT, and it opens the door to ultra-rapid recovery. In fact, I usually (but not always) see a complete or near-complete elimination of negative feelings in one extended (two-hour) therapy session. Here are some reason why Positive Reframing can be helpful: When you see that your negative feelings are the expressions of your core values, rather than your defects, this reduces feelings of shame, so you might feel a little better right away. You don’t have to shoot for perfection, or complete recovery, but rather a reduction in your negative feelings. This is pretty sensible, and more realistic and relaxing than shooting for total change. In addition, you are no longer fighting against your negative thoughts and feelings.  Your resistance to change will diminish because you can honor your negative thoughts and feelings, and work to reduce them rather than thinking you have to change completely. You’re in control—the therapist is not trying to “sell you” on something. “Selling” nearly always triggers fairly strong resistance. You may suddenly see the benefits of many of your negative thoughts and feelings, so you no longer feel so “broken” or defective. When you "listen" and finally hear what your negative thoughts and feelings are trying to tell you, the volume and intensity of your negative thoughts and feelings will suddenly diminish, like a balloon with a hole in it. Thanks for listening today! Rhonda and David  

Ask David featuring four terrific Should questions, and more questions about “asinine, stupid, narcissistic, self-serving humans! “ Oliver asks: Can a thought be thought as moral or immoral? Vincent asks: I have suffered from depression for about 3 years and say to myself, "I should have gotten better sooner." Isn't this "should" appropriate? Charles says: Your concept of “no self” shot my anxiety way up and made me feel hopeless. . . . It makes me feel worse than before! Michelle asks: How is your requirement that new patients must agree to not make any suicide attempts for the rest of their lives any different to a “suicide contract” which you mention are not effective? Brian asks: I’ve done a few things that made me feel intensely guilty. . . . The knowledge that I didn’t do what I should have done led to a lot of guilt and shame, and eventually depression. Just wondering your thoughts on this Carrel asks: I'm a Democrat in Texas. How can we use disarming to heal the political rifts in our country? Natasha asks: How do I stop the dark thoughts of wishing harm to come to stupid humans who do asinine, narcissistic, self serving, irresponsible things—like driving massive, loud pickup trucks around the neighborhood, honking incessantly as they wave their 20 ft political flags; or bringing the family for a paddle boat ride in the local pond, taking delight in teaching their human offspring to paddle the boat as quickly as they can to chase after the beautiful, innocent geese and ducks trying earnestly and fearfully to swim to safety. and more.   Dear Dr. Burns, Can a thought be thought as moral or immoral? In many podcasts and articles, you use "Thou Shalt Not Kill" to demonstrate morally should statement, which is one of the 3 valid should statements in English. I'm still somewhat confused about this concept. To tell you where I get stuck, I come up with three thought experiments. Imagine the following situations in which a should statement may come to mind: Situation 1 Lisa stole some money from a grocery store. When arrested by police, Lisa said with tears, "I shouldn't have stolen money. I feel ashamed for what I have done." In this case, it is obvious that "I shouldn't have stolen money" is a morally should statement, and also a legally should statement, because Lisa did something that violates the law and her moral principle. DAVID’S COMMENT: YES, YOU ARE CORRECT. LISA’S STATEMENT CAN BE CLASSIFIED AS A LEGAL SHOULD AND A MORAL SHOULD. Situation 2 One day, Bob went to Walmart to buy a suit. When he was passing by a shelf, a thought appeared in her mind. "What would happen if I steal this suit? I really want it, but I have very little money." When he came back home, he talked to himself," I shouldn't have felt the urges to steal things. And I shouldn’t have thought about stealing the suit." DAVID’S COMMENT: THESE WOULD NOT BE CONSIDERED VALID SHOULD STATEMENTS BY MOST PEOPLE, SINCE WE HAVE FREEDOM OF THOUGHT. HUMAN BEINGS HAVE ALL KINDS OF FANTASIES AND URGES ALL THE TIME—AT LEAST I KNOW THAT I DO! AN URGE ONLY BECOMES IMMORAL OR ILLEGAL WHEN YOU ACT ON IT. HOWEVER, ALTHOUGH I DO NOT THINK THESE ARE VALID SHOULDS, BUT I TRY NOT TO IMPOSE MY VALUES ON OTHERS FOR THE MOST PART. I AM A SHRINK, SO I WORK WITH PEOPLE WHO ARE ASKING FOR HELP. FOR EXAMPLE, PEOPLE WITH OCD OFTEN PUNISH THEMSELVES JUST FOR HAVING “FORBIDDEN” THOUGHTS, FEELINGS, OR URGES. THE FIGHT TO CONTROL THEM IS THE ACTUAL CAUSE OF THE OCD. THE SHOULDS TYPICALLY MAKE THE PROBLEM WORSE, NOT BETTER. SELF-ACCEPTANCE CAN BE ONE OF MANY HELPFUL TREATMENT STRATEGIES. RELIGION CAN SOMETIMES BE A SOURCE OF OPPRESSIVE SHOULDS, ESPECIALLLY THE MORE FUNDAMENTALIST TYPES OF RELIGION. RIGIDITY MAY BE A PARTIALLY INHERITED TRAIT. FOR EXAMPLE, MANY RELIGIONS AROUND THE WORLD PROMOTE THE IDEA THAT HOMOSEXUALITY IS “WRONG” AND THAT PEOPLE “SHOULDN’T” HAVE URGES AND ATTRACTIONS TOWARD PEOPLE OF THE SAME GENDER. THIS IS AN AREA WHERE “SHOULD STATEMENTS” BECOME HIGHLY CONTROVERSIAL, AND ARE OFTEN A SOURCE OF HORRIFIC HATRED AND VIOLENCE, SOMETIMES IN THE NAME OF SOME “HIGHER POWER.” Situation 3 Lucy was buying fruits in a grocery store when she found that a man was taking an apple off the shelf and hiding it in his clothe! Obviously, the man was stealing an apple. Lucy was very angry and said, "the man shouldn't steal things from the store. It's not right!" In this case, Lucy didn't steal apples, the man did. But Lucy made a moral judgement about the man's behavior, not Lucy's behavior. Then is this should statement valid for Lucy? DAVID’S THINKING. TO MY WAY OF THINKING, YES THESE ARE VALID LEGAL SHOULDS AND MORAL SHOULDS, SINCE OUR CIVILIZATION (AND ALL CIVILIZATIONS) HAVE DECIDED THAT STEALING IS ILLEGAL, AND IS ALSO CONSIDERED MORALLY WRONG IN MOST RELIGIONS: “THOU SHALT NOT STEAL” IS, I THINK, ONE OF THE TEN COMMANDMENTS. THE GOAL IS NOT TO CLEAN UP YOUR SPEECH SO THAT YOU NEVER USE SHOULD STATEMENTS THAT DO NOT FIT INTO ONE OF THE THREE VALID CATEGORIES OF LEGAL SHOULDS, MORAL SHOULD, AND LAWS OF THE UNIVERSE SHOULDS. AT LEAST I HAVE NO INTEREST IN THAT. MY GOAL IS TO HELP PEOPLE WHO ARE SUFFERING BECAUSE OF SHOULD STATEMENTS. sincerely Oliver   Hi David, What is it with "shoulds" related to recovery from depression? I suffer from depression for about 3 years and say to myself "I should have gotten better sooner." Isn't this "should" appropriate? Because who really wants to suffer through this agony? Greetings from Geneva. Vincent Hi Vincent, "I wish I had gotten better sooner." This is a correct statement without the "should." This simple shift in language is called the Semantic Technique, and it was developed by Dr. Albert Ellis who kind of gave birth to cognitive therapy in the 1950s, along with Dr. Karen Horney about the same time. Instead of using a should, you use “it would be preferable if” or “I wish X was true.” In addition, it isn't actually true that you "should" have gotten better sooner! The universe does not always conform to our expectations. Just because we want something, it doesn't follow that it "should" happen. I'd love to have a new Tesla sports car, at least in fantasy, but it isn't true that I "should" have one. It would be “great” if you had gotten better sooner, that’s absolutely true. “I should have gotten better sooner.” That’s totally false. In addition, although one might think that no one would "want" depression, my research and new clinical work indicate that resistance is nearly always the key to recovery. In other words, people do cling to depression, anxiety, troubled relationships, and habits and addictions, but don’t realize why they are resisting change. Once you suddenly see why you are resisting, your resistance paradoxically disappears, and recovery is then just a stone’s throw away. You can learn more about this in my new book, Feeling Great, available now on Amazon. Thanks! PS let me know if you like the new book, and if you find it helpful! All the best, David   A new comment on the post "108: Do You Have a "Self?"" is waiting for your approval Author: Charles Dr. Burns, First off I want to say thank you. Your work has been helping me through my anxiety. However, I really struggled with this podcast. The concept of no self shot my anxiety way up and made me feel hopeless. It made me feel almost as if I was not real or that there is nothing worth striving for. I love helping people. But I feel like I don’t have a purpose if I don’t have a self. It makes me feel worse than before. David’s answer. Hi Charles, The “great death” of the self is a challenging concept, and while it is incredibly liberating, lots of people—most, in fact—don’t “get it.” Some get angry. Some struggle with trying to understand what this could possibly mean. And some find the concept very threatening. That’s why I deleted the chapter from my book. In fact, a couple extremely brilliant and interested colleagues totally couldn’t grasp it, and felt frustrated by my writing on the concept. sometimes, ideas are so simple and basic that people cannot grasp them. The Buddha ran into this problem 2500 years ago. People thought he was fantastic, but almost none of his followers experienced the enlightenment he was so excited to teach them. The 20th century philosopher, Ludwig Wittgenstein, ran into the same problem. He solve all the problems of philosophy, but when he was alive, it was rumored that only seven people in the world, including one of his favorite students, Norman Malcolm, could grasp what he was saying. He went in and out of intense depression and loneliness during his life, in part because of his frustration with trying to teach the obvious. In my book, Feeling Great, I teach that there are actually four “Great Deaths” for the patient, corresponding to recovery from depression, anxiety disorders, relationship conflicts, and habits and addictions. There are also four “Great Deaths” for TEAM therapists. Those sections might be helpful for you! In addition, I focus on the fact that people can never judge your “self,” only something specific that you think or do. Depression cannot exist on the specific level, only up in the clouds of abstraction. For example, Overgeneralization is one of the ten cognitive distortions I described in my first book, Feeling Good. When you Overgeneralize, you see a negative event as a never-ending pattern of defeat, and you might also Overgeneralize from some specific flaw or defect to your “self.” You will read about an attractive and vivacious young professional woman who had the thought, “I’m unloveable,” when her boyfriend of two years broke up with her. This is classic depression thinking, and “self” thinking. She thinks she has a “self” that can be loveable or unloveable. But this is simply not true, and it’s not productive, because she’ll spend all her time ruminating and feeling worthless. An alternative is to focus on why the (overall excellent) relationship didn’t work out, and what she can do to change and learn and grow, so as to make the next relationship even better. You can pick up on the details in the chapter on Overgeneralization if you’re interested! As I point out in Feeling Great, the “death of the self” is not like a funeral, it’ like an incredible celebration of life. Death of your old concept of what you are is liberating, and leads to instant rebirth. My teachings cannot make you happy or unhappy. Your thoughts about what I’m saying create all of your feelings, positive or negative. At any rate, thank you for a most important question that most of my audience will definitely related to. As an aside, I lost my “self” years ago, and what a relief that was. Sadly, it comes back to life from time to time, and then I struggle again, until I realize what’s happening. One day, what I’m saying may make sense! In the meantime, please accept my apologies concerning the “self!” If it gives you comfort to believe you have a “self,” no problem. But the “self” is just a concept, and not a “thing” that could exist or not exist. When you lose your precious and protected “self,” you lose nothing, because there was never anything there in the first place! But while you lose nothing, you do inherit the earth, as nearly all great religious leaders—Buddha, Jesus, and others—have taught us. David   Hi Dr. Burns, I’ve just listened to your podcast episode on suicide and found it really interesting and useful but I have a few questions. Firstly, how is your requirement that the patient agree to not make any suicide attempts for the rest of their life any different to a ‘suicide contract’ which you mention are not effective? Also, you talk about doing this assessment at the intake and making non-attempts a condition of therapy. If the patient/client agrees to this, why then do you continue to monitor suicidal thoughts in each session in the BMS? Presumably because the agreement is no guarantee of cessation of thoughts. Surely if you’ve told them it’s a condition of therapy with you to not make any attempts then they’d be likely to not tell you about them even if they occurred, and don’t see how setting the initial ground rule resolves the problem. And lastly, when suicidal thoughts, urges, or fantasies do come again in the BMS how do you handle it then? Do you tell them you’ll end therapy, say “but you promised”? Looking forward to your reply. Thanks, Michelle. Hi Michelle, I have scheduled your email for an upcoming ask david episode, and will use your first name unless you prefer that i use some other name. Here is a brief reply. Most patients with borderline personality disorder will become enraged by the gentle ultimatum at the initial evaluation, and if they decide this is not the type of therapy they want, so be it. The techniques I use will not be effective with patients who continue to threaten suicide. TEAM therapy requires TEAM work. Most, nearly all, patients will "get it" and will decide to continue with the therapy. They can have suicidal thoughts and urges, and we can work on them together in therapy. However, to my way of thinking, it is important that they therapist and patient be protected, in a safe environment. If the patient starts threatening to make a suicide attempt, then they will need another form of more intensive treatment like hospitalization, day care, or intensive outpatient treatment. These are options I cannot personally provide for them. I monitor suicidal urges before and after each session with every patient with no exceptions to protect the patient and to protect myself as well. Thanks! PS the suicide contract is an agreement not to attempt suicide "while we are working together." This is very weak, as the patient can suddenly decide he or she is dropping out of therapy and making a suicide attempt. And this often happens. My contract is more demanding, and intentionally so. Patients must also agree to do psychotherapy homework, too. Some patients want to make the therapist a hostage with suicide threats, which can and so work as a form of manipulation and hostility. Then the therapist is in an almost constant state of agitation, anxiety, and frustration. If I allow a patient to make my life miserable, how can I teach that patient how to be happy? We are all ONE—we go up and down together. If I allow you to make my life miserable, then I am allowing you to make your own life miserable, too. David   Hello David, Thank you so much for everything you do. I’ve listened to all of your podcasts, and read most of your books, and am very grateful for the changes you, Rhonda, Fabrice and the rest of the team have made to my life. I’ve just listened to this episode, and there’s one thing I’m struggling with, which is the concept of the moral should. I’ve done a few things that made me intensely guilty – one in particular was not standing by and supporting a friend who needed people when he was going through a particularly hard time. He was angry and disappointed with me, and, in hindsight, rightly so. He has since forgiven me but I still struggle with it. I feel that supporting him was a moral should. The knowledge that I didn’t do what I should have done led to a lot of guilt and shame, and eventually depression. You say that a moral should is valid; so therefore, I feel that my negative thoughts on this are not misguided but valid – I did something morally wrong and deserved to feel bad for it. Just wondering your thoughts on this. Thanks again, and keep up the good work! Hi Brian, thanks! Would love to include this on an Ask David, using just your first name, or even a fake name if you prefer. A quick response might be to ask how many minutes per day would you like to dedicate to feeling guilty? And for how many days, months, or years? In your spiritual or religious beliefs, is a person supposed to feel intensely guilty forever? Most of us have done things we are ashamed of, or feel guilty about. How much guilt and shame would you recommend for me, for example? And what is the goal of the guilt and shame? And how guilty would you recommend I feel, between 0% and 100%? That's one approach. Another approach would be A = Assessment of Resistance, listing what the guilt shows about you that's positive and awesome, and then asking yourself why in the world you'd want to let go of the guilt, given all the many real positives. Then you might validly decide to “dial it down” to some more acceptable level. For example, if you now feel 90% guilty, perhaps 15% or 20% would be enough. In addition, you could also decide how many minutes of guilt you would recommend. If you now feel guilty about eight hours a day, would 10 minutes be enough? If so, you could schedule your “guilt periods” ahead of time, and then really work hard at feeling guilty during those ten minutes. Then, when you’re done with your “guilt work,” you can return to joyous and loving living! Also, instead of one ten minute daily guilt binge, you could schedule, for example, three guilt binges, each three minutes long, in the morning, at lunch time, and in the evening, like three pills the doctor prescribed! David In reply to Dr. Burns. Hi Dr Burns, Thanks so much for your quick response! I really appreciate your advice; I will dedicate a bit of time today to approaching it the way you say. And also, I’d be delighted if you included it on a podcast! You can use my first name by all means. Thanks again! Brian   Comment from Carrel I'm a Democrat in Texas. How can we use disarming to heal the political rifts in our country? How does one find agreement across that ever-widening divide? Carrel David’s reply Hi Carrel, It’s really tough, for sure! Have you listened to my podcast on this topic? There is a search function on my website. If you type in “political divide,” this podcast will pop right up: “127: How Can We Communicate with Loved Ones on the Opposite Side of the Political Divide?” Let me know what you think! David David emphasizes the value of the search function. Often you can find your questions have already been addressed. In addition, the many podcasts on the Five Secrets of Effective Communication could be invaluable (links), and the emphasis would be on using the Disarming Technique to find some truth in what the other person is proclaiming and arguing for. But first, you have a decision to make, and this is always based on ONE person you may want to interact with. First, ask yourself if you do actually want a better relationship with person X, Y, or Z. There is no rule that says we have to get along better with everyone. I think that Joe Biden is doing a pretty good job of promoting unity, and not diverseness in our country. Hopefully, the forces of love and unity will win out over the forces of hatred and war, but it’s not at all clear what direction our country is heading for. And we’re seeing now that at times the tensions are become so intense, and the hatred so strong, that violence is once again on the increase. In the next Ask David we'll have a really cool session devoted to the intense anger that many of us feel when confronted by human behavior that strikes us as narcissistic, vicious, self-serving, and aggressive. This topic should appeal to lots of people! And we have a wonderful question from a woman who's feeling pretty darn enraged! David and Rhonda  

Last week, you heard part 1 of the live work with Sunny. Today, you will hear the dramatic conclusion of that session. My wonderful co-therapist is Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, California. Jill also co-leads our Tuesday training group at Stanford. This session took place between 5 and 7 PM at a recent Tuesday group because we feel that personal healing is a critical part of psychotherapy training. We will begin with a summary of A = Assessment of Resistance. David will summarize  Sunny’s Positive Reframing list, as well as the “turning point” when David challenged Sunny’s first negative thought, telling himself that he shouldn’t be getting anxious again. Once again, the moment he saw that he actually should be getting anxious, and that this was a good thing, and not a bad thing, the dam kind of broke open, and Sunny suddenly saw everything in a radically different perspective. This is one of the core principles and goals of TEAM—helping the patient suddenly see that his or her suffering is not the expression of what’s wrong with you, like a “chemical imbalance” in your brain, but what’s most beautiful and awesome about you, and your core values as a human being. During this phase of the session, Sunny expressed anger about parents who tell their children they SHOULD do X, Y, and Z, and thus sowing the seeds of low self-esteem and the need for approval. We continue and conclude the M = Methods, using: Identify the Distortions The Enhanced Cost-Benefit Analysis (Enhanced CoBA) The Externalization of Voices, with Self-Defense and the Acceptance Paradox The Hidden Emotion Technique The Five Secrets of Effective Communication Final T = Testing. You can see Sunny’s end of session mood ratings on his completed Daily Mood Log, as well as his end of session scores on the Brief Mood Survey and Evaluation of Therapy Session. Here is Sunny’s follow-up email to the Tuesday group: Hi folks. Just want to give you an update of what happened after our group meeting. I was exhausted after our session. But I felt very good - even different than other times when I did self disclosure and deep-down part of me was looking for some validations from others. This time, I came out feeling very confident about myself and my ability to swim without the floating bubbles (approval from others). Most importantly enjoy life now. In fact I didn’t think talking with my mom was necessary because I was not angry with her the next day. Somehow I wasn’t blaming her anymore because I know she changed since then. And I was thankful because I wouldn’t be where I am without that push. But I did chat with her tonight. I told her how I was hurt when I felt a lot of pressure from her when I was young. And that I love her very much and now am happy that I am confident about my own life decision without needing approval from others. And she told me that she is happy that I am happy. And when we were young, she And she will always love me and support me. And she is happy that I am doing whatever I love so I don’t regret in life. And on and on... lots of loving languages that we don’t use together usually :) Net net: it was an awesome chat and we are closer. But as importantly, I wasn’t looking for any validation from her - more like giving her some good news about my personal growth. And I felt more confident and equal but loving when I talked with her. So it’s all good :) I do have an insight on self disclosure. From my experiences, there is a fine line between self disclosure vs approval seeking type of sharing. Both can have similar Immediate results - feeling good and emotional. So make sure our clients are clear of the objective of the self disclosure. And that there is no approval seeking hidden inside - if that’s not the objective. See you all next Tuesday Sunny And here is some of the feedback from members of the Tuesday group: What did you like the least about today’s Tuesday group? Nothing comes to mind Sunny was fabulous! This isn't something I disliked, but a question... I'm trying to figure out how David and Jill are able to get through the process so quickly and yet have it not feel rushed.. I suppose a lot of practice! Also curious about how Sunny will talk to his mom- thinking about doing this with my mother, I'd be worried that she'd feel like I was blaming her for something and become defensive and close down (which she typically does when anyone tries to bring up their feelings or even when they ask about hers), so I'd be curious about the specific details of the 5-secrets approach here Nothing — I loved everything about our session tonight Please describe what you specifically liked about the training? What was the most helpful? Agree with David that the learning which takes place via live personal work may be the most powerful of all. Helpful to review the various steps and methods while also watching the masters weave the art and science of It all together. Thank you to the brave Sunny for sharing this work with us tonight. This Session was also an awesome dose of relapse prevention for myself, as while I have made major strides with approval addiction this year, I still drift in and out of enlightenment, as is expected! I appreciate that Sunny's courage to share his vulnerability. His cultural background and parenting style are very similar to mine. I enjoyed the masterful use of empathy from David and Jill I share Sunny's approval need without being told by a parent, at least not obviously. The 'talking back to distorted thoughts' helped me a lot. Also, watching the flow of the therapy by David and Jill was educational in my interactions in similar situations. I loved seeing the whole process of TEAM being modeled with Sunny. I especially liked the positive reframing and empathy stages the best, but it was all so blow away to experience. I'm so grateful to be able to be a part of this group. I loved watching the whole session unfold. It was a powerful positive reframe and Jill really honed in on the hidden emotion which seemed to really resonate with Sunny. I love the live sessions. It went so deep, and was so moving and beautiful. I appreciate Sunny's courage and authenticity, and the skill of David and Jill. Feeling so grateful to be able to see the live demo of TEAM by David & Jill on Sunny. It feels like watching the very painful but beautiful grief process of letting go of this infamous approval addiction, which I relate to so much as a Chinese woman. Watching how the enhanced CBA is a very magical, powerful & dynamic uncovering tool to address outcome resistance & change his mood rapidly. I loved being able to walk patiently through each step of the therapy. I am frequently amazed at how quickly the work goes once the TEA is managed fully and effectively. I love this stuff! Thanks for allowing me to be an observer and participant in this group. I like seeing the richness of live work. It was uplifting to hear group members share with Sunny how the session affected them and how they think about their parent-child relationships. It's always great to watch a full session. This has been a wonderful session and also a surprise. I see clients and do not get to check emails before we start and was not aware we were heading for another individual work - what a treat! This has been an amazing session. Sunny is a very bright and sensitive guy and admire his eagerness to work though his challenges and open up to the group. I have learned so much from his insights and felt most honored to be an invisible participant in this process. Thank you Sunny! Jill and David you were wonderful! This has been a particularly powerful session. Thank you. It was great to see the shift in thinking and feeling in session. Sunny was so open to talk about his past and his pain; he had been reflecting about his approval addiction for some time. It seemed that through the positive reframing he was able to see his "addiction" from a different perspective. Approval addiction is something I have struggled with myself over the years and I felt so grateful toward Sunny for his vulnerability. Also really appreciated Jill's pausing to address the anger that came up in the Externalization of Voices, and David's teaching point about how important it is for the patient to really "SEE" something during the positive reframing. Loved that Sunny was willing to be truly vulnerable and authentic. I always love seeing the model from start to finish. Session tonight was exceptionally awesome. Thank you, Sunny for your willingness to work on something so painful and deep in front of the whole class. This has been one of my favorite classes. You touched my heart because you were genuine,, honest, and very very humble. Thank you! And thank you to David and Jill for their superb teaching. As always, I learn so much from them when they do live. With immense gratitude – Sara Demonstration by David and Jill. It was such an amazing opportunity for us to witness how T.E.A.M works and get through the process. Approval addiction is something I have wanted to work on myself..... I need to listen to the recording and review! I enjoyed seeing the ease in which the TEAM method was used Jill's way of connecting some dots and inquiring with sunny about his mother’s understanding of his experience. Jills ability to do this always blows my mind because I'm still trying to tap into that deep level of listening. Thank you for sharing Sunny! Love the cultural aspect that was brought in This live session was moving, insightful, and very instructive for me. It gave me insights into my own approval addiction, it moved me to see how Sunny went through his internal conflict throughout the session, and it was beautiful and very instructive to see two master therapists like David and Jill at work. Thank you so much Sunny, David, and Jill! Thank you Sunny, David and Jill. I was moved and touched by the therapy. I like David and Jill asked Sunny his feeling at an appropriate moment during the therapy instead of only at the beginning and the end. For instance, David asked, "You are opened up to us. How are you feeling now?" Jill asked how angry he was when he expressed his feeling of anger to his mom. It is very powerful. I liked how David asked Sunny to communicate with his mom. Although I am learning the Five Secret skills, it is still hard to use them in daily life. I need to practice it. Sunny can be reached at: Sunny Choi, LCSW sunny@bettermoodtherapy.com Better Mood Therapy Thanks for listening today! David and Rhonda

In today’s podcast, we will work on another common Self-Defeating Belief, the Approval Addiction. Here are two definitions: My worthwhileness as human being depends on getting approval. I need approval to feel happy and fulfilled. I thought of calling this podcast “Curing a Case of Siliconitis” because here in Silicon Valley, there is a pronounced tendency for people to measure their self-esteem based on their accomplishments, so today’s program also has some overlap with the Achievement Addiction we featured recently. Of course, you don’t have to live in Silicon Valley to struggle with the Approval and Achievement Addictions. These problems are almost universal throughout the United States as well as the entire world. In fact, for today’s special guest, Sunny Choi, the problem originated in Hong Kong when he was growing up. And although your life may be very different from Sunny’s, you may discover that you, too, sometimes struggle with the need for approval, and the tendency to base your self-esteem on your achievements. So I’m hoping that the healing Sunny experienced might be contagious and end up helping you! I want to thank Sunny for allowing his personal work to be broadcast, raw and unedited, on the podcast. Personal work is absolutely essential to becoming a world-class therapist, because you can’t really heal others until you’ve healed yourself. But sharing your inner struggles, your tears, and your shame, can be extremely frightening, making you totally vulnerable, so Sunny has given all of us an incredible gift! I also want to thank my amazing co-therapist, Dr. Jill Levitt, who helps lead the Tuesday group. She is also the Director of Training at the Feeling Good Institute in Mt. View, California. I love teaching and doing co-therapy with Jill. TEAM therapy does NOT require two therapist, but I love to work with a co-therapist whenever I do live therapy in a teaching situation, as it often makes for a richer and more dynamic session. The session will be broken into two consecutive segments. Today, you will hear the T = Testing and E = Empathy parts at the start of the session. Next week, you will hear the A = Assessment of Resistance and M = Methods parts. At the end of next week’s podcast, Sunny will join us for a follow-up so we can see how he’s been doing since the end of this session. At the beginning of the session, we reviewed Sunny’s scores on the Brief Mood Survey, which indicated minimal feelings of depression, mild anxiety, and just a touch of anger. However, his happiness score was only 22 out of 40, indicating significant unhappiness, and his Relationship Satisfaction score, thinking of his mother, was only 16 out of 30, which is also not very good. However, he said that this score is higher than it’s been, indicating longstanding dissatisfaction with his relationship with his mother. Sunny explained that he’s been seeking and getting approval since he was a small boy. He was the “good golden boy” who always wanted what his mother wanted, and he always got rewarded. In addition, since he was a boy, he always got the best food, and his sister always got the less desirable dinner. In addition, she was a rebel, and often punished and beaten by their mom, which made Sunny feel guilty. At the same time, he was good at getting approval from just about everybody, so lots of people like him. His first frightening step toward independence was coming out as a gay man in his 20s. This was an intensely anxious time in his life. After his family migrated to California, he pursued a career in high tech, which was what his mother wanted, and he was very successful and earned a high salary. But he was unhappy, because it wasn’t what he really wanted to do with his life. He wanted to help people, but because of a lisp in his speech, his mother urged him to pursue engineering, which, of course, he did, and he also graduate from Stanford University, which gave him even more approval and “success.” His second frightening step toward independence was six years ago when he decided to leave high tech to pursue a master’s degree in clinical social work. This was a bit anxiety provoking because he did his master’s work at a program that was adequate, but not at all prestigious. That was about the time he joined my weekly training group at Stanford. Sunny took the TEAM model very seriously, and mastered it, developing superb therapy skills. Following his licensure, he took a job at a local mental health clinic and worked with many immigrants struggling with depression, anxiety, and somatic complaints, and experienced tremendous success, since most of us patients recovered in just a handful of sessions. However, he was anxious and ashamed of his success, since TEAM is so radically different from the more conventional forms of therapy his colleagues at the clinic were using. He feared their disapproval, and always tried to hide or downplay his success. Recently, Sunny took a third frightening step toward independence. He decided to quit his full-time job, and take a half time job with an online startup, so he could have half of his time to do what he wanted, instead of trying to please or impress others. And although this is working out well, and he’s been feeling pretty good, and making progress, at times he gets anxious, and feels like he’s swimming in the ocean without his flotation device to keep him safe. And although he knows rationally that he can swim really well on his own now, at times he descends into spells of anxiety and self-doubt. He even yelled at himself out loud for being “stupid.” He explains: What helped was when I called my Mom and said, “I feel useless if I’m not working full-time,” and started crying. She is now 80, and was accepting, and that helped quite a bit, but in the past I’ve always been surrounded by people who approve of me because of my success. Now I feel lost and lonely, and I’m dealing with anxiety again. Sunny also said he felt frustrated because, once again, he sought and got his mother’s approval. He explained: I feel bad. I’m concerned that I will never get better. I feel sad that I’m stopping myself. My approval is my flotation device. I’m scared and lonely at times. I’m used to someone saying, “You’re doing the right thing.” I feel like I’m not good enough. Right now I want the approval of the Tuesday group, but that will just prolong my addiction. You can see Sunny’s Daily Mood Log here. Next week, Jill and I will work with Sunny on A = Assessment of Resistance and M = Methods! Sunny can be reached at: Sunny Choi, LCSW sunny@bettermoodtherapy.com Better Mood Therapy David and Rhonda

In today’s podcast, we discuss a few of the many differences between Feeling Good, my first book, and my new book, Feeling Great, which was just released. We also discuss some of the differences between the cognitive therapy that I launched in Feeling Good, and the powerful new TEAM therapy that I feature in Feeling Great. I wrote Feeling Great because there’s been a radical and enormous evolution of the treatment methods and theories in the 40 years that have elapsed since I first published Feeling Good in 1980. I now have many more techniques than I had then, and there’s been with a radical development in my understanding of the causes of depression. I also have new ideas about the most effective treatment techniques, based on my clinical experience since I wrote Feeling Good (more than 40,000 hours treating individuals with severe depression and anxiety), as well as fresh insights about what's important, and what's not, based on four decades of my research on how psychotherapy really works. Rhonda asks many questions about the unique features of TEAM including the new T = Testing techniques, the new E = Empathy techniques, the A = Assessment of Resistance techniques, as well as the M = Methods. Rhonda is particularly curious about the four “Great Deaths” of the therapist’s ego in TEAM therapy, which correspond to the four TEAM components of TEAM, as well as the four “Great Deaths” of the patient’s ego, which correspond to recovery from depression, anxiety, relationship problems, and habits and addictions. One of the goals of TEAM is not simply the complete and rapid elimination of the symptoms of depression and anxiety, but the development of personal enlightenment and the experience of great joy and a deeper appreciation of life. Toward the end of the podcast, David tearfully talks about the life of his hero, Ludwig Wittgenstein, who is viewed by many as the greatest philosopher of all time, and David, a philosophy major when he was a student at Amherst College, would definitely agree with this assessment. But Wittgenstein was very lonely, and prone to depression, because very few people understood his ground-breaking contributions when he was still alive. In fact, it was thought that only five or six people in the world “got it.” Part of the problem is that what he was saying was so basic and obvious that most people just could grasp it, or the extraordinarily profound implications of his work. His depression and loneliness, sadly, perhaps also resulted from the fact that he was gay, and living at a time when this was far less acceptable than it is today. He never published anything when he was alive, because when he was depressed, he thought he'd made no meaningful or enduring contributions. However, his remarkable book, Philosophical Investigations was published in 1950, following his death, and was soon regarded as the greatest book in the history of philosophy. Because of that book, David gave up his goal of a career in philosophy, since Wittgenstein wanted all of his students to give up philosophy and do something practical instead. So that’s what I did! My only regret is never having the chance to meet Wittgenstein and tell him, “I got it!” and thank him for his incredible contributions. If you want to learn more, check out the short read by his favorite student, Norman Malcolm, who wrote “Ludwig Wittgenstein: A Memoir.” I cry like a baby every time I read the book, and tears come to my eyes when I even look at the book, which is proudly displayed in my office. If you ever visit me at home, make sure you check out the  book. I feel so fortunate to be able to work with Rhonda and bring my message to so many of you every week. Thank you for your support!  [Note from Rhonda:  I feel extremely honored to work with David and be a part of bringing David's message, and the TEAM therapy model to our listeners!] David and Rhonda

How to Change a Self-Defeating Belief (SDB) (cont'd) Last week, you had the chance to listen to our Tuesday training group at Stanford as we worked on the "Achievement Addiction," Part 1 (Podcast 211). Although we were working with a therapist named Zeina Halim, it turned out that just about everybody in the group had this belief, and perhaps you do, too--thinking that your worthwhileness as a human being depends on your achievements, hard work, and productivity. This belief, which is also known as the Calvinist work ethic (e.g. you are what you do) is actually at the heart of Western Civilization. And while it can trigger intense achievement, it can sometimes also trigger angst, including feelings of depression, anxiety, and endless self-doubt, wondering if you and your achievements are "good enough." In last week's podcast, we played the first half of the Tuesday group's session, featuring the Cost-Benefit Analysis. In today's group, we play the the recording of the last half of the group, featuring these three additional techniques. At the end of today's recording, Zeina joins us and talks about the session, and the techniques that were the most meaningful for her. The Semantic Technique. This involves change at the intellectual level. If you decide that a SDB is not working to your advantage when you do a CBA, you can you modify it so you can keep all the advantages you listed while getting rid of most if not all of the disadvantages. This is a bit of practical personal philosophy exercise with significant emotional implications. The group members came up with a wide variety of alternate beliefs, and I critiqued several of them, pointing out the benefits and pitfalls of each new version. The Feared Fantasy. Here's where change at the gut level begins, and you also can begin to challenge the idea that high achievers really are more worthwhile. We did a version of this technique that I've often demonstrated in my workshops called the "High School Reunion." It is a humor-based technique, but the goal is to make a powerful point at the gut level, so you can (hopefully) suddenly "see" that it is simply not true that people who achieve a great deal really are more worthwhile human beings. The Double Standard Technique. Here's where change at the gut level continues, and you will hear a beautiful example in Zeina's dramatic interaction with Dr. Levitt. Dr. Levitt plays the role of someone trying to figure out if she really is less worthwhile than people who achieve a great deal more. Rhonda and I hope you enjoyed our podcasts on the Achievement Addiction. We'd also like to thank our courageous Zeina for sharing her very personal work with all of us. Live work--and showing how a technique works--is generally far more inspiring and illuminating than simply teaching how a technique works. Please let us know if you'd like more Feeling Good Podcasts like this in the future, with recordings from our weekly training group,  and also if there are additional Self-Defeating Beliefs you'd like us to feature. My new book Feeling Great, is now available on Amazon (see the link below) as a hardbound volume or as an eBook. It features all the new TEAM therapy techniques, and is geared for therapists as well as the general public. Rhonda and David

How to Change a Self-Defeating Belief (SDB) Many of you have expressed an interest in my free Tuesday training group for mental health professionals. Today, you can attend, thanks to the generosity of our group in allowing the group to be recorded on Zoom, and thanks Zeina, the group member who courageously volunteered to have us work on her “Achievement Addiction.” I also want to thank my beloved and brilliant co-teacher, Dr. Jill Levitt, who always adds tremendously to our group, on so many different levels. Last week, we taught the group members how to pinpoint Self-Defeating Beliefs that trigger depression and anxiety, and we promised to show them how to challenge and modify a Self-Defeating Belief in the group you’re about to “attend.” We decided to focus on the Achievement Addiction, which is the belief that your worthwhileness as a human being depends on your achievements and productivity. Perhaps you share this belief! Most people do. Here’s how a Self-Defeating Belief works. Let’s say that you base your self-esteem on your achievements. As long as you think you’re achieving and being successful, we would predict that you’ll feel happy and contented. But we would also predict that you may experience episodes of depression, anxiety, and self-doubt when you fail or fall short of your goals and expectations. That’s when you’ll be most likely to start beating up on yourself with distorted negative thoughts, like “I’m a loser,” or “I shouldn’t have screwed up,” or “I’m not good enough.” So, in short, the combination of an SDB (“My worthwhileness is based on my achievements”) plus a negative event, like a perceived failure, triggers distorted thoughts (like “I’m a failure” or “loser”) which trigger negative feelings, like depression, anxiety, shame, inferiority, or even suicidal thoughts. In addition, cognitive therapists believe that if you modify the SDB, it will not only help you in the here-and-now, but it can also make you less vulnerable to painful mood swings in the future. But how in the world can you do that? If you like, take a look at the list of 23 common Self-Defeating Beliefs and see if you can find any of yours! Zeina said she wanted help with her tendency to base her feelings of happiness and self-esteem on her accomplishments. In the group, we demonstrated four techniques for changing this or any SDB, including: The Cost-Benefit Analysis.  You list the advantages and disadvantages of the belief you want to change. You can find the one we worked on with Zeina during the group if you click this link. If you want a blank one you can work with, you can find one on page 2 of this link. The Semantic Technique. This involves change at the intellectual level. if the SDB is not working to your advantage, could you modify it so you can keep all the advantages you listed while getting rid of most if not all of the disadvantages. This is a bit of practical personal philosophy exercise with significant emotional implications. The Feared Fantasy. Here's where change at the gut level begins, and you also can begin to challenge the idea that high achievers really are more worthwhile. The Double Standard Technique. Here's where change at the gut level continues, and you can hear a beautiful example in Zeina's dramatic interaction with Dr. Levitt. In today's part 1 podcast, we completed the Cost-Benefit Analysis. I would urge you to do your own CBA while you're listening. When you're done, balance the advantages against the disadvantages on a 100 point scale. Put two numbers in the circles at the bottom to show whether the advantages or disadvantages are greater. For example, if the advantages of this belief greatly outweigh the disadvantages, you might put 80 - 20 in the two circles. If the advantages and disadvantages of this belief are about equal, you can put 50 - 50 in the two circles. And if the disadvantages are somewhat greater, you might put 45 - 55 in the two circles. When you do your own weightings, please note that the number advantages or disadvantages is not important--that's because one advantages could outweigh several disadvantages, and vice versa. Instead, look at the lists as a whole and ask yourself how they feel, and how this belief is working for you. In addition--and this is super important--remember that you are NOT evaluation the advantages and disadvantages of achievement. There probably aren't any disadvantages of achievement! Instead, you are evaluating the advantages and disadvantages of basing your self-esteem and feelings of worthwhileness on your achievements and productivity. At the end of the group work with the CBA, I emphasize that the goal of the CBA is simply to find out if you (or in this case Zeina) want to change your SDB. This is a motivational question. If the advantages and disadvantages are about equal (50 - 50), or if the advantages out weight the disadvantages (eg 60 - 40), then there may be no reason to change the belief. But when the disadvantages outweigh the advantages, you can then change the belief so that all the disadvantages diminish or disappear entirely, while at the same time you keep all the advantages. That sounds like a pretty good deal! In next week's podcast, you'll learn how to make this happen with the help of the Semantic Technique, Feared Fantasy, and Double Standard Technique! There are a great many additional techniques for challenging and modifying any SDB as well. The four I listed above are just a kind of “Starter Kit” for SDBs to give you a feel for how some of the techniques work. If you like this podcast, we may focus on other SDBs as well, such as the Approval Addiction, the Love Addiction, and more. Let us know if you’d be interested, and which beliefs interest you the most. We’ve already done a podcast on perfectionism, as well as a popular Live TV program on perfectionism on Facebook that features Jill and me, but there are tons of beliefs we haven’t yet addressed. To make today’s podcast more dynamic, you can do your own Cost-Benefit Analysis while you watch, and make sure you do your own weightings at the bottom, just like the therapists in our Tuesday training group. I think you’ll enjoy it, and it might nudge your thinking a little, too! Please let me know if you've enjoyed "eavesdropping" on my Tuesday training group, and if you'd like more Feeling Good Podcasts like this in the future. Let me know, too, if you'd have an interest in attending a weekly TEAM therapy training group for therapists or for the general public. My new book Feeling Great, is now available on Amazon (see the link below) as a hardbound volume or as an eBook. It features all the new TEAM therapy techniques, and is geared for therapists as well as the general public. Rhonda and David

Corona Cast 8: Live Therapy with Dan. How Could You Treat an “Existential Depression” in the Midst of a Pandemic? Today David and Dr. Jill Levitt feature live work with Dan, a licensed clinical social worker who’s been struggling with an “existential depression” for 15 years, but it has been recently exacerbated by the COVID-19 pandemic. The session took place in one hour and forty minutes on a Tuesday evening on July 23rd, 2020, in David’s and Jill’s Tuesday training group at Stanford. Live personal work is one form of training that is vital to professional growth and learning, so it is extremely beneficial for the person who volunteers for the role of “patient.” At the same time, the live work also provides superb learning for those observing the process, since you can see what is really happening during a T.E.A.M. therapy session. Hopefully, you will learn a great deal as you listen to Dan’s live and uncensored therapy session. Jill and I feel very grateful to Dan for allowing us to publish such an intensely painful and personal experience. You will likely feel grateful to Dan as well! All live therapy sessions tend to be dramatic and illuminating from a variety of perspectives. Today’s session is unique in that the A = Assessment of Resistance was outstanding and unique. The remarkable changes that occurred would not have been possible without outstanding E = Empathy and A = Assessment of Resistance, which were stellar. However, the M = Methods portion of the session was also strong, especially in the use of humor and role-reversals during the Externalization of Voices to blast Dan’s Negative Thoughts out of the water. That portion of the session confirmed by the three basic tenants of cognitive therapy: You FEEL the way you THINK. All of your negative feelings are caused by your thoughts in the here-and-now, and not by the actual events in your life. In other words, the COVID-19 pandemic cannot “cause” anyone to feel depressed or anxious. Depression and anxiety are the world’s oldest cons. When you’re depressed, anxious, or angry, the Negative Thoughts that upset you will not be valid. They’ll be distorted and illogical. Depression and anxiety are the world’s oldest cons. You can see the ten cognitive distortions I first published in my book, Feeling Good, at the bottom of Dan’s Daily Mood Log (link). You can CHANGE the way you FEEL. The very instant you stop believing your distorted thoughts, your feelings will change. Recovery is not a long, drawn-out process that requires weeks, months, years or decades, as so many people believe, including the majority of mental health professionals. Recovery happens in a flash, an unexpected “ah-ha” moment when your perceptions of the world are suddenly transformed. You will witness such an event in today’s session. Now let’s see what actually happened! T = Testing Take a look at Dan’s Brief Mood Survey (BMS) at the start of the session. He was feeling moderate to severe depression, no suicidal impulses, and just a little anxiety and anger. His Happiness score was quite low, only 7 out of 20, paralleling his depression score of 12, and his satisfaction with his relationship with his wife was a perfect 30 out of 30. He indicated he’d been doing a lot of psychotherapy homework. This, by the way, is the latest version of the BMS. We’ll ask him to complete it again at the end of the session to see what changes occurred during the session. Because the BMS asks how Dan is feeling “right now,” it’s like an emotional x-ray machine, allowing therapists to see exactly how much, or how little, a patient is changing at every therapy session. The patient’s scores at the start of the next session also allow the therapist to see exactly what happens between sessions in multiple dimensions. At the end of today’s session, Dan will also fill out the Evaluation of Therapy Session (ETS), and rate Jill and David on Empathy, Helpfulness, and Session Satisfaction, and indicate how willing he is to do psychotherapy homework, whether he had unexpressed negative feelings during the session, and whether he had difficulty filling out any of the survey questions honestly. The BMS and ETS are invaluable tools that have been game-changers in psychotherapy. To my way of thinking, it is difficult, if not impossible, to do good therapy, much less outstanding therapy, without these powerful and extremely accurate tools. They have the potential to radically transform clinical work and have been an important key in the evolution of TEAM. E = Empathy After briefly reviewing Dan’s starting scores on the BMS, Jill and David empathized while reviewing the Daily Mood Log that Dan filled out prior to the start of the session. The upsetting event was sitting at home on a Friday night with nothing to do, since his wife was studying for an upcoming exam. He points out that when he’s busy doing therapy, he generally feels fine, but sometimes when he has nothing specific to do, intense negative feelings suddenly hit him and take all the joy out of life. As you can see, his feelings on his Daily Mood Log are similar to his feelings on the Brief Mood Survey but some are far more intense, since he’s focusing on a moment of angst. If you look at his Negative Thoughts, you will see that they all revolve around a common theme that life has no meaning, since people are suffering and dying all over the world, and since all of us will also die one day. He says, “the good things that happen are just like dust in the wind,” and tells himself that “life is unfair.” Dan explains that in the last couple of years he’s experienced several painful events. He got married, but got divorced after just three months when things did not work out with his wife. But he’d sold his condo, and his practice was not going well, and he could barely pay his bills, so he had to move back home with his mother, who then died of cancer. Then, right after she died, things suddenly took a turn in a far more positive direction. He began dating and found an extremely loving and wonderful woman in 2017, whom he married last October, and his clinical practice began to blossom around the same time, so he and his wife were able to purchase a new home. But still, the Negative Thoughts kept popping unexpectedly into his mind, and they can turn feelings of joy (“Wow! I really came back”) into despair in an instant (“I’ll probably lose everything again, and it makes no difference because I’ll eventually die.") David pointed out this is a little like PTSD, when you’re suddenly reminded of a previous trauma and get overwhelmed by angst. And the frequency and intensity of these sudden despair attacks have increased since the start of the pandemic. Dan gave Jill and David an “A” on empathy after about 30 minutes of listening without trying to “help,” and this was a sign that we could move on to the next portion of the session. A = Assessment of Resistance Jill asked Dan if he wanted help tonight, or needed more time to talk and vent. He said he was ready to roll up his sleeves and get to work. His goal was to reduce or eliminate his negative thoughts and feelings, if that was possible. Jill asked if he’d press a “Magic Button,” if that would cause all of his negative thoughts and feelings to instantly disappear completely, with no effort, and he said he would. Almost everyone says they’d push it—which is completely understandable. When you’re in great pain, we all want relief! Jill indicated that we did have powerful tools, but weren’t convinced it would be such a good idea to use them to eliminate Dan’s feelings, and suggested we might first make a list of indicating: What each negative thought and feeling showed about Dan and his core values that were positive and awesome. How his negative thoughts and feelings might be helping him. Doing this skillfully is an art form, since it is radically different from the inept “cheerleading” so many therapists and family members attempt when a loved one is feeling down. You will hear this process unfolding when you listen to the audio of the session. Notice how Dan’s memories of the death of his older brother when he was just three years old and the recent death of his mother bring tears to his eyes, and help him change the way he thinks about his angst, not as something “bad,” but as something beautiful that honors his mother and his brother who passed away. But this is just the tip of the iceberg, as a long list of positives emerges during this portion of the session, which is designed to melt away subconscious “resistance” to change. The A = Assessment of Resistance is really the secret key that opens the door to the possibility of rapid, profound, and lasting change. David and Jill make it look easy, but it is, in reality, quite challenging to learn, because it goes against the very grain of our human inclination to try to “help.” Instead, Jill and David are assuming the role of Dan’s resistance, and showing him, in a gentle and loving way, that his negative thoughts and feelings are not actually symptoms of a defect or “mental disorder, but are really the manifestation of something positive and beautiful about Dan. David and Jill are selling Dan on the status quo and are still NOT trying to “help.” Paradoxically, this procedure typically has the opposite effect of greatly intensifying the patient’s determination to change. But now, the therapists have put Dan into a confusional state, and bind. On the one hand, he desperately wants to change. He doesn’t want to continue throwing cold water on the cherished positive moments in his life. But at the same time, if he presses the Magic Button, all of the positives will go down the drain along with his negative feelings. This is resolved with the Magic Dial. David and Jill ask Dan if he’d be willing to dial his negative feelings down to some lower level instead of lowering them all the way to zero. You can see his goals for each negative feeling on the “% Goal” column of his Daily Mood Log. M = Methods Now David asks Dan which Negative Thought he wants to work on first. He chooses this one: “It’s pointless in life to strive towards anything, because, in the end, we are all going to die.”  Dan believes this thought 80%. While identifying some of the many distortions in this thought, he comes up with this Positive Thought: “Some things are worth striving for!” This thought is 100% true, and his belief in the Negative Thought suddenly drops to 10%, as you can see on his Daily Mood Log (Daily Mood Log.) Next, he wants to work on this thought, which he believes 60%:  “People are dying in the world right now, so I don’t deserve to relax and have fun.” After identifying five distortions in this thought, he challenges it with this Positive Thought: “Although the deaths of so many people are tragic, it isn’t my fault that people are dying all over the world.” Dan rates his belief in this thought at 100%, and his belief in the Negative Thought drops to zero. Then he decides to work on this thought: “I’ve had so many good things happen in the last several years, but I can’t enjoy them, since it’s inevitable that I’ll lose those things.” He adds, “After all, what goes up, must come down!” After a couple of rounds of Externalization of Voices with Jill, he still couldn’t completely crush this thought, so David steps in to give it a try, with Dan playing the role of the Negative Thoughts and David playing the role of Dan’s Positive Thoughts. David interrupts Dan’s verbalization of this thought with some irreverent Buddhist humor. At that moment, Dan suddenly “gets it,” and the floodgates open up as Dan crushes the thought. Some people have called this “ah-ha” moments the “cognitive click.” It’s like waking up from a trance or nightmare, and the patient suddenly sees the world in a radically new and far more realistic light. Jill and David complete the M = Methods portion of the session by challenging the rest of Dan’s Negative Thoughts using Externalization of Voices, including role-reversals with the Self-Defense Paradigm and the Acceptance Paradox. I think you will find these exchange fascinating, and you will hear the tides coming in and the tides going out as Dan sometimes struggles and then defeats all of his Negative Thoughts. You can review Dan’s end-of-session mood ratings on his Daily Mood Log as well as his end-of-session Brief Mood Survey and his ratings of Jill and David on the Evaluation of Therapy Session. The Necessary and Sufficient Conditions for Emotional Change If you look at Dan's Daily Mood Log at the end of the session , you will see that the belief in each Positive Thought was high, and that his belief in the corresponding Negative Thoughts was drastically reduced. This is exactly why his feeling suddenly changed so dramatically. Cognitive Therapy (including TEAM) is NOT about telling yourself positive things or uttering positive affirmations. Instead, it's about crushing the distorted thoughts that trigger all of your negative feelings. The very moment you stop believing your Negative Thoughts, your feeling will instantly change. At the end of the session, Jill gives Dan a critically important “homework” assignment. Listening to the audio of a session and doing written work with the Daily Mood Log are vitally important aspects of TEAM. What happens between sessions is just as important as what happens within sessions! Thank you for listening today, and a HUGE thanks to Dan! I hope you learned a ton, on many different practical plus philosophical levels, and enjoyed today’s live therapy session! The Tuesday group at Stanford is free to all Bay Area mental health professionals as well as graduate students in some form of mental health training. The only “fees” involve a commitment to consistent attendance and the willingness to use the BMS and ETS with all patients, plus the willingness to do homework between Tuesday groups so you can really learn and master the very challenging TEAM techniques. Rhonda and David

Social anxiety has been one of our most popular topics. It seems like lots of people get anxious in social situations. and a great many have even greater difficulties talking to strangers and people they might be interested in dating. When I was in private practice, social anxiety, and “singleness,” were exceptionally common. In fact, 60% of my patients were single—they’d been divorced and didn’t know how to get back into the dating scene, or, they’d never developed romantic relationships in the first place. So today, we offer more tips and help for people who are afflicted with social anxiety. Rhonda and I are very proud and excited to be joined today by a brilliant colleague and expert on social anxiety, Dr. Jacob Towery. Dr. Towery is a Stanford-trained pediatric psychiatrist, and was a student of mine when he was a psychiatric resident, He practices in Palo Alto and helps teach our weekly Tuesday TEAM therapy training group at Stanford. Today (the day we recorded this podcast) was Jacob’s 41st birthday, so Rhonda and I sang a rousing Happy Birthday for Jacob at the start of the podcast! He kindly tolerated our fairly awful but heartfelt rendition of that classic song. Perhaps you could think of it as our own (fairly mild) Shame-Attacking Exercise. As we begin today’s podcast, Rhonda reads a sad but moving email from Davide, who desperately wants to open up and connect with people on a deeper level, but says “these things scare me like hell.” In his email below, he describes his struggles and lists his negative thoughts about talking to people he doesn’t know. He is especially afraid of Self-Disclosure—telling people that he struggles with social anxiety. To his credit, Davide has made significant progress, has worked hard on challenging many of his negative thoughts and self-defeating beliefs, and already has a girlfriend! But he wants to take his progress and growth to a new level. Here’s the email I received from Davide: Hi David! There is no month that I don't listen to your podcast and take some notes. Yes, you can read my email and use my real name as you like! I really think that your methodology is a breakthrough in self-help and coping with emotions. Also, the new technique of positive reframing is very helpful. When I started using it for myself at the beginning of every daily mood log I really noticed a faster improvement. I completely agree with your vision that it would be better if there weren't schools of psychotherapy but tools that work. Your books and works have really changed my life for better and I'm looking forward your next book Feeling Great! In these two years I have done many Daily Mood Log, I have also done every day for a month the Smile and Hello Practice and I got a girlfriend for the first time in my life! I'm still not very good at breaking my negative thoughts though. I often end up with a lengthy, verbose and not so effective positive thought. Sometimes it seems that I understand rationally that a negative thought isn't true, but I don't feel better. Also, my social anxiety is reduced, but not gone. I still have a lot of social anxiety when I'm around people. I understand the Spotlight Fallacy and Brushfire Fallacy at the intellectual level and I'm definitely improved a little, but still today I can't remember a single good conversation with a person that I don’t know and I'm not very comfortable with. I tried to use the Five Secrets but I can't think of anything good to say in real conversations. I want to do some shame-attacking exercises and also disclosure to random people on the street about my social anxiety, but these things scare me like hell and I don't have the courage to do these exercises. I know that these will help, but I feel really really scared and so far, I haven’t mustered up enough courage. I want to leave home (I'm in Italy) for work in another country in Europe next year, but for me social anxiety is a really huge obstacle. This makes me feel a little sad because I see my social anxiety like a prison. These are some of my anxiety thoughts at the idea of disclosure to random people on the street that I want to go to work abroad but I'm too shy and suffer from social anxiety: I will not be able to say what I want to say because of anxiety. I will stumble in words and an inconclusive thing will come out. The other person will think that I'm completely crazy and I will frighten him/her with my behavior. I should never scare other people with my behavior. In the future I will remember all the things that I said wrong and I will beat myself up over and over again. I will waste the other person’s time when I try to talk to them. I should never waste anyone’s time. If I stop a woman, she will think I'm crazy creepy guy who wants to sexually assault her and I will scare her. The other person won't stop to talk to me and will just go their way, pretending I didn't exist. Sorry for this lengthy email. When I read your response I exploded with joy and I decided to write a lot of things. Thank you, Davide Jacob begins with a personal story of his romantic adventure with a woman he’d just met at a Hot Springs. After talking for a while, some good chemistry seemed to develop, so Jacob asked, “Would you like a kiss?” Jacob immediately backed off when she seemed reluctant. Although he felt slightly rejected, they continued to talk and enjoy each other. Then things suddenly took a surprising and exciting turn in the opposite direction! Jacob emphasizes the value and importance of asking for what you want, and recommends getting “enthusiastic verbal consent” before touching. that’s because non-verbal consent can easily be misinterpreted by both people. In contrast, enthusiastic verbal consent is respectful and empowering toward both people. It leads to less mind-reading and a greater chance of being on the same page with the person you are interested in.  Rhonda acknowledges Jacob's tremendous respect for the person he is dating with his emphasis on "enthusiastic verbal consent." Jacob, Rhonda and David also talked about the Burns Rule: People NEVER want what they CAN get, and ONLY want what they CAN’T get,” and how you can use this rule to your advantage if you avoid being pushy or needy. Jacob used the Burns Rule skillfully, and if you listen to the podcast, you will hear the surprising conclusion! We also discussed the power of playfulness, taking risks, and sometimes being silly. In my experience (DB), people struggling with social anxiety are sometimes way too serious, and this can turn people off, particularly if you want to date. I can speak to that from personal experience, as I struggled with five different kinds of social anxiety when I was a young man! With Jacob’s leadership, we illustrated a number of techniques that might be helpful to Davide, and perhaps to you as well, including: The “Consensual Compliment.” This is a safe, non-threatening way of approaching strangers, especially people you might want to get to know better or even date. Essentially, you ask a stranger if they’d be open to receiving a compliment. Jacob and Rhonda demonstrate this technique with role-playing, and explain what to do if the person seems negative or ambivalent, or if the person says yes. I suspect that Jacob created this awesome method. Talk Show Host. This is a great, non-threatening way to make conversation with any stranger in any circumstances. David and Rhonda illustrate it in a role-play. Shame Attacking Exercises. You do something bizarre in public to make a fool of yourself, so you can overcome your fears of looking foolish. Dr. Towery is one of the world’s most creative and funny teachers of this techniques, and I recounted one of his incredible Shame-Attacking Exercises in the Macy’s Department Store near Stanford. Smile and Hello Practice. You force yourself to smile and hello to ten strangers each day. Rejection Practice. Instead of trying to get a date, you try to collect as many rejections as possible, so you can get over your fear of being rejected. I (DB) once skipped medical school classes for two weeks and did rejection practice all day long every day with a young friend, Jeff Evans (aka Spyder). We both had a 100% rejection rate, but it helped us get over our fears. The late psychologist, Dr. Albert Ellis, also emphasized the value of the rejection practice he did in New York when we was a young man. He asked 200 women in a row for a date in one week. They all said no, except for one, but she didn’t show up for the date! But he said this helped me overcome his fears as well, and he ended up with an incredibly rich dating life and even ended up writing an advice column in a men’s magazine for several years. Jacob said that he's experienced many rejections as well, and agrees on the importance of overcoming this fear! Externalization of Voices. You talk back to your Negative Thoughts. Jacob, Rhonda, and David illustrate this powerful method, using the seven Negative Thoughts in Davide’s email. Jacob strongly recommended several other resources, including podcast 197 with Dr. Matthew May as well as several of David’s FB Live videos on flirting, featuring Dr. Angela Krumm (part 1) and (part 2)and Kyle Jones. My book, Intimate Connections, is a bit dated now, but the wisdom and techniques in this book will be invaluable for anyone in the dating scene. Lots of people have told me that they started dating and got married after a long period of loneliness because of that book! Jacob has recently published a book on depression for adolescents and teenagers called “The Antidepressant Book,” which is available on Amazon. If you have or know of a young person who is struggling with depression, this book might be a great gift for him or her! My own new book Feeling Great, was released September 15, and is also available on Amazon (see the link below.) It features all the new TEAM therapy techniques, and is geared for therapists as well as the general public. If you would like to contact Dr. Towery, feel free to visit his website is www.jacobtowerymd.com . Rhonda and David

Last week you heard Part 1 of David’s TEAM Therapy session with Neil Sattin, who became pretty despondent and discouraged right after the first shut down because of the covid-19 pandemic in March of 2020. David and Neil went through the T = Testing and E = Empathy parts of TEAM, and David helped Neil develop a Daily Mood Log so he could record his negative thoughts and feelings at one specific moment at the end of a day when he was feeling like he hadn’t gotten enough work done. Perhaps you’ve had the same problem at times! Today you’ll hear the A = Assessment of Resistance and M = Methods parts of the session. As they begin, David asks Neil the Magic Button and Miracle Cure questions, and Neil says that he definitely does want help and would push the Magic Button to make all of his negative thoughts and feelings on his Daily Mood Log disappear. David cautions against that and suggests Positive Reframing, asking two questions about each negative thought and feeling. What does this thought or feeling show about you that’s positive and awesome? What are some potential benefits, or advantages, of this thought or feeling? Here’s Neil’s list of Positives: My sadness: Shows that I’m ambitious Motivates me to achieve a lot Shows that I have high standards My anxiety: Shows that I’m responsible Keeps me vigilant Fuels me to take action Reminds me that I’m doing important things My guilt: Shows that I have a moral compass My feelings of defectiveness and inadequacy: Show that I want to be a good role model Show that I’m willing to be honest about my flaws Show that I hold myself accountable Show that I’m humble My feelings of being alone show that: I value connections with others Allow me to feel close to people My feelings of embarrassment and humiliation show that: I have high standards and goals I want my life to mean something I value acceptance My discouragement shows that: I have a vision I’m realistic about the many challenges I face and the sheer volume of work I have to do I’m willing to face the truth My frustration shows that: I’ll persevere. I won’t stop and give up. Feeling annoyed and irritated: Shows that I won’t tolerate things that get in my way Gives me energy and determination Feeling overwhelmed: Reminds me that I might be taking on too much Protects me from trying and failing Shows that I’m looking for ways to take care of myself. After listing these positives, Neil used the Magic Dial and indicated that he’d like to dial down his negative feelings to lower levels, rather than getting rid of them entirely, as you can see in the “% Goal” column of his Daily Mood Log. Then they moved on to M = Methods, focusing first on Neil’s Negative Thought (NT): “I’m not capable of getting organized. After identifying a number of distortions in the thought, Neil was able to generate a positive thought that fulfilled the necessary and sufficient conditions for emotional change: The Positive Thought (PT) has to be 100% true. The PT has to drastically lower your belief in the Negative Thought. You can see this on his DML. David and Neil used a variety of techniques, including Externalization of Voices, to challenge the rest of his NTs. Neil re-rated his negative feelings at the end of the session. They all feel to zero except feeling alone, which went from 80 to 5, which was his goal. Rhonda and David

Rhonda begins with a plug for David’s new book, Feeling Great, which will be released on Amazon, on September 15, the day after after this podcast will be published. You can check it out at the link at the bottom of today's show notes. Today and next week you will hear parts 1 and 2 of a live therapy session I (David) did with Neil Sattin, host of his own terrific “Relationship Alive” podcast, which has received 5 million downloads. But as you know, we all sometimes need a little mental tune-up, including therapists. The session you are about to hear occurred on March 23, 2020, when the pandemic shut-down first occurred. Rhonda begins today’s podcast with a moving email from a fan who heard Neil's live therapy session with David on Neil’s Relationship Alive podcast. Then Neil explains how his  work on troubled relationships were born out of his work as a dog trainer, and he saw many similarities with relationship issues! In addition to hosting his popular podcast, Nel does coaching for individuals and troubled couples. Neil explains that, “I’ve always been a person who people have turned to for relationship help. I saw the struggles my parents experienced, and I have experienced my own struggles, and I wanted to figure out how we might use struggles to deepen and improve relationships, so people can thrive and get past those challenging moments. Prior to his personal work with David, Neil sought help from a cognitive therapist, but it wasn’t helpful thought. Neil thought it was too formulaic, a sentiment that David agrees with. Neil prefers working “in the moment,” the way David does therapy. Today, you will hear the T = Testing and E = Empathy portions of Neil’s TEAM therapy session with David, and next week you will hear the A = Assessment of Resistance and M = Methods portions. You can check out the Daily Mood Log that David and Neil filled out at the beginning of session. As you can see, the upsetting event was simply feeling like he hadn’t gotten enough done when evening approached. Perhaps you’ve sometimes felt like that, too! You can also see that Neil had many negative feelings. Most were intense and Neil felt overwhelmed. He was telling himself there was way too much to do, that he was incapable of getting organized, and that he was going to end up unhealthy, weak and broke. These were messages he’d heard from his dad when he was growing up: “You’ve gotta clean your room. . . You’ll never succeed.” Tearfully, Neil says, “I’ve always wanted his blessing. . . but I’ve never gotten it. I wish he could see my role in the world, the impact I’ve been making, and I wish he would admire it! . . . I love him dearly, but there are things I just don’t understand, things that have been the sources of my sadness and anger ” Tune in next week for the exciting conclusion of the session! Rhonda and David

Ask David What do you do when someone won’t stop asking questions? Hello David, It’s been a while since I’ve emailed you, but that’s because I’ve been doing really well thanks to you! I started a new job 3-1/2 months ago, & this woman seemed to take to me right from the start. It was nice at first having someone to talk to etc, but it has quickly turned bad. She sits in the cubicle right next to me. All day long she talks to me asking me questions. What did I do after work? Who was I with? How long was I gone? What did my husband do? And on & on. It feels like she’s interrogating me because the questions never stop. I’m trying to get more vague with my answers hoping if will deter the conversation, but no luck. It really becomes distracting at times & then other times it just feels like she’s being nosy & freaks me out. I just want her to leave me alone! I think this would be a good opportunity to use the 5 secrets of effective communication, but I’m struggling. Could you help? Thank you, Brittany Hi Brittany, Will send to Rhonda for an Ask David. But a simple approach would be to tell her that you admire her and appreciate her interest, but that you sometimes find the questions distracting from doing your work. Perhaps you could sit down with her for lunch or something, and then use your five secrets skills. Using the relationship journal, you could write down one thing she said to you, and exactly what you said next. Then we can see exactly what you are doing that is fueling the problem! I've attached one, and you could send it to us after you have completed Steps 1 and 2. David Thank you for the reply! It really made my day. I attached the relationship journal. It was actually more helpful than I thought it would be for this situation. Once I was able to think of a good example, I realized that maybe my lack of inquiry or showing interest in her is causing her to ask me all these questions. Although if I ask her more about herself, I don't know if it would result in her talking even more? Hard to say. Thanks for your help, and I appreciate your thoughts on my relationship journal. -Brittany Hello, Wanted to give you an update on how it went using the five secrets. First thing Monday morning my coworker started right up with the questions. I used the five secrets & said something similar to what I wrote to you. She apologized for bothering me, & things have been great all week! She actually brought in headphones & has been listening to music now. And there’s no tension or animosity between us which was my fear initially. We still chat here & there & are friendly. Thanks again! -Brittany How can a pastoral counselor get training in TEAM-CBT? Dear Doctor David, I am a pastor from South Africa, married to an Australian, living in Dubai :) I was struggling with mild depression & came across your book "feeling good" and read it & applied all your techniques & it has been life-changing - THANK YOU! What surprised me most was the simplicity and effectiveness of the exercises. I believe that much of what you teach is life skills everyone should have! I wish I was taught these things when I was younger! Over the years I have helped people, from all walks of life - inmates, students, business people, etc., but primarily from a spiritual perspective. I believe I can be more effective and help so many more out there if I learn how to apply your exercises to others. I would love to train in TEAM and learn how to apply these techniques with the people I minister to, but I am not a psychologist or certified as per your requirements. I realize practice and critical feedback is paramount in order to get really good in TEAM. Please advise me on an alternative route. Any help with this regard would be highly appreciated! Thanking you in advance. Yours sincerely, Gareth Noble Hi Pastor Noble, Sure there is a certification program at the Feeling Good Institute. I believe pastoral counselors would be very welcome. They offer many online introductory classes in TEAM-CBT. Check our my free weekly Feeling Good Podcasts, too. I will include your question, with your permission, on an Ask David Podcast. I also offer a free depression class on my website, and about to post an anxiety class too, also free. There are tons of resources, almost all free, on my website, www.feelinggood.com. You can check out my website page from time to time for online workshops. Dr. Angela Krumm angela@feelinggoodinstitute.com is head of the certification program at FGI, which is www.feelinggoodinstitute.com. Angela and I are both PKs (Pastor’s kids)! All the best, David Is love an adult human need? Rhonda said that people in the TEAM certification listserve thought they heard David say that love is not an adult human need. Is this true? David comments on hearing Dr. Beck say that decades ago, in one of Dr. Beck’s weekly training groups at U. Penn, and what he (David) discovered. What’s the best training program to learn TEAM-CBT? David and Rhonda, I hope this note finds you well. I'm writing for a few reasons. The first is to thank you for your podcast and related resources. I found your podcast and started listening at the beginning of COVID-19 (mid-March) because I was feeling acute anxiety. The T.E.A.M. approach and your teaching are such an amazing gifts. The positive reframing in particular is truly life changing and revolutionary for me. Considering what my negative thoughts show about me that's positive and awesome and then finding the cognitive distortions has provided me such relief. I have been so excited about T.E.A.M. therapy that I often discuss it with my husband, friends, and family. I really loved David's comment in the most recent podcast that good therapy isn't evangelizing; rather it's letting the patient define problems and goals within his/her own values. I also liked your comment that doing therapy well is like an artform or a dance- that's such a beautiful sentiment, and I've been able to see the conversational "dances" you perform in the amazing, transformative, empathic live therapy sessions with Michael, Rhonda, Sarah, and others. These sessions have often brought tears to my eyes. This brings me to my second reason for writing. Listening to the podcast has been transformative for me in another way- it's made me seriously consider becoming a therapist myself. I have considered this possibility over the years, but now that I'm familiar with the T.E.A.M therapy approach and can see how helpful it is, I'm excited to explore this path more. I have a B.A. in psychology so I would need additional education- do you have suggestions for masters programs that you think would provide good alignment with the T.E.A.M. approach? I live in Charlottesville, Virginia and have two young children, so a local or online program may be the best bet for me. Thanks in advance for any ideas you may have. All the best to you, Molly Hurt Thanks, Molly. We can read your wonderful email on an Ask David if that is okay with you, but here is the quick answer. In graduate school, you don’t typically learn much that is useful. It is more getting a license to practice, then you learn from mentors, workshops, etc. The FeelingGoodInstitute.com has training and certification programs, including 12 week beginner classes in TEAM that are excellent. The whole area of coaching is emerging now too, and the certification is rather informal. If you get a degree like a masters degree in social work online, and then get licensed to do therapy, that is one approach, but there are many ways to get certified—counselor, psy d degree, marriage and family therapy, and so forth. So in short, I would, personally, find some way—the easiest way—to get certified so you can legally do therapy. But concentrate on learning TEAM as the tool to use. In California, as an aside, anyone can call themselves a “psychotherapist,” but you need the degree and license to call yourself a “psychologist.” Good luck, and thanks again! david Why are should statements considered distortions? Thanks for your quick and helpful reply. It's useful to have a better sense for how to prioritize my time and training. I'm excited to continue to explore T.E.A.M. therapy! And you are welcome to read my email on the podcast, thanks for asking. If I may, one other question for you: how do you recommend someone defeat "should" statements when his/her behaviors aren't healthy or beneficial? For example, "I should not overeat when anxious" or "I should not procrastinate" or "I should not be impatient with my daughter." I understand that saying "should" in these cases adds pressure and can lead to shame, but I don't see the distortion in these statements. In other words, these statements may not be helpful to a patient, but how are they not 100% true? I would appreciate any additional guidance you can offer on what I find to be the most difficult cognitive distortion! Thanks again to both of you for generously sharing your loving and kind approach to helping people deal with their problems and feel better. The impact you're having is profound. I love listening to you empathize with patients- it makes me strive for building an even more loving connection with my husband and daughters, as well as others in my life. Best, Molly Hi Molly, You may want to listen to podcast #205 pm Should Statements. You can also find a lot in my books, like Feeling Good, which you may have already read. There is also a chapter on how to crush should statements in my new book, Feeling Great, which will be released on September 15, 2020. Shoulds are distortions because they are not valid. It is not true that you “should not overeat when anxious.” You SHOULD overeat when anxious because it is very appealing, tasty, and makes you feel better. A correct statement would be, “It would be preferable if I did not overeat when anxious.” This statement removes the shame and pressure, while honoring your goal. There are three correct uses of should: the moral should (thou shalt not kill), the legal should (you should not drive 90 miles an hour because you’ll get a ticket) and the laws of the universe should: this pen should fall to the floor if I drop it because of the force of gravity. But overeating when anxious is not immoral or illegal, and it does not violate the laws of the universe. So it is not a valid use of the word. There is a podcast on this, I think, and you can search for it on my website use the search function. Rhonda and David  

Today, the Cognitive Distortion Starter Kit Focuses on Blame This is the final podcast on the Cognitive Distortion Starter Kit. Today, we focus on techniques to combat Blame. There are two common forms of Blame, and both can be deadly. Self-Blame: You beat up on yourself and blame yourself for things. Self-Blame is nearly always accompanied with self-directed Should Statements: “I really screwed up. I shouldn’t have done that!” Self-Blame triggers depression, worthlessness, and guilt, and sometimes triggers feelings of hopelessness and suicidal urges. Other-Blame: You beat up on others and blame them for the problems in your relationships. Other-Blame is nearly always accompanied with other-directed Should Statements: “He’s such a loser. He shouldn’t have such ridiculous beliefs!” Other-Blame triggers anger and conflict in relationships, and can sometimes trigger rage, violence, and even murder. Rhonda describes going on a bicycle trip with her husband. But when they got to the trailhead, they realized that her husband had put the wrong bicycle for Rhonda on their car. Sadly, the much-anticipated bicycle ride was ruined, and Rhonda began fuming and blaming her husband for having made this mistake. but then she decided to back off and think about her own role in the problem, and soon they were bake in a loving mood again. Unfortunately, for many people, the outcome is different, with escalating arguments and lasting feelings of resentment and indignance. David describes his work with a married woman who blamed herself for sexual difficulties and a history of sexual abuse as a child, who stood in front of a mirror with a razor blade to her neck the night before her first session with David. She was debating, “Should I just slit my throat and get it over with, or should I show up for my session in the morning?” Rhonda presses David for details about the treatment, which had a glorious outcome. David also gives a dramatic example of Other-Blame—a man who shot two obnoxious and aggressive teenage boys with his crossbow during a road rage incident. He shot one of the boys through the heart, and he fell and bled to death. Then he shot the other boy through the spinal column, and that boy survived but ended up paralyzed for life. The man was arrested and given a life sentence in prison. When interviewed by a television reporter and asked if he had any remorse or regrets, the man said, “Regrets! Hell no! That was the greatest accomplishment of my life! I think about constantly and it makes me euphoric. If I had the chance, I’d do the exact same thing again!” And that the huge problem with Other-Blame. Although negative thoughts containing Other-Blame are nearly always extremely distorted, just like the thoughts that cause depression, thoughts with Other-Blame trigger feelings of moral superiority and anger that can be extremely addictive. That’s why anger and relationship conflicts can be way harder to treat than depression and self-blame. One potentially helpful technique is a Blame Cost-Benefit Analysis, listing all the many advantages and benefits of blaming others for your problems and relationship conflicts. Once you’ve seen all the benefits, you can list the disadvantages, and then balance them against each other on a 100-point scale. if the advantages of blame are greater, there’s no reason to change. If you’re interested, you can check out this link to a Blame CBA that my daughter and I prepared. Check it out! David explains how he used this technique to help a physician with chronic, refractory depression and episodic rage attacks in a single therapy session! It’s a great technique to try if you’re feeling unhappy and blaming others for the problems in your relationships with them. Rhonda and I have  enjoyed creating this series for you. If there are other series you’d like to hear, let us know. For example, we could have a series of podcasts on all the different kinds of anxiety, illustrating the most helpful techniques for each one. We could also have a series on all of the different kinds of Self-Defeating Beliefs, like the Spotlight Fallacy, and how to defeat them. Or, if there are techniques you want us to highlight, we'd be more than happy to do that, too! Rhonda and David

Today, the Cognitive Distortion Starter Kit Continues with Should Statements Rhonda begins by reading a beautiful email from one of our listeners, and I give a brief shout out for my new book, Feeling Great, which can be pre-ordered on Amazon now (see below for the link). Thanks to your support, as of today (July 2) it is already the #1 best seller in the Amazon depression AND anxiety categories for impending new books! David and Rhonda briefly summarize the history of Should Statements, starting with the Buddha 2500 years ago, and culminating in the work of Karen Horney and Albert Ellis in the 20th century. They both emphasized that nearly all emotional suffering as well as relationship conflict results from “Shoulds.” David and Rhonda describe the four categories of Should Statements: Shoulds directed against yourself cause depression, anxiety, guilt, and shame. and even lead to suicidal urges. Should directed against others cause anger, and can even lead to violence. Shoulds directed against the world cause frustration. Hidden Shoulds. They also describe the three valid types of Should Statements: Moral Shoulds Legal Shoulds Laws of the Universe Shoulds David and Rhonda provide vignettes illustrating the tremendous emotional damage that can result from “Shoulds” and describe a number of strategies for combating them, including: Positive Reframing the Semantic Technique Socratic Questioning the Acceptance Paradox The final podcast in this series will focus on the two types of Blame: Self-Blame, which nearly always marches hand-in-hand with Self-Directed Shoulds Other-Blame, which nearly always marches hand-in-hand with Other-Directed Shoulds Rhonda and David

Today we feature a brilliant and beloved colleague, Dr. Alex Clarke. At the start of today’s podcast, Alex describes his unexpected journey from psychoanalysis / psychodynamic therapy to TEAM, but discovered that TEAM can actually be viewed as a type of psychoanalytic therapy. In fact, the two fathers of cognitive therapy, Albert Ellis, PhD, and Aaron Beck, MD, began their careers as psychoanalysts. They were simply looking for specific techniques to help their patients develop rapid and tangible change, and not just understanding that unfolds over a period of years. David and Alex discuss some of the surprising overlaps between TEAM and psychodynamic therapy, as well as some of the striking differences. Similarities Changing the Focus: Often there’s tension in the room, especially during therapy sessions. When you bring it to conscious awareness in a kindly way, it will often lead to therapeutic breakthrough. The Relationship Journal: This is a rapid way to highlight the recurring patterns that cause conflicts in intimate relationships. Interpersonal Downward Arrow: This is a high-speed version of psychoanalysis which reveals your “core conflict” in ten minutes, as compared with five years on the analyst’s couch. Hidden Emotion Technique: This is the idea that anxious individuals are overly “nice” and feel they have to suppress certain kinds of positive or negative feelings, which then emerge, in disguised form as some type of anxiety, such as chronic worrying, a phobia, a panic attack, OCD, and so forth. Differences T = Testing techniques: Most analysts are dead set against testing, thinking it will somehow hurt or ruin the “transference.” TEAM therapists are convinced it is difficult, if not impossible, to do good therapy without session by session assessments to track how patients feel, and how they feel about the therapist. E = Empathy training and methods: TEAM therapists get highly accurate and sensitive empathy ratings after every session from every patient. Many therapists get failing grades from most patients at most sessions. The patient’s criticisms are not taken as evidence for the patient’s distortions of the relationships, but rather as valid indicators of the therapist’s actual errors. This information is used to deepen the therapeutic relationship. A = Assessment of resistance: Freud devoted his career to understanding and trying to solve the puzzle of resistance—but his free association on the couch was not terribly effective. TEAM therapists bring subconscious resistance to conscious awareness quickly, and melt it away rapidly with a variety of techniques. This opens the door to the possibility of ultra-rapid recovery. M = Methods: TEAM therapists use more than 100 methods drawn from more than a dozen schools of therapy. The therapist and patient work together collaboratively to solve specific problems, and homework between sessions in mandatory. Alex’s current passions span a broad range of mental health treatment, and as a result, provide lots of great opportunities for fun and collaboration with David, as well as the rest of the TEAM community. Clinical work: Alex sees patients three days per week, using TEAM and occasionally medications if needed. Training / teaching: He teaches with David and several other experienced TEAM therapists at David’s weekly training group at Stanford. The Feeling Great app: Alex is assisting David and Jeremy Karmel in the process of making TEAM Therapy accessible to everyone as an electronic app. The app will include real-life examples bringing the techniques to life along with step-by-step instructions for how to put techniques into action. Putting these powerful psychotherapy ideas and methods in patients’ hands provides an exciting opportunity to accelerate healing and augment therapy, since the tool can be assigned as homework between therapy sessions. Also, when patients get stuck with topics in the app, they can discuss these with their therapists, deepen their understanding, and bring them to life through role-plays, etc. Statistical modeling: With David’s mentoring, Alex is working to learn data analytic and statistical modeling methods that can help investigators explore and understand how effective psychotherapy actually works. Measurement and Search: Alex has joined David’s son, Erik, on the exciting mission of promoting measurement-based and feedback-informed treatment as the standard of care in mental health. They are currently in the final phases of developing and rolling out an electronic system for use by therapists and patients to assess mood before, after, and between therapy sessions in order to assess changes in therapy as well as relapses between sessions. This system will provide unique insights for clinicians as well as patients about what’s helping, what’s not helping. The tool will also have a search-engine celebrating clinicians who commit use measurement consistently in their clinical work and will help patients find clinicians with outstanding skills in the areas where they need help. Alex was born in Seattle and grew up splitting his time between the east and west coast. Alex went to high school and college in North Carolina and played in a band for several years after finishing college. He also worked in restaurants, real estate, audio engineering, and even owned a vending machine business for several years! He’s always been a giant outdoors enthusiast, loving to hike, ski, climb, and surf. When Alex went to medical school, he planned to become an emergency room physician because of his love for adventure and wilderness. During medical school, Alex fell in love with the operating room and almost decided to become a surgery resident. However, during a summer research internship, Alex became increasingly interested in neuroscience and began devouring literature on consciousness and emotion research, as well as the brain-machine interface. When he discovered psychiatry during his clinical rotations, he was sold. Psychotherapy struck him as particularly awe-inspiring and he decided to dedicate himself to its learning and practice. In his final year of medical school, Alex traveled around the country doing rotations at medical centers across the US in an effort to learn how mental healthcare is practiced in different settings and regions. He searched broadly for psychotherapy mentors and feels wildly lucky to have found Dr. David Burns during his residency at Stanford. During residency, Alex trained in several different schools of psychotherapy, including advanced psychodynamic training with the SFCP (San Francisco Center for Psychoanalysis). As he puts it “there are lots of metaphors for human experiences, but all of these schools for some reason feel a need to use their own jargon, which can sometimes be off-putting or confusing.” I, David, would add that I agree with this 200%. For example, there is a concept called “projective identification.” For years I felt intimidated by this term and couldn’t figure out what it meant! Then someone explained it to me, and for a brief moment, I “got it.” But now, I again have no idea what it means! Alex decided that understandable language was important and discovered that Dr. Burns had been developing “common language” for important psychotherapy ideas as well as a framework for understanding how effective treatment works. Alex loved this and decided to join David is his mission of translating essential psychological and philosophical ideas into practical, usable healing techniques. One of things that Alex expresses that he admires most about David is his strength in taking complex ideas and bringing them down to a simple, digestible, human level. I, David, would add that I love working with Alex, and have learned so much from him, both in terms of the numerous technical discoveries and amazing breakthroughs that have evolved in our research, but I have also learned a little about the incredible value of humility and “selflessness” from this kindly gentle giant! I, Rhonda, would liked to add that I also love working with Alex.  I admire his kind soul, his gentle disposition, and his perceptive mind. Rhonda and I feel extremely lucky to be working with Dr. Alex! Rhonda and David Dr. Alex Clarke can be reached at: 650-382-2090, alex@clarkemd.com   Alex is available by video appointment for anyone located anywhere in the state of California.  He provides psychiatric evaluations, TEAM psychotherapy, and medication management for any condition, so don't hesitate to reach out to him by phone or email anytime to discuss evaluation/consultation options or treatment needs.  He is also available to clinicians for TEAM case consultation.   Thank you!!!    

Today, the Cognitive Distortion Starter Kit Continues with Emotional Reasoning Rhonda begins by reading a beautiful emails from a listener who was greatly inspired and helped by the personal work Marilyn Coffee did on several previous podcast. I also give a brief shout out for my new book, Feeling Great, which can be pre-ordered on Amazon now (see below for the link). Rhonda and David begin with a brief overview of Emotional Reasoning. this is a term i coined when I first created the list of ten cognitive distortions in the mid-to late 1970s. There is the definition: Emotional Reasoning is when you reason from how you feel. Here are several examples: “I feel like a loser, so I must really be a loser.” “I feel hopeless, so I must be hopeless.” “I feel anxious, so I must be in danger.” “I feel like a bad therapist, so I must really be one." “I feel judged. This means that people are judging me.” “I feel guilty. This means that I did something bad.” Emotional Reasoning is a distortion because your feelings all result from your thoughts. And if your thoughts are distorted, then your emotions / feelings will not reflect reality. Sometimes, your feelings are no more realistic than the images you see in funhouse mirrors in an amusement park.  This is worth knowing because for decades mental health professionals have promoted the ideas that getting in touch with your feelings is the key to mental health. There's truth in everything, and this is sometimes true. Being open with your feelings can be an important key to intimacy and to genuine relationships with others. But your feelings can also deceive you. For example, the feeling of hopelessness is always based on distortions and is never true. But sometimes believe it so strongly that they attempt suicide as the only escape from their suffering. David and Rhonda discuss examples of emotional reasoning and the techniques that can be helpful, including, but not limited to: The Double Standard Technique The Socratic Method Truth Based Techniques, such as: Examine the Evidence The Experimental Technique The Survey Technique David describes a father who was convinced he was a bad father because he shouted at his sons, and Rhonda describes an aspiring writer she recently treated who felt like she was dull and unimportant prior to a meeting with prospective agents. We are nearing the end of the distortion series, but still have two mega-important distortions to discuss: Should Statements Blame David mentions that Emotional Reasoning is not only important in emotional problems like depression and anxiety, but also in anger and conflict with others, as well as racial and religious bias. You feel like other racial or religious groups are inferior, and you feel superior, so you think you are right! Thank so much for listening. If you like our podcasts, tell your friends, colleagues, and patients about them! This is all volunteer work, so our only marketing budget is your good will. Each month our downloads are increasing, thanks to you, and we will hit three million downloads early next year or late this year. Rhonda and David  

Today, Rhonda and David discuss seven great questions submitted by podcast fans like you! Are depression and anxiety states of self-hypnosis? How do you deal with somatic symptoms in TEAM? Should we forgive Hitler and Stalin? What if a patient feels stuck and unable to identify emotions? Do you still really believe that depression and anxiety, regardless how severe, can be treated even without the use of prescription drugs? Do you have to work on your negative thoughts the moment they appear? What role, from your years of practice, does spirituality have in the psychotherapy? Are depression and anxiety states of self-hypnosis? Hi David, I have two questions after listening to Corona Cast 7: “My Struggle with Covid-19! Is it REALLY True that only Our Thoughts Can Upset Us?” I was struck by thinking of anxiety as the result of hypnotizing ourselves into believing our fears. Can depression by thought of in a similar way, except that we hypnotize ourselves into believing our distorted thoughts about ourselves? How do you deal with somatic symptoms in TEAM? Can you do an episode about how to deal with unpleasant somatic situations, as Michael was experiencing during the recording, that suggest there might be some psychological distress but don't seem to have thoughts associated with them? Thanks! Hi Derek, Another great couple of questions, thanks! Will add these to the next Ask David podcast, but the short story is yes, for sure—both depression and anxiety can be thought of as states of self-hypnosis, or trances, because you believe the messages you give yourself, (eg your negative thoughts) that are not true. I think one could add other positive and negative emotions to the list as well, including anger--believing the other person really IS wrong, bad, inferior, and so forth--as well as mania and narcissism, telling yourself that you really ARE a superior person, etc. This is a hugely important topic, and "emotional reasoning" fuels these trances: I FEEL worthless / inferior, so I must BE worthless / inferior, and so forth. With regard to your second question, you might want to listen to yesterday’s live session with Sarah, (Podcast 193, https://feelinggood.com/category/dr-davids-blogs/feeling-good-podcast/) since it focuses on intense somatic sensations generated by emotions, and you can actually hear the exact moment of recovery, when the physical sensations disappeared. David Should we forgive Hitler and Stalin? Hi Dr. Burns, Do you honestly think what Hitler and Stalin did should be forgiven? Albert Ellis said one should. I disagree! Tom Hi Tom, I only help people with problems they are asking for help with. I am not an evangelist or moral authority! David What if a patient feels stuck and unable to identify emotions? A new comment on the post "Uncovering Self-Defeating Beliefs (SDBs)--For Therapists (and Interested Patients) Only!"/ Hi Dr. Burns, Awesome blog post! Your accessible and kind demeanor shine through clearly. What if a client feels stuck and unable to identify emotions? Holly Do you still really believe that depression and anxiety, regardless how severe can be treated even without the use of prescription drugs? Hi Doctor Burns, My name is Jasmine, and I just started going back to therapy about a year ago. I have really improved, and both my mom AND my therapist recommended you HIGHLY. I’m a millennial and I’m just happy you are still alive! I also wanted to ask, do you still really believe even today that depression and anxiety, regardless how severe can treated even without the use of prescription drugs? I am asking because I just bought about three of your books and want to make sure that your confidence in these theories has not wavered. Sometimes I feel like a lost cause because this is the first time in my life that I am truly dealing with and facing my own problems instead of turning the other cheek. Also, how are you doing, sir? Jasmine Hi Jasmine, Doing great, thanks! The new techniques have added even more power to cognitive therapy. Check out my free Feeling Good Podcasts, free depression class, and more on my website, www.feelinggood.com. All the best, David PS My latest book, Feeling Great, can be pre-ordered on Amazon and will be released in Sept. Check our the link below. Do you have to work on your negative thoughts the moment they appear? Hello David, My name is Shivam, I wanted to ask you a question regarding the double column technique for disputing your thoughts. Do we have to work on that moment(upsetting) immediately as it happens or we can work on it later when we get free time? How often should we do it? Its very effective but consumes a lot of time as I keep writing on and on. Any suggestions? I really appreciate that you reply me back. Thanks for everything. love Shivam. What role, from your years of practice, does spirituality have in the psychotherapy? From: Jerry Souta Subject: spirituality in psychotherapy David: Your seminar today (Psychotherapy Leading Voices) was awesome! What role, from your years of practice, does spirituality have in the psychotherapy? Is there a correlation between spirituality and between feeling good/feeling great? Thank you for time taken in response to my in questions! Blessings! Jerry Souta, Jr. (MSW/LCSW/MDIV) Thanks, Jerry. I will answer this on an Ask David, we will be recording it soon. Your question will be featured on a Feeling Good podcast. The short answer is yes. Deep and rapid change nearly always involves a spiritual dimension, for example, one of the four “Great Deaths” of the self. There’s a whole section on this in my new book, Feeling Great.

Today, Rhonda and David discuss three great questions submitted by podcast fans like you!  This thoughtful question is from our beloved Rhonda! . . . And the answer may surprise you! When something terrible happens, like being raped or having your house burn down, or being a victim of racial discrimination, doesn’t the event itself upset you? Do you really have to have a negative thought before you can feel anger, fear, grief, or worthlessness? Hi David! For example, if our house burned down and we lost everything, or we or someone we loved was raped--doesn't the event affect you directly? Do you really have to have negative thoughts before you can feel sad, depressed, anxious or angry? Do all of our feelings REALLY result from our thoughts?  What about people who have been treated unfairly or been discriminated against because of their race, religion, gender identity, etc.  Aren't their feelings a direct result of their experience  and not just their thoughts? Rhonda What do you do when patients fall in love with you? Hi David and Rhonda, My name is Ben and I live in Maryland. I started listening to the feeling good podcast about 3 years ago when I was in a period of life transition. The podcast has been incredibly helpful to me as I dealt with my childhood trauma, explored my motivations and drives for life, and reoriented my personal relationships and career, away from what I thought I should be doing, toward what I love and deeply want for my life. In part because of the podcast's inspiration, I have decided to pursue a master’s degree in social work, and hope to become a psychotherapist. Thank you for all that you do, and the amazing help you have been to me personally. I do have one question. In one past episode. You mentioned the possibility of using five secrets to defuse the situation when a patient falls in love with the therapist because they feel understood and cared for. This has happened to me a few times when I talk with a friend about their personal difficulties, and they begin to develop feelings for me. I would like to keep these relationships friendships, rather than romantic. I would love to have your advice on how best to both inoculate against and resolve such situations. Thank you again. Ben What can you if your boss is not empathic? Hi Dr. Burns, You guys are always so good at empathy. I’d love to hear one day your method about how to cope when there is lack of empathy, but you still have to keep a relation. For example: when your boss doesn’t empathize with you and his message makes you feel bad, but you still need the job. I had an experience like that and it really hurt the ego. Cheers, David. Have a great day! Andres Hi Andres, One can always learn a lot from one exchange with the boss. What did he say and what, exactly did you say next? Waiting for empathy from others is never something I have recommended! That’s a really long wait! But you CAN discover how you are provoking the very problem you are complaining about if you have the courage. This empowers YOU to change. David Questions on the next Ask David: Are depression and anxiety states of self-hypnosis? How do you deal with somatic symptoms in TEAM? Should we forgive Hitler and Stalin? What if a patient feels stuck and unable to identify emotions? Do you still really believe that depression and anxiety, regardless how severe, can be treated even without the use of prescription drugs? Do you have to work on your negative thoughts the moment they appear? What role, from your years of practice, does spirituality have in the psychotherapy? Rhonda and David

Podcast #200: Meet Linda Jackson! We celebrated our one hundredth podcast with an interview with Professor Mark Noble, who talked about TEAM-CBT and the brain. Today, we celebrate our two hundredth podcast with another special guest, Linda Jackson, the publisher at PESI Publishing and Media Company.  You may know of PESI for their work in continuing education programs as well as training products for mental health professionals. You may not be aware that PESI is the publisher of my new book, Feeling Great, which will be released in September, 2020. One focus of our interview with Linda was the teamwork that is so important between any author and his or her publisher, as well as the editor. I have been really thrilled with the incredible teamwork and support that PESI has provided on this project, under Linda’s skillful leadership. That was my strong motivation in selecting PESI, and I’m really glad I made this choice. It will be their first general public “self-help” book, and I hope it is a huge success for them, and for me! Rhonda asks how this book compares with my first book, Feeling Good. It is the first true sequel, although I have written many spin-off books based on the cognitive therapy techniques I first described in Feeling Good. But now, after 40,000 therapy sessions with individuals struggling with mild to extreme depression and anxiety, as well as four decades of research on how psychotherapy actually works, I have many powerful new techniques that you can learn about in Feeling Great. Feeling Great is based on the TEAM-CBT that has evolved in the past ten to fifteen years in my weekly psychotherapy training and development group at Stanford. My book Feeling Good was about cognitions, and how to crush distorted thoughts.  What I have learned over the past 40 years of practice, research and teaching is that cognitions, while massively important, are not the only dimension in change. Of course, it is still true that when you change the way you think, you can change the way you feel, but now there is another powerful component:  many people seem, tp get stuck in depression or anxiety and resist change. They sometimes “yes-but” their therapists and often fail to do psychotherapy homework between sessions. Why? In Feeling Great, you will discover why people resist change and you will also learn how to eliminate resistance. The developments have ushered in the era of ultra-rapid recovery from depression and anxiety. Therapists who are interested in learning these new techniques will now have a clear guide, and members of the general public who are struggling with negative feelings will have the chance to use these techniques on their own, whether or not they are in treatment with a therapist. Linda talks about her personal history and how she happened to find a career in publishing. She describes her passion for writing, journalism and editing, going all the way back to her teenage years, something that I can totally identify with. Linda also describes her background in marketing, and her appreciation of its importance. You could have the greatest book in the world, but without a strong marketing effort, it will just sit on bookstore shelves unnoticed. Linda explained that PESI has been absolutely committed to publishing practical guides that therapists can use to improve their clinical work. But now, PESI is branching into publishing books for the general public as well, because people want answers to their questions of how to deal with feelings of depression, anxiety, and inadequacy. Linda said that PESI was not looking to publish a self-help book, but when someone in their organization heard that David was looking for a publisher, they felt it was “meant to be” that they would publish his new book. Linda believes that this book is going to help so many people who want to “feel great.” Something I (David) have deeply appreciated about working with Linda and her PESI team has been the comradery of the writing, editing and publishing process. We discuss my brilliant editor for Feeling Great, Jenessa Jackson, who happens to be Linda’s daughter-in-law. I (David) felt especially lucky to work with Jenessa, who not only provided incredibly helpful editing, but her background in neuroscience as well as clinical work were tremendously helpful. She clearly “got” my message, including the special chapter on "micro-neurosurgery" by Professor Mark Noble. I also am especially grateful for the marketing support PESI is providing for my new book.  I described the complete lack of support I had from the publisher of Feeling Good shortly after it was first published. That was understandable, because at the time I was an unknown author of a book on depression, and the president of the company (William Morrow & Co.) was convinced that Feeling Good had little or no commercial potential. As a result, in those early years after it was first published, I had to do everything on my own—and it was really hard! I encountered rejection after rejection when I tried to interest magazines or radio or TV shows in interviewing me about Feeling Good. In fact, it took eight years before I finally landed a top national TV show in 1988—the Phil Donahue Show—and the book immediately jumped to the top of all the best seller lists within minutes of the airing of that show. It was like magic! With Linda’s strong background in marketing, we are hopeful that Feeling Great will also get the market support it needs to help as many people as possible. After all, you owe it to yourself to Feel Great! Rhonda and David

Today, the Cognitive Distortion Starter Kit Continues with Labeling Rhonda begins by reading two beautiful, inspiring emails from listeners, and I give a brief shout out for my new book, Feeling Great, which can be pre-ordered on Amazon now (see below for the link). Rhonda and David begin with a brief overview of Labeling. There are two types of Labeling: Self-Labeling and Other-Labeling: Self-Labeling is where you attach a negative label to yourself, such as "I'm a loser," or "I'm a failure." Self-Labeling can be further divided into Labeling your role or Labeling your "self." Here are some examples of Labeling your role: "I'm a bad father," or "I'm a bad mother," or "I'm a lousy teacher," and so forth. Here are some examples of Labeling your "self:" "I'm a loser," or "a failure," or "worthless," or "defective." Other-labeling is exactly the same, except that it's directed at some other person, as in "he's a jerk," or "she's a loser." Labeling can be extremely hurtful, causing intense depression and anxiety, as well as anger, hatred and rage. However, labeling is a distortion, because a human being cannot be captured by a label. Humans are more like rivers that flow--in this direction and that direction, without a specific "shape." We have many, many dimensions, perhaps an infinite number! Many techniques can be helpful for Labeling, but it is always necessary to use any technique in the context of working systematically with the TEAM model, and doing great T = Testing, E = Empathy and A = Assessment of Resistance before trying any M = Methods. It's almost never a good idea to throw techniques at patients without these other vitally important steps first. And if you're working on yourself, it will be vitally important to do the A step before the M step too! David and Rhonda illustrate two techniques that can be especially helpful for Labeling: Let's Define Terms and Be Specific. They do a role play to bring the first technique to life, and play an actual recording of a portion of a TEAM session to bring the second technique to life. We are nearing the end of the distortion series, but still have three hugely important distortions to discuss: Emotional Reasoning Should Statements Blame Thank so much for listening. If you like our podcasts, tell your friends, colleagues, and patients about them! This is all volunteer work, so our only marketing budget is your good will. Each month our downloads are increasing, thanks to you, and we will hit three million downloads early next year or late this year. Rhonda and David

Today, Rhonda and David discuss ten great questions submitted by podcast fans like you! I can’t find any distortions in my thoughts! What’s the cause of this? Crushing Negative Thoughts. Do you have to write them down? Can’t you just do them in your head? PTSD Question: Does the trauma have to be life-threatening and experienced in person/ How can I get over anxiety and panic? Do demons cause depression? How is Sara now? Is anger just “ossified tears?” How do you explain the basic concepts of CBT and cognitive distortions to patients who are not familiar with your work? Can I help myself as much as Rameesh did? How can I start a self-help group based on your book, Ten Days to Self-Esteem? How can I find my favorite podcast? I can’t find any distortions in my thoughts! What’s the cause of this? A new comment on the post "001: Introduction to the TEAM Model" is waiting for your approval https://feelinggood.com/2016/10/27/001-introduction-to-the-team-model/ Hi Dr. Burns, I just ordered your book and am writing my cognitive distortions daily. I ran into one I did not know how to label it. I am a 73-year-old, attractive woman, When I see a young beautiful woman having a great time, say in an ad, I feel angry, sad and jealous. This does not apply to family members only strangers. charlotte Crushing Negative Thoughts. Do you have to write them down? Can’t you just do them in your head? A new comment on the post "190: How to Crush Negative Thoughts: Overgeneralization" is waiting for your approval https://feelinggood.com/2020/05/11/190-how-to-crush-negative-thoughts-overgeneralization/ Dr. Burns, Why is writing the negative thought down important? Can’t I just pinpoint it in my head and simply switch the negative thought to positive one? I know it will not work but i am not able to convince others or myself why I have to write them down. Why is the writing process so important? After practicing for a while will you have the habit of think positively? I am wondering why some people have this way of positive thinking without even practicing? Toni PTSD Question: Does the trauma have to be life-threatening and experienced in person/ A new comment on the post "147: High-Speed Treatment of PTSD?" is waiting for your approval https://feelinggood.com/2019/07/01/147-high-speed-treatment-of-ptsd/ Hi David, I am a fan of your great work and contribution to psychology. I have a question about PTSD: does it necessarily have to be life-threatening in person or can it be caused for example by a threat via online message? Thank you! MB Thanks, MB, great question. Only your thoughts can upset you, not the actual trauma, so the answer is yes. Anything that is profoundly upsetting is profoundly upsetting, period! There is no objective way to measure the impact of any trauma other than via your own thoughts and feelings! This is so important, and yet most of the world, including those who have written the DSM-5 (and all earlier editions) / don't yet "get it." The DSM states that for a diagnosis of PTSD, you have to have some trauma that is “objectively horrific.” But there is no such thing! david How can I get over anxiety and panic? Debby asked a question about podcast 189: How to Crush Negative Thoughts: All-or-Nothing Thinking I have your book When Panic Attacks. I am at a loss at what to use to get over anxiety and panic. It is exciting because you said that you can get rid of both fairly soon; which would be great Hi Debby, Thanks for your excellent question! The Daily Mood Log described (I believe) in chapter 3 of When Panic Attacks is a great place to start. Do it on paper, and not in your head, focusing on one specific moment when you were anxious. Thanks! One teaching point is to focus on one specific moment, and not try to solve anxiety or any mood problem in generalities. A second teaching point is to record the situation, your feelings, and your negative thoughts you were having at that moment. This is always the starting point for change! You’ll find tons of resources on my website, feelinggood.com, including the show notes for all the podcasts with links, search function, and way more, all for free. You can learn a great deal if you put in the time and effort. For example, I am now creating a free class on anxiety and it will soon be available on my website! David Do demons cause depression? Brian W. commented on Podcast 189 on All-or-Nothing Thinking Hi Dr. Burns, Amazing podcast as always doctor Burns! Question: have you ever encountered anything in your patients that you might consider supernatural? I'm Catholic and there's the idea that demons can cause depression or mental illness. I know it sounds crazy, but I've seen weird things. Thank you. Brian Thank you for your question, Brian. Depression results from negative thoughts, not demons. That's good because you can learn to change the way you think and feel. The type of therapy I do is entirely compatible with all religions, including Catholicism, and there is often a spiritual dimension in recovery. All the best, david How is Sara now? Is anger just “ossified tears?” Dear Dr Burns, Though doubting that you’ll ever read or answer this, nevertheless I’ll cast it to the cloud for something-or-other! I’m an old fossilised blind British harpsichordist (good combo?!!) and a devoted fan of your podcasts, as well as selectively slowly making my happy way through the 27 hours of RNIB’s Talking Book version of ‘Feeling Good’ (Must tell you that the Braille Music Translation Programme I use invented by a great buddy in Pa. is called ‘Goodfeel’, so you guys must have something in common!). Alas I have 2 questions. First, as a ‘floating’ OCD sufferer for 70 years or so, I wildly enjoyed Sara’s ‘high speed cure’ in podcast 162. However, surely with this new Coronavirus threat – the virus remaining on cardboard for around 24 hours and other surfaces including shopping for at least 2 days or more -, her cure must have now been reversed? The fact, and I mean from much research ‘fact’ is that ‘what you touch could kill you’. Sure, it might not but, in as bad health otherwise as I am, I believe it’s imperative to be as careful as pos. which, courteously put, is screwing my brain! How about Sara?! Finally, well I suppose it’s a comment more than a question. I’ve been enjoying and, indeed, beginning to benefit from your section in the book on anger. I wonder though whether, unless I haven’t got there yet (which is eminently possible!!), you might have left out one aspect of anger? I’ve often thought that it, as well as hatred and violence could be designated ‘ossified tears’ and, believe me, in my case, if so, they’ve turned into unbreakable rocks!! Keep up the great work, Dr Burns. We all need such an unique communicator and erudite intellect as you, oh and I fervently hope you can stay clear of this virus. Very best and thanks, John Henry (Not the old American horse, . . . but rather a British, almost human John Henry!! David and Rhonda respond to both of John's questions! How do you explain the basic concepts of CBT and cognitive distortions to patients who are not familiar with your work? Hi David and Rhonda, You previously answered a question of mine on your podcast. It was quite helpful, thanks! I have a new unrelated question. While the live sessions have been very illuminating in many ways, your patients have always been trained therapists who are already familiar with the concepts of CBT and cognitive distortions. I understand this is an ethical necessity. As a family physician I struggle with that first step - how do you introduce the concepts of CBT and the cognitive distortions to non-therapist clients? I imagine it must take at least a full session just to do education on the distortions. This may be a question best for Rhonda. Thanks again! Calvin Hi Calvin, Thank you for another great question. If you prescribe the book, Feeling Good, it can help you and your patients in three ways. First, they’ll get all the concepts and some sound psychoeducation, saving you time. Second, the book is at least as effective as antidepressants, so it is prescribing something that may be very helpful with no side effects. Third, it will be a test of their motivation. Motivation appears to have a massive effect on recovery from depression. Also, there are tons of great classes in TEAM for beginners if you check them out at FGI (www.feelinggoodinstitute.com). There are also free classes on depression and other topics on my website, www.feelinggood.com. These classes may also help your patients. On the show, Rhonda will explain how she introduces these topics to her patients as well! All the best, David Rhonda’s note to Calvin: You flatter me, because all questions are best answered by David, but I will give it a try. I do ask all my patients to read David's book Feeling Good, which is superb at describing what CBT is and why it is effective. I have an intake telephone call with all my new patients before we start working together, and before they read Feeling Good. In that call I explain CBT like this, imagine a triangle that has Thoughts, Feelings and Behavior at each point. Your thoughts drive your feelings and your behavior. So, if you can change the way you think, you can change the way you feel. David gives the example of someone walking in the woods who hears a twig break. Imagine that hiker thinking that a murderer is creeping behind him or her, what do imagine he or she would feel? But imagine that same hiker thinking that his or her best friend is joining the hike? What would he or she feel then? There are lots of examples like that: two students who have studied the same amount. One walks into the test room thinking, I did a good job studying, the other walks into the test room thinking I should have studied more. Who do you think will do better on the test? This is an actual study that has been done, and if you guessed the student thinking more confidence did better, you would be correct. It makes logical sense. I don't explain cognitive distortions in my intake discussion, but when we first start working with a Daily Mood Log, after we have gone through T = Testing, E = Empathy, and after A = Assessment of Motivation, when we are going through the M = Method "Identify the Distortions" for the first time. I explain that cognitive distortions are embedded in our negative thoughts, and they are simply ways that our mind convinces us of somethings that aren't really true. By this time patients have read part of Feeling Good, so they have more psychoeducation. But I find if patients still don't understand the concept of cognitive distortions, as we go through the Identify the Distortions method, they soon understand what distortions are. I hope that makes sense, and that you find this helpful, Rhonda Can I help myself as much as Rameesh did? Hello Dr David, I saw how Ramesh changed dramatically and I want that kind of change in my life. but I am doubtful. It was you who managed to melt away his resistance using different techniques. Is it possible that we can manage to change ourselves so effectively? Shivam Hi Shivam, Thank you for this incredibly important question. Research indicates that many people have been helped by reading my books and doing the exercises, such as Feeling Good. Motivation and hard work are critically important in personal change and recovery. I am also working on a new app, and hope to get data to answer this exact question! Best of luck! Will make this an Ask David question, as it is so important! David How can I start a self-help group based on your book, Ten Days to Self-Esteem? Dr Burns, I know your book, Ten Days to Self Esteem, has a group leaders manual. Can anyone start one of those groups of do you have to be a therapist of some sort? Has anyone told you that they started one? How did they say it went? Any tips for starting one? Thanks Richard Hi Richard, Many pilot studies using this program with lay leaders have been effective. The program at my hospital in Philadelphia, also using lay leaders, was very effective. David How can I find my favorite podcast? Hi David I am a therapist and was reminded of one of your podcasts as I was listening to a particular patient. I wanted to share the episode and then couldn’t find it so felt silly. It was an episode where a father (perhaps Indian? Maybe a doctor?) empathizes and listens in a whole new way to his adult son and has a miraculous turn of events in the relationship- simply by being present and not being defensive when the son tells him how he feels about his father. It was beautiful and moving. A great example of “opposite action”- agreeing with the criticism rather than defending against it. Does that episode ring a bell and can’t you point me in the right direction to retrieve it? I know how busy you are. Thank you for your wonderful podcast and for any help you can provide. Thanks, Pam Hi Pam, It might be the follow-up to the live therapy with Mark. Use the search function on my website. He is from Iran, and is an OB-GYN doctor who has faithfully attended my Tuesday training group for years. He is one of my favorite people. Learning the Five Secrets takes lots of commitment and practice. He has formed his own Five Secrets practice group with friends and colleagues who are not shrinks. They’ve met weekly for years, so his skills are quite refined now. Thanks! David On the podcast, I emphasize the search function you can easily find on every page of my website, www.feelinggood.com. Pam’s comment on the Five Secrets is also important. Desire, commitment and ongoing practice are the keys to mastery! Rhonda and David  

Loneliness has existed since the dawn of time.  I frequently receive questions from lonely individuals wanting to know how to connect, and how to find companionship, intimacy and love.  Lonely men ask me, "How do I talk to women?"  Lonely women ask, "How can I find a good man?" Regardless of your gender or gender identity, you may struggle to find a loving romantic partner for a variety of reasons, some of which I have outlined in my book, Intimate Connections.  Although dating can be an incredibly stressful, disappointing, and time-consuming hassle, there are tremendous rewards for those fortunate enough to connect and develop an intimate relationship. So today, we address some of those issues. Our special guest today is Dr. Matthew May.  He is a former student of mine, a good friend of David and Rhonda, a regular on the podcast, and a loving wonderful man. Today, Matt brings us a wealth of information for those interested in improving their dating lives, based both on his clinical work, as well as his own experiences overcoming social anxiety, falling in love and being in a loving relationship. Matt begins with an inspiring reminder of why we would go through all the trouble, stress and disappointment inherent to dating, highlighting some of the rewards that await those who are persistent, including how good it feels to be understood, accepted, loved and cherished by someone who feels the same towards us.  The poetry of his writing is beautiful and inspirational. He also provides some common-sense guidelines for individuals who are interested in dating, so they can do so safely.  We then delve into more psychologically complex and personal matters. Here are Matt's tips on maintaining safety when you are dating someone you don't know for the first time--for example, it might be someone you may have met on the internet. Although these tips are primarily for the protection and safety of women, they may also be helpful to men who are dating. 1.      The first time you meet someone you've met on the internet, meet in a public place, like a restaurant or coffee shop, where you'll be safe. 2.      Use your own transportation. Don't let someone you've never met pick you up, because then you'll be vulnerable in case things don't go well. 3.      Tell someone you know where you're going, and when you're going to return. 4.      Get to know the other person as much as possible. What does s/he do, who are his or her friends, and so forth. 5.      Don't provide any identifying information, including your date of birth, to anyone you've just met on the internet, as you could be vulnerability to identity theft. Sometimes the most charming people are scam artists. 6.      Listen to your intuition. If you have a creepy feeling about someone you're thinking of dating, pay attention to it. Something might be "off" about the other person. 7.      Don't drink too much, as you could become a victim of date rape, especially if the man slips a sedative chemical in your drink. 8.      Give (or ask for) consent prior to any touching. Matt emphasizes that emotional vulnerability is the price tag on intimacy, and this can be frightening because we all naturally fear rejection. Matt defines emotional intimacy as being seen as our true and vulnerable self, so we are accepted for who we really are. He talks about how most of us have a deep yearning for this kind of relationship, and yet struggle to be vulnerable and open in ways that make intimacy possible. Rhonda, Matt and David describe the delicate balance between game playing--which can be crucial in the early stages of dating--and vulnerability, which can lead to a meaningful and lasting relationship. Some people try to skip the game-playing stage, thinking it is too superficial, and try to jump right into vulnerability the moment they meet someone they like. This often leads to rejection. People like to have fun, and you don't always have to be "heavy" or overly "sincere." But too much game-playing can leave you feeling lonely as well. I describe a patient I once treated who was almost unbelievably successful in the dating arena. You might even say he was an incredibly effective womanizer. But he felt tremendously lonely and anxious on the inside. He was handsome and charismatic, and got tons of sex, but wasn't really happy. Matt describes another common barrier to successful dating, especially in men: entitlement and anger. He says that he, like many lonely men, used to think that "women should like me the way I am," and "I shouldn't have to put on airs to date." Years ago, I pointed out that Matt was not dressing in a very sexy way, and suggested a change might be in order. Matt insisted that he shouldn't have to, and that women should love him just as he was! I asked Matt to fantasize about his ideal woman. Matt described a woman who's looking terrific--great clothes, nice hair, makeup, and so forth. Then I pointed out that most women are looking for pretty much the same thing--a man who dresses well and looks his best. I urged Matt to get a good "sex uniform" for dating--in other words, get some great, sexy clothes and look your best--it can make a tremendous difference. Rhonda and Matt discuss the fear of being alone, which is one of the great barriers to finding love. Overcoming the fear of being alone must be done first; then dating will become far easier because you will no longer be needy. The Neediness Problem--telling yourself that you NEED love to feel happy and fulfilled--can drive people away and lower your attractiveness. That's because of the Burns Rule: People NEVER want what they CAN get, and ONLY want what they CAN'T get. So if you're needy, you'll be desperate, and you'll be what people can get. Then they won't want you. Life works like this on many levels, and not just romance. When you think you need something, it eludes you. When you let go, and no longer "need" that thing, it tends to come to you. When you discover  that you can be completely happy when you're alone, then you won't "need" a loving partner any more. This will put you in a much stronger position, and people will be more attracted to you because you won't be so needy and available. I can show you how to overcome the fear of rejection and the fear of being alone in the first section of my book, Intimate Connections. Although it's perhaps one of my lesser books, it can be helpful if you're struggling in the dating arena. Many people have told me that this book helped them find someone to love and marry after years of frustration and loneliness. So, what's the secret of sex appeal? Some people think it's based on looks. Other people think it's based on power, status, or wealth. Well, if you're gorgeous, powerful, and wealthy, you will find that dating is a lot easier because lots of people will be attracted to you. But those are not the secrets of sex appeal, and they do not guarantee a successful marriage. I have treated many people who were gorgeous and tremendously successful, but they still suffered from severe depression and intense loneliness. Matt and Rhonda reveal the real key to sex appeal for individuals of any gender or gender identity:  self-confidence. This is pretty basic: if you think you're hot, you're hot. And if you think you're not, you're not. When you're feeling depressed, lonely, and insecure, developing self-confidence and sex appeal might  seem impossible, but we are convinced that the magic of sex appeal and happiness can happen for pretty much anyone. For those who are interested, there are lots of step by step tools to help you achieve greater self-confidence in Intimate Connections. Matt describes how I helped him with his own social anxiety when he was a psychiatric resident, and how his love life suddenly went from rags to riches. One of the techniques that helped him the most was when I gave him a homework assignment to do "Rejection Practice." This exercise helps you get over your fear of rejection. I asked Matt to collect 25 rejections from attractive women as fast as possible, so he could confront this fear and discover that life still goes on after rejection. You will be entertained and charmed by his delightful and surprising story. Dating problems and social anxiety have always been my favorite topics because of my own fairly severe social anxiety when I was a young man. In addition, when I was in clinical practice in Philadelphia, 60% of my patients were single. Some of them were divorced, and unable to get into the dating game, and some of them had never found a loving partner in the first place. I just loved working with this population. it was so rewarding to help my patients find self-love first, and then the love of another special person. In fact, that's why I wrote Intimate Connections. I just love to show people how to overcome their shyness and "singleness" and get partnered up! With love, Rhonda, Matt and David

in today’s podcast, Rhonda and David address eight fascinating questions submitted by fans like you: What’s the difference between David’s Therapist Toolkit, his eBook (Tools, Not Schools, of Therapy), and the EASY Diagnostic system? Is there a dark side to human nature? Is being “forceful” or confronting patients ever important in therapy? What’s the 5-session schizophrenia cure? How do you suddenly switch into “Sitting with Open Hands” during a session? Questions about OCD Questions about racism What if there are more advantages than disadvantages in perfectionism? What’s the difference between the Toolkit, the eBook, and the EASY Diagnostic system? I am a Licensed Clinical Social Worker (LCSW) and I am interested in either the Toolkit or the EASY diagnostic tool. It looks like the Toolkit includes quite a few questionnaires so I am wondering if I would need both. I would love to have a comprehensive checklist to give to clients during their initial assessment so I originally looked into the EASY Diagnostic tool. I’m just looking for a little guidance on which one would be the most helpful and if I would actually need both. Thanks so much! Cindy What do you think about the idea that there’s a dark side to human nature? Are humans inherently good, as so many mental health professionals seem to believe? It could be entitled, “The Dark Side of Human Nature,” or “Is there REALLY a dark side to human nature?” Jeremy Rhonda and David believe that human beings have positive loving impulses and dark violent impulses as well, and that both are an inherent and basic aspect of human nature. They discuss several aspects, including: The example of cats. They are genetically little serial killers. They love to capture and torture rodents, even if they have had a loving childhood. Many people love violent revenge movies and video games. Many people love killing animals, chopping their heads off, and mounting them on the wall, in much the same way that human serial killers get intense excitement from their killing and torturing, and they also keep trophies. David argues that it is important for therapists to recognize and address the dark side—areas where therapists will typically get in trouble due to blindness / denial / rationalization of negative motives, and excessive idealism. Problematic areas for therapists can include: the suicidal patient the violent patient—David describes a woman who was plotting to kill her husband. disability patients with a hidden agenda of remaining disabled. patients who don’t want to do their therapy homework people, for the most part, don’t get addicted because they’re depressed, anxious, or lonely, but because it’s really awesome to get plastered / high. Many, and perhaps all humans, like to judge others and feel superior to them, and also enjoy exploiting others, but our denial can be intense. People enjoy bullying people. It makes you feel powerful and generates feelings of excitement. We acknowledge that although the dark side to human nature may be strongly influenced by our genes, the environment we grow up in can also have a strong impact on our thoughts, feelings and impulses. Is being “forceful” or confronting patients ever important in therapy? This is another great question submitted by Jeremy Karmel. David gives many examples of times when it is absolutely necessary to be forceful and confrontational in therapy, but this requires a strong therapeutic relationship with the patient and perfect empathy scores and high levels of trust and mutual respect. Therapeutic examples where forcefulness or confrontation may be important include: Exposure techniques in the treatment of anxiety. The patient will nearly always “wimp out” at the last minute, and here is where the therapist needs to push—but most therapists will back off out of misguided “niceness.” Pushing the patient to view his/her own role in a relationship conflict instead of buying into the idea that the patient is the innocent victim of the other person’s “badness.” The new CAT technique in the Externalization of Voices is yet another example where gentle confrontation can often lead to rapid enlightenment. Another example is use of Changing the Focus, suddenly drawing the patient’s attention to “Have you notice what just happened here between us?” This can be helpful when there’s an awkward or adversarial or evasive dynamic going on between therapist and patient. Yet another example is the Gentle Ultimatum in dealing with Process Resistance. In all of these examples, many, and likely most therapists don’t do well, due to “niceness” and fear of conflict. What’s the 5-session schizophrenia cure? Hello David: I recall you saying in one of your trainings given in San Diego a while back that you could "cure Schizophrenia in 5 sessions" using the T.E.A.M. protocol you taught us. Is there a special protocol for this disorder? One of my clients would very much like to know. I hope that this finds you, your family and everyone at the Feeling Good Institute doing well and being healthy. Kind regards, Leslie David explains that he has always insisted that schizophrenia is an organic brain disorder that sadly cannot be cured with drugs or psychotherapy. However, drugs often plan an important role in treatment, and compassionate psychotherapy can also be extremely helpful. The goal is to help the patient develop greater self-esteem and improved relationships with others. He describes the innovative group CBT program he developed at his hospital in Philadelphia which served a large population of homeless individuals as well as individuals suffer from severe schizophrenia. He also points out how easily one can get severely misquoted, and appreciates the chance to set the record straight! How do you suddenly switch into “Sitting with Open Hands” during a session? This is yet another great question from our friend and colleague, Jeremy Karmel. David and Rhonda compare good therapy to dancing, having to often change courses instantly when the patient begins to resist and fight the therapist. Questions about Obsessive Compulsive Disorder (OCD): I hope this a place where I can submit questions for "Ask David." Are there manifestations of OCD that have common links or hidden emotions? Do you hear one person's description of their OCD and immediately have an idea of what might cause it? For example: do a majority of contamination OCD sufferers have a common reason for that specific "type" of OCD? Do sufferers of something deeply distressing like pedophile OCD all have feelings of shame that manifest in that OCD, where the "what if" would result in probably the most shame they could ever feel? David and Rhonda discuss the Hidden Emotion Technique which can be invaluable in the treatment of OCD. Questions about racism Hello David and Rhonda, Thanks for your amazing podcasts, I have listened to a lot already. And thanks Rhonda for bringing this important subject to the table. :) What if “Steve” had said that indeed he is racist and can't stand African Americans or South Americans, what would Rhonda answer to that?! It would become difficult for me to keep a friendship-like relationship with someone who is at the extreme opposite on sensitive subjects. I am open to any point of view, I don't need to be disarmed here. :) David, I'm so looking forward to your Feeling Great book!!! Rhonda and David discuss two opposite strategies for dealing with someone with strong racist tendencies. What if there are more advantages than disadvantages of perfectionism when you do a Cost-Benefit Analysis? This is a question from a user who wishes to remain anonymous. Rhonda and David talk about the fact that perfectionism, like all Self-Defeating Beliefs, has many advantages as well as disadvantages. And if the advantages outweigh the disadvantages, it’s working for you, and it’s not something the therapist would need to help you with. There’s a difference between neurotic and healthy perfectionism. Many of the great historical figures, like Edison, for example, worked relentlessly and would not settle for failure. And we are all the beneficiaries of that type of genius and intense commitment to the healthy pursuit of excellence! Therapy is all about helping people who ask for help. It’s not about evangelism! David and Rhonda    

Today, the Cognitive Distortion Starter Kit Continues with Magnification and Minimization Rhonda begins by reading two beautiful, inspiring emails from Heather Clague, MD and Dipti Joshi, PhD.  Heather and Dipti are dear friends and esteemed colleagues of David and Rhonda. Rhonda and David begin with a brief overview of distortion #6: Magnification and Minimization. Magnification is when you blow things out of proportion. This is common in anxiety and is also called “Catastrophizing.” For example, during panics patients often tell themselves—and believe—that they are on the verge of something catastrophic, like a stroke, a sudden, fatal heart attack, or losing their minds and becoming hopelessly psychotic. Minimization is just the opposite. You shrink the importance of something like your good qualities or the things you’ve accomplished. Minimization is common in depression. Magnification and Minimization almost always play a big role in procrastination as well. For example, you may Magnify the enormity and difficult of the task you’ve been putting off, and Minimize the value of just getting started on it today, even if you only have a few minutes. I sometimes call this distortion the “binocular trick” because it’s like looking through the opposite ends of a binocular, so things either appear much larger or much smaller than they actually are. Techniques that can be especially helpful include Examine the Evidence, the Semantic Technique, Little Steps for Big Feats, the Experimental Technique, the Double Standard Technique, and Externalization of Voices / Acceptance Paradox. Rhonda brings these techniques to life in a description of a depressed man she recently treated who’s been divorced for 2 to 3 years, and living alone due to the Shelter in Place orders during the Covid-19 pandemic. Although he’s lonely, he’s telling himself that he’s “too depressed and scattered” to be in a relationship. At the start of the session, he feels: sad, 90% panicky, 50% ashamed, 50% worthless 50% alone, 90% hopeless90% frustrated, 90% upset, 90%. Rhonda describes her skillful and compassionate TEAM treatment of this man, starting with the Magic Button, Positive Reframing, and Magic Dial, followed by Identify the Distortions, the Paradoxical Double Standard Technique, and Externalization of Voices (including the Acceptance Paradox, the Self-Defense Paradigm, and the Counter-Attack Technique, or “Cat”) Rhonda brings these techniques to life in a description of a depressed man she recently treated who’s been divorced for 2 to 3 years, and living alone due to the Shelter in Place orders during the Covid-19 pandemic. Although he’s lonely, he’s telling himself that he’s “too depressed and scattered” to be in a relationship. At the start of the session, he feels: sad, 90% panicky, 50% ashamed, 50% worthless 50% alone, 90% hopeless90% frustrated, 90% upset, 90%. These techniques were tremendously helpful, and at the end of the session, he no longer believed his negative thoughts about himself and his negative feelings all fell to zero. He recovered, essentially, in one extended (3-hour) TEAM therapy session. David and Rhonda discuss the impact of this type of experience on the therapist as well as the patient. Obviously, the patient feels fantastic, but Rhonda said she also felt “rejuvenated,” with much warmth and kindness. I (David) always feel this as well at the end of an amazing session. Rhonda and David

Today, the Cognitive Distortion Starter Kit Continues with Jumping to Conclusions Rhonda opens today’s podcast by reading beautiful email comments from Kevin Cornelius and Thai-An Truong. Both are dear friends and colleagues of Rhonda and David. Then Rhonda and David discuss Jumping to Conclusions, which is the fifth cognitive distortion. It’s defined as jumping to conclusions that aren’t necessary supported by the evidence. There are two common forms: Fortune Telling and Mind-Reading. Fortune-Telling: You tell yourself that bad things are about to happen. There are two common examples: Hopelessness: You tell yourself that things will never change, that you’ll never recover, or that your problems will never be solved. David explains why this distortion is impossibly distorted and virtually never true. And yet, when people are depressed, they nearly always fall victim to the belief that things will never change. It’s much like being in a hypnotic trance, because you are telling yourself and believing things that can’t possibly be true. Anxiety: You make catastrophic predictions that gradually exaggerate any real danger. All anxiety results from this distortion. For example, if you have a fear of flying, you may be telling yourself that the plane could run into turbulence and crash. Anxiety is also a self-induced hypnotic trance, because you are giving yourself and believing highly irrational messages. For example, one of David’s graduate students screamed loudly when she saw his meek little kitten, Happy, because she had a cat phobia and was telling herself that cats are extremely violent and dangerous. Mind-Reading: You assume that you know what other people are thinking when you really don’t. There are three common examples: Social Anxiety / Shyness: For example, other people are judging you and can see how anxious you are. You may also assume that other people rarely or never get anxious and that they wouldn’t be interested in you. Relationship Conflicts: You may tell yourself that the other person only cares about himself/herself and that s/he is intentionally being “unreasonable.” You may also do the opposite type of mind-reading and assume that others are quite impressed with you when they’re actually turned off or feeling annoyed with you. Anxiety: You make catastrophic predictions that gradually exaggerate any real danger. All anxiety results from this distortion. For example, if you have a fear of flying, you may be telling yourself that the plane could run into turbulence and crash. Anxiety is also a self-induced hypnotic trance, because you are giving yourself and believing highly irrational messages. For example, one of David’s graduate students screamed loudly when she saw his meek little kitten, Happy, because she had a cat phobia and was telling herself that cats are extremely violent and dangerous. Depression: You tell yourself that nobody loves you or cares about you. Many of the Truth-Based Techniques can be useful, such as Examine the Evidence, the Experimental Technique, or the Survey Technique. Motivational Techniques like Positive Reframing can be tremendously helpful. And Role-Playing Techniques like Externalization of Voices with the Acceptance Paradox can also be very useful. David and Rhonda play a short audio clip from the treatment of a severely depressed man named Bradley with a history of extreme abuse growing up. He is struggling with feelings of hopelessness, which he rated at 80 (on a scale of 0 to 100) due to these two thoughts: I’m damaged beyond repair so nothing can help. Psychotherapy homework can’t possibly help so there’s no use trying it. Prior to the audio clip, David and Bradley have done Positive Reframing asking: What do your negative thoughts and feelings show about you and your core values that is beautiful and awesome? What are some advantages, or benefits, of your negative thoughts and feelings? David and Bradley then attack his negative thoughts using a variety of role-playing techniques, with many role reversals. By the end of this approximately 13-minute excerpt, Bradley no longer believes these two thoughts and his feelings of hopelessness have dropped to zero. We are incredibly grateful to “Bradley” for giving us permission to publish this very personal and inspiring audio clip! Thanks for listening! Rhonda and David

On February 24, 2020 we published Podcast 181, "Live Therapy with Sarah: Shrinks are Human, Too!" This was a live session with Sarah, a certified TEAM-CBT therapist, conducted at my Tuesday psychotherapy training group, because Sarah was struggling with intense anxiety, bordering on panic, during  therapy sessions with her patients. It was a phenomenal session with outstanding results. The Hidden Emotion technique was the main focus of that session, bringing to conscious awareness some feelings of anger and resentment that she'd been sweeping under the rug. This is a common cause of anxiety. But a month or so after that session, Sarah relapsed in a big way, so I agreed to treat her again during the psychotherapy training group at Stanford, and Dr. Alex Clarke was my co-therapist. This time, we used very different treatment techniques. Once you've recovered, the likelihood of relapse is 100%--that's because no one can be happy all the time. We all hit bumps in the road from time to time, and when you do, your "fractal" will come into prominence again. This means that the same kinds of negative thoughts and feelings will return in an almost identical form. This can give you the chance to defeat them again and strengthen the positive circuits in your brain. That's exactly what happened to Sarah. Approximately one month after the first treatment session, she had a viral infection, and began taking large amounts of Advil to combat the symptoms. This led to severe feelings of nausea, followed by panic. Multiple trips to the doctor failed to reveal any diagnosable cause for her somatic symptoms, aside from the possibility of Advil side effects. However, the discomfort was so severe that she panicked, fearing that she had a more severe medical problem that the doctor had overlooked. She lost 13 pounds over the next two months, and requested an emergency TEAM-CBT session, which Dr. Clarke and I were very happy to provide, since live work almost always make for superb teaching. If you take a look at Sarah's Daily Mood Log, you'll see that the upsetting event was waking up Sunday morning still sick and anxious for the 100th day in a row. She circled nine different categories of negative emotions, and all were intense, with several in the range of 80 to 100. and she had many negative thoughts, including these. Please note that she strongly believe all of these thoughts: Negative Thoughts % Now 1.    I should be able to defeat my anxious thinking and reduce my suffering. 95 2.    If I can’t heal my own anxiety, I’m an inadequate hack of a TEAM-CBT therapist. 95 3.    I was strong, confident, vivacious. Now I’m fragile, weak, and self-doubting. 100 4.    My anxiety is slowing me down—I should be able to do more and take on more. 100 5.    Something serious is wrong with my stomach, but now with Covid-19, I won’t be able to get medical intervention and testing. 70 6.    I’m not as effective in my clinical work when I’m upset and anxious. 85 7.    I might get panicky during a session and screw up. 80 8.    I should always do more. 85 After empathizing, I asked Sarah about her goals for the session. She said she wanted greater self-confidence and less anxiety, and said her husband had theorized that if the anxiety disappeared, her somatic symptoms would also go away. But when we did Positive Reframing, Sarah was able to pinpoint more than 20 overwhelming benefits of her intense negative feelings, including many awesome and positive qualities and core values that her negative thoughts and feelings revealed about her. This always seems to be a shocking and pleasant discovery for the patient! At this point, we used the Magic Dial to see what Sarah wanted to dial her negative feelings down to, as you can see here. Then we went on to the Methods portion of the session, using techniques like Identify the Distortions, Externalization of Voices, Acceptance Paradox, and more. We also had to revert back to the Assessment of Resistance once again when Sarah began to fight strenuously against giving up her self-critical internal voice. We did a Cost-Benefit Analysis on the advantages and disadvantages of being self-critical and not accepting her fragileness, weaknesses, and flaws.  Once we "sat with open hands" and listed all the reasons for her to continue criticizing herself, she suddenly had a change of heart and really poured herself into crushing her negative thoughts. It was interesting that as she began to blow her negative thoughts away, she suddenly got hungry for the first time in months!  If you click here, you can see how she felt at the end of the session. It was a mind-blowing session, with much potential for learning. Rhonda, Dr. Clarke and I hope you enjoy it! Here were some "teaching points I sent to the tuesday group members after the session. This could not have been done in a single session. At least in my hands, a two hour session is massively more cost-effective than a bunch of single sessions. But even then, you have to have a plan and move quickly. Although you all said wonderfully admiring things to our “patient” during the E = Empathy phase of the session, few or none of you used Thought Empathy or Feeling Empathy, which is vitally important. I thought that Fabrizio did a magnificent job with “I Feel” Statements, expressing genuine warmth and compassion. As usual, resistance was the key, and could not have been overcome with efforts to “help” or attempts to use more M = Methods. Learning the dance of reverting instantly to A = Assessment of Resistance is key (revisiting this when the patient resists during M = Methods. But this requires “sensing” that the patient is resisting during Externalization of Voices, for example. You have to kind of “smell” what is happening, and then suddenly change direction. You also have to be able to “see” that the patient is absolutely committed to some underlying schema or belief, like “I should always be strong and vivacious,” etc. The Assessment of Resistance cannot just be an intellectual exercise, as it might then revert to “cheer-leading.” Emotion and tears are crucial, and amazing work was done by Sarah, our “patient,” during the tears. She gave herself compassion at that moment. But tears alone without the structure would not have had nearly the impact. Skillful therapy integrates multiple dimensions at the same time. It cannot be formulaic. It's an art form, based on science, and it is data-driven, based on the patient's ratings at the start and end of the session. During the Externalization of Voices, I would recommend that you NEVER settle for a “big” win. Shoot for huge, and stick with the same thought for as many sessions as necessary to get to “huge.” During the role playing I switched back and forth from Ext of Voices to Paradoxical Double Standard and then back frequently, as they both draw on different sources of pretty incredible healing power. As a therapist, I never give in to a patient’s feelings of hopelessness, because rapid and dramatic recovery is usually possible. Relapse Prevention Training (RPT) will now be necessary, since NTs always return. RPT only takes about 30 minutes. I apologize for taking over last night, but felt my strongest commitment is to provide relief for the person in the “patient” role. Sometimes what you think of as your worst “flaw” (eg being suddenly weak and fragile and fearful) can be your greatest asset in disguise, once you accept your flaw(s). But we fight against acceptance, thinking that if we beat up on ourselves enough, something wonderful will happen. And, of course, the self-criticism can sometimes reap big dividends. At the same time, I try to remind myself that self-acceptance is the greatest change a human being can make. The goal of therapy is not just feeling somewhat better, but getting to enlightenment and joy. That's what happened tonight! After the session, I received this awesome email from Sarah: Thank you from the bottom of my heart, David, Alex, and all members of our training group who were present tonight. Such beautiful contributions from all, and I appreciate so deeply this 2nd opportunity to do personal work, especially given that we are ALL going through difficulties during this Covid-19 crisis (or in general). I feel so much lighter, even enlightened, ate some pot roast for dinner (What??? I haven't had an appetite for something like that in a LONG time... and find myself looking forward to my sessions with my patients tomorrow). And I also know I'll have moments of relapse, but I really felt like I finally defeated those thoughts and especially the core belief. Stay healthy and safe everyone, I look forward to opportunities in the future when we reunite, to be in support of YOU. Best, Sarah Rhonda, Alex and I want to thank you, Sarah, once again, for your tremendous courage and generosity! David and Rhonda

"I don't matter!" Did you ever feel like you aren’t important? Did you ever feel like you don’t matter? These thoughts are extremely common and can be extremely painful. I know from my clinical experience over the years, with more than 40,000 hours of therapy with people struggling with mild to extreme depression and anxiety. I know from personal experience as well, because I’ve been there personally at times! And one of the reasons I love doing therapy is because of the joy of helping someone transform these feelings of inadequacy and tears into feelings of joy and exuberance, and even laughter. Today, my highly esteemed colleague, Matthew May MD, and I, work with our highly esteemed and beloved colleague and podcast host, Rhonda Barovsky, on concerns that emerged when a scheduling difficulty made it difficult for Rhonda to join a podcast recording on “The Phobia Cure” which was going to feature Matt May MD doing live exposure with a colleague named Danielle who has an intense fear of leeches. I suggested that Matt, Danielle and I could do the podcast without Rhonda, to save her from having to commute from her office in Walnut Creek, California to the “Murietta studios” twice in one week. (It’s a 90-minute commute in both directions, and sometimes traffic makes it even worse.) When Rhonda read this email, she was flooded with negative emotions, which you can see on pages 1 and 2 of her Daily Mood Log at the start of her session. As you can see she felt down, anxious, ashamed, inadequate, rejected, self-conscious, angry, jealous, and more, and these feeling were intense. Have you ever been suddenly and unexpectedly triggered like that? What triggered Rhonda’s feelings? According to the TEAM-CBT treatment model, our negative feelings are not the result of what happens, but how we think about it. So, what were the thoughts that triggered Rhonda’s angst? Take a look at the negative thoughts on her Daily Mood Log. As you can see, she was telling herself that She didn’t matter and wasn’t important. David didn’t value her. She shouldn’t have such strong negative feelings, like jealousy. The people listening to the podcast (like you, for example) will think she looks like an idiot and will judge her. She shouldn’t be taking up time and space on the podcast in the “patient” role again. One of the things I like about the TEAM model is that it gives us a clear blueprint about how to proceed. One of the things I love about Rhonda is her openness, vulnerability, courage, and intense desire to teach and reach out to others, like yourself. And one of the things I admire so intensely about Matt is his tremendous kindness and compassion which are coupled with extraordinary technical skills. I feel very blessed to have Matt and Rhonda as colleagues and friends! In the podcast, we go through the TEAM model, step by step, starting with T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods. We encountered some tears, some memories of childhood and tons of laughter as well. During the Assessment of Resistance, we used the Straightforward Invitation, Miracle Cure Question, Positive Reframing, and Magic Dial. To me it is always surprising to see how many positives are embedded in our so-called “negative” feelings and “negative thoughts.” Positive Reframing nearly always eliminates resistance and opens the door to rapid change. You can look at Rhonda's Positive Reframing list on page 5 of the attachment. You can also take a look at her Emotion's table when she filled in the Goal column on page 3 of the attachment. The first thought Rhonda wanted to challenge was “I don’t matter,” and we started with the Downward Arrow Technique to identify the Self-Defeating Beliefs that gave rise to this thought, as you can see on page 4 of the attachment. Rhonda also told a moving story about her father, and how her belief that she was not important may have gotten started. She also told a beautiful story about reconciling with her father eight years before he died. We used several methods to challenge and crush the thought, "I don't matter," including Identify the Distortions, the Double Standard Technique, the Externalization of Voices, the Feared Fantasy, the Acceptance Paradox, and Examine the Evidence to crush this thought. Several role reversals were necessary before Rhonda knocked the ball out of the park. The first negative thought is generally the most difficult to crush. Once Rhonda no longer believed this thought, she could easily challenge and defeat the rest of her negative thoughts as well, resulting in a dramatic transformation in how she was feeling, as you can see on page 3 of the attachment. It seems like when you crush one negative thought, there is a sudden change in the brain, as if the negative circuits get turned off and the positive circuits get turned on. You will have the chance to hear this first hand when you listen to the live session. If you'd like to take a peak at Rhonda's final Daily Mood Log, you'll see how she challenged all the rest of her Negative Thoughts. (David, link to final DML when you get the final version from Rhonda.) To review Rhonda's Evaluation of Therapy Session, click here.  Although this podcast was long (roughly two hours), it seemed like very little time had passed because the experience was incredibly engaging and rewarding. Rhonda, Matt and I hope you enjoyed it as well, and hope it gave you some help as well, if you—like the rest of us—have ever struggled with the fear that maybe you don’t matter, or aren’t important, either. Let us know what you think, and thanks for listening today! Rhonda, Matt, and David PS Following the podcast, Matt and I received this beautiful email from Rhonda: Dear David and Matt: My thanks to you both for an incredibly powerful experience.  I am not enough of a poet to describe my experience and gratitude to you both.  But you helped me tackle something that has been painful for me for such a long time! I am grateful and humbled by your brilliance and your commitment to me Rhonda  

This is the fourth in our podcasts series on the best techniques to crush each of the ten cognitive distortions from my book, Feeling Good: The New Mood Therapy. Today, we focus on Mental Filtering and Discounting the Positive. (This will be the last Episode recorded remotely with poor sound quality.  We thank  you for your perseverance listening to it, and guarantee better sound quality in the future with our new recording equipment.) Mental Filtering, You focus on something(s) negative, like a mistake you made, and ignore or overlook the positives. This is like the drop of ink that discolors the beaker of water. Discounting the Positive(s). this is an even more spectacular mental error. You insist that the positives about yourself or others don't count.  In this way, you can maintain a uniformly and totally negative view of yourself, the world, or other people. David and Rhonda discuss the fact that humans can be very biased in our perceptions of things that are emotionally charged. For example, if you are firmly committed to some belief, you might look for evidence that supports your belief, and discount evidence that contradicts your belief. Similarly, if there is someone you strongly admire, you may selectively focus on the positive things they do or say, and discount or dismiss things they do or say that might be quite offensive. And when you're ticked off at somebody, you probably focus on all the things they do or say that turn you off (mental filtering) and discount the positive things that they do or say. For example, when they say something kind or supportive, you might think, "S/he doesn't mean it," or "isn't being genuine. They're just acting fake." In this way, you convince yourself that he or she really is "bad." When you're depressed or anxious, you'll do this to yourself as well, thus intensifying your negative thoughts and feelings. For example, a teenager with extremely intense depression, strong suicidal urges, and anger told me that human beings were inherently selfish, insensitive, and bad. When I asked her how she'd come to this conclusion, she described seeing some kids in her dormitory who were joking in a cruel, insensitive way about girl with depression, and said that if you're looking for her, you can probably find her sitting on the edge of her dormitory window, meaning that she's probably about to jump. She also described seeing a homeless man on her way her therapy session, and said that no one really cared about him. Of course, these observations were at least partially valid, since human beings certainly DO have the capacity for great self-contentedness, insensitivity, and cruelty. But was she involved in Mental Filtering, and focusing only on the negatives? I asked her if she could think of any times in the past several weeks when someone had been cruel or insensitive to her. She couldn't think of a single instance. David and Rhonda provide additional examples, some personal, of Mental Filtering and Discounting the Positive, and suggest techniques that can be helpful when combating these distortions, including Positive Reframing, Examine the Evidence, the Straightforward Technique, and Double Standard Technique. David tells a moving story that he also told on his Tedx talk in Reno, about an elderly Latvian immigrant who made a suicide attempt because she thought she'd never accomplished anything worthwhile or meaningful. In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Jumping to Conclusions. David D. Burns, MD / Rhonda Barovsky, PsyD

This is the third in our podcasts series on the best techniques to crush each of the ten cognitive distortions from my book, Feeling Good: The New Mood Therapy. Today, we focus on Overgeneralization. There are two common forms of Overgeneralization: You generalize from some specific flaw or failure to your "Self." So, instead of telling yourself that you failed at this or that, you tell yourself that you are "a failure" or "a loser." You generalize from right now to the future, using words like "always" or "never." For example, you may tell yourself, "Trisha (or Jack) rejected me. This always happens! I must be unlovable. I'll be alone forever." Overgeneralization is also one of the most common cognitive distortions, and it causes depression as well as anxiety. I believe it is impossible to feel depressed or hopeless without Overgeneralization. The antidote to Overgeneralization is called "Let's Be Specific." Instead of thinking of your self as a "bad mother" or "bad father," you can focus on the specific thing you did that regret, like shouting at your kids when you were upset. Then you can think of a specific plan to correct this problem, like talking things over with your kids and letting them know that you love them and feel badly that you snapped at them. David and Rhonda also talk about the idea that abstract concepts like "worthless" or "bad" or "worthwhile" or "good" human beings are meaningless. Good and bad thoughts, feelings and behaviors certainly exist, but there is no way to measure or judge the value of a human being. In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Mental Filter and Discounting the Positive. David D. Burns, MD / Rhonda Barovsky, PsyD

Rhonda begins by reading several brief heart-warming endorsements from listeners like you. We are grateful for all of your kind and thoughtful emails endorsing our efforts! Announcement: My upcoming one-day workshop with Dr. Jill Levitt on the “Cognitive Distortion Starter Kit” on May 17, 2020 WILL happen. It will be exciting and entirely online so we hope you can join us from wherever you are. See the write-up below. We are joined in today’s podcast by Michael Simpson, who was among the first to contract the Covid-19 virus in New York. Michael was the star of Feeling Good Podcast #169: More on Social Anxiety. The Case for Vulnerability. I have repeatedly pointed out that our feelings do NOT result from what happens—but rather, from our thoughts about what’s happening. This idea goes back at least 2,000 years, to the teachings of Epictetus, but people still don’t “get it.” People still think that negative events can have a direct impact on how you feel. But that belief makes you the victim of forces beyond your control, because we cannot, for the most part, change what happens—there’s no way we can snap our fingers and make the Covid-19 virus disappear, but we CAN change the way we think about it. I have also pointed out that the negative thoughts that upset us when we’re depressed and anxious will nearly always be distorted and illogical—remember, depression and anxiety are the world’s oldest cons! But is this really true? Michael explains that when he contracted the Covid-19 virus on March 12, 2020, his first reaction was not fear, but excitement because he thought, “I’m getting it early, and when I recover, I’ll probably have some immunity.” But he WAS fearful. Of being intubated? Of a long hospital stay? Of death? No! What were his negative thoughts? Michael was telling himself things like this: People will shun me because I’ve got the virus. People won’t want to hang out with me any more. People will judge me as weak and unappealing. Women won’t be interested in me. My friends won’t want to talk to me. These thoughts triggered powerful feelings of shame and anxiety. Can you see any of the familiar cognitive distortions in Michael’s thoughts? Here are a few of the ones I spotted: Mind-Reading: Thinking you know how others are thinking and feeling without any real evidence: Fortune-Telling: Making frightening predictions that aren’t based on any real evidence. Emotional-Reasoning: Reasoning from how you I feel. Michael feels anxious and ashamed, so he thinks others really will judge and reject him. Should Statements: Michael seems to be telling himself that he should be far better than he is to be loved, admired, and accepted by others. Self-Blame: Michael seems to be beating up on himself and telling himself that he’s not good enough. Michael describes his decision to start posting his symptoms and insecurities on Instagram as a way of testing his fear which he described as intense. To his surprise and relief, he received something like 150 responses that were overwhelmingly loving and supportive. Michael was so excited by this feedback that he is thinking of starting his own podcast, where his guests will openly discuss vulnerable and personal topics. We look forward to that! I think it could be quite popular because so many people feel lonely and anxious due to hiding how they really feel, and putting up a false front to the world. Michael also expands a bit on David’s concept of “fractal psychotherapy.” That’s the idea that all of our suffering results from one tiny pattern of irrationality that repeats itself over and over in many different situations, and ever single time you get upset—whether it’s depression, anxiety, anger—it will be that same fractal flaring up again. Michael said that his fractal is “others will judge me and leave me.” Other fractals might be “I’m defective,” or “I’m not important,” or “I’m inferior to others.” The goal of therapy is to give you specific skills that you can use to blast your own fractal every time it’s causing problems for you. On a future podcast, (May 25, 2020) we will, in fact, do live therapy with a professional woman you might recognize who had the belief that she wasn’t important. So stayed tuned!

This is the second in a series of podcasts by David and Rhonda focusing on the best techniques to crush each of the ten cognitive distortions I first published in my book, Feeling Good: The New Mood Therapy. Today, we focus on All-or-Nothing Thinking. that's where you look at the world in black-or-white categories, as if shades of gray do not exist. For example, if you're not a complete success you may tell yourself that you're a complete failure. All-or-Nothing Thinking is one of the most common cognitive distortions, and it causes or contributes to many common forms of emotional distress, including: perfectionism depression Social anxiety-- performance anxiety public speaking anxiety shyness hopelessness and suicidal urges anger, relationship conflicts, and violent urges habits and addictions and more However, this distortion can be also be helpful to you, and may reflect some of your core values. For example, your perfectionism shows that you have high standards, and won't settle for second-best may motivate you to work hard and do excellent work prevents you from glossing over your failures and mistakes intensifies your emotional life, which may feel like a glorious roller coaster ride, with intense ups (when you do well) and equally intense downs (when you fall short.) So, before you can challenge a negative thought with this, or any distortion, you'll have to decide why in the world you'd want to do that, given all the benefits of your negative thoughts and feelings. One of the possible down sides of All-or-Nothing Thinking is that it simply does not map onto reality. There is little in the universe that is 100% or 0%. Most of the time, or even all of the time, we're somewhere between 0% and !00%. For example, this podcast is not incredibly fantastic, or absolutely horrible. It is somewhere in-between, and will hopefully be of some value to you. While it clearly won't solve ALL of your problems, it may be a useful step forward. We describe a number of example of All-or-Nothing Thinking, including a physician who was trying to diet and ended up binging on a half gallon of ice cream, and a suicidal young woman with incredibly severe depression who was involved in self-mutilation. There are many ways of crushing the negative thoughts that contain All-or-Nothing Thinking, including Thinking in Shades of Gray. Although that might sound rather drab in comparison to the drama of All-or-Nothing Thinking, you may discover that the world becomes far more colorful when you learn to think in shades of gray! In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the next distortion, Overgeneralization. David argues that Overgeneralization is arguably the cause of all depression and much anxiety, and that the first person to recognize and solve this dilemma was the Buddha, 2500 years ago. More on that topic next week! David D. Burns, MD / Rhonda Barovsky, PsyD  

On April 9, 2020, David and Rhonda did a live TEAM-CBT session with Dr. Taylor Chesney, a former student of David’s who is now the head of the Feeling Good Institute of New York City. Her husband, Gregg, is an ER / ICU (Emergency Room / Intensive Care) doctor in New York, and she was terrified he might contract the corona virus and die. Gregg was also terrified, as he had to intubate two of his colleagues who are struggling in the ICU, and recently had trouble breathing. He is working long hours and lives in a separate apartment to protect Taylor and their three young children. The response to that podcast was extremely positive. Here's an email from a therapist in India, Nivedita Singh: Dear Dr Burns, Rhonda and Taylor, Just finished listening to your 4th podcast of the Corona series. What an emotional roller coaster learning and healing journey it's been. Can never ever thank you enough. Living far away in India and watching the Corona story unfold on the international news channels has been overwhelmingly scary for most of us, especially those who have our kids attending different schools in the United States. They share their fears and anxieties or protect us (their parents) by withholding it ... both of which makes us feel helpless and fills us with dread. The podcast today built some amazing perspective. Taylor is a Braveheart to Gregg being a Superhero. The podcast was so pure, had such integrity and absolute raw honesty! It required great courage from Taylor to allow her vulnerability to surface and an equal amount of brilliant skills set by both the therapists to communicate empathy that soothed the right spot not just for Taylor but for everyone of us across the globe who are dealing with the pandemic. When you addressed the distortions you were addressing all of us and our anxieties.The role play method had us confronting our own demons! Yes! All of us on this planet who have families stranded somewhere ...  who are battling the virus ...  or fighting in the front-lines, felt therapeutically addressed. I personally found myself choking when Taylor did, relaxing when she relaxed and found myself to be gripped by fear when she became vulnerable again. I was on the rollercoaster with her. By the time the podcast drew to an end I could sense my shoulders relaxing ... my breathing getting even and my fists unclenching. Something in the head or somewhere inside of me felt right. I insisted my family and friends listen to the podcast ... and the unanimous feedback was that plenty of pennies dropped for all of us at different times in the podcast. You, Dr Burns and Rhonda made all of us feel less anxious, less fearful and more in control of our emotions; and also compassionate and super, super proud of the Greggs and Taylors of the world. I am extremely grateful to Taylor (who I have met as a beautiful and driven young professional; and I got to see the devoted mum and wife in her) for letting us in to be a part of her journey. Wish her and her family lovely times ahead.This too shall pass ... Stay safe. Take care. Warmly and even more awestruck (by you Dr Burns). Thank you again for giving us TEAM. Nivedita Singh (Your biggest fan this side of the Pacific). One week after the recording of that podcast, Taylor learned that Gregg, has, in fact, been struck by the Covid-19 virus, so her worst fear has become a reality. What do you think happened? Did the monster have no teeth, as David sometimes argues? Listen to this powerful podcast and you will find out! David describes several patients he treated who had intense fears of going bankrupt, who did, in fact, go bankrupt while in treatment. What happened when their worse fears were realized--and why? The cognitive model states that only our thoughts can upset us, and that the thoughts that upset us will be distorted. Depression and anxiety, David argues, are the world's oldest cons. Could the cognitive model be correct in this era where we are fighting something that IS real and IS dangerous? During today's podcast, Rhonda asks Taylor about her romance with Gregg, how they met, what happened on their first date playing frisbee in Central Park, and how their relationship evolved. Taylor recalls the psychodynamic training she received during her graduate work in clinical psychology, which was all about listening without teaching patients to use specific tools to change. Taylor's teachers explained that there was no point in trying to change until you discovered the cause of your problems. Gregg did not agree and urged Taylor to think more about helping her patients change their lives, using specific tools. After all, a medical doctor doesn't just help patients understand why they have pneumonia--the goal is rapid cure whenever possible--understanding the causes doesn't necessarily help or lead to change. In addition, the causes of all psychiatric problems are currently unknown, so the focus on endless talk to understand the causes of depression, anxiety, relationship problems or habits and addictions could even be seen as nonsensical. Taylor had a chance to check this out when she and Gregg moved to California shortly after they were married in 2012. Gregg had a two-year Critical Care fellowship at Stanford, and Taylor joined Dr. Burns TEAM-CBT weekly training group at Stanford to prove that the rapid-change techniques wouldn't work. But they did work. She concluded that TEAM-CBT really IS all it's cracked up to be and fell in love with TEAM. The rest his history. When Taylor and Gregg returned home to New York two years later, she founded the highly acclaimed New York Feeling Good Institute.  During today's interview, Taylor is caring for her three beautiful and charming children, but they all want mommy's attention. It's obviously an overwhelming job, on top of her clinical work with patients, and most moms face similar challenges. Taylor provided several tips for moms who may be listening to the show from home during these days of "Shelter in Place" orders, restricting people all around the world to their homes. 1. Emotional Intelligence Training. I try to check in with each child every day to get an emotional read on how they're doing. This varies for each child based on their age. For my 6 year old, we use the Yale Mood Meter since that's what he uses in school. For my 4 year old, I name a few emotions such as happy, angry, sad, and ask her what's a time today she felt any of those. For my 2 year old, I try to find a time where he's thrown a toy or pushed a sibling and mention an emotion he might be feeling such as happy, sad, or angry, and act it out. He often just laughs but it starts to help him develop his emotional intelligence. 2. Scheduling. Every evening I write out our daily schedule for the following day. This helps to keep me organized, but also helps my children know what to expect each day and gives us a flexible guide for the day. This includes things such as meals, brushing teeth, nap time, screen time, social time, exercise, and academics. Certain activities are required, while others are more flexible. Since my kids are just 2, 4, and 6 years old, there are fewer "requirements" but over time I plan to try to push them a little more to stick to the schedule. Since social distancing and being home is something we have not had any practice with, I want to ease into our new schedule. 3. Independent play. I schedule some time for independent play each day. This is a skill I've really been focusing on with each child, and find that it's important for them to learn to play by themselves. Social playing is great, but learning to be alone is important as well! For my 6 year old the goal is 20 mins, for my 2 year old it's 10 mins with minimal help from mommy. We make it a fun game, and they get a  small reward if they are able to reach their goal. The rewards could include a hug, high-five, praise, stickers or even a new action figure. I try to switch the types of rewards to keep it fun and interesting, and also so they're not just doing it so that they get X privilege or Y toy. 4. Little Steps for Big Feets. I try to set small, manageable goals each day for each child as well as myself. Sometimes it's something I impose on the kids such as "today each of you will help me with one chore, such as taking the garbage out, cleaning up your toys, washing the table, etc." At other times it's something they want to learn. For example my daughter wants to learn to write her name so for several days her goal was to practice writing her name four times. For me it's usually a small manageable goal related to work or house-cleaning. This is similar to David's principle of "little steps for big feets!" For example, instead of saying I'll clean my entire apartment today, I focus on one small goal that I can attain. Taylor gives an awesome example of how to use the Five Secrets of Effective Communication with small children, especially when they are angry or upset. This is an example every parent might want to emulate! And it's the first example I've heard of how to do this! Thanks for tuning in, and please let us know what you thought about today’s program! Rhonda, Taylor, and David

This is the first in a series of podcasts by David and Rhonda focusing on the best techniques to crush each of the ten cognitive distortions in David’s book, Feeling Good: The New Mood Therapy. David and Rhonda discuss the amazing positive feedback that Rhonda received following her two recent podcasts doing live personal work. David emphasizes that being open and genuine about your own flaws and insecurities can often lead to far more meaningful relationships with others. This is a paradox, since we often hide our shortcomings, fearing others will judge and reject us if they see how we really feel, and how flawed we are. David and Rhonda begin the discussion of the Cognitive Distortion Starter Kit with a review the three principles of cognitive therapy: Our positive and negative feelings do NOT result from what happens in our lives, but rather from our thoughts about what’s happening or what happened. Depression and anxiety result from distorted, illogical, misleading thoughts. What you’re telling yourself is simply not true. Depression and anxiety are the world’s oldest cons. When you change the way you THINK, you can change the way you FEEL. This can usually happen rapidly and without drugs. The first idea goes back at least 2,000 years to the teachings of the Greek Stoic philosophers. Although the idea that our thoughts create all of our feelings is very basic, and enlightening, many people still don’t get it! This even includes lots of therapists who wrongly believe that our feelings result from what’s happening to us! David describes an innovative "Pepper Shaker" game devised by George Collette, one of his colleagues in Philadelphia to make the hospitalized psychiatric patients aware, through personal experience, that their feelings really do result from their thoughts. The game can be done in a group setting, and is entertaining. Rhonda suggested that the therapists who attend David's Tuesday training group at Stanford might enjoy this game as well! There are key differences between healthy and unhealthy negative emotions. Healthy negative feelings, like sadness, remorse, or fear, also result from our thoughts, and not from what is happening to us. However, the negative thoughts that trigger healthy feelings are valid and don’t need to be treated or changed. In contrast, unhealthy negative feelings, like depression, neurotic guilt, or anxiety, always result from distorted negative thoughts. David and Rhonda briefly describe each of the ten cognitive distortions, with examples. They warn listeners that the goal of these podcasts will be to learn how to change your own distorted thoughts, and not someone else’s. Pointing out the distortions in someone else’s thoughts or statements is obnoxious and will nearly always lead to conflict. David and Rhonda do a humorous role-play to illustrate just how incredibly annoying it is when you try to correct someone else’s distortions, or when someone tries to correct your own distorted thoughts! David and Rhonda remind listeners to focus on one negative thought from a Daily Mood Log, like “I’m defective” or “my case is hopeless,” and to remember that the thought will typically contain many distortions, and possibly all ten. This means that there will be lots of techniques—often 20 or more—to help you crush the thought. They also discuss the new idea that you can do Positive Reframing with cognitive distortions as well as negative thoughts and feelings. In the next podcast in this series, David and Rhonda will discuss the TEAM-CBT techniques that can especially helpful for the first distortion, All-or-Nothing Thinking. David D. Burns, MD / Rhonda Barovsky, PsyD

Recently we did a follow-up podcast with Dr. Michael Greenwald, who bravely volunteered to be the patient in the live therapy demonstration on the evening of Day 1 of the fall Atlanta intensive. My co-therapist was Thai-An Truong from Oklahoma City. Although it was a total blow-away session, we did not think the audio was good enough for a podcast, because we only recorded it on Michael's cell phone. However, our beloved colleague, Dr. Brandon Vance from Oakland, offered to improve the audio quality, so we are now presenting it to you! The audio is not quite as good as a typical podcast, but is good enough, especially after the first few minutes. The podcast includes the entire session, without commentary, as well as the 15 minute Relapse Prevention Training at the end of the workshop on day 4. Because the entire audio is about two hours long, feel free to take a break half way through, perhaps after the E = Empathy portion of the session, or the A = Assessment of Resistance, and then listen to the last half later on. If you like, you can take a look at his Daily Mood Log while you are listening. The session was incredible, and half of the audience were in tears at the end. You may be, too! And thanks, once again, for your bravery and incredible gift to all of us, Michael! Michael works in Woodland Hills and is offering free monthly TEAM therapy practice sessions at his office to therapists in the greater Los Angeles area. I am hoping these will eventually morph into the first Feeling Good Institute in Southern California. Make sure you contact Michael if you are interested joining his weekly practice group (drmichaeldg@gmail.com). He is a skillful therapist and teacher, and, as you're about to discover, a totally delightful person! Thanks for listening today, and thanks for all the kind comments and totally awesome questions you submit every day! We greatly appreciate your support! Let us know if you like these extended live therapy sessions. We can break them up, if you prefer, into shorter podcasts with commentary, or even publish them as optional extra podcasts on a different day of the week. If you would be interested in some awesome training with Thai-An Truong, ncluding free monthly TEAM-CBT webinars, you can contact her at www.teamcbttraining.com. David and Rhonda

Today, Rhonda and David have the honor and pleasure of interviewing Dr. Jeffrey Zeig, the beloved founder and head of the Milton H. Erickson Institute in Phoenix, Arizona. Every four years, Jeff sponsors the awesome Evolution of Psychotherapy Conference, which draws more than 7,000 mental health professionals to hear all of the most famous and best psychotherapy teachers and innovators in the world to beautiful Anaheim, California for five days. This year, it will be December 9 to 13, 2020. In this far-reaching interview, Jeff talks about the history of psychotherapy, beginning with Freud's work beginning in 1885, all the way up to the first Evolution of Psychotherapy Conference on the 100th anniversary of Freud's origins, in 1985. He explains that up until the beginning of World War II, psychotherapists were focused on the WHY of emotional problems, in spite of the fact that the causes of depression and anxiety were then, and still are, completely unknown. Then, around 1944, therapists began to focus on the question of how we can best help people heal, change, and grow, in spite of the fact that the causes have yet to be discovered. This was a welcome and sensible shift, but led to a proliferation of hundreds of competing "schools" of therapy, most of which claimed to "know" the causes of psychological problems and also claimed to have the "best" treatment methods. Jeff's goal in creating the Evolution conference in 1985 was to bring together the best from all the schools of therapy to share ideas and focus on the common healing factors that all forms of effective therapy share. To Jeff's surprise and delight, the conference was an immediate hit, with more than 7,000 participants from around the world, and was sold out well ahead of time. Jeff also discusses his own creative and imaginative philosophy and approach to therapy, which he describes as a magical experience, requiring great skill, much like a musical creation or theatrical, and not a cookie cutter formula taken from the pages of the latest treatment manual for depression or this or that anxiety disorder. Jeff is one of the pioneers and masters of "indirect hypnosis," which originated with his mentor, Milton Erikson. Jeff fondly and tenderly describes his early days with Milton Erikson, who he describes as a wizard and genius, and likely one of the greatest therapists of all time. Erikson was also an inspiration to Jeff, and to all who had the good fortune of knowing him, because of his own extremely physical limitations caused by polio, and how he transcended those limitations and transformed them into strengths. So, mark your calendars for the Evolution Conference this December 9 - 13. It will be a chance for you to hear and meet many your own therapy heroes first-hand and to learn from superb teachers. I'll be there too, so make sure you say hello. I don' t know yet what topics I will be speaking on, but will post them on my workshop page as soon as I find out. And if you're a struggling, starving student, as I once was, Jeff wants you to know that they will need many helpers at the conference, and the helpers receive generous discounts! Now, that's a deal you can't beat! You'll network with colleagues from around the world in a gorgeous setting. Thanks for listening today, and thanks for all the kind comments and totally awesome questions you submit every day! We greatly appreciate your support! David and Rhonda

David and Rhonda are joined in today’s podcast by Drs. Alex Clarke and Diane Schiano, as well as Jeremy Karmel, who are all members of David's Tuesday training group at Stanford. Alex is a clinical psychiatrist and TEAM therapist who practices at the Feeling Good Institute in Mountain View, California, and Diane is a research psychologist and licensed marriage and family therapist. All three helped in the design and analysis of the survey data. We published the survey in a blog entitled "How Are You Feeling Now?" on March 26, 2020 . To review the full report of our findings, you can click here. I (David) have been curious about occasional polls of our listeners to see if we can get  meaningful results to potentially interesting questions. So this was a kind of pilot study to see if negative and positive feelings have changed in our fans since the advent of the corona pandemic. You are probably aware of the Brief Mood Survey that TEAM therapists ask patients to complete prior to and just after each session to find out how effective the session was. This tool has been incredibly powerful, because therapists and patients alike can find out right away how much improvement the patient experienced in depression, suicidal urges, anxiety, anger, happiness and relationship satisfaction in every single session. I developed an even shorter version of my Brief Mood Scale to measure similar negative and positive feelings, and all variables can range from 0 (not at all) to 100 (extremely.) So for example, a score of 25 on depression would indicate mild depression, and a score of 100 on happiness would indicate extreme happiness. In other words, high scores on the negative feelings indicate greater distress, while high scores on the positive feelings indicate greater feelings of happiness and relationship satisfaction. In the survey, we asked people like you how you are feeling right now, and how you were feeling just before learning about the corona virus. The goals of the informal survey were to answer these questions: Will people respond to the survey and can they provide meaningful information that can be analyzed statistically? Are people feeling more distress now? If so, have the negative feelings of depression, anxiety, anger and hopelessness changed more in men or women? Have the positive feelings of happiness and relationship satisfaction changed in men or women since just before the start of the pandemic? How have therapists fared, as compared with non-therapists? The five of us discussed the survey findings, which can be summarized in this way: 205 of the people who subscribe to my WordPress blogs completed the survey within a couple days. 62% of them were women and 37% were therapists. There were no gender differences in the therapists. How are You Feeling Now? Changes in Negative Feelings Since Corona Prior to the corona pandemic, the means of the negative mood variables varied from 13.2 (on a scale of 0 to 100) for hopelessness to 24.1 for anxiety. Keeping in mind that a score of 25 indicates "mild" symptoms, this means that all of these negative feelings were slightly elevated, but the elevations were minimal to mild. At the current time, all four negative feelings have increased significantly, ranging from 23.7 for hopelessness to 38.5 for anxiety, so the negative feelings are now mild to moderate. Prior to the corona pandemic, there were no significant differences in any of the negative mood variables in men vs. women. There have been significant increases in negative feelings since that time, but the greatest increases occurred in women. In fact, in women, the negative feelings approximately doubled. This means that the women who completed the survey, on average, now report feeling moderately  depressed, anxious, angry and hopeless. For men, in contrast, the only negative feeling that increased significantly was anger. There were no statistically significant differences in anger levels in men vs. women before the corona pandemic and there are no significant differences now. How are You Feeling? Changes in Positive Feelings Since Corona Prior to the corona pandemic, the means of the happiness and relationship satisfaction scales were 55.6 and 58.6 (on a scale from 0 to 100), meaning they were just a tad better than moderate. This indicates that there was quite a bit of room for improvement in positive feelings prior to the pandemic. At the current time, the mean of happiness has dropped to 41,1 but relationship satisfaction has held steady at 56.8 (not a significant change.) There were no significant differences in happiness in men vs women before the pandemic, and there are no differences now. Happiness has decreased in both men and women, and the decreases have been similar in men and women. In contrast, relationship satisfaction did not differ in men vs. women at either time point, and there have been changes in relationship satisfaction in men or women since the pandemic. This is encouraging, and means that although men and women are more distressed now, feelings of intimacy and closeness to others have not diminished. In other words, social distancing has not led to feelings of isolation or emotional distancing in our population. How Are Therapists Feeling Now? Do you think that the therapists who completed the survey will have significantly different scores than non-therapists on the negative and positive mood variables? And if so, do you think the mean therapist scores will be higher or lower? Here are the findings: Therapists scored 9.85 points higher on happiness as well as relationship satisfaction than non-therapists at both time points. This was highly significant. For example, non-therapists scored 50.2 on happiness and relationship satisfaction at time 1 (moderately happy and moderate relationship satisfaction), while therapists scored 60.1 on happiness and relationship satisfaction. Of course, there's a lot of room for improvement in both groups, since these variables range from 0 to 100. Therapists also scored better than non-therapists on the negative variables at time 1, and the magnitude of the difference was 7.7. So for example, on depression, the non-therapist mean at time one was 21.2 (approaching mildly depressed), while the therapist mean was only 13.5. However, at the current time, things have changed. Now the therapists scores on depression, anxiety, anger and hopelessness are no different, on average, from the scores Open-Ended Questions: The People Behind the Numbers Dr. Diane Schiano led the charge in the discussion of several open-ended questions in our survey. The results can be summarized like this: People are feeling concerned about getting sick, dying or something bad happening to a loved one. People are coping by connecting with friends and loved ones and trying to keep up physical and mental health. People think digital therapy is a good idea, even if it’s not ideal For example, one respondent wrote: "I remember hearing about the [the corona virus] when [the pandemic] first started in China, but I wasn't overly concerned. I felt like it was a bad flu and would likely blow over. Then I watched the news unfold, particularly in Italy, and realized how serious this is. Once they started shutdowns in California, I realized how serious and close to home this is." Rhonda pointed out the discrepancy between our findings and a recent UN reports of increases in domestic violence since the start of the pandemic. While our survey of podcast fans did document increases in anger in men and women since the outbreak, satisfaction in personal relationships was absolutely unchanged in men and women, and was identical in men and women. At the same time, the mean relationship satisfaction level in our group was only "moderate," which is not especially high. There are a few disclaimers. First, the findings in this survey probably do reflect the people who receive my Word Press blogs, but may not reflect the US population as a whole. The individuals who receive my blogs or listen to my podcasts are therapists, patients, and general citizens with a fairly strong interest in mental health topics as well as self-help, so the feelings in our group might easily be skewed in a somewhat more negative direction. Second, we are measuring peoples' perceptions of their feelings prior to learning of the pandemic. We did not actually measure their feelings prior to the corona epidemic. Thanks for tuning in, and please let us know what you thoughts about today’s program! If you'd like me to publish more polls, suggest some interesting poll questions, if any come to mind. Rhonda, Jeremy, Diane, Alex, and David  

Rhonda and David address five fascinating questions in today’s podcast, including these: “I’m incredibly shy. How do you talk to girls?” How did you get over your fear of vomiting? Do you still use behavioral techniques like Exposure? Should I try to include the E and A of TEAM when trying to crush my negative thoughts on my daily mood log? And how would I do this? Please give us a podcast on how to express anger. Nandini writes: I have zero experience dating and talking to girls. I don't know how to even make girl as friend. Whenever I talk to a girl, the next day I think “How should I talk to her?” Should I go to her because now she wants me to talk to her? Which makes me very nervous. And also. if am talking to a girl I think about when I will have to go to her next time. When I’m doing my work, I think should I go to her, because she works in our office. Means I don't know how to do that! Can you help? Rhonda and David respond with some simple advice, but encourage all listeners to use the search function on his website to get lots of great links to helpful material on just about any mental health topic, including flirting, dating, shyness, or just about anything. In additon, my book, Intimate Connections, could be really helpful to Nandini, as well as my books, When Panic Attacks and The Feeling Good Handbook, that all have extensive sections on anxiety. You can find all of them at my books page (https://feelinggood.com/books/). In addition, we’ve recently featured several podcasts on shyness and social anxiety, including: 128: Intense Social Anxiety–I’m Losing Control! What Can I Do? 134: Smashing Shyness: Part 1 135: Smashing Shyness: Part 2 169: More on Social Anxiety–the Case for Vulnerability 142: Performance Anxiety: The Story of Rhonda, Part 1 143: Performance Anxiety: The Conclusion 088: Role-Play Techniques —Feared Fantasy Revisited How did you get over your fear of vomiting? DB, I know you probably don't remember me because it's been years since we emailed, but you helped me via your Ask The Guru section of your old website years ago and we occasionally emailed back and forth after that. Which reminds me to once again thank you for your books and how you've dedicated your life to your work. It has made a difference in my life and I would imagine literally millions of others. What a wonderful thing. I stumbled upon an article about you in the Stanford Magazine from 2013 and learned something I didn't know -- you suffered at one time from a fear of vomiting. I've dealt with that since I was a kid. It's not as severe now as it once was, but I'm wondering what CBT methods might be useful for that particular issue. (No chance I'm taking ipecac syrup!). I know you're busy so I understand if you can't answer, but wanted to reach out anyway. Thanks in advance, Steve  Do you still use behavioral techniques? Dear Dr Burns, I really appreciate your efforts in this area cognitive behavioral therapy, but your efforts and techniques are so powerful and you use them so efficiently that almost no time you have to use the behavioral part of it as patients seem to be relieved enough with cognitive work. One thing I am curious about is that if you can't get enough response with cognitive work, and if you have to use the exposure model, and the patient is afraid of exposure because he or she goes into a severe state of anxiety, depersonalization or derealization symptoms and feels like gonna go crazy and lose control, would you still push him or her to the cognitive exposure and are there any risks of it? Thank you very much. Jordan  Should I try to include the E and A of TEAM when trying to crush my negative thoughts on my daily mood log? And how would I do this? Dr. Burns, It would be impossible for me to heap sufficient praise over you and your podcasts because I've really gained an intangible amount of benefits and continue to learn something actionable from both on a weekly basis. I'm currently finishing Feeling Good Together and am finding the experience transformative. I wanted to see if I could ask you a question regarding the Daily Mood Log and crushing negative thoughts. I'm completely on board with the notion of fractal psychotherapy and the idea that all of our negative emotions will be captured in a single negative thought and by crushing it, we will feel substantial relief and even euphoria. I've been using the Daily Mood Log to inconsistent effect. I write down my negative thoughts, identify the distortions and then identify statements to attack that thought that are 100% true. Perhaps I am rushing through the exercise too quickly, as I try to make it a daily habit. But is it possible I'm missing an element? I've noticed in your live therapy that you allocate a sizable chunk of time to Empathy and Agenda Setting. Is it possible that the E and A in TEAM's absence in my Daily Mood Log is stunting my progress? Is there a way and should I be implementing both into the exercise? I would appreciate any input you have on this question and I look forward to continuing to listen to the podcast as new episodes come out, along with your new book and App! Best regards, Tommy Dr. Burns, Thank you! I’d be happy for you to use my first name. I’ll look out for it in the upcoming podcasts. Have a great rest of the week. Tommy Please give us a podcast on how to express anger! Hey Dr. Burns, I’m loving the podcast, and my favorite podcasts are the Ask David and Live Treatment ones! Also, I can’t wait for the new app and book! I did have a question, which I can go into more detail if need be. Specifically, what podcasts and book would you recommend for anger? I’m unsure how to express anger in a productive way (in my relationship), and would love more guidance and practice prior to trying to use the 5 secrets “live”. Thanks in advance! Thanks for listening today, and thanks for all the kind comments and totally awesome questions! David and Rhonda

David and Rhonda are joined in today’s podcast by Dr. Taylor Chesney, a former student of David’s who is now the head of the Feeling Good Institute of New York City. She is a prominent TEAM-CBT therapist and trainer, and specializes in the treatment of children and teenagers. Taylor kindly agreed to do some live work today on her panic and despair because of the impact of the pandemic on her family. Her situation is especially challenging and poignant because her husband, Gregg, is a highly esteemed Emergency Room / Intensive Care physician in New York, and he is constantly working to save the lives of Covid-19 victims. Ten days ago he moved to a separate apartment several blocks away so he will not put his wife and children in harm’s way in case he contracts the Covid-19 virus. But will he, himself, be struck down by this vicious virus? He told Taylor that he recently had to intubate several of his colleagues, which is horrifying. Taylor fears that  she may lose her beloved husband, and that her three children may have to grow up without a father. She also feels overwhelmed because she’s supporting many people now. David begins with a brief overview of the cognitive model, including several key points: All negative feelings result from thoughts, and not from what’s actually happening. So even in a crisis that is as real and devastating as the Covid-19 pandemic, all of our emotions will still result from the way we think about it. Remember the teachings of Epictetus 2,000 years ago, when he wrote: “People are disturbed, not by things, but by the views we take of them.” This is potentially empowering, because we usually cannot change the fact—the pandemic is real and we are powerless to make it disappear—but we may be able to change our perceptions (eg thoughts, or “cognitions”) about what’s happening. There’s a healthy and an unhealthy version of every kind of negative feeling. For example, healthy fear is not the same as unhealthy anxiety; healthy sadness and grief are not the same as clinical depression; healthy remorse is not the same as neurotic guilt. And so forth. Our goal is not teaching you how to be happy all the time no matter what—that would be absurd—but simply to reduce or eliminate unhealthy negative feelings. Healthy negative feelings result from valid negative thoughts, and do not have to be “treated.” Unhealthy negative feelings, in contrast, result from negative thoughts that are distorted and illogical. David reminds us that even in a crisis, depression and anxiety are still the world’s oldest cons, and that you CAN change the way you feel. But is this possible? It just doesn’t sound right! Can Taylor really change the way she thinks and feels when the crisis is so overwhelming and so real? And can you? As the session unfolds, Taylor tearfully describes her intense fears for her husband, who she loves so greatly, as well as their three young children. She says that 75% of the time, she’s “okay,” when she’s awake and involved with caring for her kids, but 25% of the time—especially late at night when she’s alone with the kids—things get pretty desperate, and sobs for 30 minutes or more while experiencing “sheer terror.” What’s making the situation more painful is that Gregg is temporarily living six blocks away in order to protect his family in the event he does contract the potentially deadly virus. Taylor says that “it feels like we’re kicking him out. He’s at war. He’s fighting, struggling, suffering.” She says he’s passionate about his work, but she wishes he’d quit! Take a look at Taylor's  Daily Mood Log at the start of the session. As you can see, she is focusing on how she is feeling every night before going to sleep. She circled seven different categories of negative feelings, and all are intense, including the depression, anxiety and frustration clusters (all are 100%), the lonely and hopeless categories (both 90%), as well as feeling “bad” (50%.) You can also see the negative thoughts she recorded. She is telling herself that: Negative Thoughts % Now 1.      I shouldn’t have to do this alone. 90 2.      I can’t handle parenting alone. 70 3.      I shouldn’t burden Gregg with my feelings. 70 4.      I should share my feelings. 50 5.      I should be strong and tough. 80 6.      I’ll let my patients down if I don’t have enough time for them. 50 7.      I’ll lose Gregg. 50 - 100 8.      I shouldn’t have to do this. 100 9.      I should be able to work and support my family while Gregg stays at           home safely. 50 You can also see that her belief in these thoughts varied from 50% to 100%. After empathizing for 30 minutes, Rhonda and David asked about her goals for the session, which would be to turn down the intensity of her negative feelings. Together, Rhonda, Taylor and David do Positive Reframing, asking two questions about each negative thought and feeling: What does this negative thought or feeling show about Taylor that’s positive and awesome? What are some benefits, or advantages, of this negative thought or feeling? Together, they generate an impressive list of Positives. Then Taylor decides she can use the Magic Dial and reduce her negative feelings, while not eliminating them completely, as you can see at this link. Then they use a variety of techniques to challenge each negative thought, staring with #4, “I shouldn’t share my feelings.” Taylor identifies many distortions in this thought, including Should Statement, Emotional Reasoning, Mind-Reading, Self-Blame, and Mental Filter. Taylor decides to think about it like this instead: “It’s okay to share my feelings. It could bring us closer together. It’s human to be struggling, given the circumstances. My feelings matter to Gregg.” She believes this Positive Thought 100%, and her belief in the Negative Thought fell to 5%, which was enough, since there was a little truth in the thought. You might have to be thoughtful about the timing of self-disclosure. Rhonda and David continue to challenge the rest of Taylor’s Negative Thoughts, using a variety of techniques such as the Externalization of Voices, Acceptance Paradox, Paradoxical Double Standard Technique, and more. The most challenging Negative Thought was #7—her fear that Gregg might die. At the end of the session Taylor recorded a substantial reduction in her negative feelings. Thanks for tuning in, and please let us know what you thought about today’s program! Rhonda, Taylor, and David

My mother won't follow my advice! David and Rhonda are joined in today’s podcast by Alex Clarke, MD, a former student of David’s who is practicing TEAM therapy at the Feeling Good Institute in Mountain View, California, and by Zeina Halim, a TEAM therapist and student in David’s Tuesday Stanford psychotherapy training group. In our last two podcasts (Corona Cast 1 and 2) (links) we focused on the impact of the corona crisis on internal feelings like depression, anxiety, panic, hopelessness, and so forth. In this week's Corona Cast 3, we will switch our focus to the impact of the pandemic on personal relationships, using a real example. Zeina was concerned that her mother, aged 72, was not being sufficiently careful about social distancing. Zeina felt panicky because she feared her mother might get the virus and die. However, Zeina’s mother is very self-reliant and independent, and didn’t take kindly to Zeina’s frequent reminders to do this or do that so as to be safe. They ended up arguing and feeling frustrated with each other. Perhaps you’ve also run into problems with friends and loved ones because of the corona crisis. When people get confined into close quarters, under conditions of intense stress and uncertainty, clashes are almost inevitable. When you’re angry with someone , you’ll nearly always be viewing the other person in a distorted way. For example, you may be telling yourself that s/he “should” not think, feel or behave the way he or she is thinking, feeling, or behaving. Of course, this is a classic other-directed “should statement.” Or you may be telling yourself that the other person is being “stubborn” or “unreasonable” (Labeling; Mind-Reading). Or you may tell yourself that you’re right and the other person is wrong (All-or-Nothing Thinking; Blame). And in most cases, you’ll be telling yourself that the conflict is the other person’s fault and that you’re the innocent victim of his or her bad behavior (Blame.) These are just a few of the cognitive distortions (link) that fuel conflict. But it’s these distorted thoughts, and NOT what the other person is thinking, feeling, or saying, that actually causes your negative feelings. You are making yourself angry--the other person is NOT causing your anger or frustration! You are creating these feelings. And the thoughts that trigger these feeling are wrong thoughts. This can be a VERY hard pill to swallow. You, and not the person you're mad at, are triggering your feelings of frustration and anger. In addition, the thoughts that upset you are not valid. They’re distorted, and just plain WRONG. If you don’t like this message, you might want to stop reading! I get it! It is SO MUCH more rewarding to blame the other person! In today’s podcast, we discuss and illustrate a sophisticated TEAM-CBT technique called "Forced Empathy" (link). Forced Empathy forces you see things from the perspective of someone you’re at odds with. It will ONLY be effective if you want a closer relationship with the person you’re at odds with. If you want to remain in battle--as most people do--then you're welcome to do that. Go for it. If, in contrast, you do want to feel closer and more loving, Forced Empathy can lead to a helpful shift in how you think about the person you’re angry with. When you suddenly see things through the eyes of the person you're angry with, you may suddenly discover that your thoughts about the other person’s motives were not correct. Alex and David describe how the technique works in a step-by-step way, and then illustrate it with a role-play between Zeina and her mother. This is a recreation of the technique they used live in the Stanford Tuesday group a couple weeks before the recording. Forced Empathy proved to be extraordinarily helpful to Zeina, and brought tears to her eyes. Once she saw things from her mother’s perspective, the tone of their interactions suddenly softened, and the tension was replaced by feelings of love and acceptance. Zeina was surprised to discover that, among other things, her mother, while not wanting to die, had no fear of death, but didn’t appreciate being constantly told what to do, or what not to do, and that she loved and admired Zeina tremendously. Zeina also discovered that in the highly unlikely event that her mother did die, she would want to spend her last days or weeks with her Zeina, feeling close, and loving one another, instead of arguing. Is this relevant to you and your friends and loved ones? In today’s podcast, we talk about how you can improve your relationships with friends and loved ones during these challenging times using the Five Secrets of Effective Communication. We emphasized one of the important take home messages in podcast 164 on "How to Help, and How NOT to Help." Sometimes, people just want someone to care about them and listen, without having someone trying to help them or give them advice. Learning to do this can be incredibly freeing, but it’s not easy, because so many of us are addicted to “helping.” If you want some additional help, check out David’s book, Feeling Good Together. Thanks for tuning in, and let us know what you thought about today’s program! Until next time, Rhonda, Alex, Zeina, and David

With the "Shelter in Place" orders in California, we are recording these podcasts from our homes instead of from the Murietta Studios.  The sound quality may not be as high as usual while we are learning to use the new technology. (I apologize for the echo in this week's podcast. It won't be there again-Rhonda) Let us know what you think!  Thank you, David & Rhonda David and Rhonda are joined again in today’s podcast by Jeremy Karmel, who is working with David on the new Feeling Great app. In our first Corona Cast, we promised to present an example of how TEAM-CBT can be helpful for individuals who feel depressed and anxious about the personal impact of the pandemic. Rhonda kick starts today’s session by describing her treatment with a patient we're calling Alice just a few days ago. Alice woke up feeling stressed and having trouble settling in and getting to work. If you click here, you can see how she filled out the first few steps of the Daily Mood Log just before the start of her session with Rhonda. The Upsetting Event was simply waking up and feeling out of sorts. She circled and rated her negative emotions, which were fairly intense, especially the feelings of depression, anxiety, inadequacy, despair, frustration. Her anxiety was only minimal, but she was also feeling tremendously "jittery." Why was Alice feeling so upset? Her feelings didn't result from the corona virus epidemic, but from her thoughts about it. As you can see, she was telling herself: 1.      This could be the new normal. 2.      My life is going to waste. 3.      I should be handling this better. 4.      I could catch the virus and die. 5.      No one is in charge. She strongly believed all of these thoughts except #4, which she only believed 40%. You may recall that in order to feel upset, two things must be true: You must have one or more negative thoughts on your mind. You must strongly believe these thoughts. How are we going to help Alice? In the old days, I would have jumped right in to help Alice challenge her Negative Thoughts, but now we have a far more powerful and systematic approach called TEAM-CBT, as most podcast fans probably already know! These are the four steps of TEAM-CBT: T = Testing. Rhonda tested how Alice was feeling at the start and end of the session. E = Empathy. Rhonda provided warmth and support without trying to "help" or "cheer-lead." A = Assessment of Resistance. This is one of the unique aspects of TEAM-CBT, and it's the secret of ultra-rapid recovery. Rhonda used the Miracle Cure Question, Magic Button, Positive Reframing, and Magic Dial to bring Alice's "resistance" to change to conscious awareness, then quickly reduced it before trying to "help." M = Methods. Rhonda helped Alice identify the many cognitive distortions in her thoughts. For example, her first Negative Thought, "This could be the new normal," was an example of All-or-Nothing Thinking, Overgeneralization, Mental Filtering, Discounting the Positive, Fortune Telling, and Emotional Reasoning. The goal of the M = Methods phase is to crush the Negative Thoughts that  are upsetting you. Do you know how to do this? You have to come up with a Positive Thought that has two characteristics: It must be 100% true. Positive affirmations and rationalizations and half truths are worthless. Cognitive therapy is based on the Biblical idea the "The truth shall set you free." The Positive Thought must drastically reduce your belief in the Negative Thought you've recorded on your Daily Mood Log, and ideally your belief in it will go all the way to zero. In fact, the very instant you stop believing the Negative Thought, your feelings will change, and often quite dramatically. Rhonda helped Alice challenge her Negative thoughts with a powerful technique called the Externalization of Voices. For example, Alice was telling herself that "I should be handling this better" because she'd been having trouble adjusting to the home isolation and had been procrastinating instead of focusing on her writing, and she was also telling herself that "My life is going to waste," thinking she'd be procrastinating and feeling miserable forever: "The new normal." The Positive Thought that crushed it was, "I have a lot of experience as a self-starter, and I've got eight weeks of free time now to write, which is pretty awesome. In addition, I can give myself a break, instead of putting myself down, and give myself a little to regroup!" After all, there are hundreds of millions of people around the world who are feeling isolated and in distress, and probably most of them aren't being nearly as productive as they usually are, but clearly, that isn't going to go on forever! Instead of putting yourself down, you can give yourself some support and encouragement, in exactly the same way you might talk to a dear friend. Once Alice crushed her Negative Thoughts with strong Positive Thoughts, her feelings suddenly changed. Although the session was only one hour long, Alice experienced incredible improvements in how she felt, thanks to Rhonda's compassion and skillful guidance. Alice's depression went from 95 to 5, and her anxiety dropped from 95 all the way to zero. The rest of her negative feelings dropped to very low levels or zero as well. Did it last? Long-term follow-up isn't possible for such a recent session, but she did call Rhonda the next morning to say that she woke up Feeling Great . . . which is the name of my new book, due for release in September. You can see the cover below! If you want, pre-ordering on Amazon may be available by the time you hear this podcast. In next week's Corona Cast 3, we will switch our focus to the impact of the pandemic on personal relationships, using a real example of a young woman named Zeina who felt her mother, aged 72, was not being sufficiently careful about social distancing. Zeina felt panicky because she feared her mother would get the virus and die. They ended up arguing and feeling frustrated with each other. We will illustrate a sophisticated TEAM-CBT technique called "Forced Empathy" that brought tears to Zeina's eyes, and we'll also talk to you about how you can improve your relationships with friends and loved ones as well during these challenging times. Thanks for tuning in, and let us know what you thought about today’s program! Until next time, Rhonda, Jeremy, and David  

With the "Shelter in Place" orders in California, we are recording these podcasts from our homes instead of from the Murietta Studios.  The sound quality may not be as high as usual until we all get the necessary recording equipment, and learn the new technology.  Please bare with us during this transition.  Thank you, David & Rhonda David and Rhonda are joined in today’s podcast by Jeremy Karmel, who is working with David on the new Feeling Great app, and Dr. Alex Clarke, a former student of David’s who is practicing TEAM therapy / psychiatry at the Feeling Good Institute in Mountain View, California. One of our loyal podcast fans, Phil McCormack, sent a heartwarming email which read, in part: In light of the pandemic taking us into uncharted territories, I thought it might be interesting to hear of some tips from you that would help folks deal with the situation, kind of like the David’s Top Ten Tips podcast but this one focused on the hysteria which is prevalent as I write. I’m sure your fans would appreciate it and it might be a good jump start for your new book and app, both called Feeling Great. I realize you are incredibly busy and don’t expect an answer. And if you want to tell me to screw myself, I can use your techniques to handle that! I responded like this: Thanks, Phil. I’m trying to put together at least two or three podcasts on the coronavirus from a variety of perspectives! Might read you question to kick start the first one we do, if that’s okay. david Phil immediately shot back this email: You’re an animal! I have no idea of where you get all your energy and motivation–obviously your techniques work (drug free!) so that must be part of it! Kudos to you for all your effort. It is so, so much appreciated!! I sincerely hope you someday get the recognition you deserve!!! I think Feeling Great might be your ticket... Hope so. Please feel free to read question and thanks for not telling me to “screw myself!” Really appreciate that! Phil How cool is that! Rhonda and I are planning several podcasts on this important topic including today’s as well as a podcast on how Rhonda used TEAM to help a woman with severe feelings of depression, anxiety, inadequacy, despair and frustration about the current corona crisis in a single session. We are also planning podcasts on how to communicate with friends and loved ones during the crisis, as well as a survey to assess changes in mood (depression, anxiety, anger, relationship satisfaction and happiness) since the corona virus hit, and possibly  more. When the survey is ready, we’ll announce it and send you a link in case you’d like to let us know how you've been feeling, and how your feelings might have changed since the virus hit! Rhonda kick starts today’s session by reading a list of negative thoughts from folks who are freaked out about the corona virus, including these: Negative Thoughts with Probable Cognitive Distortions The world will turn into an apocalypse. I’ll be a carrier and won’t know it and then I'll infect my partner and children who will get really sick. I’m divorced and I think my ex- will try to keep me from my kids. She won’t be as vigilant as I am about keeping our kids healthy. They’ll get sick and infect me. I’m looking for a job right now, but no one will be hiring for a long time and I’ll never get a job. I won’t have enough money to pay my rent and I’ll be evicted from my apartment and end up homeless (or) my business will go out of business. I won't have enough money to have fun for several months. My parents will contract the virus, especially one of my parents who has some chronic health stuff, and get really sick or die. I’m going to get cabin fever. I will lose a sense of self/connection to reality with how surreal everything is. People in my life will die from the virus. * * * Negative Thoughts that are Probably Not Distorted The numbers of infected people are way higher than what's being reported because there's no testing The pandemic is worsening. The pandemic will get much worse than we realize now. Needier populations -- people who have lost work who really need it (restaurant workers, hotel, caterers, production staff, people with no savings, etc) — will suffer. The social fabric is going to break down. Things are going to continue worsening as climate change worsens. I live too far from my parents to help take care of them. Rhonda, Alex, David, and Jeremy begin by discussing several of the basic ideas of TEAM-CBT. We feel the way we think. In other words, the events of this world—like the corona virus—cannot have any effect on how we feel. All of our negative and positive feelings result from our thoughts, or “cognitions.” This idea goes back nearly 2,000 years to the teachings of the Greek Stoic philosopher, Epictetus, who said that people are disturbed, not by the things that happen, but by our views of them. Some negative feelings are healthy and some or not. Healthy fear is not the same as neurotic anxiety. Healthy sadness is not the same as depression. Healthy remorse is not the same as neurotic anxiety. And so forth. Healthy anger is not the same as unhealthy anger. Healthy negative feelings result from valid negative thoughts, like “We are in danger because of the spread of the corona virus, and we need to be vigilant to protect ourselves and our loved ones.” Unhealthy negative feelings result from distorted negative thoughts, like "The world will turn into an apocalypse." Anxiety, panic, and depression, in contrast, result from distorted negative thoughts, like many of those that Rhonda read. For example, think about this thought: “My parents will die and I may never see them again.” Review the list of  cognitive distortions and see if you can spot some! This thought is likely to be at least somewhat distorted since your parents probably won’t die. For example, in China there have been around 3,300 deaths so far, and the epidemic has finally been slowing in the past few days. Since there are more than a billion people in China, the odds that you or someone in your family will die, while significant, appear to be incredibly low. So while there is clearly some risk, the distortion would be Magnification, Fortune Telling, and Emotional Reasoning, the three distortions that trigger all feelings of anxiety. In addition, you can see your parents right now if you like, using Skype, for example. So, while that thought also contains a grain of truth, it arguably involves Discounting the Positive as well. In spite of these considerations, TEAM therapist don’t try to “fix” or “help” just because someone may have distorted negative thoughts. Trying to help without first addressing therapeutic resistance is the most common error therapists make, and the most common error most people us make. For example, you will hear politicians telling people to “stay CALM,” or trying to encourage people with good news or promises which sometimes don’t seem entirely honest. Instead of jumping in and trying to "help," TEAM-CBT therapists first ask the person who is upset if they are looking for help. Sometimes, people aren't asking for "help" or cheer-leading, they just want someone to listen and provide validation and support. If the person does want help with negative feelings like panic, depression, frustration, loneliness, or inadequacy, we do a little thought experiment and say: "Imagine that we had a Magic Button, and if press it, all your negative feelings will instantly vanish, with no effort, and you'll feel terrific. Will you push the Magic Button?" Most people say they'd gladly push the button! Then we say that while we don't have a Magic Button, we've got some tremendous techniques that could help them reduce or even eliminate their negative feelings, but don't think it would be such a good idea to do that because their negative thoughts and feelings may be expressions of their core values as a human being, and what is most beautiful and awesome about them, and that their may be some important benefits, or advantages of their negative thoughts and feelings. And maybe we should list those before making any decision to press the Magic Button and make everything disappear. If you're upset, you can try this right now. First, circle your negative feelings and estimate how strong each category is, between 0 and 100%. If you click here, you can see an example of this on the Emotions table of the Daily Mood Log of a woman who was upset about the corona virus scare. Then ask these two questions about each feeling: What does this negative feelings show about me and my core values that’s positive and awesome? What are some benefits or advantages of this negative feelings are. How might it help me, or my loved ones? I call this new technique Positive Reframing. In other words, I want to honor your negative thoughts and feelings before we think about changing them! This is called Positive Reframing and it is the key to the incredibly rapid changes we typically see when using TEAM-CBT.  Typically, we come up with a list of a long list of compelling positives. Then I point out that if they push the Magic Button, all those positives will go down the drain, along with their negative feelings. Would they really want to do that? Now you're in a trap, or dilemma. One the one hand, you are suffering and desperately want to feel better. But at the same time, you don't want to lose all of those awesome positives! Fortunately, we can resolve this paradox. Instead of trying to make your negative feelings disappear by pushing the Magic Button, imagine that we had a Magic Dial instead, and you could dial each negative feeling down to a lower level that would allow you to keep all the positives on your list, and still feel better. What would you dial each type of negative feeling down to? For example, if you're feeling 80% panic or 90% depressed or angry about the corona virus, and you could dial each emotion down to a lower level, what would you dial them down to? You can see an example of this if you click here. As you can see, this person has put these new levels in the "% Goal" column of the emotion table. Jeremy provides a touching real life example of this. He feel intense anger because his fiancé, a nurse—is working in a hospital with a shortage of protective masks. He becomes tearful when he realizes that his anger is actually an expression of his intense love for her. The change in how he feels is almost instantaneous, and touching. The group further illustrate this by using Positive Reframing with many of the negative feelings our podcast listeners like you may be having. Jeremy concludes by drawing a critically important distinction between Positive Reframing, which is nearly always helpful, and “cheer leading,” which is rarely or never helpful, and  can actually be downright irritating! This table below highlights some of the critical differences. Is Positive Reframing Just Cheerleading Warmed Over? by David and Jeremy Cheer Leading Positive Reframing You’re trying to cheer someone up to make them feel better. You are highlighting the benefits of NOT changing. You say generally nice things about someone, like “you’re a good person,” or “you’re a survivor,” or “don’t be so hard on yourself.” The positives are not general but embedded within specific negative thoughts and feelings. You don’t acknowledge the validity or beauty of the person’s negative thoughts and emotions. In fact, you’re trying to tell them that they’re wrong to feel upset! This is always preceded by doing superb empathy. Positive Reframing is actually a deeper form of empathy because you’re honoring the patient’s core values. Cheerleading is irritating to almost everybody who’s upset, because you aren’t listening or showing any compassion or respect. The effect is enlightening and leads to feelings of relief, pride, peace, and acceptance. You’re trying to control the other person. You’re telling them how they should think and feel. There’s no acceptance. You’re Sitting with Open Hands. You’re bringing hidden motivations to conscious awareness so they can decide where to steer the ship. Hollow praise sounds dismissive, glib, and insincere. This technique is very difficult and challenging to learn because you have to let go of the idea that you know what’s best for other people. Thanks for tuning in, and let us know what you thought about today’s program! Oh, if you clicked on the two links to the Daily Mood Log of the woman who was intensely upset about the corona virus, and want to find out what happened in her magical TEAM-CBT session with Rhonda, tune in to our next CoronaCast! Until then, Rhonda, Alex, Jeremy, and David

Today, Rhonda and David answer several challenging questions submitted by listeners like you. What schools of therapy are embedded in TEAM? Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither? “Can TEAM-CBT help bipolar patients during the depressed phase?” How do you make Externalization of Voices work? I get stuck! For example, my patient said, "It's unfair that I cannot get a job!" Is there a cure for OCD? 1. What schools of therapy are embedded in TEAM? Dear Dr. Burns, I have some questions specifically about T.E.A.M. therapy. You mention in a blog post that T.E.A.M. therapy "integrates features and techniques from more than a dozen schools of therapy." I'm aware of many of the CBT techniques you use, but I don't think I've read yet of any technique belonging to any other schools of therapy. Would you be so kind as to mention such techniques? Madelen Hi Madelen, This is important because I believe we need to get away from competing schools of therapy and need to create a new, data-driven structure for therapy based on research on how therapy works, which is what TEAM is. At the M = Methods part of the session, you can include methods from any school of therapy. Here are some of the schools of therapy that I draw upon TEAM-CBT. Individual / Interpersonal downward arrow: same (psychoanalytic / psychodynamic) Flooding / Experimental technique: behavior therapy (exposure) Externalization of Voices: Gestalt / Psychodrama / Buddhism Acceptance Paradox: Buddhism Self-Defense Paradigm: REBT CBA / Paradoxical CBA / Devil’s Advocate: Motivational techniques Identify the distortions / examine the evidence: cognitive therapy Empathy: Rogerian (humanistic) therapy Five Secrets / Forced Empathy: Interpersonal therapy Shame-Attacking Exercises: Humor-based therapy / Buddhism Be Specific / Let’s Define Terms: Semantic Feared Fantasy: Role-Playing / Psychodrama / Exposure One-Minute Drill / Relationship Probe: Couple’s Therapy Time Projection / Memory Rescripting: Hypnotherapy Anti-Procrastination Sheet: Behavioral activation therapy (Lewinsohn-type therapy) Brief Mood Survey / Evaluation of Therapy Session: data-driven therapy Talk Show Host / Smile and Hello Practice / Flirting Training: Modeling / teaching effective social behavior Storytelling: indirect hypnosis. Positive Reframing: Paradoxical psychotherapy. Hidden emotion technique: psychoanalytic / psychodynamic Do you need more? Can provide if you want. Let me know why you have this particular interest!At any rate, I really enjoyed and appreciate your thoughtful questions, thanks!David 2. Do negative feelings cause negative thoughts? Or do negative thoughts cause negative feelings? Or both? Or neither? Hello Dr Burns, I would like to thank you for your podcasts. I greatly enjoy listening to them and find them very much helpful both in my personal life and my work as a psychologist. I do have a question: you talk about how cognitive distortions cause anxiety and depression. Are cognitive distortions also a result of depression and anxiety? For instance, if a person was to become depressed after experiencing loss, would they then discount the positive in their lives to a larger extent, for example? Thank you very much! Audrey Hi Audrey, Yes, depression creates a negative bias in perceptions, so you pick out information and details that support your distorted thoughts, like "I'm a loser" or "my case is hopeless." My research, which I'll report in my new book, Feeling Great (sept 2020) indicates that negative thoughts trigger feelings of depression and anxiety, which, in turn trigger more negative thoughts. This is a negative vicious cycle. There is also a positive cycle, in that positive thoughts that you believe to be true trigger positive feelings, which, in turn trigger more positive thoughts! Thanks for the question, Audrey. david  3. “Can TEAM-CBT help bipolar patients during the depressed phase?” Name: Sarah Comment: Hi, Dr. Burns. I am a big fan of your work and very much enjoy reading your blogs and listening to you and Fabrice on you weekly podcasts. I am writing with a question that has to do with the depression side of bipolar disorder and the potential usefulness of CBT. I have not heard you speak about this topic before. My sister in law lives in Switzerland and has been diagnosed with a fairly severe case of bipolar disorder. She does not cycle rapidly, but her manic and depressive states are quite severe. In fact, she has been hospitalized several times during her manic episodes. For the first time in her life, I believe my sister in law has finally accepted the fact that she is bipolar, and she is actively pursuing treatment and trying to get better. After hearing me talk about all the great information I have learned from you, my husband has hunted down several CBT practitioners in Switzerland, in the hopes that changing my sister in law’s thoughts will help her navigate the overwhelming depression she is currently experiencing. Unfortunately, most of the practitioners she has contacted have said that they cannot help her, because she has bipolar disorder. Of course, this is only adding to her sense of hopelessness. In your opinion, could CBT and challenging negative thought distortions be helpful to someone who is bipolar and currently experiencing the depressive side of the disease? In my mind (a layperson who has used CBT to help with panic disorder) it seems so obvious that it could help, but several Swiss psychotherapists seem to disagree with me! Are these therapists afraid to take on a complicated case or is there really nothing they can do? I would love to hear your take on it. Thank you so much for your endless work helping people to feel good! Sarah David will describe his experience running the lithium clinic in Philadelphia at the VA hospital, and will discuss the very important role of good psychotherapy for bipolar patients, although medications will also play an important role in the treatment. 4. Externalization of Voices: How do you make it work? I get stuck! "It's unfair that I cannot get a job!" Dear Dr Burns and Rhonda, I've just finished listening to all of the Feeling Good Podcasts. What a gift! My immense gratitude to you and Fabrice for the time and effort that has gone into these podcasts, as well as the wonderful show-notes. I am a family physician and I work with impoverished patients, many of them refugees. Depression and anxiety are common. We can't find CBT therapists for our patients within their means, so I end up trying to provide some counselling despite not having much background or training (a dangerous proposition, I know, but we have little choice.) Medications tend not to be too helpful, as David points out. I am starting to try to integrate TEAM concepts. I have a question about Externalization of Voices. In all of the examples you've shared in the podcast, whenever David does a role reversal and models the positive voice, he always seems to "win huge". I'm less experienced and find I'm not batting 1000. What do you do when neither you nor the patient have been able to win huge? Many thanks again for all you do, Calvin PS The episode on How to Help and How Not to Help was one of the best yet! Hi Calvin, Thanks for the kind comments! Can you tell me what the thought is that you’ve failed with? All the best, David D. Burns, M.D. Hi David, There have been a couple of examples where we could only get a small win. With the first patient, the thought he was tackling was: "It's not fair that I've worked so hard in life, but I can't get a job." I tried modelling self-defense, along the lines of "I've accomplished a lot given how many challenges I've faced." I also tried suggesting the Acceptance Paradox with something like: "It's true that life's not fair. Who said it should be fair?" This was only a 'small win.' I felt stuck. Another patient felt her chronic insomnia was driven by anxiety. She feared she would never sleep well again. The though was "I'm going to be chronically tired and no longer able to enjoy life the way I used to." We tried: "Sure, I may be more tired than I used to be, but I'll still be able to enjoy life to some extent." Again, this was a small win, not enough to crush it. Thanks again for your willingness to help! Calvin David’s response Hi Calvin, All therapeutic failure, pretty much, results from a failure of agenda setting. I’m not sure you’ve been trained in A = Paradoxical Agenda Setting. The A of TEAM is now also called Assessment of Resistance. When people can’t easily crush a Negative Thought, it is nearly always because they are holding on to it. This is called “resistance.” Let’s focus on the first thought, "It's not fair that I've worked so hard in life, but I can't get a job." This thought triggers anger, and anger is the hardest emotion to change because it makes us feel morally superior and often protects us from feelings of inadequacy, failure, or inferiority. If you do not deal with the underlying resistance to change, the patient will defeat your efforts. When you do Positive Reframing, you start with a Daily Mood Log with one specific moment when the patient was upset and wants help. The anger will be only one of a large number of negative emotions the patient circles and rates, and there will always be numerous negative thoughts as well. The negative feelings might also include sad and down, anxious, ashamed, inadequate, abandoned, embarrassed, discouraged / hopeless, frustrated, and a number of anger words like annoyed, resentful, mad, and so forth. This is super abbreviated, but you would then do A = Paradoxical Agenda Setting (also now called Assessment of Resistance.) You would start with a Straightforward or (better in this case) Paradoxical Invitation—does the patient want help with how he’s feeling? You might tell him he has every right to feel angry and upset and might not want help with his negative feelings as long as he has no job. If he insists he DOES want help, you can ask the Miracle Cure Question, and steer him toward saying he’d like all of his negative thoughts and feelings to disappear, so he’d feel happy. Then you can ask the Magic Button question. If like most patients, he says he WOULD push the button, you can tell him there is no Magic Button, but you DO have lots of powerful techniques that could be tremendously helpful. But you’re not sure it would be a good idea to use these techniques. When he asks why not, you could say it would be important to look at the positive aspects of his negative thoughts and feelings first. Then you do Positive Reframing, and together you can list up to 20 or more positives that are based on each negative emotion and each negative feeling. To generate the list of positives, you can ask: 1. What are some benefits, or advantages, of this negative thought or feeling? 2. What does this negative thought or feeling show about me, and my core values, that’s positive and awesome? For example, My sadness is appropriate, given that I don’t have a job. If I was feeling happy about this, it wouldn’t make sense. The sadness shows my passion for life, for work, and for being productive. My anger shows that I have a moral compass and value fairness. My anxiety motivates me to be vigilant and to look for a job, so I don’t get complacent and starve. My anxiety, in other words, is a form of self-love. My anger shows self-respect, since I have a lot to offer and contribute. My hopelessness or discouragement shows that I’m honest and realistic, since I have tried so often and failed. This is just an example, and with a real patient, it can be very powerful as I have the facts and know the patient, whereas in this example I am just making things up. Then once you have a long and incredibly compelling list, you can ask, “Well, given all of those positives, why would you want to press that Magic Button? If you push it, all these positives will go down the drain at the same time that your negative thoughts and feelings disappear. Then you resolve the patient’s dilemma with the Magic Dial. All this is done AFTER E = Empathy (you have to get an A from your patient) and BEFORE using any M = Methods, like externalization of voices. If you do this skillfully, the Externalization of Voices technique will go way better, because the person will be determined to reduce the anger and other negative feelings. But if the patient says he or she does not want to change, and wants to be intensely angry, that’s fine, too! If this is not clear enough, you could also get some paid case consultations from someone at the Feeling Good Institute, which could be invaluable. This is the most challenging and valuable tool of all! Not sure how much training you’ve had in TEAM.  There are online classes that are excellent. Also, on my workshop page you can check out my upcoming workshop with Dr. Jill Levitt on resistance. There are podcasts, too, on resistance / paradoxical agenda setting as well as fractal psychotherapy. Thanks! David 5. Is there a cure for Obsessive Compulsive Disorder (OCD)? Hi Dr. Burns, I have been suffering from OCD and depression post the delivery of my daughter and have been on antidepressants for the last 7 years. I have recently start going for counseling too with a psychologist. In fact, she is the one who recommended your book which I am finding very useful. Your website is very helpful too. I had just one general question: Are OCD and Depression 100% curable or are they only controllable and one has to be on medicines for the rest of their lives? Reason why I am asking this is the last time we tried to taper down the medicines I ended up having a worse relapse. I want to know if I can plan for a second pregnancy. I know you do not reply to personal messages but would really be grateful if you could reply to this mail Looking forward to hearing from you Regards "Betsy" In my dialogue with Rhonda, I emphasize that I rarely use medications in the treatment of anxiety and depression, including OCD, and I would urge this listener to use the search function on my website to search for podcasts and blogs on antidepressants, anxiety, OCD, and Relapse Prevention Training, and you will find lots of specific resources. For example, if you type in OCD, you will find the Sara story (episode 162) plus lots of additional great resources on OCD, including podcasts 43 - 45 (this page provides links to all the podcasts), and more. Also, my books, When Panic Attacks, and the Feeling Good Handbook, could be very helpful, and you can link to them from my books page. I use four models in the treatment of OCD, and you can find them if you listen to the basic podcasts on anxiety and its treatment. They are the Hidden Emotion Model, the Motivational Model, the Exposure Model, and the Cognitive Model. All are crucial important for recovery, and clearly explained in the podcasts on anxiety. Thanks for listening today, and thanks for all the kind comments and totally awesome questions! David and Rhonda

Today, Rhonda and David talk about how to give potentially hurtful feedback when you sense racial bias in a friend or colleague. She describes an incident in her office where the glass coffee table in her waiting room was found smashed and shattered when her office mate "Steve" (not his real name) arrived Monday morning. Although many people, including the cleaning crew, had used the office over the weekend, Steve asked Rhonda to discuss the broken table with someone who uses her office on the weekends, Kenya.  Kenya is African American, and a highly esteemed professional and beloved friend and colleague of Rhonda's.  Rhonda thought there was implicit bias being played out in this situation but did not know how to discuss it with Steve. But how can she convey these feelings to her office mate, who conveyed the impression that a black man must be the one who broke the table? David suggests one of the advanced communication techniques called "Changing the Focus" discussed and demonstrated in a previous podcast #158.  They illustrate how to apply that method to the current situation, and struggle a bit along the way! David reiterates the story of when he was accused of being racist at a psychotherapy workshop near the Texas / Mexico border, and how his own teachings in that very workshop saved the day for him. He emphasizes that it can be so painful to be accused of racist tendencies, or to discover them in yourself, and that this is another case where the cover-up is far worse than the crime! David and Rhonda

Today, Rhonda and David answer three great questions submitted by listeners like you. I am confused about the terms, negative and positive distortions. Help! “How do you treat an “existential crisis?” Can you use the Five Secrets with someone in a hypo-manic state? Won’t agreeing with their accusations just make things worse?  1. I am confused about the terms, negative and positive distortions. Dear Dr. Burns, I do have one question about terms I have heard on the podcast. The terms that confuse me are "negative distortions" and "positive distortions." I think I understand that they are both "bad" distortions, but the  positive distortions are distortions related to moods or thoughts that are unhealthily high or "up," such as in mania or narcissism. And negative distortions are the ones related to lower mood states/depression. Is this correct? I don't know if it is a brain thing, but even though I think I understand the concepts, my brain still seems to automatically think of positive distortions as good, and so I become quite confused when trying to understand how to fight them or help someone else fight them . . . Thank you again, so much, for all of your hard work on the podcast, as well as your diligence in training therapists in your TEAM model. I am a super-fan of the model already after only a week or so of listening! And the Five Secrets have challenged me to examine my communication abilities much more honestly and helped me in several important interactions already (even as a novice making many mistakes😬). Thank you, thank you, thank you! Please also tell Fabrice and Rhonda many thanks for all of their hard work and excellence as well. They both bring such gifts and refreshing honesty, brilliance  and genuineness to the discussions. I especially admire Rhonda for sharing her personal work. Such powerful and transformative stuff! It gives me hope that someday I might be a fraction as brave to DO that kind of work, much less share it openly with others for their benefit. What a generous as well as brave thing to do! I feel so hopeful and encouraged to know there are therapists like you, Fabrice, and Rhonda helping people to heal from vast amounts of mental and emotional suffering. I can't wait for TEAM to be as commonly known everywhere as CBT is now. Sign me up to volunteer for any promotional efforts if that is ever needed! For now, I will continue to tell everyone, including quite a few other counselor friends, about the podcast and the TEAM model. Sincerely, A new super-fan podcast listener, Holly Miller Hi Holly, Many people are confused, so this is a great question! Rhonda and I will gladly discuss this on our podcast. And thanks for your kind words! david  2. Can you use the Five Secrets with someone in a hypo-manic state? Won’t agreeing with their accusations just make things worse? Hi David and Rhonda, Thank you so much for the podcast. I have been an avid listener since the early days of the podcast, and it has helped me through very difficult times and still is. My question is related to my relationship with my future to be divorcee. She is at times in a hypo mania state due to her bipolar illness (which is diagnosed and treated). Is it possible to use the five secrets of effective communication with someone who is in a state of hypo mania? I feel that agreeing with unreasonable accusations and complains is not helping at all and only causes her to hold to these claims. I know that you usually like to relate to specific correspondence but it is more of a general question. I hope you can give me some guidelines on what works and what doesn’t. Thanks! Al Hi Al, The devil is in the details. Can you provide a specific example of one thing she said, and exactly what you said next, that you need some help with? General questions about the Five Secrets are NEVER productive. Great question, thanks! david David D. Burns, M.D. Hi Dr. Burns, Thanks for the prompt reply. Well, I was asking a general question if it is possible at all to use the 5 Secrets with someone who is totally unreasonable? She would say "You started to be a father when you decided to divorce" referring to the fact that I am claiming for joint custody. The fact of the matter is that she has been going in and out of long depression periods and manic periods and I had to take care of the kids, maintain the house and keep a job (working from home). I would answer that I was there taking care of the kids all the years and now that I decide to break I want to keep my fair share of the time with them. Prior to that she always claimed that I am not a good spouse although I took care of her during all the years and had at times to reduce my workload in order to be available for the kids and her. So, the claims and accusations are always discounting what I did for her and the kids. And she is not accepting the fact that she has been ill and that this had a toll on the family. She says I need to look forward even though these episodes on hypo mania keep repeating. Hope I was specific enough. If you still feel I am vague then it may be that this is not the right forum to ask such questions and may need to get proper consultation. All the best and looking forward to reading the new book. I already started with the free chapter. Al David and Rhonda describe 'mania" and "hypo-mania" model how to find truth in criticisms that seem irrational, exaggerated, untrue, or unfair. They also discuss the tendency to blame others for the problems in our relationships, and why and how that is rarely or never helpful. 3. “How do you treat an “existential crisis?” Good afternoon Dr. Burns, Have you treated anyone that went through an existential crisis before and were you successful? I have a wife that deals with depression and I was in the past able to help her (even though my mind set was "life is awesome. so why or how can you be upset?") I have also dealt with my own anxiety and was able to get myself out of that 10 years ago, using exposure techniques. But I have ran into a bit of a wall here with what I believe is an existential crisis. I've noticed that I am unable to find anything of that subject in any of your topics. Thank you for your time, Dr. Burns. In the podcast, Rhonda and I demonstrate how to respond effectively to someone who is depressed, and why cheer-leading (“life is awesome,” etc.) will generally not be helpful. Hi Arturo, There are no existential crises in California at this time, as the Buddha pointed out more than 2500 years ago. However, specific and real problems exist, and once you identify what’s bugging you and you deal with it you’ll find your “existential crisis” has disappeared. Check out my podcast on the teenage girl who was having an “identity crisis." Our podcast on “How to Help” might also be useful to you! You might also enjoy my book, When Panic Attacks, especially the section on the Hidden Emotion Technique. If you go to my website, you can type any topic in the search box in the right-hand panel of every page, and a lot of useful information, will suddenly pop up. David and Rhonda

In my workshops and weekly training group for community therapists at Stanford, we often include personal work as a part of the training. The personal work can help in several ways: When you’ve successfully done your own personal work, you will feel greater joy and energy in your personal life and in your clinical work as well. You will have a much deeper understanding of how TEAM-CBT actually works. You will be able to deliver faster and deeper therapy to your patients. You’ll be able to tell your patients, “I know how you feel, because I’ve been there myself. And what a joy it’s going to be to show you the way out of the woods, too!” Those who observe the therapy develop a greater understanding of how the fine points of effective therapy. When the person in the “patient” role has a profound change, we all share that joy and feel inspired by the miracles that can often be accomplished in a relatively short period of time. As they say, “seeing is believing.” Rhonda recently surveyed some of our listeners about live therapy we sometimes offer on our podcasts—do you prefer to have the live therapy presented all at once, in an extended, two-hour podcast, or split up over two or more podcasts with expert commentary along the way? Our listeners were split on this. So today we are presenting an actual and dramatic therapy session in its entirely. If you don’t have two hours to listen all at once, you can stop after an hour or so, and then return to the last portion when you have more time. And please let us know what you think of this live therapy podcast format! In today’s session, we are very grateful to Sarah, a certified TEAM-CBT therapist, for allowing us to share her very personal and powerful session with you. Sarah was having intense anxiety during her sessions with patients, and her anxiety was bordering on panic. This is actually not unusual. In my experience, most shrinks struggle with feelings of insecurity from time to time. But when we shrinks experience insecurities, we often feel strong shame as well, telling ourselves that we “should” have it all together because we are supposedly “experts.” I’m no exception! I can remember how anxious I used to feel on Sundays when I was starting out in private practice. I’d tell myself, “Wow, I’m going to have all of these high-powered patients tomorrow, and what if they notice that I don’t actually know what I’m doing half of the time!?” But then, halfway through Monday morning, it would dawn on me that my patients didn’t seem to notice or care about my flaws, and I’d relax! Although Sarah brought a Daily Mood Log to the session, listing all of the negative thoughts that were triggering her anxiety, along with many other intense negative feelings, the session took an unexpected turn in the direction of the Hidden Emotion Model. We’ve done several podcasts on this powerful technique before, and now you have the chance to see how it works first-hand! Instead of challenging Sarah’s negative thoughts, as we usually do, we asked whether there was something bothering Sarah that she wasn’t telling us about, due to her arguably excessive “niceness.” I think you’ll enjoy listening, and you may learn a little, too! My co-therapists for this session included Dr. Rhonda Barovsky, my beloved and brilliant podcast host, as well as Kevin Cornelius, MFT, a fabulous TEAM therapist whom I’ve recently featured in a recent blog! Rhonda and I want to thank you, Sarah, once again, for your tremendous courage and generosity! David and Rhonda

Rhonda and David are joined today by Jeremy Karmel who is working with David on a new Feeling Great app. Rhonda begins by reading several amazing emails from fans whose lives have been changed by the podcasts as well as David’s books, including Jessica, Tim, and Mike. Thank you, everyone, for such kind and thoughtful comments! This great photo of Rhonda is courtesy of Nancy Mueller, a local photographer who kindly took some pics at my home in Los Altos, California. David describes his upcoming book, Feeling Great, which will be released in September of 2020. It will move well beyond his first book, Feeling Good: The New Mood Therapy, all will incorporate all of the latest hi-speed treatment techniques in TEAM-CBT (aka “Feeling Great Therapy.”) David describes his excitement about the team he is working with to publish his latest book, including Linda Jackson at PESI (the publishing company), and Jenessa Jackson, his editor. Jeremy describes why he approached David to develop a Feeling Great app. As a Stanford student, he was depressed and had to drop out of school for semester. Antidepressants and talk therapy had done nothing for him, so he was feeling hopeless. Then Jeremy discovered one of Dr. Burns’ students, Dr. Matthew May, and recovered in just two weeks, which was mind-blowing. Matt was one of the first practitioners in the world to use the new TEAM-CBT, Jeremy felt a tremendous drive to make these powerful new techniques available to people around the world. David and Rhonda, of course, share this goal! In fact, Rhonda has recently gone to Mexico City as well as India to support the sudden and strong emergence of TEAM-CBT in those countries. Rhonda asks Jeremy many questions about the amazing recovery he experienced in his work with Dr. May, and how he’s been doing since. Then Rhonda, Jeremy, and David address a number of intriguing questions about the new app. For example, there is tremendous evidence from research that David’s first book, Feeling Good, has significant antidepressant effects. In fact, many published studies have confirmed that more than 50% of depressed individuals will recover or improve dramatically within four weeks if you just give them a copy of the book. Is it possible that an app that incorporates all the great methods in Feeling Good, plus all the new techniques in TEAM-CBT, could be even more effective? And if so, would this mean that an electronic app could even outperform human therapists as well as antidepressant medications? David says that this has been his dream for more than 40 years, and he thinks this is a definite possibility. Jeremy agrees, since the app, now in creation, has the potential to be far more powerful and systematic than reading a book or even going to a therapist. Rhonda asks: "Are you trying to put human therapists out of business?" David believes that there will always be a place for human therapists, since the person to person support and connection is invaluable and desperately needed. However, the Feeling Great app can actually be a friend of human therapists, just as his book, Feeling Good, has been, working hand in hand with therapists helping to accelerate the recovery of their patients. In addition, the app can bring rapid help and relief to millions of people worldwide who cannot afford therapy, and those who simply cannot find effective therapy. David emphasizes the goal of having an entirely free version of the app for people without resources. Rhonda asks: "Will you be doing research as well as self-help “treatment” with the new app?" The answer to that is absolutely, yes, and the implications for incredible research into the causes and treatments for depression, anxiety and relationship problems are immense, especially if thousands or even tens of thousands of individuals use the Feeling Great app. For example, David has developed many psychological assessment instruments to help therapists and patients alike, but the costs and time required to develop and validate even a single short test can be substantial. In contrast, one might get more than enough data to evaluate a new instrument in just one day, which is mind-boggling. In addition, every time someone uses the app, we will learn more and more about what works, and what does not. This type of analysis is vitally important, but practically impossible, or at the very least arduous and confusing, when working with human therapists, due to the complexity of what’s happening, and the intense bias of therapists and researchers alike. The computer, by way of contrast, does not mind being wrong and moving in different and more promising directions! Rhonda, Jeremy and David will let all of you know when a beta version of the new app, is available, and hopes that many of you will try it out and let us know what you think! David will also let you know when pre-ordering for his new book, Feeling Great will be available as well! David and Rhonda Thanks for listening to today's podcast! David    

Rhonda and David are joined today by Dr. Michael Greenwald, who was in the studio following his recording of last week’s podcast. We address a fascinating question submitted by a podcast fan: Sally asks” “How can I help my depressed husband who is leaving me?” Hello Dr David, My husband is going through severe depression and anxiety. He blames me frequently for all the bad decisions he made, and he says he married the wrong woman. He regrets almost every decision he made and says he made the decision [to marry me] under my pressure. Our marriage of 20 years is almost leading to separation. I don’t want to separate, but I don’t know how I can improve the situation. He doesn’t want to go to any doctor. Do you think if I decide to go to TEAM certified therapist, they can work on me to get him out of his depression? If yes, how many sessions will it take? Sally David, Rhonda and Michael discuss this sad and difficult situation that Sally describes. Feeling loved and cared about is vitally important to nearly all of us, and when an important relationship is threatened, it can be extremely painful. It sounds like Sally's husband may be on the verge of leaving her. David describes a powerful and paradoxical strategy he described in Feeling Good: The New Mood Therapy, that he has often used to help abandoned wives. The approach is the opposite of "chasing," and is based on experimental research on the most effective ways of shaping the behavior of rats! It also sounds like Sally and her husband have some significant difficulties communicating in a loving and supportive way, like nearly all couples who are not getting along, and certainly some couples therapy or consultation might be a useful step. However, the prognosis for couples therapy isn't terribly positive unless both partners are strongly committed to each other, and willing to work on their own problems, as opposed to trying to change or “fix” the other person. We place a strong emphasis on the Five Secrets of Effective Communication, especially the listening skills, when criticized by a patient, family member, colleague, or just about anyone. If Sally committed herself to learning to use these skills—which are NOT easy to learn—she might be able to develop a more loving and satisfying relationship with her husband, whether or not they separate or stay together. David expresses the opinion that her fixation on “helping” or “fixing” him might be misguided, and might actually irritate him and drive him away. Rhonda, Michael and David illustrate David’s “Intimacy Exercise,” which is a way of learning to use the Five Secrets, and they practice with three of the criticisms Sally has heard from her husband: “You pressured me into marrying you.” “You’re to blame for all the bad decisions I’ve made.” “I married the wrong woman.” After each exchange, the person playing Sally’s role receives a grade (A, B, C, etc.) along with a brief analysis of why, followed by role-reversals. These role play demonstrations might be interesting and useful for you, too, because you’ll see how this exercise works, and your eyes will also be opened to just how challenging it can be to respond to a painful criticism in a skillful way, and how mind-blowing it is when you do it right. You will also see that trained mental health professionals often make mistakes when learning these skills, and how you can increase your skills through this type of practice. David emailed Sally with some additional resources that could be helpful to her. Hi Sally, Thank you so much for your question, and for giving us the permission to read and discuss your question on a podcast. We will, however, change your name to protect your identity. For referrals for treatment, you can check the referral page on my website,  or go to the website of the Feeling Good Institute. There may be some excellent therapists in your area, too. I would recommend the recent Feeling Good Podcast on “How to Help, and How NOT to Help.” . The idea is that listening is sometimes far more effective and respectful than trying to “help” someone who is angry with you. Also, the podcasts on the Five Secrets of Effective Communication, starting with #65, could be helpful, along with my book, Feeling Good Together. There’s also search function on almost every page of my website, and if you type in “Five Secrets,” you’ll get a wealth of free resources. Your husband might benefit from my book, Feeling Good: The New Mood Therapy, available on Amazon for less than $10. Research studies indicate that more than 50% of depressed individuals improve substantially within four weeks of being given a copy of this book, with no other treatment. However, the depressed individual must be looking for help, and it’s not clear to me whether the treatment is more your idea, or his idea. You seem to be asking for training in how to treat your husband. Perhaps, instead, you could learn to respond to him more skillfully and effectively using the Five Secrets. Learning how to do psychotherapy requires many years of training, and since he is not asking you for treatment or for help, that plan does not seem likely to be effective, at least based on what I know. In fact, trying to “treat” someone who is clearly annoyed with you runs the danger of creating more tension and anger, but this is not consultation, just general teaching. You would have to consult with a mental health professional for suggestions. Obviously, we cannot treat you or make any meaningful treatment recommendations in this context. But there is no doubt in my mind that there are many things you can do to improve the way you communicate with him and relate to him, if that would interest you. But this would require looking at your own role in the relationship, as well as lots of hard work and practice to learn to use the Five Secrets. Sincerely, David D. Burns, M.D. Thanks for listening to today's podcast! David

In today’s podcast, Rhonda and David are honored to interview Dr. Michael Greenwald, a courageous clinical psychologist who helped make the Atlanta Intensive a truly amazing event. Michael volunteered for the live demonstration to work on his lifelong problem with social anxiety, which seems to be a popular topic these days, and likely a personal problem for many podcast fans. My co-therapist was Thai-An Truong, a highly respected TEAM therapist and TEAM therapy trainer from Oklahoma City. Thai-An also joins today’s podcast via Zoom and dialogues with Michael for the first time since the intensive. The session with Michael was powerful and inspiring, with a good 50% of the audience in tears (of joy) at the end. Michael recorded the session on his cell phone, but the quality was not up to the quality of our podcast recordings, so he agreed to fly up to the “Murietta Studios” from his home in Los Angeles so we could at least describe what happened and share the magic with you. If we can find a way to do some sound enhancement on the cellphone recording of the session, we will likely publish it as a separate mid-week podcast for those who like to hear the incredible therapeutic process unfolding in real time. If you review Michael’s Daily Mood Log at the start of the session, you’ll see that he was feeling depressed, anxious, ashamed, worthless, lonely, self-conscious, discouraged and stuck, and all of these feelings were intense. In addition, he told us that he wasn’t feeling much joy, self-esteem, pleasure or satisfaction in his life. But the strongest feeling was anxiety. He said that coming up on stage to face his fears was an enormous challenge, and that this was the first time he’d ever done something like this. We will do T = Testing again at the end to see what changed, and by how much. We’ll also ask Michael to complete the Empathy and Helpfulness surveys, so we can find out how he experienced Thai-An and David during the session. You may be saddened by the upsetting event Michael recorded at the top of his Daily Mood Log, which was “sitting with my son and trying to make conversation with him.” He said their conversations were always pretty superficial, and that he would typically leave the room after short interactions with his son because he felt so anxious. Here’s an example of a typical exchange. Michael’s son, a graduate student in clinical psychology, was working on his applications to internship programs. Michael: What’s up? Son: I’m working on my applications to internship programs. Michael: That’s good. How’s it going? Are you getting them in on time? Son: Yah, it’s fine. Michael: Are you completing them? Do you want me to look at them? Son: All fine. If you review the negative thoughts on Michael’s Daily Mood Log, you’ll see that he felt like a failure as a father because he did not know how to get close to his son or how to tell him just how much he loved him. He was telling himself things like this: Something is wrong with me because I can’t talk to him. 100% I am failing him as a father. 100% He deserves so much better than me. 100% He must wish he had a different father. 95% And more. I was sad to see that Michael had been beating up on himself pretty badly for years, and I'm pretty sure that the therapists in the audience felt the same way, because it was so clear that he was a tremendously humble, giving and loving father who was totally devoted to his sons. I found myself thinking, "My gosh, I wish I'd been half the father that Michael is!" The E = Empathy phase of the session lasted about 30 minutes. Michael indicated that Thai-An and I had done a good job, and that he felt understood and accepted, so we went on to A = Assessment of Resistance in a step-by-step manner, using these tools: The “Invitation Step” to find out if he was ready to roll up his sleeves and get to work on his social anxiety The “Miracle Cure” question to find out what he hoped would happen in the session The “Magic Button,” to see if he’d want all of his negative thoughts and feelings to disappear suddenly, just by pushing it “Positive Reframing,” asking Michael these two questions about each negative thought or feeling: “What does this negative thought or feeling show about you and your core values that’s positive and awesome?” “What are some benefits, or advantages, of this negative thought or feeling?” At first, these questions didn’t make any sense to Michael, since he was so used to thinking about his negative thoughts and feelings in a negative light, thinking they were “bad” and were the result of some kind of personality defect or mental disorder, like “social anxiety disorder” described in the DSM5. This is also the hardest part of TEAM-CBT for therapists to learn, because it is so anti-intuitive. But as the list of positives grew, Michael began to “get it,” and we could actually see his mood lightening up before our very eyes. It was so cool, and this was the first hint the audience had that something remarkable was afoot. This, for sure, is one of the most powerful and innovative components of TEAM-CBT. The “Pivot Question” and “Magic Dial” Question. Michael decided it wouldn’t be such a great idea to press the Magic Button, since then all of the positives on the Positive Reframing list would go down the drain along with his negative thoughts and feelings. He decided, instead, to dial down his negative feelings to much lower levels that would allow him to feel better without losing any of the positives. You can see this on the “% Goal” column of his DML For example, he decided that it would be desirable to dial his depression down from 85% to 20%, since some sadness was appropriate, given his difficulties getting close to his son. In fact, if his depression disappeared completely, it would be like saying he didn’t really care. Michael decided to dial down the rest of his negative feelings as well in the range of 5% (for discouraged and stuck) to 15% (for anxiety), and 10% for the rest of his negative feelings. This ended the A = Assessment of Resistance phase of the session, and that took about 25 minutes. We then went on to M = Methods, focusing on his negative thoughts, one at a time, and attacking them with a variety of techniques like Identify the Distortions, Externalization of Voices, Acceptance / Self-Defense Paradigms, Examine the Evidence, and the Paradoxical Double Standard Technique. At the end, we went into the audience so Michael could ask participants if they were judging him, and what they thought about him as a father. This is called the Survey Technique, and it is usually pretty threatening to people with social anxiety, or any of us, really! But as you’ll hear in the podcast, the feedback he received was jaw-dropping. Thai-An joined us at the end and dialogued with Michael about the loneliness he’d struggled with, as well as how he could most effectively share his feelings of love and insecurity with his son. His “homework” after the session was to call his son and report back to all of us the next morning! The next morning, Michael reported that he’d had the most phenomenal dialogue ever with his son! He was practically floating on air, and reports that after the intensive, his life has changed dramatically in many ways, including: A terrific relationship with his son. Feelings of true joy, even ecstasy, that he’d never previously experienced or even thought possible. Way better connections with people in general, due to being open and vulnerable for the first time. Greatly improved clinical experiences as a result of using TEAM-CBT in his clinical work. In fact, he is thinking of starting a free weekly TEAM-CBT practice group in the Los Angeles area, and hopefully opening a Feeling Great treatment center somewhere down the line. Make sure you contact Michael if you are interested joining his weekly practice group. (drmichaeldg@gmail.com) You can see his amazing mood scores at the end of the session on his final DML. He also gave us perfect scores on the Empathy and Helpfulness scales, and described his experience as a “transformation.” After the session, he added that he’d seen that people really could improve quickly during other live demonstrations at my workshops, but felt skeptical that a TEAM session could trigger joy, even euphoria, as he’d never actually felt those kinds of feelings. But now, he realized this was actually possible! I would like to thank Michael, as well as my amazing co-therapist, Thai-An Truong. Thai-An is located in Oklahoma City and specializes in treating post-partum depression with TEAM-CBT. She also does one-on-one case consultation as well as awesome online TEAM training for mental health professionals, including free weekly webinars as well as her “TEAM-CBT bootcamp intensives.” If you would like to contact Thai-An, she can be reached at Thai-An Truong thaian@lastingchangetherapy.com. After the show was recorded, I received this amazing email from Michael. I think you'll enjoy it! Dr. Burns, Just some additional thoughts I'd like to mention about the changes I've noticed since the Atlanta therapy demo. The ones you put in the show notes are totally accurate. But the positive changes I've experienced since the demo go way beyond those. I'm not writing this to suggest you include these; I'm great with what you wrote. I only wanted to elaborate a bit on how things have been for me because it's such an incredible change for me. Please feel free to add to the notes, or not, at your discretion. And by the way, we are now two months post-demo and my mood scores remain essentially at zero with high positive feelings. My stress tolerance has increased a great deal. Prior to the demo, when I made a mistake or did something stupid, I would rip into myself with intensely harsh criticism and self-judgment (I think I shared with you about the time I dropped the bottle of Cologne as one example showing the different reactions to myself). Now, when the same sorts of things happen, those harsh voices are absent or merely a whisper, and easily dismissed. So there is no accompanying self-hatred like before. I'm far more outgoing with people in general. I feel closer than ever to my friends and family. I've been more present and available to my friends and family. I'm more open and far less defensive than I've ever been in my life. I feel more positive feelings than ever, and I laugh more than ever. I have more compassion for others as well as for myself. I'm more aware of my emotional world and have more access to my feelings. I'm able to connect more with others in general. The types of situations that would trigger feelings of irritability or anger, no longer do. I'm more able to be available for others, whether in my personal or professional life. I'm closer with my wife, and, honestly, with everyone in my family and social circle. I've been in several social gatherings since the demo, and my levels of anxiety have never been lower, and my level of engagement and participation has never been higher; I'm like a different person. I'm more optimistic and hopeful than before. So I know this is a bit of rambling, but I just wanted to mention these things. As I  had discussed with you during our visit, I've been struck by how far-reaching the benefits of the therapy demo have been for me. We focused on the one moment of one problem on the DML. We blew away those negative thoughts and feelings. That outcome, had it been limited to that specific target, would have been amazing and a total success for me. But as per your model, that was a 'fractal'. And the change in the brain circuits happened with that fractal and the new networks were created, and I feel that they continue to grow. For me, it's truly been the opposite of the drop of ink in the glass of water, discoloring everything, as a distorted thought or belief will do. The therapy demo was the drop of 'clarity' that shined the light on all my distorted thoughts and beliefs at one time. Maybe that's corny, but this is what it feels like to me. So feel free to use or not use any of this as you see fit. I only wanted to mention these things. There's more, but I think this gives the flavor. Thanks again. Love, Michael Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast. See below for details and links! David    

Rhonda, Fabrice, and David discuss psychedelic-assisted psychotherapy, Fabrice’s wonderful new marriage, his fascinating new podcast (http://peaceatlast.us/), and more. David and Rhonda are thrilled to have our beloved friend and colleague, Dr. Fabrice Nye, as the special guest on today’s podcast. Many of you will remember Fabrice as the man who gave birth to the Feeling Good Podcast, and acted as host for the first 133 podcasts. Fabrice describes many events since he turned over the reins to Rhonda earlier this year, including his recent marriage and move to the beautiful but fire-ravaged Russian River area roughly 100 miles north of San Francisco. However, Fabrice still maintains his clinical practice on a part time basis in Redwood City, in the San Francisco Bay area. The main focus of today’s podcast is Fabrice’s participation in promising new research on the treatment of PTSD. The participants in the study are veterans receiving psychotherapy that is assisted by treatment with MDMA during extended treatment session. MDMD is also known as the party drug, Ecstasy. However, the MDMA used in the research is chemically pure, whereas Ecstasy is generally obtained on the street and may not be pure. Fabrice describes MDMA as an “empathogen” that makes people more loving and more in touch with their emotions. This can make it easier for patients with PTSD to talk about their traumatic experiences and painful feelings, which people with PTSD usually try to avoid. Avoidance makes all forms of anxiety much worse, where as exposure is usually beneficial. Patients in the study received three treatment sessions, and a preliminary analysis indicated that one third of them improved to the point that they no longer had symptoms severe enough to be diagnosed with PTSD. Further studies are in progress, including a study with a control group, as well as follow-up studies to find out whether the improvement continued and whether some of the patients relapsed. Fabrice also describes the fascinating new trend in treatment of a variety of conditions with psychedelics, including psilocybin, mescaline, and ayawauska. I expressed my personal support for this trend, as these substances have been used by hundreds, if not thousands of years, for spiritual purposes by indigenous people throughout the world. And perhaps the coolest thing we learned was that Fabrice will be starting his own terrific podcast entitled PeaceAtLast.us about the time today’s podcast will be published. PeaceAtLast.us will focus on the overlap between spirituality and psychotherapy, a topic that I have always found extremely interesting and helpful in my own clinical work using TEAM-CBT. You might want to check out the new Fabrice podcast! I know that Rhonda and I will! After the podcast, we received the following email from Fabrice, which includes many resources for those of you wanting more information about psychedelics and psychotherapy, as well as his new podcast. Hi David and Rhonda, It felt so good to be reunited with you for an hour. Wish we didn’t have to cut it so short. Here are some of the links that you may want to provide to your listeners. Multidisciplinary Association of Psychedelic Studies (MAPS), which sponsors and funds the Phase 3 trial of MDMA-assisted psychotherapy for PTSD: https://maps.org/ Michal & Annie Mithoefer, lead researchers for the study: https://mapspublicbenefit.com/staff/michael-mithoefer-m-d/ Psychedelic research at Johns Hopkins University: https://hopkinspsychedelic.org/ Roland Griffiths, main researcher for psilocybin studies at JHU: https://hopkinspsychedelic.org/griffiths List of federal clinical trials involving psychedelics in the U.S.: https://clinicaltrials.gov/ct2/results?cond=&term=psychedelic&cntry=US Article on how to have a legal psychedelic experience (but not necessarily a safe one): https://psychedelic.support/resources/legal-ways-to-pursue-psychedelic-experiences/ And finally... Here’s how to find my new podcast, to be launched on February 6, 2020: http://peaceatlast.us/ Fabrice Nye fabrice@life.net    

  Rhonda and David discuss two challenging questions submitted by listeners like you.  Question #1: Cindy asks: My suicidal daughter refuses to talk to me! What can I do? Comment: Dear David, I stumbled upon you teaching in another podcast a few months ago. Immediately I was stunned by how much your words echoed in my mind. I have listened to your book three times in Audible and many of your podcasts. You Changed my life!!! I am much more relaxed now and I can sleep!!! I talked about you with my massage therapist and she bought your book for her daughter (who has anxiety attacks) and her niece. Her daughter is an aspiring artist who said that she would buy your book and give them away to teens when she becomes famous. I now ask you to change another life, that of my daughter's. She has been depressed for more than 20 years, suicidal (bought a noose, watches suicide movies, talked about ways to kill herself) and no therapists could help. We went to therapy together this past summer and it only ended that she abruptly canceled and is no longer responding to me by any means: phone, text, card, or email. The last time I saw her was late August and she was very down and had very poor personal hygiene. I have since sent her a loving text at least every other day, I offer to drive to her city (an hour away) to have dinner with her, I sincerely apologized for everything I could think of that I have done wrong since she was a child, I sent gifts to her by mail, I invite her to come for holidays, I ask her cousins to call (she did respond to them). No response to me at all. I am wondering how to communicate with a loved one who just totally shut you off. Always your fan, Cindy Thank you, Cindy. Sorry to hear about your daughter, very concerning. My heart goes out to you. Our own daughter had a rough time as a teenager, too, but now is doing great. I hope things evolve with your daughter, too. This podcast may help: https://feelinggood.com/2019/10/28/164-how-to-help-and-how-not-to-help/ as well as this one: https://feelinggood.com/2019/02/04/126-how-to-communicate-with-someone-who-refuses-to-talk-to-you/ The first podcast highlights common errors in trying to “help” someone who is hurting, and emphasizes how to respond more effectively, using the Five Secrets of Effective Communication. The second podcast illustrates how to get people to open up using one of the advanced secrets called “Multiple Choice Empathy / Multiple Choice Disarming. My book, Feeling Good Together, explains these techniques in detail, with practice exercises, and includes an entire chapter on how to talk to someone who refuses to talk to you. You can learn more on my book page. (https://feelinggood.com/books/). Some support from a mental health professional might also be helpful to you, as these techniques sound simple, but are actually challenging to master. Your daughter might also benefit from my book, Feeling Good: The New Mood Therapy (https://feelinggood.com/books/). It is not a substitute for treatment from a mental health professional, but research studies indicate that more than 60% of the people who read it improve significantly in just four weeks. It is inexpensive, and I’ve linked to it if you want to take a look. All the best, David Question #2: Lorna asks: How can I deal with my jealousy? Comment: Hi David, I've recently discovered your books and your podcast and CBT has really been helping me in my personal life. I really want to thank you for all the amazing work you do!! The issue I'm having however seems to still really get my moods down and I was wondering if perhaps you could offer some general advice via the podcast. I'm in a great relationship but the ex-girlfriend of my partner has recently moved back to the city where we live and now we are in similar social circles. They were together for a very long time and now I'm really struggling with the prospect of spending time with her. When we all spend time together, it’s actually fine, but afterwards I really struggle with thinking about them together, getting to know her and thinking about her personality and how we compare. I think most people would find this uncomfortable, but it really has triggered a downward spiral for me. My partner and I argued about it and I struggle to let things go that were said in arguments. Do you have any advice on dealing with a situation of an ex-partner being on the scene and perhaps how to not dwell on things that were said during arguments? Thanks, Lorna Hi Lorna, Thanks, might work. What does this mean: “Do you have any advice on dealing with a situation of an ex-partner being on the scene and perhaps how to not dwell on things that were said during arguments?” The rest of the email seems to suggest feelings of jealousy, insecurity, and so forth, as if she is a threat to your current relationship. is this correct? David Hi David, Thanks so much for getting back to me! I don't actually think she is a threat to our relationship, and don't feel that they have feelings anymore for each other, but it just makes me super uncomfortable to think about how long they spent together. I'm always comparing our relationship to what I think their relationship was like in the past. I know I should stop thinking about those things but I really struggle to stop! I know my partner and I are very much in love but I keep having thoughts like “It’s not fair that I have to spend time with her,” or “I feel really guilty because he wants to be friends with her but can't due to how I feel about the situation.” I also feel like he blames me. I was hoping you could shed some light on what you think in general is a good strategy for dealing with situations where an ex-girlfriend/boyfriend of your partner is on the scene and you all have to spend time together. I do have feelings of jealousy and insecurity but I struggle to understand why as I don't believe they want to be together anymore at all. We had a few arguments about it initially where he said things like “you are just angry that I have an ex-girlfriend” or “what's the big deal about it all?” I was so hurt by the way he made my feelings seem petty and trivial. We have both apologized but I keep remembering what he said and how hurt it made me feel. Do you have any advice on letting go of past arguments when the 'problematic situation' (ex-girlfriend being around) is still on-going? Thank you so much! Lorna David and Rhonda discuss this question, and include David’s story in Intimate Connections as a medical student when David had a broken jaw and the ex-boyfriend of Judy, the girl he was living with in Palo Alto, charged into his house with a tough-looking friend and demanded to see Judy. David called the police, and the two fellows left and set, "we're going to get you!" David was terrified, since his jaw was still broken, and got some jaw-dropping advice the advice from his buddy, Sergio. You will be surprised to hear about what happened next! In addition to learning to "let go" of jealousy, Rhonda and David discuss many additional strategies for dealing with jealousy, including: Use of Self-Disclosure Positive Reframing: do you really want to give up your jealousy and vigilance? Cost-Benefit Analysis: Is it worth the hassle of constantly being suspicious, as opposed to simply deciding to trust and let the chips fall here they may? Downward Arrow: What are you the most afraid of? Love Addiction Fear of Rejection Fear of Being Alone Overcoming the fear of being alone and the “need” for this man’s love, or any man’s love, is discussed in the first section of Intimate Connections. Exposure: You could fantasize the two of them together, making yourself as anxious and jealous as possible, until the feelings diminish and disappear. Self-Monitoring: Counting your thoughts about them on a wrist counter or cell phone for four weeks. David describes his work with an intensely jealous law student after his girlfriend broke up with him so she could date another fellow in his class. Understand the frequent ineffectiveness of apologizing, and why it doesn’t work! This is really important. David describes a powerful vignette about a troubled couple, where “I’m sorry” was CLEARLY a way of saying “shut up, I don’t want to feel about how hurt and angry you feel.” The Five Secrets of Effective Communication are a vastly more effective way of dealing with negative feelings. David and Rhonda contrast effective vs. dysfunctional “apologizing.” While it can be important to say "I'm sorry," this formulaic response is usually insufficient because it often ends the conversation but the difficult or hurtful feelings remain. What's important to add is talking about the other person's feelings, thoughts and experiences of the conflict and sharing your own thoughts and feelings.  When you say, "I'm sorry," it's sometimes insufficient because it often ends the conversation, but the difficult or hurtful feelings remain. What's important to add is talking about the other person's feelings, thoughts and experiences of the conflict and sharing yours. After David emailed Lorna with the outline for the podcast, Lorna replied: Hi David, Thank you sounds great! Can’t wait to listen to the episode. I think I will definitely order your book - I think it’s the only one missing for me to have the complete collection. Thanks again! Lorna Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast. See below for details and links! David

Rhonda and David address a question from Karolina, a therapist in Poland who was failing with a depressed patient who felt totally convinced he was a “useless” human being. I think you will find their discussion of this case fascinating, as it deals with the cause of practically ALL therapeutic failure, and illustrates the solution al well, using TEAM-CBT methods and concepts. Today’s podcast is intended for therapists and patients alike! For the show notes, we are including the email David received from Karolina, as well as his initial response. Dear Dr. Burns, I've been listening to your podcast for 6 months now and it's been so helpful with my work as a therapist as well as in my personal life. I'm starting to develop a habit of considering every unwanted state with a "what does it say that's awesome about me?" and I'm much happier now :). I'm wondering if you'd consider helping me some more. I have a client who's been struggling with depression for many years. At the moment he's doing ok and his mood is up. Lately the topic of his uselessness came up again and he's willing to work on that. He said he'll consider the possibility that he's not a useless human being and asked me to not to dismiss the possibility that he is - that's how he'll know that I'm not just trying to cheer him up. It's been bugging me ever since. Although I've agreed, I really can't find in me any part that is ready to think that. I strongly believe he's not a useless person. I can't imagine labeling anyone in that way and in his case it feels so personal as I like him very much and I care about him. I'm starting to have dreams about our next session when I fail him by trying to convince him to think as I do. How can I be open about our conclusion when my mind is already fixed? Any thoughts on this would be deeply appreciated. Best wishes from Poland Karolina Hi Karolina, Thanks! The term has no meaning. It is just a vague put down, like what a bully might say. I might ask him what time of day he was feeling useless, and then have him fill out a Daily Mood Log for that moment, step by step. We can only help him at one specific moment. You can use a large number of techniques but must first get an A on Empathy, and then do effective paradoxical agenda setting, starting with the Paradoxical Invitation Step and then asking “what type of help would you be looking for?” then you can do the Magic Button and Positive Reframing. All of the negative thoughts and feelings on the Daily Mood Log will be advantageous and will show something about him that is awesome and positive. You should be able to generate a list of at least 25 overwhelming positives. Then you can use the Magic Dial. When you get to M = Methods, you can put the thought, “I am a useless human being” in the middle of a recovery circle, and then select a minimum of 16 methods to challenge it. You can start with Identify the Distortions. There are likely at least 9 distortions in the thought, including AON, OG, MF, DP, MAG / MIN; ER; LAB; SH; SB. You can try, “let’s define terms,” and ask what’s the definition of a “useless human being”? You’ll find that no matter how you try to define it, The definition will apply to all human beings. The definition will apply to no human beings. The definition does not apply to him. The definition does not make sense. The definition is based on some kind of arbitrary cut-off points. You can do this as a role-play, being a close friend trying to find out if you’re useless, and asking him for guidance on how to find out. You can do the Paradoxical Double Standard Techniques, Downward Arrow, Hidden Emotion, Externalization of Voices, Acceptance Paradox / Self-Defense Paradigm, Examine the Evidence, Semantic Method, and on and on. The problem is NOT that he’s a “useless human being” but rather that he’s obsessing and wasting time on a meaningless construct, and beating up on himself. The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge, since it may be working for him, and also reflects all those 25 wonderful things about him. The whole key to success will be agenda setting. You can take the position that maybe this is not something that he really wants to challenge, since it may be working for him, and also reflects all those 25 wonderful things about him. Remember that just about 99.9% of therapeutic failure results from Agenda Setting errors. Is this something you want to help him with, or something he is desperately asking you for help with? I am almost 100% positive that this is your agenda, not his. In fact, your need to “help” him with this may actually keep him stuck. In fact, here is the proof. You write: “I'm starting to have dreams about our next session when I fail him by trying to convince him to think as I do. How can I be open about our conclusion when my mind is already fixed?” If you don’t understand this, I recommend some supervision from a TEAM therapists or join one of the online classes, or attend my workshop on resistance, coming up in a month or so, check out my website workshop page for details. You can join online. David D. Burns, M.D. Hi Dr. Burns, Thank you so much for your quick and thorough response! I kinda felt that my "helping" is the issue here as I've felt my own frustration rising... Thanks for reminding me that uselessness is just a meaningless concept, I needed that. And I love the idea of role-playing as a friend asking for help with defining his uselessness. I'll pace myself, though, and give us time to walk through all the steps, especially Empathy and Agenda Setting and check how it goes and what my clients wants, not I. I appreciate information on the resources and supervision I can access online, so good to know there are options! You can use my real name, can't wait to hear the podcast :). Karolina Thanks for listening today! By the way, if you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. You'll learn how to use the techniques described in today's podcast. See below for details and links! David

People in the featured photo for today's podcast. Back row: Amir, David, Rhonda, and Dave. Front row: Steve and Barb This will be our first podcast of 2020, so we wanted to make it a really good one! Rhonda, Dave and I are very proud to welcome Steve Reinhard and his wonderful wife, Barb, on today’s podcast. Steve and Barbara flew in from Colorado to join the Sunday hike and do this podcast in the “Murietta Studios” following the hike. Steve is a former electrical contractor and lay minister, and is the first certified life coach to be admitted into the TEAM-CBT certification program at the Feeling Good Institute in Mt. View, Ca, (link). The following is a heart-warming email I received from Steve prior to the show. Subject: Re: looking forward Hi David, Woohoo! We are partners in crime! I'm feeling super comfortable now. Thanks David for your generous invitation! I'm happy to jump on any of the 3 options you suggested for the show. I'd love to hear your stories, especially those of undistorted sadness where you celebrated with tears, aware of the suffering we folks tend to keep hidden. I cry a lot these days, laugh a lot too. In that regard I'd love to have my own personal Ask David session. David, I love the old, demented, weak human guy, while admiring the pioneering, genius who teaches so clearly & humanly. My questions wouldn't be so much for me to learn or be taught but to connect with you. I'm crying as I write. As a listener I want to connect with the human, David. May or may not be something you want to do. We have loads to interact with. Yep, I take a "spiritual " approach & would love to interact with you being anti-religious. Listeners might find this helpful & it sounds fun to me. A great opportunity for me to experience a death of the ego & the acceptance paradox which I have found liberating before I knew what it was called. I'd love to talk about what it's like to be diagnosed with blood cancer and holey bones & some of the nutty things we say to each other when we don't know what to say. Empathy in the Five Secrets way is extremely rare from my distorted perspective. Aging & being willing to challenge the many shoulds & shouldn'ts that accompany things being different than they were last year would be fun to talk about. I can't keep track of the # of times folks repeat "getting old is hell", same with cancer, vision problems, walking problems, drug side effects. I would love to hear your stories & experience as an old demented guy who can't walk as fast as he did a couple years ago. Thanks for your generous invitation. I still find it surprising that I get to have this experience with you all. I'm really looking forward to today’s show. Steve We began the podcast with a discussion of the role of lay therapists in the field of mental health. Coaching is newly emerging field of counseling that does not require graduate work in psychiatry, psychology, social work, or counseling. In the past, coaches have not been permitted to enter the TEAM-CBT certification program. However, Dr. Angela Krumm, who is the head of the FGI certification program changed that policy specifically so that Steve—and now, other certified coaches as well--can be certified in TEAM-CBT, and I applaud this change. The role of lay therapists has always been highly controversial. I can recall that when I was in college in the 1960s, there was a lively debate about so-called “lay psychoanalysts.” Previously, you had to be an MD to be a psychoanalyst, but over time, non-MDs were permitted to become psychoanalysts. To my way of thinking, this debate has always been more about power and the protection of territory than about skill or the capacity to heal. Now we are seeing the same questions being raised about certified life coaches. In my experience, graduate training doesn’t always guarantee that someone will be a skillful therapist, and sometimes the opposite is true. In fact, in my experience, the LESS previous training therapists have, the easier they are to train in TEAM-CBT, because they don’t have so much training they have to “unlearn.” The Buddhists say that an empty cup is better than a full cup, because the full cup spills over when you try to pour the wine. Of course, there’s a downside, too, since therapists can also be sometimes exploitative and can be hurtful to patients. This includes coaches as well as mental health professionals with graduate training. Next, we asked Steve about the role of spirituality in his TEAM-CBT counseling, since he is a also a lay minister. I am convinced that the spiritual dimension can be important and powerful in therapy, and that at the moment of our deepest change, the change is not only psychological, emotional, and behavioral, but also spiritual, because we may suddenly “see” things from a much deeper perspective. Much in TEAM-CBT is easily integrated with spirituality. For example, the Acceptance Paradox is an inherently spiritual technique that can play an important role in recovery from depression and anxiety. One of Steve’s motives I doing this podcast was to have his own Ask David session, and one of his questions was, “What is it like to be regarded by many people as a guru?” I described the blessings as well as the occasional curses and problems that come with this moniker! Then the conversation turns to Steve’s devastating diagnosis of blood cancer—multiple myeloma—just over a year ago, and how hard and frustrating it has been for Steve to get people just to listen and provide support, including his doctors, and how incredibly meaningful it is when people express simple compassion and love. Steve also talks about how he has decided to accept his cancer, and not to “fight it” or to go to war with his body. And acceptance does not mean refusing treatment—Steve is receiving chemotherapy for his multiple myeloma. The acceptance we are describing is more of a mind-set of peacefulness. We also talked about the fact that the problems of aging are not unique, but are simply the problems of living, problems we can encounter at any age. The whole basis of cognitive therapy is that our feelings result from our thoughts, and not the circumstances of our lives. This is a very optimistic message because we often cannot change the facts of our lives, but we can do a great deal to change the way we think and feel. I ended the podcast by raising the question of “Sadness as Celebration.” I asked whether tears and feelings of sadness in response to the suffering of others might actually be one of the highest experiences a human being can have, and is perhaps the deepest meaning of spirituality. I described a somewhat bizarre experience I had on the Nevada desert when I was a Stanford medical student in the 1960s—it was an experience I have kept secret for nearly 50 years, and talk about for the first time on this podcast. After the podcast, I emailed Rhonda to get her “take” on the show. Usually, we focus on specific techniques our podcast fans might want to learn. But this time, we just kind of were “hanging out” together, so I was concerned and feeling a bit self-critical. I was also concerned that I may have sounded like a loony at times on the show, since my personal story was perhaps over the top. Here’s how Rhonda replied: Hi David, As I was listening to the Steve podcast, it struck me that it was really friends talking, getting to know each other, sharing stories and joking around and being serious sometimes. That's why I thought it was really lovely. I listened to Steve's podcast after dinner. I loved it! You are so charming, and tell sweet stories that open up your life to the listener. I think everyone will love how endearing you are. Steve was articulate, vulnerable and open. While it's not an episode where you are teaching anything specific, it is a lovely podcast and I think regular listeners will love the opportunity to get to know you. Rhonda So, let us know what you think! Thank you, Steve and Barbara, for your generous appearance on today’s show. And we also thank YOU for tuning in today! Rhonda and David PS After the show, Rhonda and I got this great email from Steve: Hi David and Rhonda, Just getting back to communicating after a full & thrilling trip to California! Arrived home Monday evening, then off to Chemo center most of Tuesday & now regaining energy. I like your show notes David—mucho. Really enjoyed the hike, lunch, getting to sit in on Amir's podcast, then to interact with David, Barb, & Rhonda. Loved your stories, David, and the whole experience of tears and celebrating sadness. Oh yea, and the big kiss on the lips! A lot of other ideas & questions have popped into my thinking since the podcast. One being that us Christians are pretty judgmental. This is supremely true, and is probably one of the best-selling points of religion that's kept hidden behind the smoke and mirrors. It's so much fun to judge folks, look down on everyone else and have that feeling of moral superiority! Probably better than LSD I'm guessing. What bugs me about "religion" most is how many folks suffer under the whip of having to improve and become better and jump over impossible standards. Of course, they could move on to the Acceptance Paradox and right into celebrating sadness in a split second if they wish. What wonderful time it was with you all. Feeling grateful to share life with each of you. Love you, Steve Second PS: If you are looking for CE credits or training in TEAM-CBT, my upcoming workshop on therapeutic resistance on February 9, 2020 will be a good one. See below for details and links!  David

This will be our last podcast of 2019, so we wanted to make it something special. We also want to thank all of you for your support over the past year, and wish you all the very best in 2020! Thanks to all of you, we surpassed 1.5 million downloads this year, and will likely hit 2 million in the spring of 2020. If you like the Feeling Good Podcasts, please tell your friends and family members, as word of mouth is our best marketing by far. In addition, if you are a member of any mailing lists, send them this link to the list of all the Feeling Good Podcasts. On any given day, 30% of human beings are feeling depressed and / or anxious, so you'll be doing lots of  people a favor, since the podcasts, as you know, are entirely free. We are joined today by Amir Sabouri, PhD, MD, a highly esteemed neurologist from Iran with extensive medical training in the United States in addition to his PhD research in molecular immunology in Japan. Amir specializes in the treatment of horrific neuromuscular disorders such as ALS (the dreaded Lou Gehrig's Disease) at one of our local Kaiser Hospitals here in the San Francisco Bay Area. In today's riveting and inspiring interview, Amir describes how he discovered that, in spite of his extensive technical training, his strongest and most effective medicine by far is sometimes a healing dose of humility and compassion, delivered with the Five Secrets of Effective Communication. We are also joined by our wonderful host, Dr. Rhonda Barovsky, as well as my friend and neighbor, Dave Fribush, who has joined many of our podcasts recently, as well as Steve Reinhard, a certified coach and TEAM-CBT therapist who flew in from Colorado for the Sunday hike and podcasts. Steve will be the featured guest on next week podcast, along with his wife, Barbara, on the topic of "Sadness as Celebration." Back row: Amir, David, Rhonda, and Dave Fribush. Front row: Steve and Barb Amir and I have had a friendship and professional collaboration that goes back several years, when Amir first joined one my Sunday hikes, along with his wife, Dr. Sepideh Bajestan, PhD, MD, who was one of my students during her psychiatric residency at Stanford. In the past couple years, Amir has attended the Sunday hikes regularly and has worked hard to learn and master TEAM-CBT, especially the Five Secrets of Effective Communication, which have begun to play a huge role in his clinical and professional work. Amir begins with a description of the first time he did personal work on one of the Sunday hikes.  At the time, Amir was struggling with feelings of sadness, guilt and inadequacy about his role as a physician and neurologist. That's because, in spite of his incredible background training and research in molecular immunology and neuromuscular pathology, the bottom line was that he had no cure to offer his many patients he had to diagnose with incurable diseases, such as ALS, and he confessed that he often felt like a failure in his attempts to help these unfortunate patients and their families. However, by looking at his own negative thoughts, and pinpointing the distortions in them, he was able to challenge and crush those thoughts, and accept the incredible value of the immense caring and compassion he brought to his work with his patients. The change he experienced on that hike was quite pronounced, and was arguably his first "enlightenment." It was a very moving experience for me, too. Next, Amir tackled the Five Secrets of Effective Communication, and worked extremely hard to practice and master these techniques, which have also been invaluable in his medical work. He describes two recent patient encounters where these skills were invaluable. One involved an angry new patient who aggressively criticized Amir from the very moment he walked in the door. The many also criticized bitterly all the other doctors he'd seen. He complained that he didn't want to be there, that nobody could help, and that nobody cared about him. Amir responded using the Five Secrets of Communication, empathizing and disarming hat the man was saying, and using "I Feel" Statements, Feeling Empathy, Stroking, and Inquiry as well. The man suddenly began to sob and share his deepest feelings throughout his entire encounter with Amir. At the end, Amir was concerned that he'd given him "nothing" other than his efforts at skillful listening using the Five Secrets, and was afraid the man might issue yet another complaint. One hour later, Amir received a touching email from the patient, filled with praise and gratitude, and he said he felt hope for the first time! We talked about the paradox of "giving nothing," just listening with compassion, without trying to help or fix. and how this is often the greatest gift of all. Amir also talked about his interaction with a young woman who suffered horrific complications from a powerful medication that Amir had prescribed for her neurologic problem, and Amir was flooded with guilt and fear, thinking that he had failed her and that he might get sued. But once again, his use of the Five Secrets transformed their interaction into a deeply meaningful connection. We discussed how training in the Five Secrets should perhaps be mandatory for medical students, and residents as well, since rigorous training in communication with patients is not really a part of medical training, although the doctor patient relationship is, of course, given lip-service. Of course, we also strongly feel that Five Secrets training should be mandatory for all human beings! I mentioned an experience I had as a medical student working in the medical outpatient clinic at Stanford under the direction of Dr. Allen Barbour, who wrote a beautiful book on the human side of medicine, Caring for Patients. I was assigned to a mailman who had been struggling with intractable angina, which is relentless chest pain due to problems with the blood supply to the heart. He was scheduled for one of the first open heart surgeries at Stanford. The idea was to improve the blood circulation to the heart, and the surgery was brand new and still somewhat experimental, and potentially quite risky. While I was examining the patient, I had a hunch that something was "off," and asked the man if there were any problems in his life that were bothering him. This led to an unusual and unexpected set of events you can hear about on the podcast. Telling the story so many years later brought tears to my eyes. After the podcast, Steve Reinhard, who had been in our "live audience" at the "Murietta Studios" today, began to cry and mentioned his own struggles with cancer. He told us how hard it has been for him to find compassionate doctors who seem to care, and how wonderful it would be if he could find a gentle, humble and loving doctor like Amir! We decided to edit Steve's comments into today's podcast as well. High tech medicine is wonderful, and evolving rapidly, with new healing miracles every day. But the doctor's most powerful medicine, by far, is still the bedside manner, just as it has been for the last two thousand years. The Five Secrets of Effective Communication can enrich your life, too, and can vastly improve your interactions with loved ones, friends, and colleagues. These tools can also make you more effective in the business world, or in any human interaction. Our world seems very troubled these days, to say the least, and we can all start some healing by changing the way we relate to others and learning to speak with our third "EAR," which stands for Empathy, Assertiveness, and Respect. I hope that doesn't sound hopelessly corny, elderly, or demented, but if so, I will have to plead guilty as accused. Thanks so much for tuning in today, and if you like these shows, please tell your friends! If you would like to learn more about the Five Secrets, a great first step would be to read my book, Feeling Good Together. Make sure you do the written exercises while you read, and make sure you practice as well! On the right hand panel of every page on my website, www.feelinggood.com, you'll find a Search function. If you type in "Five Secrets" or "Relationships," you'll find many helpful podcasts on this topic as well. Learning the Five Secrets takes lots of commitment and practice. It's like learning to play the piano or learning to play tennis. You'll have to work at it. Amir is incredibly brilliant, and he had to work at, too. If you're willing to do the same thing, the results can change your life, too! All the best, Amir, Rhonda, Dave, Steve, and David Note: As an Amazon Associate I earn from qualifying book purchases. My books are available from virtually any online or in-person book seller.

Happy Holidays to everyone! Today's podcast is nestled between Hanukkah (on the 22nd) and Christmas Eve (on the 24th.) We send our warmest greetings to all of our listeners of all religious faiths. Today, Rhonda, Dave and David discuss three questions you have submitted: Does emotional trauma cause brain damage? Do you have to have a good cry when something traumatic happens? Why does avoidance make anxiety worse? 1. Is it true that emotional trauma affects the brain? Hi again Dr Burns, I love the 5 secrets, and have had great success in my new job by implementing them! I keep listening to all the 5 secrets podcasts over and over to keep it fresh for me and really loved the podcast on advanced techniques. My question today is about how trauma affects the brain. ‘Trauma’ is the new buzz word in education, and psychologists are creating presentations geared for teachers and other school professionals that claim the “trauma-affected brain” is altered and cannot learn as easily. They allege imaging technology can prove this. Do you know if PTSD/trauma actually impacts a person’s ability to learn? I thought that it was the negative thoughts that interfere with attitudes toward learning, not an actual brain impairment. Another term that is used frequently is “intergenerational trauma”, meaning if my parent experienced trauma, it could be passed down to me and therefore impact my ability to cope with life stressors. Any thoughts? Any credible research you are aware of? In the Ask David, could you also include your opinion on how Adverse Childhood Experiences impact people's mental health and ability to cope?  There are a range of experiences cited in studies from moving around a lot in childhood to witnessing a murder to molestation.  After listening to your podcast episode 147 (Garry with PTSD) I was satisfied with the effectiveness of TEAM to treat trauma rapidly.  But then I remembered a documentary I had seen about 'feral children' who were extremely neglected as children, and I wondered if there are some cases where the psychology or potential of a person is forever impacted by an adverse childhood experience.  Your take? All the best, Jackie Educational Consultant Mountaintop School Division Answer David finds these buzzwords and buzz-theories somewhat misleading, and sometimes even pseudo-scientific. He has treated large numbers of patients struggling with the effects of severe trauma, and has found that trauma patients are usually the easiest to treat and the quickest to learn. David like to focus on rapid healing, using TEAM-CBT, rather than sending people the message that they are impaired, damaged or defective because of some emotionally traumatic experience. In fact, nearly all humans have experienced quite a lot of traumatic events, which can range from mild to extreme. And lots of us have some degree of brain damage. My brain (David Burns) was squashed at birth, for example, and there are certain cognitive functions that I’m not very good at. For example, for some reason, I can't often find something that's right in front of me, and I have lots of trouble remembering names and faces. I just try to accept my many shortcoming and work around them. The problem is rarely our flaws or imperfections, but rather the distorted negative messages we give ourselves; messages that generate anxiety, fear, inadequacy, shame, and so forth. Of course, animals and humans with traumatic experiences at a young age, or any age, may struggle with fear and may seem, as you say, "feral." My wife and I (David) have adopted many feral cats, and have found that consistent warmth and love can lead to dramatic changes and the development of trust. We all have a history, and every person's story and suffering deserve respect and profound compassion. 2. What’s displacement? Is it true that you have to have a good cry when something traumatic happens? Hi there again, I've been practicing TEAM-CBT for a year while at the same time studying Dr. Gordon Neufeld's theories on the need for "tears of futility" for true healing (including adaptation, maturation and development of resilience). He states that if we only work on the cognitive level, we risk to just displace the symptoms in our clients and they would miss out on maturation and adaptation. I'm wondering if you have ever seen a displacement of the symptom in treating your patients with TEAM-CBT? In most live sessions I've seen with you you seem to have this gift / skill to make it safe for the client to let the tears flow and that this often seem to be the moment when a breakthrough is about to happen. So I wonder if you think the client needs to shed tears or at least feel the feelings of futility or "true sadness" before we should move forward to methods (in addition to getting perfect empathy scores)? And what role you think tears play in the healing process? Would love to hear your thoughts on this! (See my last e-mail if you want more details to why I'm asking.) Thanks, Warmly, Malena Answer I am really pleased to see that you, Malena, are a certified TEAM-CBT therapist in Sweden! I always love to hear from a fellow Swede! You are right, Malena, that emotion is very important in therapy, since it shows that the patient trusts the therapist and is willing to be vulnerable. This is a critical part of the E = Empathy in TEAM-CBT. Therapy without emotion, without tears, may be overly technical, dry and almost "empty." In addition, some patients do intellectualize as a way of avoiding emotions. I call this fear of negative emotions “Emotophobia.” I try to confront patients who do this in a gentle way. I might say, “Gee, Jim, I just asked you how you were feeling, and I notice that you didn’t really answer my question. Did you notice this as well?” This technique is called Changing the Focus, and it has to be done in a kindly, non-threatening way. We discussed it on a recent podcast that was one of our most popular. I’ve seen a patient recently who had incredible problems sharing his own feelings in interactions with his wife, and equally intense problems acknowledging her feelings. If a patient is determined to overcome this fear of his or her feelings, using the Five Secrets of Effective Communication, tremendous progress can be made, but the patient’s resistance has to be dealt with first. Early in my career, I was aware of the idea that if you don’t cry when a traumatic event, like the loss of a loved one happens, that you are setting yourself up for emotional difficulties, so I often pushed my patients to cry. And occasionally this was very helpful. But in general, I have not found it necessary to think that every patient has to cry, and it is definitely not true that crying during sessions is a panacea. During my residency training, I had many patients who cried constantly during therapy sessions without any improvement at all. They just kept crying and crying every session! You could even argue that this makes patients worse, because you continually activate and strengthen the same negative circuits in your brain. When I learned cognitive therapy, I had many tools to help patients change their lives, and that's when I became to see far more improvement and recovery. The tears were helpful, but rarely or never curative. If you are getting perfect empathy scores from your patients on the scales on the Evaluation of Therapy Session, Malena, you are doing great! Way to go! David (a fellow Swede) 3. Why does avoidance make anxiety worse? Hi Dr. Burns, I love your show and work so much. I can't wait to buy "Feeling Great." There's a question I've had for about three years that I've badly wanted to get my head wrapped around. It's in regard to something I've heard you say on a Feeling Good Podcast: "Most experts in exposure therapy or behavior therapy say that attempts to control your symptoms (of anxiety) is the cause of all anxiety." I have heard others say that too/ Why is this? I understand if you push-through an anxiety you can learn whether it's warranted or not. But how is trying to avoid an anxiety actually the cause of all anxiety? I want to be able to understand it for when I feel myself trying to move away from social anxiety I can understand at a moment's notice why doing so actually is the cause of all my anxiety. To be able to skewer the rationalizations in my mind of why I shouldn't push-through. Thank you David. Best Regards, Mark Answer Rhonda, David and Dave discuss why avoidance makes anxiety worse, and why exposure often leads to improvement or even complete recovery. David describes the incredible resurgence of his own fear of heights when he took his children on a camping adventure in Havasupai Canyon in Arizona one spring when he and his wife were living in Philadelphia, and he avoided climbing down a cliff he had climbed down many times when he was younger. Anxiety is not caused by the thing you fear, but by your distorted thoughts and fantasies. When you pull back instead of confronting the monster, you do not get the chance to discover that the monster has no teeth, so your negative thoughts and fantasies can quickly spiral out of control. We will see you again next week for our final podcast of 2019. Thanks for so many wonderful questions, and for your support during the past year. We have had more than 1.5 million downloads, thanks to you! We look forward to serving you again in 2020! If you like the podcasts, please tell your family, friends, and neighbors. You are our marketing team! And if you are a mental health professional, you might be interested in my February workshop on therapeutic resistance with Dr. Jill Levitt. It's going to be a good one, and you can find the details below. Rhonda, David, and Dave  

Today, Rhonda rejoins us as host after a three week hiatus! My neighbor, Dave Fribush, joins us as well, as we answer two thought-provoking questions! Is it possible to treat “burnout?” Can negative feelings can make physical pain worse? 1. Does "burnout" exist? How do you treat it? Comment: Hi! I have been listening to your podcast for a while now and it has helped, and has encouraged me and made me feel less alone. Thank for your work and sharing your podcast with us! My situation now is very much defined by my burnout syndrome (a medical diagnosis in Sweden, not sure about the US) and/or depression. From what I’ve learnt there is no evidence of CBT as a treatment for burnout - really nothing other than adaptations at your workplace. What triggered me to ”hit the wall” was studying too hard and not giving my body and mind time to recover. Do you have any thoughts on burnout and effective treatment of it? I feel I have made huge progress in the underlying reasons to my burnout like perfectionism, performance-based self-esteem, figuring out how I want my life to be, who I am etc (although the last one is a big one!). All this with the help of CBT and other sorts of therapy. What remains is mental fatigue, on and off anxiety, not being able to focus and hardly any mental or emotional resilience. Through healthcare, you are basically treated for depression, the treatment being anti-depressants. I’ve been on sick leave full time for over four years now, am in my late twenties and am constantly frustrated, sad and feeling stuck. I want to get going towards this life I now know that I want but I don’t seem to get any better. I eat and sleep well and exercise. I realize this could be a complete medical question but nobody REALLY seems to know anything about burnout. A long question but hey ho :) Would be grateful for any thoughts you might have, thanks again! Sincerely, Elisabeth Hi Elisabeth, I’m sorry to hear that you’ve been struggling for some time, but I'm glad you've been making progress, and I'm so glad you wrote to me. To my way of thinking, there is really no such “thing” as burnout. Depression, anxiety, anger, and other negative feelings do exist. Burnout is just a vague buzzword for feeling upset when something upsetting has happened. When I was in clinical practice, I saw as many as 17 depressed and anxious patients in one day, and as the day went on, I just got higher and higher and more energetic. That's because I loved what I was doing and felt I had something to offer, a lot, actually. I only got "burned out," or unhappy, if I felt I had said something that hurt someone's feelings, or if I had not done a good job for someone. Then I got really upset, but it was my thoughts, and not what I was doing, that caused my feelings. That, of course, is the cognitive model. I found it helpful to zero in on one moment when I was feeling depressed, anxious, or “burned out,” and to do a Daily Mood Log focusing on that moment. I’ll attach one to this email in case you are interested. I’ve also included a completed one so you can see how it works. This is not a similar case, just something I grabbed by way of illustration. Thanks, David (a fellow Swede) On the show, I describe one of the most stressful experiences of my career, when I appeared on a Philadelphia TV show with Maury Povich, and a patient of mine threatened to commit suicide. Fortunately, the story had a surprise ending that was very positive. So my message is one of hope. The idea is to focus on some specific thing you are upset about, as opposed to getting overly focused on a concept like "burnout." I think we all feel pretty exhausted at times, and if you've been studying or working too hard, it definitely makes sense to take a break to take care of yourself. When I transferred from my residency training program at Highland Hospital in Oakland, California, to the residency program at the University of Pennsylvania, in Philadelphia, one of my supervisors gave me this advice--he told me to make sure I set aside at least one half a day a week to stare at walls. What he meant was that I was working intensely, 24/7, during the first two years of my residency, and he wanted to make sure I gave myself a break to rest from time to time. So every Sunday afternoon I just watched football games on TV, often with a cat on my lap. This was refreshing and helpful, and my supervisor's advice helped me avoid feeling guilty for not working 24/7! 2. More on physical pain. Is it really true that negative feelings can make physical pain worse? We recently did a podcast with Dr. David Hanscom, a back surgeon who emphasized non-surgical treatments for back pain that can be surprisingly helpful. In that podcast, I described my research indicating that 50% of the pain we experience can the result of negative feelings, such as depression, anxiety, and anger. And if you can reduce or eliminate those negative feelings, your physical pain will often diminish substantially, and may even disappear entirely. I first discovered this amazing phenomenon when I had a dramatic and traumatic personal experience as a medical student. One night I was drinking beer at a bar in Palo Alto, and hurt a commotion, and turned to look. A fight had broken out, and although I was not involved in the fight, I saw a beer mug flying in slow motion toward my face. It hit my jaw, and glass exploded everywhere, and blood came gushing out of my mouth.  I realized that my jaw was broken, and my front teeth were loose as well, so I ran outside to my old VW Beetle and drove at high speed to the emergency room of the Stanford Hospital. I ran inside and announced that I was a medical student and my jaw was broken. They put me on a gurney, and ordered an x-ray. I was in intense pain, and I was scared and angry, and still intoxicated, and probably wasn't the most cooperative patient. Eventually, a plastic surgeon was consulted and he talked to me after reviewing the X-ray. He explained that I had a broken jaw, and that he was going to hospital me and do surgery in the morning. He said my jaw would be wired shut for six weeks. I asked if I was going to lose my front teeth that were loose. He said he didn't think so, but that I would have a dental consult to check things out after they removed the wires on my jaw in six weeks. Then he said that he knew I was in severe pain, and that he'd ordered pain shots for me during the night. He said he wanted me to be comfortable, and explained that he wanted me to request a pain shot any time I was in pain during the night. Then he put his hand on my shoulder and said, "This is very routine, and you're going to be fine." At that very moment, my pain instantly went from severe to zero, and I did not need a single pain shot all night long. Dave Fribush emphasizes that while the surgeon's warmth and compassion were helpful, the thing that made my pain suddenly disappear was the sudden disappearance of my negative feelings--intense anxiety about losing my teeth, as well as anger at feeling that I was being neglected. And the very moment my negative feelings changed, my anger disappeared as well. My later research confirmed that negative emotions can, in fact, magnify the experience of physical pain, and that, on average, 50% of the pain we experience results from our negative emotions. This finding should provide hope for individuals struggling with physical pain, especially since this is a drug-free treatment not involving opiates. if you want to reduce your negative feelings, one approach would be to read one of my books, like Feeling Good or When Panic Attacks. They are, of course, not guaranteed to cure you, but research confirms that many people who read them do develop a more positive outlook on life and experience significant reductions in depression and anxiety. And the can be obtain inexpensively at Amazon or other book sellers.  Next week, David, Rhonda and Dave will discuss three more questions you have submitted: Does emotional trauma cause brain damage? Do you have to have a good cry when something traumatic happens? Why does avoidance make anxiety worse?  David & Rhonda

Today, Rhonda could not join us due to the religious holidays, so we have recorded several podcasts with my wonderful neighbor, Dave Fribush, as host. In addition, we are joined by Michael Simpson, a friend and colleague from New York. Dave, Michael and I answer two thought-provoking questions! 1. Working with Abused Women Hi David (and Rhonda!), I want to start out by stating how much I love your podcast. It has helped me understand myself, and, in turn, has made me a much more effective counselor. I'm a drug and alcohol counselor, working here in Los Angeles. I work primarily with women from 18 - 25 years old who have aged out of the foster care system. They are an endearing group of women, as I know you are aware (I've heard you speak of working with this population), and they just want to feel loved and worthy. However, their deep-seated beliefs of being unworthy of good things happening in their lives prevents them from attaining their goals of getting jobs, getting their children back, and gaining housing. These deep-seated beliefs are based on mistreatment by their families of origin, and their subsequent experiences in the social services system. Most were sexually abused or physically abused as children, taken out of their homes, then bounced around from one Foster Care family to the next. Despite my best efforts, the majority of these women go back out to the streets just shy of completing our 6- to 12-month treatment program. Once on the streets they return to drug dealing, prostitution, and crime. After which, if they are lucky, they get picked up and incarcerated. Many die on the streets of drug overdoses or murder. I'm using all of the tools I can to help them change their core beliefs, but it is challenging to say the least! My question to you is—is there a book coming out which goes into depth about T.E.A.M. therapy? I need to become the most effective counselor I can in order to help these women recover and lead normal lives. Thank you so much for your help! Keep up the good work. You are definitely saving lives!! Pennie Hi Pennie, Thank you so much for your question. I did work with this population at the Presbyterian / University of Pennsylvania Hospital in Philadelphia, and found the patients to be incredibly rewarding and hungry for help, love, and connection, as you have said. I’m sure it is heart-breaking for you to see so many fall short, continue to struggle, and even die on the streets. I found this population to be particularly easy and rewarding to work with because they seemed so grateful to be getting any kind of help at all. Many of our patients were homeless, and about a quarter of them could not read or write. We gave them more than eight hours of cognitive group therapy every day in a residential treatment setting, so they got 40 to 50 hours of therapy per week. The program was very inexpensive to run, and was more or less free to the participants, paid for by some type of medical assistance insurance, as well as by our hospital. Most patients showed dramatic changes within three or four days. The average length of stay was something like a week or ten days or so. In today's podcast, I describe a patient in one of our groups, a woman who was severely depressed. She thought of herself as "weak" and "a bad mother." She recovered from her depression in just 20 minutes or so when I used a TEAM-CBT method called "The Paradoxical Double Standard Technique. My book, Ten Days to Self-Esteem, is the program we used at my hospital in Philadelphia when working with this population. It is a simplified version of CBT, and it is a ten-step program that can be administered individually or in groups (which I prefer.) It is written using simple words for individuals with little education. We gave a copy to every patient entering our program, and found that really boosted our outcomes. The hospital purchased them in quantities of 50 or more, and got the wholesale price, which made the books cheaper than having to copy the materials for the patients. There's also a companion Ten Days to Self-Esteem, The Leader's Manual, that you can get as an eBook. It shows the group leaders how to set the groups up and what to do at each of the ten group sessions. There are many additional resources for you, if you'd like to learn more about CBT, as well as TEAM-CBT. First, my new book,  Feeling Great, is now at the publisher, PESI, and should be coming out in 2020. I'll update you as more details become available. But yes, it does have all the new TEAM-CBT stuff in it. It is intended for therapists as well as the general public, and features lots of written exercises while you read, so you can really master the many new methods and concepts. My psychotherapy eBook, Tools, Not Schools, of Therapy, is for therapists, and we use it in all of our TEAM-CBT training programs. It is an interactive book that shows you how to do TEAM-CBT in a step-by-step way. this book also features many challenging interactive written exercises to complete as you read. You might enjoy some of my in person workshops, as well as the many weekly online TEAM-CBT training programs at the Feeling Good Institute.  My one day workshops with Dr. Jill Levitt are really well received, and you can join online from anywhere in the world. My yearly intensives in the US and Canada are usually pretty awesome as well. I hope this information is helpful, and Iwish you the very best in the important and compassionate work you are doing with this incredibly deserving group of women who are suffering so greatly! 2. Why don’t you advocate “Wellness” or “Holistic” Approaches? A therapist named Georgina recently emailed me and was pretty excited about her clinical work which was dedicated to “Wellness” and to “Holistic” treatment methods. I mentioned in an email that I am “intensely anti-wellness and anti-holistic.” She sounded a bit shocked and added: “I'm one of those clinicians who provide consults to other clinicians on Pilates and yoga in integrative psychiatry.” Hi Georgina, Thanks for your thoughtful emails! I know my statement was “politically incorrect” in an era that emphasizes lots of non-specific treatment methods like meditation, healthy dieting, daily exercise, yoga, and so forth. The quick answer to your question, which you can also hear in the podcast on “fractal psychotherapy,” (https://feelinggood.com/2019/03/04/130-whats-fractal-psychotherapy/) is that I focus narrowly on one specific moment when the patient was upset, and if it is an individual mood problem, like depression or anxiety, I ask the patient to record his or her negative thoughts and feelings at that specific moment on the Daily Mood Log. This activates just a few brain networks, out of the billions or trillions of networks in the brain, and we selectively modify those networks using techniques specifically chosen for this individual patient. There are no no-specific interventions. The goal is rapid complete recovery followed by highly specific Relapse Prevention Training, so the patient will know exactly what to do the next time s/he falls into the black hole of depression, hopelessness, and despair. Essentially, I give the patient a little ladder that she or he can use the next time the Negative Thoughts return. No one can feel happy all the time, but nearly all people can learn to limit those bumps in the road that we all encounter from time to time. It sounds like the work you do for patients with Parkinson’s Disease is terrific, and desperately needed. My father in law died of Parkinson’s Disease several years ago, and we saw and experienced personally what a devastating and tragic disease it is. Although I do not include any ”wellness” or “holistic” tools or concepts in my treatment plans, I have nothing against aerobic exercise, yoga (my daughter totally loves it!), meditation (my host, Rhonda, is a strong advocate), or a healthy diet, or anything else someone may find fun, exciting or helpful. It’s just that I’m trained in, and have developed, highly specific, super-fast acting treatments. I believe that “non-specific techniques” have only a placebo effect on mood, although the placebo effect itself can be quite strong and potentially very helpful. In addition, I believe that non-specific techniques can ONLY change mood if you change the way you think. So, if you jog, or eat a healthy diet, or meditate daily, and tell yourself, “Wow, I’m really living a healthy life,” you will feel good if you believe this thought. The jogging or food you eat will not, itself, cure your depression, or panic attacks, or fix your broken marriage, or help you recover from OCD, or PTSD, and so forth. These conditions ARE highly treatable, however, using specific, fast-acting techniques that are individualized to you. We call this treatment TEAM-CBT. Again, I’m sure that many people will HATE what I just said, but I guess we will need some pretty refined research—research that’s never been done—to find out! The research that’s out there definitely cannot answer this question. All I offer is a quick cure for specific problems. I’m not offering “everything” to “everybody.” I am aware, too, that my answer may be cheered by some and may be angrily booed by others. I like to speak from the heart, and from my experience, but I’m often wrong, and sometimes way off the mark, so no problem if you disagree or think I’m nuts! You might also find our first and second podcasts on Mindfulness Meditation to be useful or interesting. David    

Today's podcast features Michael Simpson, a friend and colleague of Dr Burns, who describes his personal battle with social anxiety. Dave Fribush will again be our host, since Rhonda is celebrating the important religious holiday of Yom Kippur with her family. Michael first became acquainted with David when he read David’s book, When Panic Attacks, which he says was SO GOOD! But when he went to David’s website, www.feelinggood.com, he was shocked to see so much terrific free content for people, but the website was not well-presented. In fact, it was pretty sucky! So, Michael sent David a brief video, pointing out all the problems, and offered to redo the website in exchange for some help with his social anxiety—and the relationship took off from there! Michael describes his own experiences with social anxiety, which amounts to slight to moderate nervousness, tension and dis-ease during interactions with people. There is no apparent pattern to his triggers: he can become anxious (or not) around friends, strangers, men, women he is attracted to, and women he is not attracted to. He experiences the anxiety physically: butterflies in his stomach, tension around his face and a general tightness in his body. He is usually unaware of his negative thoughts, which involve fears of looking weak, being judged by others because of his anxiety, and being unable to connect with others while he is feeling anxious. He usually tries to hide all of these fears. In addition, his social anxiety does not appear to inhibit him — he is a tall, handsome, articulate man, and when he confides his social anxiety to others, they are usually extremely surprised that someone who outwardly appears so confident could possibly be struggling with social anxiety.  Michael describes one of his first “homework assignments” from Dr. Burns, who suggested that instead of hiding his anxiety, he should approach attractive women he encounters on the street and simply tell them that sometimes he becomes anxious when speaking to attractive women. The purpose of the exercise was to confront his fear (Exposure) and do a real-world experiment to find out if his fears of being judged are realistic.  Opening up about his anxiety was very challenging for Michael, to say the least, given that he had spent most of his life trying to hide it. He describes walking around Times Square in New York City, procrastinating, and trying to muster up the courage to follow through on his assignment.  So, he finally approached a woman from Brazil whom he found exceptionally attractive. He kind of had to chase after her to stop her to tell her. We can call her Adrianna. Adrianna did not judge or reject Michael, and the two of them seemed hit it off tremendously. And they talked and hung out together every day. Michael described their relationship as one of the deepest and most fulfilling relationships he’d ever experienced. He was amazed by Adrianna’s warmth, compassion, and openness, and appreciated the respect and love she conveyed to everyone she met. Michael also describes visiting her and spending a week together in Brazil after she returned home. One of the take-home messages for Michael was that vulnerability, rather than trying to be cool, or trying to impress people that you have it all together, is the real key to intimacy and joy in our relationships with others. Dave Fribush and David Burns feel very indebted to Michael for his awesome work on today’s podcast. Michael hopes his experiences will be helpful to any of you who have also struggled at times with social anxiety. My new website makeover will probably be launched by the time you read this, so let us know what you think! It's will be at the same address: www.feelinggood.com. If you are struggling with social anxiety, you might also enjoy my book, Intimate Connections. It's now a bit dated, but the ideas can still be tremendously helpful. Here's an unsolicited endorsement I recently received from a young professional woman: "I’d like to share a story about a book I started reading on my trip to Asheville this past weekend.  On the plane, both tears and uncontrollable laughter simultaneously streamed from my face while reading the Intimate Connections book.  No more peanut butter and jelly sandwiches telling myself what a loser I am!" ZR David

Happy Thanksgiving if you live in the United States! This is my favorite holiday, because it means just hanging out with the people you love, eating some wonderful food together, and doing simple things like a family hike, without the commercialism and "push" of some of the other holidays. I wish the very best to you and yours, too! Today, Rhonda could not join us due to Yom Kippur, the highest Jewish holy day. So we will record three podcasts with my wonderful neighbor, Dave Fribush, as host. In addition, we are joined by Michael Simpson, who flew out from New York to attend my Empathy workshop two days ago. He will also join the Tuesday group at Stanford tonight. Michael is doing a massive upgrade / fast lift of my website, www.feelinggood.com, which will likely be published by the time you read this. Let us know what you think about the new "look." Dave Fribush, Michael and I answer many thought-provoking questions submitted by listeners like you! 1. How can I overcome my fear of blushing? Hi David, Hopefully this reaches you well. I am dealing with Erythrophobia (the fear of blushing) and have been having issues with going out with friends, being in public, in work meetings, etc. The weird part is that I don't even get red, but the visualization in my head is so vivid sometimes (Kool-Aid man) that I believe it. Sometimes, if I think about it long enough (like an internal panic attack for 20+min), I get kind of red. . . . Currently, I am trying to just break this habit and I have been reading your book When Panic Attacks and it has been pretty good at helping me. I have been facing my fears and going out into public and hanging out with friends; I'm kind of anxious on the inside of getting red all of sudden, which puts me on edge. I look in the mirror and see that I am not red, but it’s been hard to train my brain to believe it. I started reading your book five days ago and it has helped a lot already. Since then, I have been able to accept I don't mind being occasionally red or nervous and I'm fairly confident, but I struggle to accept the idea of being perpetually red? Part of me wants to accept the idea that "Eff-it! If I'm red, I'm red! That's who I am,” but another part of me knows that it's not true; occasionally I might blush but it’s not the norm. Please let me know if you have any advice. I think this might be a great podcast topic because I know a lot of people with Rosacea deal with anxiety and I'm sure that would help a lot of others. Best, Alex Hi Alex, I have a awesome podcast on the fear of blushing! You might find it helpful (Podcast #88, published on May 14, 2018.) I cannot do therapy through this medium, so this is just general teaching, but exposure / self-disclosure in one method you could use. You could tell 5 to 10 strangers every day something like this: “Could I speak to you for a moment? I’ve had the fear of blushing almost all of my life, and I’ve been hiding it from everybody out of shame. But today, I’ve decided to stop hiding and being ashamed, so I’ve decided to tell people, and that's why I'm telling you.” You’ll find tons of additional ideas in the podcast and in one of my books, like the one you’re reading, When Panic Attacks, as well as The Feeling Good Handbook. Actually, blushing is NEVER a problem. The only problem is the shame. Without the shame, the blushing, like shyness, can be an asset, making you more human and more appealing. Also, on my Sunday hike yesterday, we were joined by a young Stanford dermatologist who showed us some photos and videos of a new laser treatment for rosacea, which is similar to blushing. Apparently, the treatment is quite effective. Thanks, David 2. How can you get over a broken heart? Hi David, First of all, I would like to thank you from my bottom of my heart for the wonderful jobs you are doing. I have a question regarding aftermath of divorce and searched feelinggood.com for any post but I couldn't find any. My best friend is going through divorce process and he cannot forget the good memories he had with this wife. He still loves her so much and would like to continue their relationship but she's not interested in that. They have been separated for 4 years and he tried his best to bring her back. How can I help him move forward? Those good memories are haunting him? Thanks, Didi Hi Didi, Thanks for your terrific question, as most of us were rejected by someone we loved at some point in our lives. You’re in luck! We just recorded a podcast on how to help a friend or loved one who’s hurting, and by the time you read this, it will have been published. It's Podcast #164 on “How to HELP, and how NOT to Help!” It was published on October 28, 2019. You can find the link on the list of all of the published podcasts on my website. I would definitely listen before trying to "help" your friend! Resources for your friend might include the book I wrote on this topic, which is called Intimate Connections. One of the themes is that rejection could never upset a human being—only distorted thoughts about being rejected. This book can be helpful to the many people who have been divorced, or who have broken up with someone they loved, and are having trouble getting back into the dating game effectively, as well as the many people who are having trouble getting into the dating game for the first time. Another great resource for him would be the chapter on the Love Addiction in Feeling Good: The New Mood Therapy. It describes a woman who had just been rejected by her husband, who was having an affair with his secretary, and she was telling herself that she couldn’t be happy without his love. The story had an amazing outcome, and might be very helpful for your friend. Of course, motivation is incredibly important. Your friend might not want to be “cured,” so to speak, since his depression and thoughts about his Ex keep the relationship alive in his mind, and also give him an excuse to avoid dating and developing new relationships, which can be anxiety-provoking and effortful for just about anybody! David 3. How would you treat someone with anorexia nervosa? This question was submitted by our friend, Professor Mark Noble, on behalf of one of his colleagues at the University of Rochester. I, David, explain what anorexia is, and describe my experience with an anorexia patient I treated in Philadelphia when she was discharged from the inpatient unit. I emphasize the need for the TEAM-CBT technique called the Gentle Ultimatum, since the patient didn't want o maintain her weight at a safe level, and just wanted to talk talk talk during sessions without doing any psychotherapy homework.  I also describe the “Coercive Therapy” also called Family Therapy for anorexia,  developed at the Maudsley in London, and we talk about how the same principle—getting the parents to work together on the same team, with firmness, intense mutual support, and compassionate insistence—works for almost any problem children are having. However, this requires the parents to support one another, and work together as a strong and loving team, and many parents who are in conflict will find it difficult to do this, since the urge to argue and fight can be so powerful. Then the parents sacrifice the well-being and happiness of their children in the name of ongoing war (blame, fighting, sticking up for “truth,” and so forth). Dave F. and Michael Simpson ask why this approach of getting parents to work together, can be so incredibly powerful and helpful to children. David

Professor Mark Noble was our special guest on the one hundredth Feeling Good Podcast. In that podcast, he described the effects of TEAM-CBT on the human brain. Many listeners were enthralled by Dr. Noble's revolutionary ideas! Today, Dr. Noble returns to discuss his illuminating ideas, and prevents an overview of his chapter entitled, "TEAM CBT and the Art of Micro-Neurosurgery: A Brain User's Guide to Feeling Great," which will appear in David's new book, Feeling Great, which will be released by PESI in 2020. Rhonda begins the podcast by asking how Dr. Noble met Dr. Burns. What brought the two of you together? Dr. Noble explains that he read about David's work on drug-free treatments for depression in the October, 2013 issue of Stanford Magazine entitled Mind Over Misery, This article became the most-read article in the history of the Stanford Magazine.  Dr. Noble was particularly interested in drug-free treatments for depression because of some alarming research emerging in his laboratory on the central nervous system impact of some popular antidepressants on lysosomes in the brain. So, Dr. Noble made a trip to California so he could visit David's Tuesday training group at Stanford and participate in one of David's famous Sunday hikes. This was so much fun, and so intellectually rewarding, that he become an irregular regular at the Tuesday groups and Sunday hikes! Since that time, there have been many Sunday hikes and many Tuesday groups in the emerging friendship and professional collaboration between David and Dr. Noble. David describes some of the resistance he runs into from mental health professionals who cannot believe that the rapid recoveries David sees in TEAM-CBT can be real. Most therapists were trained to believe that depression develops slowly, over many years, and that effective treatment must also be very slow, often requiring many years, or even more than a decade of weekly sessions. But Dr. Noble argues that the amazingly rapid changes David routinely sees in TEAM-CBT are actually highly consistent with the latest neuroscience understanding of how the human brain works. David and Dr. Noble on a Sunday hike In fact, Dr. Noble presents the amazing idea that if you had to invent a form of psychotherapy that was specifically developed to capitalize on how the brain works, you would come up with something very much like TEAM-CBT. Dr. Noble discusses neuroscience in simple, everyday terms that anyone can understand. Even me (david)! Dr. Noble teaches in a kind of clear, accessible way of communicating that I (david) admire greatly. I have seen this in all of the teachers that I've admired the most in college, medical school and beyond. Dr. Noble explains that if you want to change the way you think, feel, and behave, you have to change certain specific networks in your brain. That's because networks of nerves are the biological equivalents of thoughts. But how do you do that? How can you change the networks in your brain that cause you to feel depressed, anxious, and inadequate? It's through two basic concepts of neuroscience called FTWT and WTFT! In Dr. Burns' new book, Dr. Noble writes: "One of the most famous concepts in the science of learning is called, "What Fires Together Wires Together" (FTWT). Nerve cells that frequently interact with each other become functionally connected, and the more they fire together, the stronger the connections become. This is how new networks are formed and how existing networks become stronger. "In addition, nerve cells that are Wired Together tend to Fire Together (WTFT). WTFT. This idea explains why once you've learned something it gets easier to repeat it every time you do it." Dr. Noble also views TEAM-CBT as a kind of micro-neurosurgery, because you replace highly selected negative brain circuits that send distorted signals, such as "I'm not good enough," or "I'll never recover," with new circuits that are far more accurate and positive. Dr. Noble also explains why Dr. Burns' concept of "Fractal Psychotherapy" is so complimentary to our understanding of the human brain, as are the other components of TEAM-CBT, including T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods.   David and Dr. Noble following a Sunday hike, just before the dim sum feast with the hiking group at the Joy Luck Palace in Cupertino, California, Notice the slightly bulging but happy stomachs from both doctors! Dr. Noble also explains why conventional therapy--where the patient comes in week after week to vent about his / her problems--may actually make the patient worse. This is because the neurons that Fire Together every week, actually Wire Together. So, in simple neuroscience terms, conventional therapy may actually lead patients in the wrong direction, by strengthening the negative circuits in the brain. You will love this down-to-earth discussion of TEAM-CBT and the human brain! David D. Burns, M.D. & Rhonda Barovsky, Psy.D.

In today's podcast, David and Rhonda interview Dr. David Hanscom, a renowned and controversial spine surgeon who gave up a large and lucrative surgical practice in favor of helping and educating people struggling with back pain, directing them on the path to recovery without surgery or drugs. Dr. Hanscom describes his personal journey and recovery from panic, pain, and other disabling somatic symptoms when he read Dr. Burns' book, Feeling Good: The New Mood Therapy, and began doing the written triple column technique to challenge his own negative thoughts and overcome his own feelings of depression, panic, hopelessness, and anger. He also began to study alarming research reports indicating that many of the surgical procedures were no more effective than placebos; and even worse, he could see that back surgery often had damaging and even disabling and horrific effects on patients. And he also discovered that most of the patients seeking surgery for back pain could be helped simply through talk therapy and support, by focusing on the problems in their lives, rather than simply focusing on pain and pills. Dr. Burns supports Dr. Hanscom's premise, that even physical pain can have powerful psychological causes and cures. Dr. Burns briefly summarizes his own research on hospitalized inpatients with significant emotional problems as well as chronic pain. He wanted to answer the question of why physical pain and negative feelings so often go hand-in-hand. To find out, he studied changes in negative feelings, like depression, anxiety and anger, as well as the intensity of pain, in more than 100 patients attending a 90 minute cognitive therapy group. He saw that there were often massive shifts in negative feelings, like depression, anxiety, and anger, as well as the severity of physical pain, during the groups. He analyzed the data with sophisticated statistical modeling techniques to evaluate two competing theories about why pain and negative feelings go hand-in-hand. Physical pain could cause negative feelings, like depression, anxiety and anger. This seems plausible, since physical pain is so debilitating, and just plain awful. Negative feelings could have a causal effect on physical pain. The analyses indicated that there were causal effects in both directions, but the most powerful effect, by far, was the effect of negative emotions on physical pain. In fact, the analyses indicated that, on average, half of the physical pain these patients were experiencing, on average, was the direct result of their negative emotions. This means that if you're in pain, and you're emotionally upset, which would be totally understandable, that a great deal of the pain you are feeling is the result of a magnification of the pain by your negative emotions. There is a positive implication of this finding that supports what Dr. Hansom is saying--namely, that if you are in pain, including chronic pain, and you are willing to overcome your negative feelings and deal with the problems in your life, there is a good chance that your pain will improve substantially. Some people, as David saw in the groups, will experience a total elimination of pain--something he often observed within the group. It is also possible that you will experience a reduction of your pain, but not a complete elimination. And it is possible that your pain will not improve when your negative feelings disappear--but at least you won't have to struggle with pain and depression! So he has now devoted his life to making people, as well as his surgical colleagues, aware of the realities vs. the myths of back surgery. To learn more, visit his website, or pick up a copy of his terrific book, Back in Control. The book includes a section on your personal roadmap out of pain. Rhonda and I are incredibly grateful to Dr. Hanscom for this illuminating, challenging, and profoundly personal interview. We hope you enjoy it! And if you've been struggling with any kind of chronic or debilitating pain, we hope you will find some hope, as well as a drug-free path to recovery! David D. Burns, M.D. & Rhonda Barovsky, Psy.D.

In today's podcast, David and Rhonda answer two questions about suicide submitted by podcast fans. Question 1. Why do shrinks kill themselves? Dear Dr Burns, Before I get to my question (which I hope you will consider addressing in your 'Ask David' segment of the podcast), I would like to extend my gratitude to you. Your book, Feeling Good, came to me at a time when I was struggling to make sense of my depression and anxiety, and it has been a vital part of my recovery journey. The exercises and the podcast have been such lifelines, and I am grateful to you for the incredible and life-changing work that you do. I know you have addressed the topic of suicide in a previous episode, but I recently was struck by a piece of news from my alma mater, the University of Pennsylvania, where a senior member of the college's counselling services (CAPS) died by suicide. Here was someone who had spent his life's work on promoting suicide prevention, and had a great deal of knowledge on resilience. How can we process/understand the decisions that someone like this might make to take his life. How can I arrive at the understanding that his decision doesn't necessarily spell doom for the rest of us? What TEAM-CBT exercises can we do to make sense of the world when it might not make much sense at first glance, during situations like these? Thank you very, very much, Sindhu Dr. David's Answer Thanks, Sindhu, this is a really great question. I’ll put this in the Ask David folder. Should I use your name? Here’s the short answer. It’s a lot like saying that an infectious disease expert shouldn’t get pneumonia, or that an orthopedic surgeon shouldn’t have back pain, or a broken leg. I know of at least three mental health professionals who have committed suicide, but my knowledge based is tiny. I’m sure there are thousands of mental health professionals who have committed suicide. People can commit suicide for many reasons, and I can only mention a few here, as my knowledge, like yours, is limited. Hopelessness is one of the most common causes of suicide in depressed individuals. Hopelessness always results from cognitive distortions, and never from a valid appraisal of one’s circumstances. Depressed people often turn to suicide, thinking (wrongly) that it is the only escape from their suffering. You may have done something that you are profoundly ashamed of, and fear it is about to be made public. Like the fellow in New York arrested for child abuse who hung himself just a few weeks ago. I am convinced that sometimes people commit suicide to get back at someone they are angry with, someone perhaps who rejected them. Physician-assisted suicide. I believe that physician assisted suicide is absolutely indicated and compassionate if someone is in excruciating pain from an irreversible terminal illness. The Achievement Addiction. Feelings of failure and worthlessness. In our culture, we sometimes (wrongly) base our feelings of self-esteem on our success in life, our income, or our achievements. And so, if your achievements are only “ordinary,” you may feel worthless, like “a failure,” and kill yourself. The Love Addiction: Many people (wrongly) tell themselves they must be loved to feel happy and worthwhile, and then kill themselves when they are rejected by someone they thought they loved and “needed.” Drug and alcohol abuse: These habit, when severe, can greatly disrupt a person’s life. They can also make someone more impulsive, and more likely to jump or pull the trigger when intoxicated. There are likely way more causes than just these common ones. For example, a psychotic process like schizophrenia might sometimes play a role as well. I suspect you may have a hidden “Should Statement,” telling yourself that a mental health professional “should not” get depressed or have the urge to commit suicide. But to me, that would be a nonsensical claim, and it isn’t even clear to me why you might think that way. In fact, most people are drawn to this profession because of their own unresolved suffering. There is, I suspect, MORE depression and anxiety in mental health professionals, but I have not seen data, so I’m not certain of this. But I’ve trained tens of thousands of mental health professionals, and pretty much ALL of the ones I’ve known personally have struggled at times, and sometimes intensely. People also ask, “Why did so and so commit suicide? S/he was so famous and loved and wealthy!” Well, famous and loved and wealthy people often suffer and commit suicide, too. Finally, I would say that suicide is both tragic and devastating—for the patient for sure, for the family and friends who typically suffer for years, and for the therapist as well. Fortunately, the family and friends can be helped, if they ask, but it is too late for the person who was depressed. And the tragedy is needless in most cases, since the patient’s intense negative feelings can be treated effectively in nearly all cases. David Question 2. How can you find out if a friend or loved one is suicidal? Many people are afraid to ask a depressed friend or family member if they are feeling suicidal, fearing this will create conflict or may even cause the person to become suicidal. For the most part, these fears are unfounded, and the biggest mistake could be avoiding the topic. Most people who are feeling suicidal are willing to discuss their feelings fairly openly. Several types of questions can be useful. Suicidal thoughts or fantasies. Most people with depression due have suicidal thoughts or fantasies from time to time, and these are not necessarily dangerous. First, you can ask, “do you sometimes feel hopeless, or have thoughts of death, or wishing you were dead?” If s/he says yes, you can ask him / her to tell you about these thoughts and feelings. You can also ask if s/he thinks of suicide as the only way out of his / her suffering. Second, you can ask if s/he simply has passive suicidal thoughts, like “Sometimes I feel like I’d be better off if I were dead,” or active suicidal thoughts, like, “Sometimes I have fantasies of killing myself.” Suicidal urges. You can ask if s/he sometimes has urges to kill himself / herself. Suicidal thoughts or fantasies without suicidal urges are usually not especially dangerous. Suicidal plans. You can ask if s/he has made any plans to actually commit suicide. If so, what method would s/he use? Jumping? Shooting? Hanging? Cutting? You can also ask if s/he has been acting on these plans. For example, if shooting is the choice, you can ask if s/he has access to a gun and bullets. If jumping is the choice, you can ask where s/he plans to jump from. Deterrents. When evaluating suicide, you can also ask if there are any strong deterrents, such as religious beliefs, impact on family and friends, and so forth. If there are no strong deterrents, the situation is more dangerous. Desire to live, desire to die. You can also ask the person how strong their desire to live is, and how strong is their desire to die? Past suicide attempts. If the person has made suicide attempts in the past, the risk of a future suicide attempt is greater. Drugs and alcohol. You can ask if the person drinks or uses drugs, and has ever has a stronger urge to commit suicide when intoxicated. This is a danger sign. Impulsiveness. Some people make suicide attempts when they’re feeling impulsive, kind of on the spur of the moment. You can ask if they every have these kids of sudden impulses. Willingness to reach out. You can ask if they’d be willing to reach out and ask for help if they ever have a suicidal urge. Honesty. You can ask if they were felt reasonably open and honest in asking your questions, or if it was difficult to answer some of the questions. Once you have explored these types of questions, you can decide whether action is necessary. If the person seems in danger of making a suicide attempt, you can bring him / her to an emergency room for an evaluation. If s/he refuses, you can dial 911 and ask for help. Generally, the police will come immediately and do a safety check, and bring the person to an emergency room involuntarily if necessary. You can also call his or her therapist and alert that person to the situation. This may all sound grim and very unpleasant, but these kinds of conversations can sometimes be lifesaving, and can protect you from much greater pain later on. In a future podcast, we will focus on this question: How do you treat someone who is suicidal using TEAM-CBT? David D. Burns, M.D. & Rhonda Barovsky, Psy.D.    

Lately, I’ve received numerous emails asking, in essence, "how can I help my loved one who has this or that problem?" I would say that I get several emails like that every week. For example, here's one from a man we’ll call “Karl.” Love you podcasts. Listen as often as I can. keep reading your books. Our son is in an unhappy marriage. Last night we talked and he mentioned that there is no love in their marriage. Just coldness. The children "feel" the chasm. There is a lack of trust in the home. Our son feels he did not protect the children in defense of their mom, even though he disagreed with her. Now the children feel their father does not have their best interests. Our daughter-in-law feels that everything is fine. She uses the passive-aggressive "silent treatment" to punish others. Our son says she is controlling and manipulative, and that the children have become that way also. There's no truth in the home. Years ago, she wanted them to go to counseling, but our son refused; now the tables are turned. Sad. We want to help but don't know how to approach it. What podcasts would be helpful to us? And to our son and daughter-in-law? We visit our grandchildren often, sometimes one-on-one. Communications are open with them and with our son. Daughter-in-law feels, and tells others, we are conspiring against her Karl Thank you Karl, for that moving email. It can be really sad and frustrating to see a couple in conflict who are at odds with each, especially when your son and grandchildren are involved. And I can imagine you might also be feeling anxious and a bit helpless, and deeply concerned! When I wrote Feeling Good forty years ago, I tried to make it clear that the cognitive therapy tools I described in that book are for people to use to help themselves. It is okay to correct your own distorted negative thoughts in order to break out of a bad mood. But it is generally NOT a good idea to try to correct someone else’s distorted thoughts, because they’ll just get ticked off at you! This is a very understandable error, because you may get really excited by the things I’m teaching, and how helpful they can be when you’re feeling depressed, anxious, or insecure. So it just makes sense that you would want to share these tools with others. But those are generally NOT the tools to use when you’re talking to your son, daughter, spouse, or friend who’s feeling down in the dumps. There is a way to help someone you love who’s hurting—but you’ll have to use an entirely different set of tools and skills—the Five Secrets of Effective Communication—WITHOUT trying to “help.” So, the short answer to your question is—skillful listening is all that’s called for. Anything more runs the risk of getting you into trouble. But this may require a radical change in the way you communicate, as well as your personal philosophy. Let’s talk about what TO do, and what NOT to do when patients, friends or people you care about express angst, or seem troubled, or describe problems in their lives, and they seem to be hurting a lot. DO NOT Give advice Try to help Try to cheer the person up Try to solve the problem s/he is struggling with Try to get the other person to think or act more positively Try to minimize the problem by saying it’s not that bad, or things will get better. Point out ways the other person may be thinking or acting in a self-defeating manner. Before we tell you what does work, let me focus on just one of these errors, to bring it to life for you. Recently, Rhonda and I recorded a live therapy session with a man named who was upset because his mother had lost the use of her legs to due a rare neurological disorder, and needed much greater care in an assisted living facility. This required selling the house his mother was living so they could afford the assisted living facility, and it was a great loss for everyone, since Kevin was raised in that house, and his parents and grandparents had lived there, too. After Rhonda and I empathized with him for about thirty minutes, we asked the other therapists to offer empathy as well, as part of their practice and training that evening. We stressed the importance of simply summarizing what Kevin had told us (Thought Empathy) and how he was feeling (Feeling Empathy), without trying to “help.” One of the therapists, who was new to the group, kind of missed the mark, She did what we call “cheerleading,” telling Kevin what a wonderful and heroic person he was without acknowledging what he’d be saying and how painful it was for him. You’ll hear this brief excerpt from the session in the podcast. When we asked Kevin how he felt about her comment, he had to tell her that he was embarrassed, and not helped, by what she’d said. Here’s why. When you don’t acknowledge someone’s profound negative feelings of loss, anxiety, sadness, anger, and more, you might unintentionally convey the message that you don’t want to hear about how they really feel inside. And when you cheerlead, it also conveys the message that the person is not very intelligent, and simply has to be cheered up, and then everything will be okay! We cannot be too hard on this therapist, because her efforts came from the heart, and I'm sure she felt sad for this man. And most of us have made the same mistake at times, or even often. I frequently hear parents trying to cheer their children up, or trying to tell their children what to do, or how to change, without really listening. But, most of the time, it just doesn’t work like that! Now that you know what NOT to do, what can you do that WILL help? DO Use the Five Secrets of Effective Communication, with an emphasis on the listening skills. One of the most important skills is called Feeling Empathy—simply acknowledging how the other person is feeling, and asking them to tell you more, and if you got it right. For example, let’s say a friend or family member is procrastinating on something important, like a research report or college application, and is feeling pretty upset and self-critical. You could say something like this: “It sounds like you’re beating up on yourself for procrastinating, I’m wondering if you’re feeling down, sad or depressed? anxious, worried, pressured, or nervous? guilty or ashamed? inadequate, worthless, defective, or inferior? alone or lonely? humiliated or self-conscious? discouraged or hopeless? stuck or defeated? angry, annoyed, hurt, or upset?” I find that people really like it when I ask these questions, and I let them answer each one. Then I ask them about their negative thoughts. What are they telling themselves? What are the upsetting messages? When you use this approach, you are literally doing nothing to “help” the other person, but if you listen skillfully, she or he will probably really appreciate your listening, and you may end up feeling really close. In fact, I (David), had this exact experience just a couple days ago with a student who was struggling and feeling down. Often, the person who’s depressed will be someone you love, like a family member, so your concerns for him or her, and your desire to “help,” are an expression of your love. But listening skillfully will likely be a whole lot more effective. And you can express your own feelings, too, with "I Feel" Statements, like "I feel sad to hear how down you've been feeling, because I love you a lot." Example A woman named Clarissa was concerned because her son, Billy, who is in his early 20s, had been severely depressed for several years, and had not responded to treatment with antidepressants and even lithium. Clarissa had read my book, Feeling Good, and listened to almost all of the Feeling Good Podcasts. She described herself as a true “TEAM-CBT convert because she’d worked with a therapist trained in TEAM-CBT and no longer suffered from the depression and anxiety she’d struggled with most of her adult life. She agreed with a lot of what I’d said on the podcasts about the chemical imbalance theory (there’s no convincing evidence for it) and antidepressants (recent research suggests they do not outperform placebos to a clinically significant degree). But Billy was saying things like this: “Mom, I KNOW I have a chemical imbalance because this cloud will suddenly come over me, and I feel TERRIBLE. It’s not about negative thoughts—I don’t have any negative thoughts. My depression is clearly the result of a chemical imbalance, and I feel doomed by my genes.” Then Clarissa would try to cheer him up, which always failed, or would try to convince him that it’s not about a chemical imbalance and that if he really tried TEAM-CBT, he could overcome his depression, just as she had done. These are such common errors! How could Clarissa respond more effectively? If she focuses on good listening skills, instead of trying to win an argument, she might say something like this: “Billy, I really love you, and feel so sad to hear about your depression. You’re absolutely right, too. Sometimes a bad mood seems to come from out of the blue, with no rhyme or reason. And genes can be important. I've struggled with depression in the past, and maybe you've inherited some of my genes. Tell me more about how you’ve been feeling. Have you been feeling down, anxious, ashamed, hopeless, or angry? What you’re saying is so important, and I really want to her what's it's been like for you.” Can you see that Billy would be more likely to open up and might even share some things that he’s been hiding, out of a sense of frustration, anger, or shame? And can you also see that providing some love and support—pure listening, with compassion—might be a lot more helpful than getting into an argument about the causes of depression? He might open up about all sorts of things that have been eating away at him—problems with girls, sex, sports, or his studies, or concerns about his looks, or even feelings of shame about his depression. The next question is—when DO you help someone? And HOW do you help them. The approach I use as a therapist might be the same approach you’d want to use. At the beginning of every therapy session, I empathize without trying to help, exactly as I’ve been teaching you in this podcast, and in this document, and I give the other person some time—typically about 30 minutes or so—just to vent while I use the Five Secrets of Effective Communication—listening skillfully—without trying to “help.” Then I ask the patient to grade me on empathy. I say, “How am I doing so far in terms of understanding how you’re thinking and feeling? Would you give me an A, a B, a C, or perhaps even a D?” Most of the time, the other person WILL give you a grade. If they give you an A, you’re in good shape. But if they give you an A-, or a B+, or worse, ask them to explain the part you’re missing, or not getting right. When they tell you, you can use the Five Secrets again, summarizing the part you missed, and then ask what your grade is, to see if you’ve improved. Usually, your grade will improve a lot. Do NOT try to “help” until you received an A! So, let’s assume you’ve gotten an A. What then? Then I do what’s called the Invitation Step in TEAM therapy—I ask if the other person wants help with any of the problems s/he has been discussing. You can ask the same question. If the other person does NOT want help, but just wanted to talk and get support, your job is done. You can also ask if they want to talk some more. Most of the time, all people want is a little listening and support, and they’re not looking for help or advice. But if the other person DOES want help, you can ask what kind of help they’re looking for. Then you can decide if you’re in a position to provide that type of help. Sometimes, the help they're looking for might not be something you can provide. For example, they may be angry at someone they're not getting along with, and may want you to tell the other person to change. I explain that this is not something I would know how to do, but I could possibly help them change the way they interact with that person. This may sound really simple, but it takes a lot of practice and determination! It can be a lot harder than it looks. Many people will NOT want to go down this road, and will insist on jumping in to help or cheerlead. You can do that if you want, but in my experience, pushing help on people who are hurting is rarely helpful. The “need” to help or rescue can result from your love and compassion, but it can also result from narcissism, codependency, or the desire to control or dominate another person. I see it as a kind of an addiction, too. If you want to learn more about this, here are some things you can do: You can read my book, Feeling Good Together, and do the written exercises while reading, so you can master the Five Secrets of Effective Communication. This is a BIG assignment, but the reward, in terms of more loving and satisfying relationships with the people you love, will be equally great. You can try using "I Feel" Statements and Feeling Empathy with at least one person every day this week. David D. Burns, M.D. & Rhonda Barovsky, Psy.D.  

163: Ask David: Anxiety, Dreams, Cyclical Negative Thoughts, Secrets of Selling, Exposure, and more Can you treat anxiety without meds? How do you interpret dreams? Are negative thoughts cyclical? How can I get over anxiety when selling? How does exposure work? Will you teach on the East Coast again? Hi! We’ve had tons of great questions from listeners like you. Here’s the first: Question #1. TREATING ANXIETY WITHOUT MEDICATIONS Hi Dr. Burns, I would love to talk to you!!! I have been going to a wonderful counselor for several years, and he is the one who recommended your book. My question is how can you overcome anxiety without taking medicine? I have been on a very low dose medicine for years and would love to discontinue but when I try the anxiety seems to come back. Thank you. Lisa Hi Lisa, Thank you for your email! This is one of my favorite topics, since I’ve personally had at least 17 different anxiety disorders that I’ve had to overcome. That’s why I love treating anxiety. Whatever you’ve had, I can say, “I’ve had that too, and I know how it sucks! And I can put you on the road to recovery, too!” Did you read When Panic Attacks, or one of the earlier books? The written exercises would be the way to go, I think. You will find more than 40 methods in that book. Write back if you have questions after reading it. Focus on one specific moment when you are anxious, and do a Daily Mood Log, as illustrated in Chapter 3. You can also listen to the free Feeling Good Podcasts on anxiety. Go to my website, FeelingGood.com, and click on the Podcast tab. There, you’ll find a list of all the podcasts, with links. In the right hand panel of every page, you’ll find the search function. You can type in “anxiety,” or “social anxiety,” and so forth, and all the relevant podcasts and blogs will pop right up. You can also sign up in that same right-hand panel of every page so you’ll receive all the new podcasts, along with the show notes. In addition, withdrawal effects are pretty much inevitable when going off of benzodiazepines, if that is the type of medication you are taking. These are the drugs most often prescribed for anxiety, like Valium, Librium, Ativan, Xanax, and so forth. Typically, the withdrawal, which typically involves insomnia and increased anxiety, take several weeks to wear off. Your medical doctor can guide you in this. I cannot advise you about medications in this forum, so make sure you check with your doctor! David Question #2. How can you interpret dreams? Hello, Dr. Burns. I am terrified that this may be the most boring question you have ever received, but, I’ll press on none the less. I often experience very vivid dreams after listening to your podcasts. In fact, I recently dozed off after listening to one of your podcasts on procrastination (#75) and forgot to turn off my phone. In my dream I was in my childhood house and could hear you talking away in some far corner of the house and I was really getting quite annoyed and angry. I really wanted to find you to tell you to shut up, but I couldn’t get the words out. When I awoke, podcast #77 was playing, which seems to explain some of my unconscious hostility. I struggle with most of my relationships and don’t really want to deal with all the hard work I have to do to improve them. So, there you have it! Thanks for listening to me and all your Herculean efforts on behalf of all those in the struggle to grow. Mike Hi Mike, I explain how dreams function, and give an example with my dream that I had a broken jaw! Question #3. Are Negative Thoughts cyclical? David, I have a question about our strong attraction or inclination to negative thoughts. Are our psychological processes cyclical? People seem to recycle the same negative thoughts for years. Even if we produce a strong alternative thought or reattribution it may not be a default choice the next time. How can we make the alternative/ positive thoughts a conscious choice? Thanks, Rajesh Hi Rajesh: Negative Thoughts are not cyclical for the most part, but are an inherent part of our human nature. The podcast on fractal psychotherapy might be useful, since the same Negative Thoughts will tend to come back over and over throughout your life. And once you have learned how to combat those thoughts, you can use the same techniques to smash the thoughts whenever they pop back into your mind. The written exercises I describe in my books, like the Daily Mood Log, are extremely helpful, even mandatory, in building new brain networks and strengthening them through repeated practice. Bipolar manic-depressive illness is a little different, and it can be quick cyclical. (David will briefly explain this.) Thanks Rajesh for yet another great question! david Question #4. I’m in sales. How do I combat my Negative Thoughts about each person I approach? Hi David, I have been struggling with anxiety for the last 18 months and recently faced up to the fact I have also been suffering from depression. And then I discovered your podcasts. I have been spending a lot of time on the episodes I believe I can benefit from the most. I have found your solutions to be the most beneficial I have come across. Thank you for sharing your ideas and techniques with all of us! A couple of questions—How would you advise constructing a work day to reduce anxiety? I work in sales and feel anxious before every phone call or visit I encounter, and the anxiety can be for reasons that seem to be related solely to each sales encounter on individual basis! And my anxiety will grow as the day goes on. My second point would be, would there be a benefit in monitoring positive thoughts and feelings throughout the day, like happiness and hopefulness, rather than negative feelings? Hi Rudi, I’ve done a lot of sales work, including door-to-door sales when I was young. When I was 8 years old, I sold show tickets door to door. When I was a teenager, I sold Fiesta Chips, Cosmo’s Cock Roach Power, tick powder for dogs, and For Econoline Vans door to door in Phoenix. So, I feel a soft spot in my heart for everyone involved in sales! In fact, I’m still involved in sales! But these days I’m selling happiness, self-esteem, and intimacy. I think it could be useful to do a written Daily Mood Log on the anxiety you feel before one of your calls. I think you will find there are certain themes that are common to each call, such as fears of rejection, disapproval, or failure. Once you’ve dealt with these fears successfully, I think they will help in all of your sales encounters. If you send me a partially filled out Daily Mood Log, perhaps Rhonda and I could provide more specific tips on how to crush your Negative Thoughts. If you listen to Rhonda’s work on performance anxiety, you may find it extremely helpful. In addition, the Five Secrets of Effective Communication are the keys to successful sales. I used to think that you had to sell yourself, or your product, which is rarely true. I learned that the key is to form a warm relationship with your customers. David will explain what he learned from his mother, who sold women’s clothing part-time at a department store in Phoenix. Thanks, Rudi, I hope to hear more. Question #4. Why and how does exposure for anxiety work? Hi Dr. Burns, I am a big fan and believe that you are the greatest living psychologist of our time. I have seen you in person and hear your recent PESI presentation (link). Quick question, when exposure is used to get rid of anxiety, what do you think is the mechanism in the brain? It works paradoxically, instead of strengthening a neuro-network it extinguishes it. Any ideas how. Thanks for your time, and again I have learned so much from you in my over 30-year career, thank you for that also. Sincerely, Dr. Mark Hi Dr. Mark, With your permission, will include this on an upcoming Ask David on my Feeling Good Podcast, but I think you discover a couple things during exposure: When you stop running away and confront the monster, you discover that the monster has no teeth, so you go into enlightenment. This is the basis of Buddhism and the teachings in the Tibetan book of the dead. During exposure, you also discover that after a while the anxiety just kind of wears out, dwindles, and disappears. The brain simply cannot continue creating anxiety for prolonged periods of time, especially when you are doing everything you can to make it as intense as possible. You discover that you can, in fact, endure the anxiety and survive, and that you do not have to “escape” from the feeling of anxiety via avoidance. One other thing that is important is that I treat anxiety with four models, not one: 1. The Motivational Model; 2. The Hidden Emotion model; 3. The Exposure Model; and 4. The Cognitive Model. All play vitally important and unique roles in the treatment of anxiety. Exposure alone is NOT a treatment for anxiety, just one tool among many that can be helpful, and often incredibly helpful, as you’ll see in the upcoming podcast on the treatment of Sara, a woman struggling with severe OCD for more than 20 years. Great question! Hope to catch you in one of my upcoming in-person / online workshops! Thanks, David Mark’s reply and a brief final question Hi Dr. Burns, Yes, of course you have my permission to use my question! Also, I do understand your impressive approach to treatment (not just exposure), and again it is genius. I also love that you see the connection between Buddhism and cognitive restructuring, where as Dr. Beck only went as far back as Socrates and the Greek Stoic philosophers. I don’t know if you ever read the Dhammapada (best translation I found is Eknath Easwaran) as it clearly states that our life is shaped by our mind, and that our feelings follow our thoughts just like a cart follows the ox that pulls it. Thanks again! Will you be coming to the East coast again soon? Hi again, Mark, Yes, I’ll be coming to Atlanta for a four-day intensive in November! Check my workshop tab at www.feelinggood.com for more information. (https://feelinggood.com/workshops/) david David D. Burns, M.D. & Rhonda Barovsky, Psy.D.    

“Yikes! I might get contaminated!” The Treatment of Sara Today we are joined by a woman named Sara, who will be featured in one of the chapters from my new book, Feeling Great. Rhonda begins today’s podcast by reading two heart-warming endorsements from podcast fans. Then we did a brief overview of OCD. OCD consists of two components, obsessions and compulsions. The obsessions are intrusive, anxiety provoking thoughts, like “what if I forgot to turn off the burners on the stove.” Compulsions are rituals that temporarily relieve the anxiety, such as going back into the kitchen repeatedly to make sure that the burners really are turned off. This problem can become more and more severe until the obsessive thoughts and compulsive rituals consume massive amounts of the patient’s time and become crippling. You are probably aware that OCD plagued the life of the billionaire playboy, Howard Hughes, featured in the recent film, “The Aviator.” During the last years of his life, he became totally consumed by concerns about germs, and ended up isolated in the penthouse suite at the top of a hotel in Las Vegas. According to a “psychological autopsy” (https://www.apa.org/monitor/julaug05/hughes) published by the American Psychological Association, Hughes lay naked in bed in darkened hotel rooms in what he considered a germ-free zone. He even wore tissue boxes on his feet to protect them, and burned his clothing if someone near him became ill. Sara, today’s guest, was a victim of the same type of OCD. She describes how her intense fears of germs and contamination came on more than 20 years ago, and the devastating impact of the OCD on her as well as her relationships with friends and family. She also describes her shame about her rituals of constantly washing her hands and desperately trying to avoid contamination. Sara also describes, in vivid detail, her remarkable and inspiring five minute “cure” one evening at David’s Tuesday evening training group at Stanford earlier this year. She had courageously volunteered to be the patient so David could to demonstrate TEAM-CBT with a problem generally thought to be exceptionally challenging and refractory. And although Sara’s dramatic and mind-blowing recovery only took about five minutes, the treatment required a lifetime of courage! Fortunately, one of my students had his cell phone in hand, and made a brief video of the last phase of her treatment at the Tuesday group, which involved putting her hands into a slimy, dirty garbage can right outside the front door of our Behavioral Sciences Building at Stanford and then rubbing her fingers on her face. Check it out! (link) And yes, the effects DID last! Her treatment was many months ago, and she’s been a totally changed person! Following the podcast, Rhonda and I got two beautiful emails from Sara: Wow! What a beautiful day! Thank you, Rhonda and David for the amazing opportunity to share my story! I feel very selfish but I enjoyed every minute of it. You both made me feel so comfortable and welcome. You two are so incredibly AWESOME! You make a superb team! :) And here is the second wonderful email: David, I hope you are feeling better and that you recover from your cold soon, very soon. I wanted to share an afterthought I had a couple of days after we recorded the podcast. I wish I had thought about it before the podcast because this was so much part of my OCD. Anyway, for years (many years) I bought sanitized hand wipes and carried them in my purse, car, briefcase, you name it—I had hand wipes everywhere. I was known for having wipes with me all the time. Not long after the magical treatment of my OCD, I was at the grocery store and proceeded to add three packets of sanitized hand wipes to my basket and I burst into laughter, even though I was by myself! I, then, put them back on the shelf, as I told myself, “I don’t need these anymore!” Since then, I no longer carry them NOR NEED THEM! Funny enough, I have been approached on different occasions by family members and friends saying something like, “You always have wipes, can we have one, please?” I have to say, “Sorry, I don’t carry wipes anymore since I’ve been cured!” What a wonderful feeling that is—not to feel dependent nor a slave to the sink and hand wipes. Not to mention, all the money I am saving by not buying wipes!!! Anyway, I thought I should share that with you and I’m sad I didn’t remember it until after the recording of the podcast. Once again, thank you both for the amazing recording, all your support, and all you do for our Tuesday training group and humanity in general! With Immense Gratitude, Sara Sara Shane is a certified TEAM-CBT therapist practicing in the central valley of California (Stockton). She is multi-lingual and offers intensives—extended, single-session treatment of depression and all of the anxiety disorders. And, here’s something fantastic—although Sara is a superb therapist, her fees are modest, thus bucking the current trend of charging outrageous fees for psychotherapy in California. This is something I really admire and appreciate! If you would like to contact Sara, you can reach her at: 209-476-8867. David and Rhonda

Hearing the Music Behind the Words This podcast again features the music of two beloved colleagues we introduced last week, Brandon Vance, MD and Heather Clague MD. We will be listening to music again this week, but it will be, for the most part, a different kind of music—it’s the music behind the words when someone criticizes you. We will be focusing on the most challenging and important of the Five Secrets of Effective Communication, the Disarming Technique. This week, Brandon and Heather will help Rhonda and David illustrate how to use this technique when you’re under the fire of criticism. But in addition, Brandon and Heather will also sing one more of their extremely beautiful and fun songs, appropriately entitled, “The Five Secrets!” When you use the Disarming Technique, you find the truth in a criticism, even if the criticism seems untrue, unfair, or exaggerated. This technique is based on the Law of Opposites. The essence of the Law of Opposites is that if you genuinely and immediately agree with the criticism that seems untrue, you will put the lie to it, and the critic will stop believing the criticism. This is a remarkable phenomenon that can be enormously helpful in conflicts with patients (if you're a therapist) as well as friends, colleagues, and loved ones. However, it is challenging, because you have to be able to really listen and "hear" the music behind the other person's words. If you use the Disarming Technique, or any of the Five Secrets, in a mechanical way, it will backfire. And I (David) have noticed that even trained mental health professionals can have a tremendous difficulties learning to use the Disarming Technique. Here's an example of POOR technique. Although this is a therapy example, it is equally valid for conflicts between friends and loved ones. Let's say that you're a therapist, and your patient confronts you by saying, "This is the second week in a row that you've been late for my session."   I've seen therapists respond like this: "You're right. I have had emergencies which made me late for your sessions last week and today."  Is this a good example of the Disarming Technique? NO! Can you see why? It's because this therapist is agreeing with the criticism in a literal way, and not hearing the "music" behind the words. What is this patient really saying? He's probably saying that he feels a lack of caring from his therapist, and this may be one of his core conflicts,  thinking that the people he cares about never care about him. So the therapist's "mechanical" answer misses the boat. Here's an improved response that addresses what the patient really said. After each sentence, I'll put the name(s) of the technique(s) I used in the sentence. "Jim, it's painful to hear you say that, because you're right. ("I Feel" Statement; Disarming Technique) I was late and I let you down, and I feel embarrassed. (Disarming; "I Feel" Statement.) I wouldn't be surprised if you're feeling hurt and  annoyed, and maybe even a bit angry with me, and for good reason. (Feeling Empathy) This is particularly uncomfortable, because you've told me that everyone you care about seems to let you down. ("I Feel" Statement; Thought and Feeling Empathy) I care about you and have tremendous respect for you.  (Stroking) Although I was delayed by emergencies last week and this week, the fact is, you had to wait. (Disarming) I will try to correct the problem of getting emergency calls when I'm in the clinic, which definitely is irritating and unfair to you, and I'll gladly offer a free session to compensate the fact that you had to wait. (Disarming Technique, Feeling Empathy) I want to know more about how you've been feeling, and if there have been other times when I've let you down or perhaps said things that seemed uncaring? (Inquiry)" Can you see that this response addresses the music, or feeling, or message behind the words, and not just the words? And can you see the Law of Opposites in action? When this therapist agrees that he has let the patient down, and shows some humility, the patient will probably suddenly feel very cared about. In today's podcast, Brandon, Heather, Rhonda and David play a kind of Disarming Round Robin, taking turns responding to unexpected criticisms, using the Disarming Technique as well as any other communication techniques that may be needed. For example, one of the therapists is attacked by a patient who is a person of color who calls him "one of the rich white privileged people."  You will also hear the immediate grading of each response--was it an A, a B, a C, or a D--along with what worked and what didn't work, followed in some cases by a second try. If you want to learn the Five Secrets, and especially the Disarming Technique, this type of practice will be a must! You can practice with a colleague, or with a friend. But be prepared to check your ego at the door so you can learn from failure, because it will be very challenging for you at first! A neighbor who was helping with the recording, Dave Fribush, said that he really liked the podcast, but was disappointed it was so short--he wanted to hear more examples. So Rhonda and I recorded a  brief supplement two days later, which we will edit in.  Here are the additional criticisms we practiced: Angry friend who feels jealous / betrayed and says: You were hitting on my girlfriend last night! Irate mother, who feels neglected / used, and says: Forget it! I’ll just do it myself! Hurt colleague, who says: You didn’t support me during the meeting! Indignant patient, who tells her therapist: You just called me Jane, but my name is Lisa! If you are serious about learning the Disarming Technique, as well as the other Secrets of Effective Communication, I would strongly urge you to study this list of Common Five Secrets Errors in addition to practicing with a friend. I know I'm asking a lot from you, but we are giving you, or hoping to give you, something precious!  And here are the words to today's featured TEAM-CBT song!  She Used the Five Secrets Lyrics by Heather Clagueto the tune of Blue Velvet by Bernie Wayne and Lee Morris. She used the Five… Secrets Madder than angry, oh was I Pissed and unhappy, I could cry At the start She used the Five Secrets She spoke my words to ‘ empathize She ‘ guessed my feelings, oh she tried  From the heart How could I stay harmed When she so skillfully disarmed How could I want to fight When she asked, did I get it right with With my Five Secrets she told me plainly how she felt Her stroking made my whole heart melt Into tears And I can still hear her Five Secrets In my ears The Five secrets Now I have learned to use them too To give up blame and follow through And face my fears And I practice my Five Secrets With my dears I love the Five Secrets! Conflict fuels intimacy Not about me but about we It’s more sincere! So with the five secrets Let love appear!  More about Brandon and Heather Brandon Vance, MD and Heather Clague, MD are both psychiatrists and certified TEAM-CBT therapists. They practice in Oakland, California. In addition to her brilliant work as a TEAM-CBT psychiatrist and teacher, Heather is a singer and improviser who collaborated in the creation of lyrics for some of Brandon’s songs. She is a member of the performance group, The Berkeley Players, and is the director of Berkeley Improv, a Bay Area school of improv that offers improv acting classes for adults and youth. Heather says, "Improv is a lot like TEAM CBT - full of laughter and enlightenment.  The best moments tend to happen when we throw shame to the wind and let magic arise from the ordinary and let our 'mistakes' become gifts." In addition to his brilliant work as a TEAM-CBT psychiatrist and teacher, Brandon has a musical group that is connected with the Justice Arts Collective at Chabot College in Hayward California. In that group, he works with students to create musical pieces with social justice themes, often in the style of hip hop with Latin beats. Most, if not all of the students have experienced personal trauma and social inequity. Through music, they can share their truths, their hearts and their wealth of experiences with each other and the community, while at the same time working for social change.  Brandon explains that “we form deep connections with each other, and it’s become something of a family . A couple of years ago, we made a music video for our song, ‘From Mt. Tamalpais to Fruitvale Station,’ and actually won first place in the My Hero International Film Festival and in the World Independent Film Festival, as well as awards in many other film festivals.  Check it out! We’re now working on a new video about immigration with our song, 'Bring Down the Wall.'" Brandon has also worked with Amy Specter in the creation of a company called Gameful Mind. He explains that “we wanted playful ways to support adults and kids in developing skills to be and stay emotionally well. So, we made the game TuneIN TuneUP, as well as some other games and playful shirts and such.” David and Rhonda

Introducing Brandon Vance, MD  & Heather Clague, MD This podcast features the music of two beloved colleagues, Brandon Vance, MD and Heather Clague MD. Brandon and Heather are both certified TEAM-CBT psychiatrists practicing in Oakland, California. Brandon is a brilliant multi-instrumentalist and singer / song writer / performer who has transformed his vision of TEAM-CBT into music! Heather is brilliant and fun improv acting teacher and performer who is quick in her mind and on her feet! Brandon and Heather have performed at David’s annual South San Francisco psychotherapy intensive for the past several years, and we are delighted to bring them to you up close and personal today! In today’s podcast, they’ll bring you their songs and amazing personal stories. And what is super cool is that you can follow the words for the music right here in the show notes. Song #1  Heather and Brandon begin with music about a familiar but painful theme for nearly all of us—the feeling of failure, and the belief that we are somehow defective or just “not good enough.” Brandon and Heather are extremely talented and successful individuals, but they are not immune from suffering. During the podcast, they describe their own painful personal experiences with depression, anxiety, shame, and defectiveness. Most therapists, including David, were trained in the psychoanalytic tradition and told that we should NEVER disclose or reveal our own personal feelings or experiences to patients. But we believe that some personal disclosure can be very healing for patients if done with skill and compassion. Most patients want to hear this type of message from a therapist: “I’ve been there myself, and know how much pain you’re in. And I can show you the way out of the woods, so you can experience feelings of joy and self-esteem again. And what a joy that’s going to be!” So, with no further ado, Brandon and Heather perform their first song: The Feel of Failure Lyrics by Heather Clague and Brandon Vance to the tune of “The Sound of Silence” by Paul Simon Hello failure my old friend I’ve come to talk with you again Because my ego softly creeping Infects my thoughts while I am preaching And that vision that was planted in my brain Still remains; becomes the Feel of Failure   Fool, said I, you are so lame Done something wrong to feel this shame Perfect is the way that you should be Self-blame coming like a tsunami Negative thoughts one hundred - percent on my DML I was in hell Suffered the Feel of Failure   My self-esteem had turned to shit I needed the magic button hit Something told me my feelings weren’t lame Began to do a positive reframe Maybe my feelings say something about me that is pretty fly I set the bar high So I have a Feel of Failure   I saw that I was not alone Dared go beyond my comfort zone I took pride in my humility Welcomed my faults as my humanity And in a moment of enlightenment I cried and then I laughed I’d finally grasped The wisdom... of the Feel... of Failure Song #2  The next song is on social anxiety. Brandon explains: “I wanted to introduce this song I wrote with Amy Specter who was on your podcast on August 5th #152 a month or so ago. It’s called, “Negative Thoughts Shut your Piehole Tonight.” And it’s about social anxiety and the idea that when you’re upset, it’s not the event or the other person who’s “making you” feel upset, it’s your own negative thoughts. “Where it gets personal for me is that I was bullied in elementary school by a group of my former friends who made up a story that I was gay - as if that's a bad thing - and then yelled things, tried to get in fights with me, etc., for really the majority of the school year. And I got really down and felt ashamed, and didn’t tell my parents or anyone else about it because of that. But what they did, didn’t make me down - it was my negative thoughts. I wasn’t actually gay, but what was important was that I told myself that I was defective, and people didn’t want to be around me. “The person who I thought was the ringleader was a blonde blue-eyed (as if those are good things) smart, handsome guy who had great social skills and apparent confidence - both seemingly more than I had. In my mind I made him into an evil person just interested in popularity. But he had many good qualities (and was a friend of mine before this). Seeing his good qualities reminds me of the concept of the disarm. “In this song, the singer is anxious about going to a party. She feels envious of Anna, a woman who’s thin (as if that's a good thing) and gets a lot of attention - both because of our culture’s preoccupation with women being thin and also because she has great social skills. So, she feels bad about herself. “But then realizes it’s just her negative thoughts and also sees that her negative thoughts and feelings helpful to her, and represent good things about her. Then she works successfully on changing the way she thinks and feels.”  Negative Thoughts, Shut Your Piehole Tonight!  by Amy Specter and Brandon Vance Tiny Anna, you’ve been getting me down. But I know it’s not you; it’s the negative thoughts doing their doo-doo. And those negative thoughts I can leave behind. That’s right, you can walk right out of my mind. You can shut your pie-hole, though you’ve given me a lot during my days. But, I don’t need you now; you can get up and walk right out of that door - and shut your pie hole on the way!   You’ve been talking since the dawn’s early light you’re an expert, attention getter, you’re quite the sight! Anna please teach me to talk at a party like the talkin' on the tv screen Now I’m gonna say something and it may not be polite! Cause I’ve realized that I’ve got some work to do But this time I’m not going to shut down and stew. My negative thoughts are bothering me much more than Anna Lee so negative thoughts, shut your pie holes tonight. Negative thoughts you’ve served me well and kept me from being in social situation hell Rejection comfortably kept at bay I don’t have to put myself out there I can keep myself at home without judgments to fear they can let me off the hook No effort to change, to learn new things or swim in another lane Negative thoughts you’ve kept me safe But I’m going to try my mind on a different train Maybe I don’t need negative thoughts and their kind to tell me if I can have a good time I can be myself and go at my own pace Even with these tiny negative thoughts flapping their tiny lips in my face Negative thoughts said there’s no room in this world for my kind well that’s just bullshit created by my negative mind I laugh about awkward autocorrects, Weird-Al and farting So why not enjoy, the people, at the party? So negative thoughts shut your pieholes tonight! Negative thoughts you’ve served me well Negative thoughts - farewell! Negative thoughts shut your pie hole tonight Tiny Anna will surely get some attention That may be true And that doesn’t mean I won’t get affection But even if I don’t have things to say, I’ll learn to chit chat the Anna way. So Negative thoughts shut your pieholes tonight, Negative thoughts shut your pieholes tonight. That’s right, negative thoughts shut your pieholes tonight!  Cause I wanna have some FUN!!! Song #3  The last song by Brandon and Heather focuses on the “A” of TEAM therapy, formerly called A = Paradoxical Agenda Setting, and now given the simpler name of A = Assessment of Resistance. We address the patient’s resistance in this very crucial and paradoxical part of TEAM-CBT. When we address resistance up front by arguing for the status quo, the patient paradoxically argues for change, and therapy becomes much easier. After that point, it’s No Resistance No Cry. NO RESISTANCE NO CRY  Lyrics by Amy Specter and Brandon Vance to the tune of “No Woman No Cry.” by Bob Marley. No resistance no cry No resistance no cry No resistance no cry No resistance no cry Next week, Brandon and Heather will return for a second podcast on listening to a very different kind of “music,” the meaning behind the words when people are critical of you. We will discuss and illustrate, once again, the incredibly important Disarming Technique, which is arguably the most important of the Five Secrets of Effective Communication. More about Brandon and Heather In addition to her brilliant work as a TEAM-CBT psychiatrist and teacher, Heather Clague is a singer and improviser who collaborated in the creation of lyrics for some of Brandon’s songs. She is a member of the performance group, The Berkeley Players, and is the director of Berkeley Improv, a Bay Area school of improv that offers improv acting classes for adults and youth. Heather says, "Improv is a lot like TEAM CBT - full of laughter and enlightenment. The best moments tend to happen when we throw shame to the wind and let magic arise from the ordinary and let our 'mistakes' become gifts." Dr. Brandon Vance has a musical group that is connected with the Justice Arts Collective at Chabot College in Hayward California. In that group, he works with students to create musical pieces with social justice themes, often in the style of hip hop with Latin beats. Most, if not all of the students have experienced personal trauma and social inequity. Through music, they can share their truths, their hearts and their wealth of experiences with each other and the community, while at the same time working for social change.  Brandon explains that “we form deep connections with each other, and it’s become something of a family . A couple of years ago, we made a music video for our song, ‘From Mt. Tamalpais to Fruitvale Station,’ and actually won first place in the My Hero International Film Festival and in the World Independent Film Festival, as well as awards in many other film festivals.  Check it out! We’re now working on a new video about immigration with our song, 'Bring Down the Wall.'" Brandon has also worked with Amy Specter in the creation of a company called Gameful Mind. He explains that “we wanted playful ways to support adults and kids in developing skills to be and stay emotionally well. So, we made the game TuneIN TuneUP, as well as some other games and playful shirts and such.” David and Rhonda    

The Secret of a Meaningful Life One of my favorite podcasts of all time, and one of the most frequently downloaded, was the live session with Daisy (podcast #79): “What’s the Secret of a Meaningful Life?” You may recall that Daisy and her husband, Zane, were looking forward with dread to the possibility of childlessness, since their efforts at pregnancy had so far failed, and Daisy was asking if she could possibly have a joyful and meaningful life without children. In today’s podcast we return to the same type of question from the other end of the spectrum. When we age and look back on our lives, and realize that our days are numbered, we may once again, "Have I lived a meaningful life?" Do you know how to answer this question? What, in your opinion, is the secret of a meaningful life? If the answer to this question is important to you, you might enjoy today’s podcast, which features, once again, two beloved friends and colleagues, Dr. Marilyn Coffee and Dr. Matthew May. Matt and I first treated Marilyn for intense depression, anxiety, and anger two years ago at the time of her unexpected and shocking diagnosis of Stage 4 non-smoker’s lung cancer. Marilyn was incredibly depressed and panicky, as you might imagine. If you are interested, you can listen to our initial treatment of Marilyn in podcast #49, “The Dark Night of the Soul.” One of Marilyn's concerns at that time was that she had lost her faith in God and had begun to doubt the existence of an after-life. She was intensely self-critical and ashamed, and was also extremely angry because she began doubting her spiritual teachers and thinking of them as frauds. These doubts were all the more troubling to Marilyn, since she’d been a devout Catholic for her entire life. In fact, she  even has a Master’s Degree in theology, along with several additional Master’s Degrees plus a PhD in clinical psychology! But now she was terrified by the prospect of her own death. During that initial treatment session, Marilyn overcome her fears, depression, and doubts, and ended up in a state of joy, and even laughter. This rapid transformation confirmed the basis of cognitive therapy, that our emotional pain results from our thoughts, and not from what is actually happening to us. And the thoughts that cause depression and anxiety will be distorted and cruel--I've often said that depression and anxiety are the world's oldest cons. Following that session, we were flooded with emails praising Marilyn. Oddly enough, many people said she was their spiritual hero. They said they were stunned and grateful her raw courage, testimony, and honesty. Now, it’s two years later. Sadly, Marilyn has just learned from her doctors that she’s had numerous metastases, and that her lung cancer has spread to the opposite lung, as well as to her bones, brain, liver, and lymph nodes. Marilyn is understandably paralyzed once again by overwhelming feelings of depression, anxiety, shame, hopelessness, and anger. Today’s podcast is based on our most recent session with Marilyn about two weeks ago. I have to warn you that the session may be sobering, and even a bit terrifying, but hopefully you will find it to be inspirational and helpful, because sooner or later, we’ll all have to share the prospect of facing our own inevitable death, and asking ourselves, “Have I had a meaningful life?” We scheduled this follow-up live therapy podcast for three reasons. First, we hoped to provide Marilyn with some relief from the devastating depression that had returned when she learned of her metastases. Second, we wanted to give you, and all of Marilyn’s many fans, an update on what’s happened in the past two years. And third, Marilyn wanted the chance to tell you about some of the positives in her life, since she so often mentions her failures, such as her bouts with alcoholism, and the fact that she never found a loving partner. Every TEAM session begins with T = Testing. You can see her scores on the Brief Mood Survey she filled out just before the session began. (link) All her scores reflect the most severe negative feelings a human being can experience. Marilyn has extraordinarily severe depression, anxiety, and anger, and her positive feelings are totally absent. Marilyn brought a partially completed Daily Mood Log to the session. If you take a look, you'll see all of her intensely Negative Thoughts and devastating feelings about the spread of her cancer.  During the E = Empathy phase, Matt, Rhonda and I gave Marilyn the space she needed to vent and describe her despair and feelings of terror. We did not try to help or cheer her up. Marilyn cried as she described her fear of dying alone, and vividly recalled a friend who died a horrible death from lung cancer 20 years ago. Marilyn says he could barely breathe, and fears a similar horrific fate. Marilyn cries, and confesses that she has not been able to cry up until now. She says she suddenly felt a spiritual presence being around Matt, Rhonda, and David. During the Empathy phase, Matt made many tender comments to Marilyn, shared his own profound sadness, and told Marilyn that joining us today is a gift to him, and to all of us. Matt and I asked Marilyn how we were doing in Empathy, in terms of understanding how she was thinking and feeling, and whether we were providing warmth, acceptance and support. She gave us high grades. When you listen, please notice that we didn’t do anything to try to help Marilyn, or to try to cheer her up. You can hear Matt simply paraphrasing much of what Marilyn had been saying, acknowledging her feelings, and sharing his own feelings of sadness and warmth toward Marilyn. After about 25 minutes of empathy, we moved on to the next phase of the session called A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) We started by asking Marilyn if she wanted any help with the problems she'd been describing, or if she needed more time to talk while we listened and provided support.  She said that she did want help. Since her remaining time was potentially short, she said she didn’t want to spend it in the misery of overwhelming depression, anxiety, worthlessness, shame, loneliness, hopelessness, and rage. Then I asked the Magic Button question—If we had a Magic Dial, and all of her negative thoughts and feelings would instantly disappear, with no effort at all, simply by pressing it, would she press the button? Marilyn immediately said that she WOULD press the button. Almost everybody says this. And it seems obvious. Why would anyone want to feel intense, relentless and overwhelming negative emotions? Matt, Rhonda, and David debated about whether or not the A = Assessment of Resistance would be needed, since it seemed like Marilyn was suffering so much that she would OBVIOUSLY want help. We decided to address the resistance, since whenever we’ve skipped it, we’ve usually regretted it. So just to be safe, we decided to do some Positive Reframing, and asked these two questions about each of the nine categories of intense negative feelings on Marilyn's Daily Mood Log, such as depression, anxiety, guilt, inferiority, loneliness, hopelessness, rage, and so forth. What does this negative feeling show about you and your core values that’s beautiful, positive and even awesome? What are some benefits of this negative feeling? How might it help you? Surprisingly, Marilyn came up with a list of more than 20 positives with some help from Rhonda, Matt and me. You can take a look at her Positive Reframing List. This process seemed to have a profound calming effect on Marilyn, just as it does on most people. I think one reason is that culture / society have trained all of us \to think about our negative feelings as defects, or “mental disorders,” like the many that are listed in the DSM5. Positive Reframing turns all of this upside down, and makes you proud of your negative feelings. Paradoxically, this make it possible for you to get rid of the feelings quickly. We concluded with the Magic Dial, and asked Marilyn what she might want to dial her feelings down to, without getting rid of them completely, since they did have many benefits, and since they also reflected what was most beautiful about her. You can see the result of the Magic Dial on her Daily Mood Log, in the “% Goal” column of her table of negative emotions. For example, she wanted to dial her depression down to 10%, but thought that she'd want to keep the anxiety in the range of 20 - 25. But she said she'd be happy to dial the guilt and shame all the way to zero! After the A = Assessment of Resistance, which seemed to lift her mood considerably, we went on to M = Methods. After easily identifying the distortions in her thoughts, like All-or-Nothing Thinking, Self-Blame, hidden Should Statements, and more, Marilyn was able to challenge and crush her Negative Thoughts pretty quickly using the Paradoxical Double Standard Technique as well as Externalization of Voices. Two strategies seemed important—the Self-Defense Paradigm and the Acceptance Paradox. I emphasized the overlap between the Acceptance Paradox and Marilyn’s Catholic faith. It is the idea that you cannot, and not have to, earn your way to heaven through your good works. Christianity is based on the idea that we are not saved by our achievements or good work, but rather by the grace of God--which is simply the acceptance of our flawed nature. David emphasizes that these ideas are not exclusive to Christianity, but are woven into most if not all religions. During this phase of the session, Marilyn reflected on some of the experiences that she’s proud of, things she would like you to know about, like her trip to Nicaragua to attend seminary at the Franciscan School of Theology. During that time, she worked with the oppressed indigenous people in relocation camps following the bombings, and joined the Witness for Peace group.  She describes this as "one of the most transformative and spiritual experiences of my life." Many of you are probably not familiar with Marilyn's fairly extensive arrest record, which she is equally proud of! She explains: "During the 80s and early 90s, I was arrested several times for political protests, primarily at the Federal Building in San Francisco.  For example, I participated in a major non-violent prayful march at Lawrence Livermore Laboratory.  Several of us were arrested and spent a month in jail (tents on the grounds of Santa Rita Jail.)" Marilyn also wants to know that she was "a damn good therapist." That's something I can attest to, having presented with Marilyn on many occasions, including our empathy workshop at one of the prestigious Evolution of Psychotherapy conferences in Anaheim, California. And still, all of her amazing accomplishments and contributions do not protect her, or any of us, from falling into a black hole of self-doubt and despair from time to time, and when Marilyn falls, the pain she inflicts on herself can be intense. You may notice that the Negative Thoughts on her Daily Mood Log today are very similar to the Negative Thoughts on her Daily Mood Log from two years earlier, during our first session with Marilyn. This confirms the concept of “fractal psychotherapy.” In other words, all of your suffering will be encapsulated in any one brief moment when you are upset. And when you suffer again in the future, it will be that same fractal--the same exact pattern of negative thoughts, distortions and feelings. This is really good news, because the methods that helped you recover initially will be helpful for you when you again fall into the black hole of depression. The goal of TEAM-CBT is NOT eternal happiness--no human being is capable of that! Rather, the goal is to understand and master the tools that will be helpful for you. One important teaching point is that Marilyn’s suffering, once again, does not result from her cancer, but rather from her self-critical thoughts, which are both cruel and distorted. She’s been telling herself that she is not religious enough, that she has lost her faith, and that her life has not been meaningful. Fortunately, these Negative Thoughts can easily be challenged and defeated, as you will hear on the podcast. The entire basis of cognitive therapy is a spiritual idea, that “the truth shall make you free.” Although this is a core Christian teaching from the New Testament (John 8: 32), it is an idea that’s embedded in many religions, including Buddhism, and probably in every religion. Toward the end of the session, Marilyn described inspiring moments when she feels the most spiritual and the most alive. It’s when she notices and profoundly appreciates the simple things in her life, like seeing a sliver of the moon in the evening when walking her dogs, watching a sunset on the beach at Santa Cruz, her first sip of latte in the morning or a bite of a delicious peach! Marilyn also described the intense mourning she feels for people throughout the world who are in poverty or pain. She also grieves for animals who are suffering, and feels devastated by the destruction of our natural resources, such as the rain forests in Brazil. You can see the final T = Testing . As you can see, she met or exceeded her goals for all of her negative feelings. You may be puzzled by the end of session rating for sadness and depression was "50%, but a GOOD 50%!" Sometimes, feelings of sadness and grief, once the distortions have been eliminated, are are the experiences that can wake us up, and provide the profound sense of meaning we are craving in our lives. The highest human experience, perhaps, is the compassion we sometimes feel for ourselves and others who are suffering. In fact, this may be the true meaning of spirituality. I call this feeling, "Sadness as Celebration," and hope to write and talk more about it in a future podcast.  At the end of the session, Marilyn said, “I feel light!” And gave us all big hugs. Will it last? Matt wisely suggests some terrific Relapse Prevention Training that you will hear when you listen to the session. Of course, it will be up to Marilyn--and to all of us--to pick up these tools and use them when we again fall into a black hole. This is also an inherently spiritual idea, and is based on the idea that we have the freedom to chose light or darkness. After the session, Marilyn emailed me and asked if I could include a few additional comments in the show notes. Here’s what she wrote: Greetings David, my dearest friend, Words cannot express my gratitude for you, Matt, & Rhonda - what special gifts you are. I hope the podcast was ok. I am deeply embarrassed because I forgot to express my gratitude and surprise from all the e-mails we received - the compassion and support was/is overwhelming. I hope I can give back! I could never had done this, if I weren’t for you & Matt - and your amazing & compassionate skills. I also forgot to mention that I probably will never get to New York or Ireland because of finances. I take one day at a time and try to be grateful for the small miracles. I go to Stanford next Tuesday. I will definitely be in touch. Thank you again. I also forgot to mention this - which is VERY important is that I am going through this process sober - not avoiding with alcohol. I am going to more meetings & speaking up. Thank you again. I cherish our friendship. With deep gratitude and love. dear friend, Marilyn Thank you, Marilyn, for this incredible gift to all of us! Matt, David, and Rhonda

David and Rhonda are joined again today by David's neighbor, friend, and hiking buddy, Dave Fribush. We appreciate his superb technical skills and thank Dave for his support of our podcasts! Rhonda starts the podcast by reading a question from a podcast fan named Rajesh, who wrote: I have often seen that estranged friends or family members do not talk or resolve a trivial conflict for years because one or both of them have ego issues or have fear of rejection. This problem of unfairness may even exist between a demanding parent and the child, ranging from secretly resenting to not talking at all. They might come face to face in family occasions or professional settings in case of friendship and bear the discomfort, but not attempt to reconcile. They might be suffering deep down emotionally but they refuse to accept that it matters. One or both members might feel they have been treated unfairly and expect apologies. But, both parties are scared to even make the move for the fear of being hurt again or rejected. On a personal level, I have faced such unfairness with a close friend. I see even if you forgive the other party, that element of resentment is still in their somewhere. How do you know you have truly forgiven someone and moved on? Whats the best that can be done at an individual level without involving the other party, at least till the time both are ready to talk it out, if it ever happens.  Once again I thank you for all the selfless Good work you do for people through your knowledge sharing. My sincere best wishes to you and great thanks 🙏. Rajesh I appreciate this question, and it is a great introduction for our podcast on Changing the Focus, one of the three Advanced Secrets of Effective Communication. We recently introduced the three advanced secrets in podcast #126, and you can listen to it for review if you like. Changing the Focus. This technique can be tremendously helpful when there’s an “elephant” in the room. Multiple Choice Empathy. This technique can be transformative when you’re trying to connect with a teenager, friend or loved one who refuses to talk to you. Positive Reframing. This technique can be invaluable when you’re fighting with a colleague, patient, friend or family member, and you’re both feeling frustrated, angry, and upset Today we take a deeper dive into Changing the Focus. This technique can be extremely helpful when you feel tense or awkward in your relationship with someone. For example, you may be arguing endlessly, or there could be some unacknowledged feelings that no one is talking about, like shame, anger, hurt, or resentment. When you use Changing the Focus, you gently point out what's happening, and focus on your feelings, and drawing out the other person's feelings, instead of continuing in the same pattern of arguing or avoidance. Although this technique can be tremendously helpful, it is very challenging, so I have written two memos explaining the technique in greater detail, with examples. One is for therapists and one is for the general public. If you are interested in learning this technique, this would be a great starting place, and it might not hurt to read both memos. In addition, you have to be skillful with the Five Secrets of Effective Communication before trying this technique. That's a lot to ask, I know!  David, Rhonda, and Dave (our new podcast co-host) model how Rajesh might use Changing the Focus with estranged friends or family members. Then Dave Fribush provides a terrific example of how he used the Five Secrets, plus Changing the Focus, in a troubled love relationship, after arguing and resisting for several years. Then I (David) provide an example with a patient I was failing with, and Rhonda provides two tremendous examples--one from her clinical practice, and one involving her sister.  See what you think about our new three-person format! Since our audience consists of therapists as well as the general public, we welcome Dave with open arms and hearts, and feel lucky!  David, Rhonda, and Dave :)

One Student’s Experience In today’s podcast, Rhonda and I are super-pleased to interview Kyle Jones again. For some time now, Kyle has been telling me that he wants to talk about his psychotherapy training experiences on a podcast. This subject is near and dear to my heart, since I do a great deal of training, so Rhonda and I decided to do this second interview with Kyle, and it’s a good one, I think! You may recall our recent interview with Kyle on his interesting research and perspective on the treatment of LGBTQ individuals several weeks ago. Kyle is a brilliant and super-friendly 5th year graduate student in clinical psychology at Palo Alto University, and has been a member of my Tuesday evening psychotherapy training group at Stanford for the past four years as well. Kyle now sees patients at the Feeling Good Institute in Mt. View, California. He has also been promoted to small group leader in our Tuesday group, and does superb work as a teacher. During today’s interview, Kyle, Rhonda and I focus on many critically important training and treatment issues. Kyle states that he has been exposed to many fine teachers promoting a wide variety of popular treatment “packages” at the Palo Alto University and at his practicum sites, including traditional CBT, ACT, EMDR, psychodynamic therapy, and more. However, in all cases, the therapist was encouraged to “sell” this or that approach to the patient. Unfortunately, this has a tendency to trigger resistance, and is the main cause of therapeutic failure in clinical settings as well as controlled outcome studies as well. Paradoxical Agenda Setting, which is the secret spice of TEAM Therapy, was never mentioned in his training at Palo Alto University. When you do Paradoxical Agenda Setting, you bring the patient’s subconscious resistance to conscious awareness, and then you melt it away with a variety of innovative techniques like the Magic Button, Positive Reframing, Magic Dial, Acid Test, Gentle Ultimatum and more. The rapid reduction the patient’s resistance often leads to the high-speed, mind-boggling recoveries we frequently see in TEAM-CBT. Kyle emphasized that he has not see a single teacher or therapist even use the simple Invitation Step in therapy, in spite of the fact that it is so incredibly basic. Essentially, after empathizing with your patient, you ask if there is something she or he wants help with during the session, or if the patient needs more time to talk and get support. Most therapists wrongly believe that this question is unnecessary since the patient is coming to therapy, so he or she MUST want help. But in fact, nearly ALL patients have some degree of ambivalence about recovery, and if this ambivalence is ignored, the patient may, and probably will, resist the therapist’s efforts to “help.” Rhonda enthusiastically agrees that the Invitation Step is incredibly powerful and admits that it took her several years to “get it,” and that she also resisted using the Invitation Step it at first, thinking it wasn’t needed. But she failed her Level 3 Certification Exam in TEAM-CBT because she didn’t know how to do it! Once she began using it, her practiced changed dramatically. And then she easily passed her exam with flying colors! Intense therapist resistance to these new techniques is extremely common. I once supervised a clinical psychology post-doctoral fellow at Stanford who resisted using the Invitation Step with her patients for the first two months of our supervision. All she did was schmooze with her patients. Finally, I asked her why she wasn’t using the Invitation Step. She told me she was afraid her patients would say, “Yes, I DO want some help with problem X, Y or Z.” And then she might not know how to help them solve whatever problem they had! She said, “As long as I just schmooze with my patients, I know that nothing will change, but they’ll think it’s good therapy!” Fortunately, after we discussed this dilemma, she began using the Invitation Step, along with many other Paradoxical Agenda Setting techniques, and her clinical work improved a ;pt. Kyle also emphasizes the incredible value of the Brief Mood Survey and Evaluation of Therapy Session with every patient at every session, and yet most teachers and therapists in his graduate program, as well as those at his practicum sites, are not using these instruments. I think this is arguably an ethics violation, since therapists’ perceptions of how their patients feel can be wildly inaccurate. I predict that within ten years, all therapists will be required by licensing agencies and insurers to use these kinds of assessment instruments. The importance of assessment instruments in clinical work and training was underscored by my experience several days ago with a patient who gave me incredibly poor grades on empathy as well as helpfulness at the end of a free, two-hour phone session. I had sensed the session had not gone especially well, but I didn’t realize just how awful it was until I saw my ratings! The scores on Empathy and Helpfulness were among the worst I’ve received in the past 25 years. This was illuminating, but disturbing, as I’d been trying my best but I had clearly failed my patient in a big way, and he was ticked off! I would not have known just how angry and upset he was if I had not been using the Evaluation of Therapy Session. I had a fairly sleepless night, and emailed him the first thing in the morning to find out what emotions I’d overlooked, and urged him to express his angry feelings toward me. This led to a tremendous and highly gratifying therapeutic breakthrough. Kyle was generous in his praise for the training we do in our Tuesday group, and I feel extremely fortunate to have had the chance to work with Kyle! I am hopeful that the training methods my colleagues and I have been developing over the past 20 years will begin to catch on, but have to admit that I’ve run into fairly strong resistance from many therapists who fight and oppose our new training and treatment methods. By the way, the Tuesday group is totally free for all clinicians in the San Francisco Bay Area, or from anywhere for that matter. We’ve had commuters and visitors from as far as Denver, Portland, and even China. If you want to dramatically improve your therapy skills, and have an interest in some of the new treatment and training methods we’re using, and want free personal work as well, this might be an option for you, and we’d be really happy to have you visit and maybe even join us! David, Rhonda, and Kyle  

Plus, Thomas Szaas, TV Shrinks, and more! David and Rhonda are joined today by David's neighbor, friend, and hiking buddy, Dave Fribush. He has incredible technological skills, and wisdom.  We thank Dave for his support of our podcasts! We open the podcast with a wonderful email from a fan named Sushant who listened to Feeling Good Podcasts for nine hours during a rigorous hike to the "Tiger Monastery" in Bhutan. You can see Sushant and his phone, showing the podcast icon, just in front of the monastery. Rhonda encourages podcast fans from around the world to send photos of yourself listening to the Feeling Good Podcast in additional unusual or exotic locations! Might be fun to see what you send to us!  Here are the questions for today's program: Ann asks: Loved your podcast (on the exposure model, #26)! But I do have a question - I have suffered from panic attacks for years - the past 2 years I've become agoraphobic and don't want to be far away from my house. So, my phobia is now "having panic attacks." Does that mean I just need to go out and have a bunch of panic attacks in public to get over my fear? The thought seems terrifying. Also, I am severely claustrophobic which affects me anytime I feel trapped (elevators, small cars, traffic, tight spaces, etc.) Is there a protocol you used to treat patients with this? Just wanted to suggest perhaps a podcast on this subject, or agoraphobia, as it does affect many people worldwide. Nathan asks: Dear David, Love your podcasts. I am currently preparing a lecture for psychology honors students here at Monash University on assessment of depression and anxiety. In your podcasts you mention that you conducted a "study on the psychiatric inpatient unit at the Stanford Hospital, in which I evaluated how accurate therapists’ perceptions of patients were after an interaction. Student researchers interviewed patients for several hours as part of a research study on psychiatric diagnosis." I was wondering if you could provide me with a reference to this study? I could not find a specific reference in your website and I would like to be able to highlight to student's the results of your research. Richard asks: I listened to your podcast on being worthwhile and found it interesting. You say all people are worthwhile. This may be true but does the whole world think this? If a person is worthwhile but the world thinks they are not worthwhile, isn't this almost as bad as not actually being worthwhile. Don't we have to play by the world’s rules, however bad, instead of our own or the Platonic rules? What do you think? Robert asks: Dear David. I am up to podcast #108. I am heading to India next month for a three-week trek and am going to download the rest onto my phone. Perhaps by the time I get back, I will be up to date! I have never heard you mention Tom Szasz, who, as I am sure you know, was making some of the same observations about the constructs of medicalizing you make back in the 1960s and maybe even in the 50s. In particular, his criticism of the psychiatric industry giving the names of diseases or syndromes to behavioral issues was very consistent with yours. Robert also asks: My other question is an idea for future podcasts and it is...How about critiquing the therapeutic approach we see so often on television and in the movies? For the lay audience, these are probably the source of much of what they know about therapy. And because these therapists are well-known and fictional, it would give you an opportunity to make critiques without having to criticize an actual person. And it could introduce some levity into what can often be quite heavy. Some of the Hollywood therapists people know best are: Judd Hirsch as the shrink in Ordinary People Lorraine Bracco as the shrink in The Sopranos Peter Bogdanovich as the shrink's shrink in The Sopranos Billy Crystal as the shrink in Analyze This! Robin Williams in Good Will Hunting Kelsey Grammer in Frasier I am sure there are many others. These are the ones who quickly came to mind I just found an article about this that might help make the case that what the public sees on TV and in the movies is not really reflective of the therapeutic process or good therapy. Here’s the link: https://www.huffpost.com/entry/therapists-on-the-big-and_b_4263798 Thanks for tuning in! David and Rhonda References for Nathan Burns, D., Westra, H., Trockel, M., & Fisher, A. (2012) Motivation and Changes in Depression. Cognitive Therapy and Research DOI 10.1007/s10608-012-9458-3 Published online 22 April 2012. Hatcher, R. L., Barends, A., Hansell, J. & Gutfreund, M.J. (1995). Patients' and therapists' shared and unique views of the therapeutic alliance: An investigation using confirmatory factory analysis in a nested design. Journal of Consulting and Clinical Psychology, 63(4), 636 - 643.  

The Story of Lorraine and “Anna” In today’s podcast, David and Rhonda interview Dr. Lorraine Wong, a board-certified clinical psychologist, and her patient, “Anna,” who sought treatment recently for depression, anxiety, and self-image / self-esteem issues. But first, David and Rhonda answer a question submitted by Estafonia, a “public image consultant,” who asks about the treatment of a woman who sees herself as “fat.” Estafonia wrote: “Hi Dr. Burns, “I am learning TEAM, CBT and implementing your techniques to help my clients change or improve their self-perception. In most cases, your techniques have been very effective. I am very grateful to you and I will happily join your list of fans! “My question is this—What would be the best method to change someone’s self-image? How can you help people change the idea that they are fat for example? “I have a patient who can't defeat the thought, ‘I am fat.’ We tried the method called Examine the Evidence,” and she has already found 20 people who see her as thin. So, the evidence clearly did not support her belief that she is fat. But this did not help. “We also tried the method called Let’s Define Terms, and we both concluded that she is not fat. But now she tells me, ‘I know I am not fat, but I can't stop thinking about it.’ “We also did the Downward Arrow Technique to probe her deepest fears and Self-Defeating Beliefs, but that didn’t seem to help, either, and she keeps ruminating about being fat. I would greatly appreciate your guidance on how to help her overcome that thought! “Thanks in advance! Estefania” Lorraine, Rhonda, David and Anna quickly diagnose the most likely cause of Estefania’s stuckness—she is trying to “help” her patient without first melting away her patient’s resistance. This is the cause of practically all therapeutic failure, and you’re not really doing TEAM-CBT if you don’t know how to eliminate the patient’s resistance. That’s because most people are ambivalent about change. As the Jesuit mystic, Anthony DeMello, has said: “We yearn for change but cling to the familiar.” Recognizing and modifying this inherent ambivalence is the heart of A = Paradoxical Agenda Setting, but you can also think of the A as standing for “Assessment of Resistance.” How could we melt away this woman’s ambivalence / reluctance to stop bombarding herself with the message, “I’m fat”? It is important to realize that this self-critical thought, and, in fact, all of her negative thoughts and feelings have huge advantages for her, and also indicate some really beautiful and awesome things about her and her core values. For example, telling herself “I’m fat” may motivate her to diet, to exercise, and to make extra sure that she doesn’t get complacent and gain a tremendous amount of weight. In addition, the thought, “I’m fat,” shows that she has high standards, and her high standards have probably motivated her success in many areas of her life. For example, she probably works really hard to stay in good health and in good physical condition. The thought, “I’m fat,” also shows that she’s humble, and on and on and on. And that’s just one negative thought. But this woman probably has many negative thoughts and feelings, like anxiety, shame, inferiority and depression, and they ALL have tremendous advantages, and they ALL reveal what is beautiful and awesome about her and her core values. In addition, the thought may be protecting this patient from things she fears, like intimacy. As long as she tells herself, “I’m fat,” she does have to risk trying to get close, or having sex, or risking rejection. So the thought, in a way, is a form of self-love and self-protection. Once Estafonia and her patient list all these positives, Estafonia could ask her patient, “Given all these advantages and positive qualities, maybe it wouldn’t be such a good idea to stop telling yourself, ‘I’m fat.’ This thought seems to be working for you in a really positive way, and also reflects your core values.” That’s the essence of Paradoxical Agenda Setting. We try, in a genuine way, to honor the patient’s resistance, rather than trying to sell the patient on change. This is very difficult for therapists to learn because of the compulsion to save, help, or rescue the patient. In addition, obsessions (recurring illogical negative thoughts like “I’m fat”) frequently result from the Hidden Emotion phenomenon, and this has to be dealt with skillfully when treating any patient with anxiety. Estafonia’s patient may be upset about something she’s not dealing with in her life, and bringing the hidden problem or feelings to conscious awareness can often be incredibly helpful. For more information, see my book, When Panic Attacks, which you can order from my books page (link). After focusing on Estafonia’s excellent question, David, Rhonda, Lorraine and Anna talk about the emotional challenges that brought Anna to treatment, including severe feelings of depression which came on when Anna returned to the United States after 13 years working abroad. She was also feeling anxious, stuck, angry, and hopeless, and was comforting herself by binging on her three favorite foods. Anna describes previous partial treatment failures, and explains that her previous cognitive therapist had “the empathy of a prison guard,” and contrasts those experiences with her successful experience with Lorraine. In fact, Anna describes the TEAM-CBT she received at the Feeling Good Institute as “cognitive therapy on steroids.” I (David) loved hearing that because this is how I think about TEAM-CBT, too! TEAM really is CBT on steroids! But, I’ve been too embarrassed to describe TEAM-CBT in this way, fearing it might sound crass or unprofessional. Anna and Lorraine explain why the T = Testing and E = Empathy of TEAM were so critical to the success of the therapy. Anna says that Lorraine was, in fact, the first therapist “who really got me, and really understood me!” Anna emphasizes the enormous importance of the A = Paradoxical Agenda Setting (aka Assessment of Resistance) as well. Lorraine helped Anna discover what was beautiful and awesome about all of her negative feelings, including severe depression, shame, anxiety, anger, loneliness, and even hopelessness. She said, “My depression and feelings of loss when I moved showed that I really care about what I do, as well as the people around me.” Anna also said that her anger showed that she was overly nice, out of her love for people, but that she had the right to set boundaries and stick up for herself, and didn’t always have to be a people-pleaser. The Positive Reframing proved to be a positive shock to the system, and Anna’s symptoms started to improve significantly even before starting the M = Methods phase of the TEAM-CBT treatment. The Positive Reframing made it relatively easy for Anna to smash the negative, self-critical thoughts that triggered her depression, anxiety, shame, and hopelessness, and then they moved on to other goals, such as using the Five Secrets of Effective Communication in her interactions with colleagues and friends. Finally, they focused on self-image issues, which brings us back to the question Estafonia had posed at the start of the podcast: How you can help patients with self-image problems and addictions to eating? Anna explained that when she was depressed, she had gained weight because of her addiction to salami (Mmmm!), ice cream (Yummm!), and rice and beans (WOW!) Lorraine used David’s “Devil’s Advocate Technique,” to help Anna challenge the tempting thoughts that always triggered her overeating. Rhonda and I are incredibly grateful to Lorraine (aka Dr. Wong) and “Anna” for this opportunity to bring TEAM to life in a very real and personal way. Thank you, Lorraine and Anna! Dr. Lorraine Wong is a certified Level 4 TEAM-CBT therapist and practices at the Feeling Good Institute in Mountain View, California. She specializes in the treatment of body image concerns and emotional eating, as well as depression and anxiety, with TEAM-CBT. Thanks for tuning in! David and Rhonda

Ask David Five Secrets Relationship Questions Kate asks: I love listening to your podcasts and am currently reading my way through your book, Feeling Good. I appreciate that you have written and spoken about relationship problems at length, but in what I have read and heard so far I do not see how this can apply to the current climate of casual dating and hook up culture which is fueled by apps such as Tinder. I don't know how it's possible to build relationships when the dominant mentality is that people are disposable. It feels like no matter how much I find truth in what my date says, stroke them and empathize with them, that they will disappear ('ghost') at the drop of a hat. I think this may be a significant problem for many of your listeners, and would greatly appreciate your thoughts, as well as any practical steps on how to date in today's world. * * *  Eli asks: Your work has helped me tremendously over the past 2 years. However, recently I’ve discovered something about myself that I don’t know how to change. I’d be really curious to hear your thoughts. For some reason, when it comes to sex, it seems that I have a lot of self-worth wrapped up in my sex drive. I’m realizing when my wife and I have sex I feel like I’m on top of the world afterwards. I feel so positive the following few days and I feel mentally and emotionally healthy. But it’s devastatingly real that the reverse is true as well... when we don’t have sex (and particularly when I reach out and she’s not in the mood) and when a week or so passes that we don’t have sex, I find myself feeling very insecure. I feel ugly, unlovable and generally less valuable as a person. Is there an exercise you would recommend for me to discover possible hidden thoughts/emotions that could be causing this? Is it possible to change this about myself? I want to have a close, intimate relationship with my wife (sexually and non-sexually) but I also want to feel valuable and positive whether or not we’re sexually active. PS - If, by chance, you address this on the podcast, could you refer to me as “Eli” or something else anonymous as you usually do. Thank you for all you have do! * * *  Susan asks: You seem like a good person to ask this question partly because you are a man. Someone I know, I won’t say whom, told me he felt emasculated when I asked him to take my car to the gas station to get the wipers replaced. He said that he should be able to replace them himself but doesn’t actually know how, so he would prefer if I took the car to the service station. I said that was stupid, granted not very diplomatic, and he said that’s what he gets for expressing his feelings, which I frequently complain he does not do. To me “emasculated“ is more of a concept or a thought. I will not get into toxic masculinity and the patriarchy, but I am curious what you think. By the way, this person and I have benefited a lot from your relationship journal exercise, thankfully we did not need it this time :-) * * *  Knaidu asks: Here’s a specific example which occurred whilst I was trying to use the disarming technique. It is one where I failed to use the technique. Anyway, I was meeting a friend of mine, and was a running a few min late for our lunch appointment. I couldn't send her text to let her know as I was driving. I arrived at least 5 min late. When I arrived she immediately said "I knew it all along, you really don't want to meet with me or actually have lunch with me!” I tried to explain that I was stuck in a traffic jam and couldn't text, but it didn’t work. Here’s what I said:  “Please Mrs. X, I was stuck in a traffic jam and that's why I am late. Have I ever said I don't want to meet with you? And if I didn't why have I bothered to arrive at all, I mean I could have just not arrived if I didn't want to meet you!" After I said that she stormed off. I am afraid I could agree with her idea that I didn't really want to meet with her, because the truth was I did want to meet but couldn't help being late. I could agree with something that was not real to me and if I did try to agree, I would be lying to her. Please help me, David and Rhonda! Thanks for tuning in, and keep the great questions coming! David and Rhonda

New Ask David Questions Kelly asks: Would love to hear a podcast about to use or not to use touch in therapy. I personally feel touch is extremely helpful (what is more natural than to hug or put a hand on someone hurting), however I believe our profession has become so “professionalized” that is leaves out such a power act of healing. Did you ever use touch when you were practicing, and do you feel it is appropriate? Against Machines Taking Over asks: You say that depression always results from distorted thoughts. But the sadness that results from a failure, rejection, or disappointment is not distorted. Can you explain a bit more about this? Against Machines Taking Over also asks: Is there something you used to advocate for before but then you changed your mind? Eduardo asks: How do you treat hypochondriasis. Almost all articles and advices I've read for hypochondriasis try to cover the writer's back by first and foremost telling you that you should get yourself checked for real causes for your concern. Eduardo also asks: I've been struggling with anxiety, and after reading When Panic Attacks, I got very interested in giving The Hidden Emotion model a try, but it seems to be structure-less. It seems to require a lot of detective work with no clear sheet or procedure. It's just Detective Work, and then do something about it. Is there some newer technique to dig into what's eating you?

In today's podcast, Rhonda and I interview the incredibly brilliant, funny, and creative Amy Spector. Amy is a licensed marriage and family therapist and credentialed school counselor with over a decade of experience working with adolescents and their families. She is passionate about providing school-based mental health services and advocates for legislation to mandate universal mental health care for youth. Amy works with "at risk" teenagers at Vicente High School in Martinez, California. This is a continuation high school, as well as teens at Briones School, an independent study school. Her students are credit deficient and at risk of not graduating from high school. Nearly all have experienced significant trauma and most are severely depressed, anxious and angry when first referred to Amy, and some have suicidal thoughts or urges as well. Although you might think that this would be an exceptionally challenging, oppositional, and frustrating group to work with, Amy has had tremendous success treating these teenagers with TEAM-CBT. She measures symptom severity at the start and end of every session, just as we do with adults, and often reports a phenomenal reduction of 60% in depression and anxiety in a single, 30-minute therapy session. Although this may be hard, or even impossible, to believe, it is real, and you'll see why when you listen to this amazing interview. Amy's secret involves a combination of superb E = Empathy skills to form a meaningful relationship, along with A = Paradoxical Agenda Setting to reduce resistance, followed by truly creative applications of M = Methods. And, of course, she does T = Testing with every student at every session, and plots her effectiveness over time. Amy describes her work with a severely anxious young man with artistic skills, who drew an "Anxiety Hero" figure who saves the world by worrying constantly about every little thing, plus a "Chilled Out" figure who never worries and ends up getting hit by a bus. In other words, Amy skillfully emphasized the many BENEFITS of the young's man's constant anxiety, as well as the downside of getting cured. This paradoxically boosted his motivation, and he improved rapidly. This is prototypical TEAM, which is difficult for many therapists to learn, because therapists are so used to, and addicted to, "helping." Amy has developed expertise in aligning with the resistance of her students. paradoxically, she ends up on the same page, and this allows some awesome TEAMwork to emerge. Amy, Rhonda and David talk about the idea of teaching TEAM through creative innovations, with many examples of games Amy has created. For example, she created a game with another one of our fabulous TEAM-CBT therapists, Brandon Vance, MD, which can be played with teens and adults, called "Tune In / Tune Up." This game provides a really fun way to learn the 5-Secrets of Effective Communication. If you're interested, you can check it out at  www.gamefulmind.com. Amy and her students have also created a podcast that you might want check out. Although I (David) have been primarily an adult shrink, I have really enjoyed working with teenagers as well. A few years back, I tested hundreds of juveniles who had been arrested in California, many for violent crimes, including murder, at the request of the probation department, using my Brief Mood Survey to find out how depressed, anxious, suicidal, and angry the kids were. Toward the end of the podcast, I describe what happened when I was invited to visit two groups of incarcerated gang members at the Juvenile Hall in San Mateo, California to find out how they felt about the tests I administered, and to get their take on the causes of so much teen violence. I think you'll find this episode to be fun, funny, and inspiring! Amy is a strong advocate for including mental health training in high schools, and her experience illustrates the enormous potential for rapid and profound mental health growth and learning in teens. If you would like to contact Amy, she can be reached at babyfreud@gmail.com.    

Are there some special techniques therapists need to use when working with LGBTQ patients? Does the therapeutic approach have to be different? In today’s podcast, Rhonda and David interview Kyle Jones, a brilliant 5th year PhD student at Palo Alto University. Kyle has been a member of David’s training group at Stanford for the past four years, and now sees patients at the Feeling Good Institute in Mt. View, California. Today’s program is based on Kyle’s doctoral research on the treatment of LGBTQ patients. To get the interview started, Kyle defines LGBTQ: L = lesbian G = gay B = bisexual T = transsexual Q = questioning, or queer. Then Rhonda asks the obvious question: How does the treatment of LGBTQ individuals differ from the treatment of individuals who are heterosexual? What are the key differences? What special techniques or procedures should therapists use? And what does Kyle’s research reveal about the important factors in the treatment of gay individuals? Kyle emphasizes that most important factor is the therapist’s attitude toward the patient, as opposed to any special techniques or procedures that are unique to the treatment of the gay population. Sensitivity to and awareness of the unique challenges this population faces in terms of hatred and prejudice are tremendously important. Kyle points out that some therapists place an excessive focus on the patient’s gayness, while some tend to sweep this “uncomfortable” issue under the rug. Kyle emphasizes that the therapeutic approach is largely the same for gay and straight patients. In TEAM, we first provide strong empathy, so the patient feels understood and accepted. This, of course, is crucial for all patients. Then we set the agenda, asking the patient if she or he wants help, and if so, what is the problem that he or she wants help with? In other words, there is no special “agenda” that the therapist should impose on the treatment simply because the patient is gay. Kyle mentions that this is not a trivial point, because many therapists will try to set the agenda for the patient, thinking there is some “correct” way one should treat gay people, or some “correct” set of issues that must be addressed. David points out that thinking there is a special approach to gay patients could actually be viewed as a type of bias, thinking that the treatment of members of the LGBTQ community must be somehow “different” or special. In TEAM, we do NOT treat disorders, diagnoses, or “types” of patients. We treat humans in a highly individualize way, using the fractal approach described in a previous podcast. In other words, we ask the client to describe one specific moment when he or she was upset and wants help. Then the treatment flows from the exploration of that specific moment, because all the patient’s problems will be encapsulated in how she or he was thinking, feeling, and behaving at that moment. The treatment might then focus on depression, anxiety, a relationship problem, or a habit or addiction. Rhonda, Kyle and David discuss the problem of therapists who have a strong anti-gay bias. David talks about his father's work, trying to convert gay students at the University of Arizona after he retired from his work as a Lutheran Minister in Phoenix, and how much shame and anger David felt about this. David described his positive bias toward LGBTQ individuals, because of the suffering most have had to endure due to hatred and prejudice. David asks whether gays therapists are obligated to announce their sexual orientation to their patients, and Rhonda and Kyle come up with some pretty cool answers! Rhonda points out that when and how to do self-disclosure is a question all therapists face, and that the goal of self-disclosure in therapy should be on how best to help the patient, not the therapist. Again, this question of the hows, whens and ifs of self-disclosure is a general therapy issue, and not something specific to gay therapists. Kyle and David reflect on some of the personal work Kyle did during his training program, and how important that work has been to Kyle as he has evolved into a dynamic, compassionate therapist and teacher. They reminisce about the first personal work Kyle did with David on one of the Sunday hikes. Kyle was feeling depressed because he’d just been rejected, unexpectedly, by his boyfriend, and was able to turn the situation around dramatically and quickly using TEAM-CBT. Kyle also describes his own discovery during college that he was gay, and what happened when he shared his sexual orientation with his parents and brother. The message of this podcast turned out to be pretty simple and basic. The key to the effective treatment of all of our patients is acceptance. The therapist needs to accept the patient, and the patient needs to learn to accept himself or herself. In fact, acceptance seems to be the path to recovery and enlightenment for all of us, whether gay or straight! David D. Burns, MD, Rhonda Barovsky, PsyD and Kyle Jones (PhD candidate)  

What can you do when you can’t identify your negative thoughts? Is it really true that our feelings always result from negative thoughts? How can I get over my public speaking anxiety? Rubens, a faithful and enthusiastic Feeling Good Podcast fan, sent me an email with a terrific question that has both  practical and theoretical implications. He wrote: Dear Mr. David, I've read "Feeling Good" and I'm reading "When Panic Attacks" now. Both have and are helping me immensely. However, the one thing I have never understood is that my anxieties and worries often don't come as a thought. For instance, I have an academic presentation tomorrow, and I'm suffering from much anxiety because of that. But the symptoms did not appear because I thought in my mind the sentence "you are going to fail!". In my case, it is usually silent. I just remember that I have a presentation tomorrow, then I immediately feel worried. My chest hurts before any thought. How do I counter-argument my thoughts, if I have none? Thank you for replying, Mr. David!  In today's podcast, Rhonda and I address this question and explain what to do when you can't pinpoint your negative thoughts. There are  two really good methods. We will also demonstrate how to deal with some of the negative thoughts that typically trigger public speaking anxiety. The cure involves changing the way you think, and changing the way you communicate with the people in your audience. If you've ever struggled with public speaking anxiety, this podcast may be helpful for you! Thank you again, Rubens, for your excellent question! David D. Burns, MD / Rhonda Barovsky, PsyD  

I recently published the results of a survey of Feeling Good Podcast fans like yourself. The findings were overwhelmingly positive and illuminating. However, there were a few criticisms as well, like the excellent and thoughtful comments Rhonda and I will address in this podcast. I appreciate negative feedback, as this provides the greatest opportunities for growth and learning.  However, like most people, I sometimes find criticisms emotionally challenging  and want to lash out, defending myself! Do you sometimes feel that way, too? When I feel defensive, its because I think I have a "self" or some cherished "territory" that's under attack. When I let go of this "self," it can be incredibly liberating to find truth in a criticism and discover that the feedback is really coming from a trusted colleague or friend, rather than some enemy who is trying to destroy or defeat you!  Here's what s/he wrote: Dr. Burns, you seem to disregard healing modalities outside of CBT. CBT is wonderful and nobody teachers it better than Dr Burns—I believe that it is a foundational practice to well-being. However, working with difficult emotions is very important and not always well addressed through CBT alone. Thinking CBT is the answer for most issues is loaded with cognitive distortions. Example--Discounting the Positive in other practices, All or Nothing Thinking, Magical Thinking, and seeing CBT as a “cure all.” In my personal healing journey CBT has been absolutely essential--as has self compassion, learning to let things go, inner child work, mindfulness, somatic awareness and more. I have noticed there has repeatedly been a dismissive tone for other valuable practices. Obviously. the Feeling Good Podcast is about CBT and sticking to your expertise is essential. However, I would be careful not to disregard other healing practices that could potentially help someone out. I have such respect for Dr Burns and his team-but your words carry weight- please be thoughtful about discounting other methods that could be helping someone. Thank you, whoever you are, for this thought-provoking feedback. And you are SO RIGHT. Cognitive Therapy has value for some problems, but it is definitely NOT a panacea. In fact, no treatment is! The belief that you have THE ANSWER for everything is incredibly misguided but unfortunately, way too common in our field.  I have no doubt that many people have shared your concerns. Let us know what you think after you hear today's podcast!  David and Rhonda

How would you overcome the fear of aging? Can you use TEAM for sports psychology? Describe your typical day, David-- do you ever get down or anxious? Hi Listeners: Thanks for your many and awesome questions. I love to answer them! And there will be more to come in future podcasts. Your questions are GREAT!  Vipul: Tell us about your new book, Feeling Great. How will it be different from Feeling Good? And can people with schizoaffective disorder be helped? (story with Stirling Moorey) Guy: What’s a nervous breakdown? Rob: How would you treat a field goal kicker who’s afraid of missing the winning field goal? Would you use positive visualizations? Michael: How would you treat someone with the fear of aging? I turn 60 in a few months, and have been experiencing anxiety around not be able to do some of the things I love as I age. Hidem: How fast is fast? I notice your frequent use of the term "High Speed Recovery" (and even Warp Speed) when describing the benefits of TEAM CBT. How rapidly does the average patient recover? Brittany: I had an idea that I think would benefit a lot of us. I’d like you to do a podcast on a week or a day in your life. The ups & downs of your moods, triggers, etc., & most importantly how you deal with them. Do you write out your own Negative Thoughts a Daily Mood Log? Thank you for all of your great questions, comments, and testimonials! Rhonda and I really appreciate that!   David and Rhonda PS Here's a great question we did not get to today. We'll do it in a future Ask David, as it's really important.  Rubens: What can you do when you can’t identify your negative thoughts? I get anxious, but don’t seem to have any negative thoughts. Is it really true that our feelings always result from negative thoughts?  

Is it REALLY Possible? And Can the Effects Last? Rhonda and David interview Garry, a veteran who David treated for PTSD several years ago at a trauma workshop in Michigan. Garry describes how a repressed horrific memory from his childhood suddenly and forcefully re-emerged when he smelled some Queen Anne’s Lace that were in blossom. He suddenly remembered how a school bus he was riding home on hit a horse with a boy, Tommy, who was riding bareback, when the horse suddenly lurched in front of the bus. Tommy was Gary’s classmate. The bus driver said, “Don’t look!” But Garry watched as his friend, who was trapped under the dead horse, “bled out” and died. Once this totally forgotten memory re-emerged decades later, roughly 18 months prior to Garry’s session with David, it constantly intruded into Garry’s every interaction for the next year and a half. Garry says, “I was seeing Tommy all the time, and having symptoms of anxiety, intrusive memory and dissociation experiences. I would often see the image of Tommy lying on the pavement superimposed over conversations I was happened with people in an intimate way. It was quite disturbing and anxiety provoking.” Garry tearfully describes what he experienced during his TEAM-CBT session with David, including his dissociation at one point during the session, and the profound changes he experienced by the end of the session. Can severe PTSD be treated in a single therapy session? Did Garry really improve? Were the changes real? Did they last? And how did the therapy work? You’ll find out when you listen to this amazing and inspiring interview! We are incredibly indebted to Garry for his courage and openness to share this experience with all of you!    

Hi Listeners: Most people do not do a very good at helping loved ones, colleagues, or friends who are upset and complaining. Have you ever noticed that when you try to help or give advice they just keep complaining? This can be very frustrating--fortunately there's a fabulous solution to this universal problem.  This special podcast features our guest, Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute. Jill is also one of the teachers at David's Tuesday evening psychotherapy training group at Stanford, as is our esteemed podcast host, Dr. Rhonda. Jill describes the "helping" errors she made when her son became despondent after some painful foot surgery. Following the surgery, he was in a cast for weeks, and when the cast was removed, he discovered that he could not move or feel his toes. This is common, and results from muscle atrophy when you are in a cast, and is not dangerous. However, Jill's son was very discouraged and frustrated, and told his mom that he didn't feel like going to school and thought he wasn't ever going to get better. Jill felt exhausted from all the demands on her that day, trying to get him off to school, and trying to get to work on time, and so forth, and gave in to the urge to say things like, "You're going to be fine," which were totally ineffective.  Jill describes a similar error that she made when her mother also complained about foot problems and the need for surgery. Her mother loves to hike and was upset that she'd be unable to hike for some time. Jill, perhaps feeling a little impatient with her mom, suggested other forms of exercise, like swimming, and this simply increased her mother's complaints. I'll bet you've experienced this same thing when you tried to "help" someone who was complaining. Even therapists make this type of error all the time.  Rhonda, Jill, and I discussed the most common errors we all make when we lose patience with someone who's complaining, and illustrated the techniques that are effective. As usual, they involve the Five Secrets of Effective Communication, especially Disarming, Stroking, and Feeling Empathy, along with some compassionate I Feel Statements. We also discussed the phenomenon of drifting in and out of Enlightenment, a concept first described by the Buddha. It is easy to drift out of enlightenment when we are rushing around, trying to get breakfast on the table, lunches made, kids to school, and ourselves off to work. It's so easy to feel overwhelmed and frustrated at those moments. Part of the process may include forgiving ourselves when we make mistakes, and using the 5-Secrets to repair relationships with our loved ones when we do. In fact, this can even lead to deeper and more loving relationships.  We also discussed a closely related and possibly controversial theme--is it okay to use the Five Secrets just to get someone to stop complaining, especially if you're angry with that person and they tend to complain most or all of the time? Do you always have to use the Five Secrets in a totally sincere manner?  I want to thank Dr. Levitt for joining us in this inspiring and illuminating podcast. Whenever Jill teaches, the heavens open up, and this podcast is no exception. Jill is simply a fabulous therapist, teacher, and human being!  Click here if you are interested in some online training with Jill! David and Rhonda

Hi Listeners: Many of our podcasts are inspired by listeners like you who send us really cool emails with show ideas. Sometimes the emails are from people wanting self-help with emotional or relationship conflicts. And sometimes, they are from therapists wanting more training and information about TEAM. Rhonda and I love your emails! Yesterday, I got the following email from Dipti Joshi, one of our listeners and TEAM-CBT therapists from India. Dipti flew all the way from India to Canada with her lovely daughter last summer for my Intensive in Whistler, Canada. I am hopeful that Dipti will one day create the first TEAM Treatment and Training Center in India. How cool would that be! Here’s the email that Dipti sent me: Dear David, I am really enjoying all the educational materials available on your website. Thank you! I will soon be taking my Level 3 TEAM certification exam, and am seeking your kind blessings for the same! Also, I have a special request for you. Is it possible to have a workshop or podcast on “paradoxical techniques?” I feel this is a very challenging area, and that a lot of skill is needed. Perhaps you can also talk about why paradoxical techniques can be so effective. Meanwhile can you suggest me something to read or listen to for this? Regards, Dipti  Thanks, Dipit! Today’s podcast will be an introduction to the use of paradox in TEAM therapy, a kind of overview. When my new book, Feeling Great, comes out, I am hoping to do a series of workshops on a variety of powerful paradoxical techniques. And of course, the new book will have a great deal of instruction on paradoxical techniques as well. These are the four key components of TEAM: T = Testing E = Empathy A = (Paradoxical) Agenda Setting M = Methods In today's podcast, Dr. Rhonda and I will explain why each of these components is inherently paradoxical. For example, when you do the T = Testing, you assess changes in the patient’s symptoms from the start to the end of the session, and the patient rates you on the Empathy and Helpfulness scales as well, When you look at the ratings, you will probably discover that you aren’t helping your patient much, if at all. You may also discover that your perxceptions of how the patient feels, and how the patients feels about  you, are off-base, and sometimes alarmingly so. This can be very disturbing, especially if you’re not use to this kind of information. However, in TEAM, we are actually hoping for failure, and welcome that kind of "disturbing" information. Why is this? Isn’t therapy all about recovery and making positive changes? Why in the world would the therapist want to know that he or she is not helping? It's because many of the most important breakthroughs in therapy come from the therapist's discovery that he or she is failing. We WANT to fail! Why?  David illustrates this paradox by describing his discovery that he was not actually helping a patient he thought he’d helped enormously. David explains how and why this shocking information led to a tremendous breakthrough. When you review how your patient rated you at the end of the session, you may discover that your patient gives you failing grades on the E = Empathy scale. The patient’s ratings may indicate that he or she didn't experience you as sufficiently warm and caring, or completely trustworthy, and that you didn’t really “get” how she or he was feeling inside. Once again, as TEAM therapists we welcome failing grades on the Empathy Scale. Why? It’s because your worst therapeutic failure will nearly always be your greatest success in disguise. How can this be? It seems absurd, or impossible. Karl Rogers told us that empathy is the necessary and sufficient condition for personality change. So why would a TEAM therapist hope to discover that he or she is failing in this category? You’ll discover the explanation for this paradox on today’s podcast. When the patient asks for help during the A = Agenda Setting phase of the session, the TEAM therapist doesn’t jump in and offer to help, using this or that therapy method. In fact, the TEAM therapist will often assume the role of the patient subconscious resistance and argue for the status quo, sincerely encouraging the patient to cling to the feelings of depression, anxiety, shame, worthlessness, hopelessness, and anger. The therapist will bring out all the reasons why the patient should RESIST change. Why in the world would a therapist want to do that? It sounds crazy! You'll find out on this podcast. And finally, during the M = Methods phase of the session, the TEAM therapist will be working with the patient on his or her negative thoughts, like, “I’m worthless,” or “I’m not as good as I should be,” or "I'm hopelessly damaged because of the abuse I experienced as a child." And the TEAM therapist’s goal is not success, but rather failing as fast as you can, trying technique after technique that DOESN'T work and the patient's belief in the Negative Thought is still 100%. Why would a therapist want to fail over and over? Isn’t that the opposite of what a skillful, compassionate, and effective therapist would want to do? Listen to this podcast and you’ll discover the answer to these questions. You’ll also see that the patient, not the therapist, is the expert in TEAM, and discover how the patient, and not the therapist, guides all the changing. David and Rhonda talk about the important difference between healthy and unhealthy use of paradoxical ideas and techniques in therapy, and describe how narcissistic therapists may use paradoxical techniques in an effort to manipulate “resistant” or annoying patients. This dysfunctional use of paradox is unfortunately common, and will rarely or never be effective.  David and Rhonda

My wife claims that I never listen! How can I possibly agree with her?  My wife left me! How can I correct the distortions in her criticisms? How can you deal with people who constantly wallow in self-pity? And more! Hi podcast fans, Today we've got some terrific Five Secrets questions that you have submitted. Mike #1: I love your Five Secrets of Effective Communication. Why does secret #4, “I Feel” Statements, not include Thought Empathy? Mike #2: I have seen communication models that include expressing and listening for needs. Aren’t needs and wants important and important to express? Al: How can I help my wife recognize her many cognitive distortions, like All-or-Nothing Thinking? It seems hopeless! Guy: If a loved one says, “You never listen,” how could I possibly find the truth in this statement? How could you genuinely agree with an All-or-Nothing statement such as, “You never ….”? Both Sonja and Eileen asked: How can you deal with someone who constantly wallows in self-pity and plays the role of victim. It's exhausting! Thanks for tuning in, and keep the great questions coming! David and Rhonda

Session with Rhonda, Part 2 Last week we published the first half of the session with Rhonda, who was struggling with severe performance anxiety about her work as the new host of the Feeling Good Podcast host. We did the initial T = Testing, which indicated many intense negative feelings, as well as E = Empathy phase of TEAM therapy session. This week, we include the conclusion of the session, with A = Paradoxical Agenda Setting and M = Methods, plus final T = Testing to see how effective, or ineffective the session was. As a reminder of the first podcast, plus the work done on this podcast, you can review Rhonda's Daily Mood Log here. When you listen, you will see that the changes Rhonda experienced were amazing,. But were these changes real? It almost seem too easy, and too fast, especially for a problem that started in childhood and persisted right up to the present moment. Was the session just a publicity stunt, perhaps, or some kind of superficial quick fix? David asks Rhonda about this, as well as this question: 'If the changes were real, what caused the changes? David and Rhonda used many TEAM-CBT techniques they during the session, including these: David Empathized with the Five Secrets of Effective Communication at the start of the session during the E = Empathy phase. Of course, good empathy is necessary throughout a therapy session. David melted away Rhonda’s resistance during the A = Paradoxical Agenda Setting. These techniques included: Straightforward Invitation Miracle Cure Question Magic Button Positive Reframing Pivot Question Magic Dial The M = Methods that were helpful in this session included included: The Individual Downward Arrow to identify the Self-Defeating Beliefs that triggered Rhonda’s feelings of inadequacy.Rhonda enjoyed this exercise and felt it was on target. We identified many beliefs, including: Perfectionism Perceived Perfectionism Achievement Addiction Approval Addiction Love Addiction Fear of Rejection Submissiveness Inadequacy schema Spotlight Fantasy Brushfire Fallacy Superwoman The Interpersonal Downward Arrow to illuminate how Rhonda saw her relationship with her father, with David, and with some other people, including the podcast listeners. This is kind of like Psychoanalysis at warp speed. Rhonda said this felt uncomfortable, perhaps because it cast David somewhat as a dangerous ogre! David and Rhonda smashed several of Rhonda’s Self-Defeating Beliefs with the Feared Fantasy Technique Identify the Distortions Paradoxical Double Standard Technique Externalization of Voices Acceptance Paradox / Self-Defense Paradigm Self-Disclosure / Exposure The Experimental Technique Thinking in Shades of Gray Finally, if the changes were real, will they last? Or will Rhonda just slip back into more performance anxiety and self-doubt? You can click on this link if you’d like to review the evolution of Rhonda’s Daily Mood Log during the session, and see her ratings on the Brief Mood Survey before and after the session at this link. You can also review her ratings of David on the Empathy and Helpfulness scales at the end of the session. You can also review her interesting comments on what she liked the least, and what she liked the most about her session with David. I want to thank Rhonda, my esteemed colleague, friend, and wonderful podcast host, for giving all of this incredible gift of her humanness.  And I, Rhonda, want to thank the most marvelous, compassionate and incredible David Burns, for the gift of healing and facilitating me experiencing enlightenment and peace from these difficult feelings and negative thoughts that were devastating me.  I feel so much gratitude, for all of our work together, for you trusting me enough to invite me to be the host of these podcasts, and for the gift of your friendship.  Words can't express the full depth of my love for you and for everything you have given me both personally and professionally! Did you like the personal work we did? Was it helpful for you personally? Rhonda took a chance and was courageous to share intensely personal experience with you. Let us know if you liked this! If you are a therapist, or an interested patient, let us know if this was it a good learning experience. Would you like to hear more podcasts with live personal work? We are here to serve you, so share your thoughts and feelings with us, as well as your wish list for future podcasts! David and Rhonda

"I sound stupid! . . . Ouch!" Have you every struggled with performance anxiety, thinking you might fail or not be good enough? I think it is fair to say that every therapist in my Tuesday training group at Stanford has struggled with fairly intense feelings of anxiety and self-doubt, and perhaps you have, too, thinking you should be smarter or better than you are, and fearing that others would judge you if they saw your “true self.” In fact, I would suspect that most of our podcast fans have struggled with these feelings at some time during your life, and maybe even recently or now. Well, today, we’ve got a wonderful program in store for you. Our own Dr. Rhonda Barovsky asked me for personal help with her own anxieties about being the new podcast host. I asked if she wanted to do it live, on a podcast, and she generously agreed! In this heart-warming and very human session, Rhonda shares the negative thoughts and feelings she had when she listened to herself on several podcasts and begin noticing this or that error she made. She felt intensely down, anxious, ashamed, inadequate, rejected, embarrassed, discouraged, frustrated, and angry, to name just a few of her negative feelings, and her mind was flooded with negative thoughts like these: I sound stupid and inarticulate, and some of my comments were inaccurate, like when I said psychiatric diagnoses are meaningless labels. I’ve had feelings of insecurity ever since I was a child, and should be over this by now! David is going to regret having me as the podcast host! Everyone will know I’m a fraud, and no one will like or respect me. People will judge and reject me, and I’ll end up ostracized and alone. She believed these thoughts at 100%. You might recall that the Necessary and Sufficient Conditions for emotional distress are: You have one or more negative thoughts. You believe the negative thoughts. In today’s podcast, you will hear the first half of the session, which included T = Testing as well as E = Empathy. During the Empathy phase, David also included two Uncovering Techniques, the individual Downward Arrow Technique and the Interpersonal Downward Arrow Technique, so that he and Rhonda could identify the Self-Defeating Beliefs under the surface, like Perfectionism, Perceived Perfectionism, the Approval Addiction, Superwoman, and more. This is because there are two goals in TEAM-CBT. The first goal is to crush the negative thoughts in the here and now, so that you’ll feel relief. The second goal is to modify the Self-Defeating Beliefs so you’ll be less prone to similar thoughts and feelings in the future. In next week’s podcast, you will hear the second half of the session, which included A = (Paradoxical) Agenda Setting and M = Methods. You’ll also hear the final T = Testing to find out how effective the session was, and how Rhonda rated David on Empathy and Helpfulness. I think you’ll find that both sessions are incredibly inspiring and wonderful sources of learning as well. I want to give a shout out to Rhonda for being so courageous and vulnerable and real, and for making this live therapy session possible! After you’ve heard Part 2 next week, let us know what you think! You’ve all responded very positively to the live therapy we’ve done on the Feeling Good Podcasts, and you’ve asked for more. Rhonda and I are committed to making that happen for you, and we are both so grateful for your support, which means a lot to both of us. Thank you! David and Rhonda  

Are the rapid changes real? And do they last? In the Spring of 2017, we published our first live TEAM therapy session so our listeners could peak behind closed doors to see an actual TEAM therapy session. Although the session lasted about two hours, we broke it up into seven consecutive podcasts including expert commentary on each segment of the session. If you have not yet heard them, they were Feeling Good Podcast #29, published on April 10, 2017 through Podcast #35, on May 1, 2017 which was exactly two years from the time today’s podcast was recorded. My co-therapist for this session was Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mt. View, California. Our patient was a physician named Mark who’d had two goals for his life when he was growing up. The first goal was to become an outstanding doctor. The second goal was to have a large and loving family. At the start of the session, Mark confessed that although he’d achieved his first goal, he’d failed to achieve his second goal because he wasn’t able to get close to his sons, especially his oldest son. At the start of the session he rated his relationship with his son on the Relationship Satisfaction Scale as only 2 out of 30, an extraordinarily low score. In addition, his scores on the Daily Mood Log indicated he felt very sad, unhappy, guilty, and ashamed. He also felt very inadequate, lonely, self-conscious, discouraged and defeated, frustrated, and somewhat resentful and upset, too. He confessed that he’d felt this way for years. By the end of the session, these feelings had largely disappeared, and Mark was in a state of joy. In fact, we all felt elated—but will it last? Many people complain that the rapid and dramatic change I experienced when I do TEAM therapy cannot be real, and cannot last, and that it has to be superficial or fake. They insist that real change can only unfold slowly, over years, or even after a decade or more of talk therapy. I respect critical thinking, and if you’d told me that such rapid and dramatic changes were possible ten years ago, before TEAM had emerged with all the new technology, I would have thought you were a con artist too! Of course, others have argued the other side of the coin, pointing out that TEAM is research-based and genuinely appears to represent a significant, or even amazing breakthrough in psychotherapy for depression and anxiety, and that the changes ARE real. They have also argued that rapid change should be the goal of treatment, rather than just nursing people along for prolonged periods of time without tangible and measurable changes. Rhonda and I had the wonderful opportunity of sitting down to interview Mark this last Sunday, following one of my Sunday hikes, so we could try to get some answers to these questions. We asked Mark whether he now felt that the changes were real, and how he’d been doing in the two years since the session. Did the changes last? The interview with Mark was pretty mind-blowing. He confessed that at the start of the session he, too, was very skeptical that years and years of negative feelings could be reversed in a single therapy session. Then he summarized the session he’d had with Dr. Levitt and me in May of 2017, and his tears flowed once again, as he recalled his feelings of failure at being unable to connect with his sons. Rhonda asked Mark what happened after the session. Did he just relapse back into the same way he’d been feeling? Mark said that right after his session, there was an amazing and almost instantaneous transformation of his relationships with all of his sons. He used the Five Secrets of Effective Communication for the first time in his interactions with his sons, and they opened up immediately. He has felt extremely happy, over joyed, really, and reported that: The changes were VERY real! The changes DID last. His relationships with his children and grandchildren are now fantastic. Rhonda and I are incredibly indebted to Mark for giving us such a transformative and inspiring interview! It probably won’t quiet all of the critics, but this information may be illuminating and inspiring for those who are intrigued by the many new developments in TEAM-CBT. And my message to those who are still critical of TEAM, or critical of me—please continue to use your critical thinking and skepticism when you evaluate TEAM or any other approach. It was my own skepticism about the things I learned during my residency training and clinical work that actually led to the emergence of TEAM therapy. I don’t want to quiet my critics, I want to praise all of you! David and Rhonda Coming Up Soon Follow-Up with Gary: Rhonda and David interview Gary, a veteran who David treated for PTSD several years ago at a trauma workshop. Gary describes how a repressed horrific memory from his childhood suddenly and forcefully re-emerged when he smelled some Queen Anne’s Lace that were in blossom, and what he experienced during his TEAM-CBT session with David. Can severe PTSD be treated in a single therapy session? You’ll find out when you listen to this amazing and emotional interview with Gary!

Do I have ADHD? Is it a real disorder?  Hi podcast fans, Today we've got some terrific questions that you have submitted. General Questions Jose and Bri both asked: How would you treat hypochondria? Christian: How would you treat an abuse survivor? I’ve heard that talk therapy is inadequate for healing trauma! Ted: Is there such a thing as healthy euphoria? Hillary: Would you do a podcast covering the treatment of mania? Jim: I think I have ADHD, but some doctors claim it’s not a true diagnosis. What do you think? Dan: What your thoughts are on LSD in the treatment of depression and anxiety? I could not get to all of your excellent questions in the time provided. The next time we do Ask David with general questions, we will include these: Guy: What’s a nervous breakdown? Rob: How would you treat a field goal kicker who’s afraid of missing the winning field goal? Would you use positive visualizations? Michael: How would you treat someone with the fear of aging? I turn 60 in a few months! Hidem: How fast is fast? You seem to get super-fast recoveries from your patients most of the time. How about other therapists? How rapidly does the average patient recover>  Rubens: What you can do when you're upset but can't identify any negtaive thoughts? Next week, our Ask David will focus on questions about relationship conflicts and problems. Rhonda and I have lots of other cool programs planned in upcoming weeks. Thanks for tuning in today, and over the past months. We will hit one million downloads in a week or two (this is April, 2019). Rhonda, Fabrice, and I deeply appreciate your support! David and Rhonda

What's Bibliotherapy? Hi podcast fans,David and Rhonda discuss and old controversy: Can a self-help book can really help? Or will you need psychotherapy and / or an antidepressant if you are seriously depressed? [gallery ids="60,357,58,54,51,50,42" type="rectangular"]   I (DB) wrote up the following overview of bibliotherapy research prior to today’s recording with Rhonda. I hope you find it interesting! I have to admit that I’ve never had much respect for self-help books. Many of them seem to be written by narcissistic individuals with pretty superficial ideas who mainly want to promote themselves, and this has been my strong bias as well. When I pick one up in a bookstore, I nearly always get immediately turned off. And I get a flood of them in the mail as well, from authors asking for an endorsement. I have a policy of not doing book or product endorsements—it’s the easiest way to say no. And I never thought of my book, Feeling Good: The new Mood Therapy, as a self-help book. My idea was that people receiving cognitive therapy could read it between sessions as a way of speeding up their recovery, so that the therapist could do the individual work and not have to do so much teaching about the basic concepts, like my list of ten cognitive distortions. But at the same time, shortly after the book was released, I began getting letters, and later on emails, from individuals who said they book had actually caused them to recover from pretty severe depression. In fact, over the years, I would guess I’ve received more than ten thousand letters or emails like that, and probably way more than that, maybe even fifty thousand. Still, it had not occurred to me that it might actually be a self-help book, in spite of the fact that lots of the people who wrote me said the book had helped them much more than the treatments they’d received over the years. One day a colleague asked if I’d seen the article about my book in the New York Times. Apparently, Dr. Forrest Scogin, a research psychologist from the University of Alabama Medical Center, had studied the effects of reading a self-help book on patients seeking treatment for moderate to severe depression. In a nutshell, their studies indicated that simply reading Feeling Good may help some patients overcome depression and may help to prevent future relapses as well. This finding was a shock, but was not entirely unexpected due to all the testimonials I’d been received from people who’d read the book. In their first study, Dr. Forest Scogin and his colleagues told patients seeking treatment for depression that they’d be placed on a four-week waiting list before beginning treatment. Half of the patients were given a copy of either my Feeling Good or a self-help book on depression by Dr. Peter Lewinsohn called Up from Depression. The researchers suggested that the patients could read their book while they were waiting for their first appointment with the psychiatrist. The other half of the patients who were placed on the four-week waiting list did not receive a copy a self-help book. Both groups of patients were contacted each week by a research assistant who administered a test to assess the severity of depression. The goal of course was to find out if there were any changes in depression in any of the patients. The results of the study were interesting. Approximately two-thirds of the patients who received one of the self-help books improved or recovered from depression during the four weeks, even though they received no other treatment with drugs or psychotherapy. In fact, they improved to such an extent that most of them did not even need any further treatment. In contrast, the patients who did not receive one of the books failed to improve during the four-week waiting period. As far as I know, this was the first time that the anti-depressant effects of a self-help book had ever been documented in carefully controlled research study published in a scientific journal. Then the researchers did a number of additional experiments. First, they gave a copy of one of the two self-help books to the patients in the second group who had not improved. They asked them to wait four more weeks before beginning treatment, but suggested they read the book during their wait. Two-thirds of them also improved and did not need further treatment. This study was published in the medical journal, Gerontologist. Some critics challenged the study, arguing that the improvement in the patients who received the self-help book might have simply been a placebo effect. In other words, maybe it was just the reading, and the expectation of recovery, that helped, as opposed to the ideas and techniques described in the books. To test this, the investigators studied a new group of patients who were asked to read a “placebo” book while waiting for treatment. The researchers chose a classic book by Victor Frankl called Man’s Search for Meaning. If these patients also improved, it would confirm that the effect of reading on mood was simply a non-specific “placebo” effect. This is incredibly important, because almost any type of intervention can have a placebo effect, so that as many as 35% of patients will improve just because they think they’ll improve. Surprisingly, the patients who read the Victor Frankl book did not improve. This exciting finding indicated that a self-help book can have a specific and fairly strong antidepressant effect, but that the book had to contain sound information that was actually helpful to individuals with depression. Finally, the investigators also did several careful follow-up studies on these patients to find out if the antidepressant effects of Feeling Good and Up from Depression would last. In several additional publications, they reported that these patients did not relapse but maintained their improved moods for periods up to three years, and that they actually continued to improve following their initial Feeling Good “bibliotherapy. However, they did not report that they were happy all the time. But when they hit bumps in the road, most of them picked up the book again, and re-read the sections that had been the most helpful, and then quickly recovered again. It’s great that two thirds of the patients improved so rapidly. This result is at least as good as the effects of antidepressants or treatment with psychotherapy—and it’s far cheaper, and with no side effects either! But at the same time, one third of the patients did NOT improve. And of course, you see the same thing with treatment of depression by a psychiatrist or psychologist. In fact, recent research indicates that only 50% of patients, AT MOST, improve with professional treatment. In my research, I’ve attempted to figure out what’s different about the patients who do not rapidly recover when treated with psychotherapy or Feeling Good bibliotherapy. And I believe I did find out why. To learn about that, you’ll have to listen to the Feeling Good Podcasts or read my new book, Feeling Great, when it comes out. Hopefully fairly soon! I was pretty inspired by the terrific and important research by Forrest Scogin, and want to thank him! If you or your patients would like to read one of my “self-help” books, the following table will show you which books are best for which kinds of problems. The reading list at the end is for individuals who might like to check out the original studies by Dr. Scogin and his colleagues. Thanks! David and Rhonda Book Topic / Problem Feeling Good: The New Mood Therapy Mild to severe depression The Feeling Good Handbook Depression and anxiety When Panic Attacks All anxiety disorders Feeling Good Together Relationship Problems Intimate Connections Dating Problems Ten Days to Self-Esteem This is a simplified ten-step program to overcome depression and boost self-esteem. it is effective individually or in support groups. Bibliotherapy Research Ackerson J, Scogin F, McKendree-Smith N, Lyman RD (1998) Cognitive bibliotherapy for mild and moderate adolescent depressive symptomatology. J Consult Clin Psychol 66: 685-690. Floyd M, Rohen N, Shackelford JA, Hubbard KL, Parnell MB, et al. (2006) Two-year follow-up of bibliotherapy and individual cognitive therapy for depressed older adults. Behav Modif 30: 281-294. Floyd M, Scogin F, McKendree-Smith N, Floyd DL, Rokke PD (2004) Cognitive therapy for depression: a comparison of individual psychotherapy and bibliotherapy for depressed older adults. Behav Modif 28: 297-318. Jamison C, Scogin F (1995) The outcome of cognitive bibliotherapy with depressed adults. J Consult Clin Psychol 63: 644-650. Mains JA, Scogin FR (2003) The effectiveness of self-administered treatments: a practice-friendly review of the research. J Clin Psychol 59: 237-246. McKendree-Smith NL, Floyd M, Scogin FR (2003) Self-administered treatments for depression: a review. J Clin Psychol 59: 275-288. Scogin F, Floyd M, Jamison C, Ackerson J, Landreville P, et al. (1996) Negative outcomes: what is the evidence on self-administered treatments? J Consult Clin Psychol 64: 1086-1089. Scogin F, Hamblin D, Beutler L (1987) Bibliotherapy for depressed older adults: a self-help alternative. Gerontologist 27: 383-387. Scogin F, Jamison C, Davis N (1990) Two-year follow-up of bibliotherapy for depression in older adults. J Consult Clin Psychol 58: 665-667. Scogin F, Jamison C, Gochneaur K (1989) Comparative efficacy of cognitive and behavioral bibliotherapy for mildly and moderately depressed older adults. J Consult Clin Psychol 57: 403-407. Smith NM, Floyd MR, Jamison CS, and Scogin F (1997) Three-year follow-up of bibliotherapy for depression. J Consult Clin Psychol 65: 324-327.

This is the second of two podcasts on the Story of Sherrie, who experienced some of the symptoms of PTSD after a traumatic event involving her husband. In the first podcast, we played the T, E, and A portions of the session. In this podcast, we will play the M = methods as well as the conclusion of this amazing session.  Dr. Rhonda and I will make some teaching comments on the session as well. If you'd like to see Sherrie's end-of-session Daily Mood Log, click here.  After the session, Sherrie received some notes from others in the audience. Sherrie,  I think what stood out for me in that session was your authenticity. No mask, no defenses. I fell like we can't really appreciate what our clients are doing when they open themselves up to face their fears until we do it honestly ourselves, and you did--in front of all of us! I feel it was a gift you gave us and I thank you! Candice  Here's another note for Sherrie: Sherrie, You Rock--I love you--and never met you before tonight. :)  You cried. You laughed. You said No.  You said Yes.  You woke up! You're a Brave Woman! What a lucky husband you've got! Thank you. A sister, a colleague,  Rita And another. To Sherrie Your session--that was brave! Shows strong commitment to yourself and to the people you work with. You will be more effective stronger, real, fee, and go even deeper with your clients. Mary If you want to send a message to Sherrie, use the comment feature below, and I will be sure to forward your thoughts to her!  When people learn about the incredibly rapid recoveries that I am so often seeing with TEAM, they always ask about whether the effects last,or whether the dramatic changes are just a flash in the pan. Of course, Relapse Prevention Training is critical, as negative thoughts and feelings will tend to come back over and over for all of us. That's just part of the human experience. And if you know how to deal with these occasional "relapses," you don't have to worry about them, because you'll know how to crush the negative thoughts and feelings pretty fast.   At any rate, Sherrie's session was more than three years ago, and here's an email I got from her a couple weeks ago: Hi David. I always enjoy hearing from you! I agree for you to show the video at the summer intensives, I am actually quite proud of it all so have nothing to hide! You can also do it as a podcast, whatever is workable. I have looked at the podcasts you sent and they look wonderful so will certainly listen to what I can over time! Okay, so for an update and thank you for asking.  The year after my cancer, my husband had his heart attack, so that was four years ago. He is, thank G-d, wonderfully healthy. There is no heart damage and he can do everything he wants to do. And he is even getting better at taking his pills, so I don't have to remind him so much. I have a question for you as what you do is not what I can or want to do. I think you said you were 75 when we met in the training. So what I don't get is how do you have the energy to see clients, write books, do podcasts, travel all over and do workshops etc? How do you fit all that in? You must want to! All the best and enjoy spring! Sherrie Thanks for listening! David and Rhonda Oh, my secret is that I am almost always doing what I want to do. Teaching and treating colleagues with TEAM give me tremendous energy, except when I screw up, which is fairly often! But I'm used to making errors by now, and I really love what I do, so I don't think of it as "work," but more like having fun hanging out with friends. It is a bit like when you were a kid and got to go out and play after dinner! That was THE BEST!  

Hi Podcast Fans, There have been many requests for more podcasts on how we would treat trauma, using the TEAM-CBT model. I have done at least 25 workshops on the treatment of trauma in the past several years, and always do a live therapy demonstration at the end of day 1, so people can see with their own eyes how TEAM-CBT actually works. About three years ago, I did a live demonstration with a wonderful woman named Sherrie who was extremely anxious about a traumatic event involving her husband a year earlier. Sherrie kindly and courageous gave me permission to share the audio tract with you. I think you'll really enjoy the session! I want to thank Sherrie for giving us this gift! I also want to thank my co-therapist during the session, Mike Christensen, who is Canada's top expert in TEAM-CBT. Here's our photo at the workshop: While you are listening, you may want to take a look at Sherrie's Daily Mood Log, which describes the trauma, along with her negative thoughts and feelings. We will publish the first half of the session in this podcast, and the end of the session in the next podcast. We'll also include a live, three-year follow-up with Sherrie that we recorded recently. Dr. Rhonda and I will make some teaching comments on the session as well. David and Rhonda

Rhonda, Fabrice and I received a number of thoughtful emails following our recent podcast on mindfulness meditation, which seems to be quite popular these days, but there some push-back from listeners who all did not agree that mindfulness is an effective way of combating negative thoughts and feelings. Email from Jeremy Hi David, I listened to the Feeling Good Podcast on meditation this morning and had some thoughts I wanted to share. For context I've been meditating daily for about 3 months. First - I personally think that if someone is struggling with depression or anxiety, TEAM-CBT is a dramatically faster acting and more powerful tool than mindfulness. I've never seen or heard about someone having a dramatic recovering in just a few hours due to mindfulness. I've never seen the idea of resistance explored in any kind of mindfulness book or article. I also don't really think much of mindfulness as a "method" in the TEAM model, because compared to the other methods for removing negative thoughts it's extremely weak. I imagine that with hundreds of hours of mindfulness practice you might reach a point where it's easier to let go of negative thoughts. (There are a lot of reports like that/) However, it's a very slow way of dealing with negative thoughts compared to externalization of voices etc.  I think for a therapist who knows TEAM to suggest mindfulness as a key practice to their patient is almost negligent, since TEAM is so much more effective. That said, I've sensed a few benefits of mindfulness which is why I've been investing my time in it: - I think you can view meditation as concentration practice, and I've found that meditation increases my ability to concentrate  - You can reach a very calm and relaxed state in meditation where you cease to have thoughts, and this state is extremely pleasurable - I've noticed that mindfulness increase my ability to enjoy experiences, including experiences I might enjoy less if I was having even positive or neutral thoughts. As an example, after about 30 minutes of meditation the other day I went for a walk in the woods and stop for about 10 minutes to look at a ridge. My visual experience was completely immersive and I even started to feel like the trees were breathing with me. It was one of the high points of my week. I suspect that even someone who had no negative thoughts might be flooded with positive but irrelevant thoughts (like a yummy meal they might be headed to eat later) would have enjoyed this scene much less.  I've also run an experiment using the PAS and CBT to remove the motivation to have distracting thoughts. (ie write down the advantages to having distracting thoughts and disadvantages of focusing on the breath, and then talk back to those) I would classify it as a highly successful experiment, after talking back to all the good reasons to think about something besides my breath my focus got dramatically better. I wonder if this technique could be used to either improve meditation or even supplant the need for it. (because it gets rid of distracting thoughts directly, while meditation is basically practice for having fewer distracting thoughts)  Anyway, just thought I would share some thoughts and ideas with you.  Best,  Jeremy Email from Paul Hey, Dr. Burns! I am with you in terms of the skepticism of mindfulness as a panacea. I also am not sure how particularly effective it is even as a tool in the fight against negative thoughts. I personally cannot seem to get anything out of it, but I am trying to make sense out of how so many people can find it useful. Perhaps you could put it like this: Mindfulness is not a specific technique for specific problems, but a general method for psychological health. If you have a specific medical condition, you'll want to get a specific treatment. Sometimes specific conditions can be alleviated by taking care of your health generally (eating healthier, sleeping better, etc.) Still, depending upon the disease, in order to get rid of it, you'll need a specific treatment. However, even when you're not dealing with a specific disease, generally good health practices can lower your chances of getting any diseases and lessen the severity when they do arise. In sum, perhaps the goals of mindfulness and CBT are different. I think that might respect what both you and Fabrice are getting at. I think this goes to answer partly a question I've had about TEAM. To what extent is alleviation of anxiety, depression, etc the final goal? Are there religious, spiritual, or psychological problems that are positive goals beyond relief? In Feeling Good, it sounded like you thought that happiness was just the absence of depression. Is that all there is to say about human flourishing? Or do you methodologically stick within the parameters of your client's value system, asking only "what can I help you with" because you're a psychologist and not a priest, for example? Paul David and Rhonda discuss several important points raised by these listeners, including: Non-specific vs. / specific interventions. David describes an elderly man named Ezekiel who had escaped from Nazi Germany as a teenager, and still felt like a “totally worthless human being” in spite of incredible success in life. He’d start out shining shoes on the streets of New York City) and end up as a wealthy industrialist, but that did nothing to boost his self-esteem. He’d decades of psychotherapy as well, but it was not effective. David encouraged him to jog long distances daily to boost the release of “endorphins” in the brain, but that did not work either. Nor would medication or meditation have worked, either. When you learn why Ezekiel felt like a “worthless human being,” you’ll see exactly why! And you’ll also learn what did work to end decades of suffering and self-doubt. The time required for meditation, not only during sessions, but in between sessions, is considerable. David would prefer his patients use this time for doing specific psychotherapy homework. Formulaic treatment. Life has always been stressful, and people are always looking for some simple “solution” to emotional problems, which seem almost universal. The current wellness fad is a great example of that. So, people promote a healthy diet, daily exercise, daily meditation, daily prayer, relaxation training, deep breathing, expressing gratitude, and a host of other things as the secret of happiness and contentment. These formulas, in my opinion (DB), do not have, and will never have, more than a placebo effect in the treatment of stress. depression, anxiety disorders, relationship problems, and habits and addictions. Sadly, those who are hugely enthusiastic about one of these fads, or formulas, will not want to hear what I just said, as sometimes we just don’t want to have our beliefs challenged. We see this resistance in politics, in religion, and in almost every aspect of our lives. Mindfulness is already a TEAM technique, even without meditation--but not a terribly effective method, in David's clinical experience. However, for certain kinds of recurrent negative thoughts, Self-Monitoring and Reattribution can be helpful. These techniques are similar to Mindfulness Meditation, but are only two of more than 100 Methods David uses in treatment, and they are not for everybody. David gives an example of the intensely anxious eye doctor with OCD who was afraid of going blind, who responded to Self-Monitoring and Response Prevention. There’s nothing wrong with a healthy diet, or meditation, or prayer, or anything that you enjoy, anything that gives you a sense of meaning. But these non-specific approaches should not be confused with specific treatments for depression, anxiety disorders, conflicts in relationships with others, or habits and addictions. Thanks for listening! David and Rhonda

How to Overcome Shyness In a recent podcast, David and Rhonda emphasized the importance of specificity--selecting one specific moment when you want help. This is very true in the treatment of shyness.  Jason, who we introduced in the last podcast, wanted to work on the intense anxiety he felt in the locate grocery store. He thought the woman checking groceries was attractive, but he was terrified about talking to her, or trying to flirt. So he said nothing, and left the store feeling like a failure.  After this humiliating experience, he filled out a Daily Mood Log and listed all the Negative Thoughts and feelings he'd had while waiting to check his groceries. After doing Positive Reframing, he decided on the Negative Though he wanted to work on first: “People will think I’m a self-centered jerk if I try to flirt with her.” David and Jason put this thought in the Recovery Circle and selected more than 20 techniques Jason could use to challenge thought.  On the podcast, David and Rhonda illustrate how to challenge that thought using many of the methods listed on the Recovery Circle, including: Identify the Distortions. They found all ten distortions in this thought. The Straightforward Technique. This technique was not effective, since the Positive Thought Jason came up with was not valid, and it did not reduce his belief in the Negative Thought. However, this technique did reveal something important about Jason—he seems to see the world in an adversarial way, and imagines he is in competition with others who will try to put him down. The Cost-Benefit Analysis. What the are Advantages and Disadvantages of Jason’s Negative Thought? Jason did a remarkable job with this technique, and found it helpful and illuminating. The Individual Downward Arrow Technique. David and Rhonda illustrated how this works, using role-playing. They were able to identify five of Jason’s Self-Defeating Beliefs that are extremely common in Social Anxiety, including: Perfectionism Perceived Perfectionism The Approval Addiction The Spotlight Fallacy The Brushfire Fallacy The Paradoxical Double Standard Technique. What would Jason say to a dear friend who was also struggling with severe shyness? Would he say, “People will think you’re a self-centered jerk if you try to flirt with her.” If not, why not? What would Jason say to a friend? And would he be willing to talk to himself in the same compassionate way? This technique was also very helpful to Jason. Examine the Evidence. What’s the evidence that people will think he’s a self-centered jerk if he tries to flirt with a young lady he’s attracted to? Survey Technique. Have his friends ever struggled with anxiety when they were starting to date? Would they think of him as a “self-centered jerk” if he was more outgoing and flirtatious? This was a homework assignment, to ask his friends. The information he got was a huge surprise. Thinking in Shades of Gray. He thinks he has to sweep her off her feet or he’ll get totally rejected and ostracized by the human race. Is there some easier goal he could shoot for? He’s telling himself that if she shoots him down, it will prove that he’s a “loser.” Are there other reasons why a grocery checker might not respond favorably to a young man who is trying to flirt with her? Feared Fantasy / Acceptance Paradox. David and Rhonda illustrate this amazing technique, with role-reversals. This technique will help Jason crush the Self-Defeating Beliefs that cause his shyness in the first place, like the Approval Addiction. These techniques were extremely helpful to Jason, and all of his negative feelings went down dramatically by the end of his first therapy session. However, he will have to do more work outside the office for homework, using Interpersonal Exposure Techniques to confront his fears of rejection, including: Smile and Hello practice Flirting Training Talk show Host Rejection Practice Self-Disclosure Shame Attacking Exercises These assignments terrified Jason, but he courageously agreed and followed through. He had his share of rejections, as we all do, but had some successes, too, and soon was dating a lot and enjoying it, and his shyness became a thing of the past. The treatment only required four sessions.  

How to Overcome Shyness David and Rhonda begin with two emails (among many) from listeners asking for more help on the problem of social anxiety. Email from “Margaret:” Hi David, How do you distinguish a personality disorder - say, for example, Avoidant Personality Disorder, from "just" (and I don't mean that in a derogatory way) being depressed and anxious? I ask because I have a strong suspicion that I may be suffering from Avoidant Personality Disorder, and I think if you knew my history you would probably agree that there are strong signs (I have been having problems from my early childhood until now, and I am 30 years old now). Also, a further question – is it possible to have severe anxiety without feeling like the confrontation with the thing you’re afraid of means you’re going to die? I have isolated myself completely, and I have no social life in any sense of the word – my only real contact with the outside world is through my job, because it is a necessity for living. But it’s not because I think I’m going to die if I hang around people – I just very strongly dislike it and ‘shut down’ or ‘freeze’ due to all the thoughts in my head about being negatively judged and watched, so I prefer to avoid contact with people, and in situations where I’m forced to endure it, I’ll usually find ways to ‘avoid’ or escape the situation.  There are many ways I do this – since I was very young I’ve had the habit of purposely looking annoyed, so that people would not approach me, even though I secretly wish they would (oh, the paradox..), and at work I will often be listening to music with earphones – both because the music calms my anxiety, and because it makes me appear less ‘available’ to other people.  In situations where I cannot escape crowds – say, in the canteen during my lunch break - I’ll sit by myself, as far away from everyone else as I can, and leave as soon as I have taken the last bite of my food. In college I would often hide in the bathroom by myself during breaks, or I would avoid interpersonal contact in some other way. And so on and so forth. These are just a few examples – I could give you a million others.  I am aware of my own behavioral patterns but still feel powerless to change them. It’s like being an observer, observing yourself committing the same mistakes over and over, but with an anxiety so strong that rationality alone is not enough to change the behavior. After 30 years of this, it’s getting old. I have never felt any other way, so I cannot fathom what it means to lead a normal life. I have never had a friend in any usual sense of the term, and I literally never spend time with anyone in my spare time except for my parents. As a consequence, I have never learned or understood how to make friends, and I have never been in an intimate relationship, or taken part in any of the social activities that are normal to other people (parties, school dances, etc.) The simplest things are rocket science to me. So, I’m interested to know when a person crosses over from “simply” being depressed or anxious into having a personality disorder. If you use any of this for a future episode I am fine with that - you can even quote me directly. But I only ask that you please don't use my real name as to not jeopardize my job and so on. Thank you. 🙂 Kind regards, Margaret David explains that there is no such thing as “Avoidant Personality Disorder.” It is just an imaginary concept created by the American Psychiatric Association, and is applied to individuals with shyness that is so severe that it causes significant problems in their lives. And yes, you can definitely deal with mild, moderate, or even extremely severe problems with the TEAM-CBT as well as exercises in my books, such as The Feeling Good Handbook, When Panic Attacks, and Intimate Connections. They also read an email from “Abdul,” a podcast fan who’s been struggling with shyness. I’m from Pakistan. Please make podcasts on shyness and public speaking and other anxiety issues. I have anxiety shyness. My father has also anxiety. I know he is not happy. I also sometime feel exactly like him. And one of my cousins is very much depressed. He is a cleaner in a garments shop. He always use to pack clothes all the time even if they are kept properly. Dr burns please guide us. It would be very very helpful. Sorry if I wrote anything unprofessional. Thank you. Several days later, David received an additional email from “Abdul:” My social anxiety has returned back. In my office I feel very lonely.  Here my negative thoughts: I should say something impressive. I'm good looking so I should not be anxious. I should talk to girls. I should say hi to people. I should mix with people. Today and next week, David and Rhonda will describe how to treat / overcome shyness using TEAM-CBT. David explains that this is probably his favorite problem to treat, since he himself has struggled with every conceivable form of social anxiety, so he really knows how to defeat this problem.  But to start out, David and Rhonda want to see how shy YOU are, so they administered David's Shyness Test verbally to listeners. if you'd like to take the paper and pencil version, click here. You'll also find the scoring. How did you do on the Shyness Test? We'll publish them next week, too. You'll find Jason's Daily Mood Log, the Recovery Circle, the Downward Arrow Technique, and more. These visuals will help your learning! We always start with a Daily Mood Log, focusing on how you were thinking and feeling at a specific moment when you felt shy. We don’t just throw techniques at patients based on a problem (shyness) or diagnosis (Social Anxiety Disorder). We're all different, so the treatment is highly individualized.  Rhonda and David describe a shy young man  named Jason who wanted to flirt with an attractive woman checking groceries when he was inline at his local supermarket on a Saturday. However, he was flooded with Negative Thoughts and feelings, and by the time he got to the front of the line, he was so terrified that he avoided all eye contact with the checker, and didn't even say a word to her, when she checked his groceries. He left the store feeling like a total loser. David and Rhonda talk about reducing the Outcome and Process Resistance before trying to “help” Jason, or any one who's anxious. Outcome Resistance means that Jason may have some pretty strong resistance to recovery, in spite of how much he's suffered, even if all he had to do was to press a Magic Button and be instantly cured. Process Resistance, in contrast, means that if Jason does want to recover, he’ll have to use some Interpersonal Exposure Techniques that will be frightening to him. Is he willing to do that if David agrees to treat his shyness? David and Rhonda illustrate how to do Positive Reframing , listing all the really positive things about Jason's negative thoughts and feelings.  They encourage listeners to turn off the podcast briefly, and see if they can list some positives before listening to the list that David and Rhonda generated. I'd encourage you to do that, too, while listening. Try it yourself before you see the "answers." They discuss how they might issue a Gentle Ultimatum, along with Dangling the Carrot and “Sitting with Open Hands,” to reduce Jason’s Process Resistance.  Once Jason's resistance has been reduced, they will go on to the M = Methods of the session, and focus on how to help Jason challenge the Negative Thoughts that Jason had while standing in line waiting to check his groceries. Next week, they'll describe the methods they selected and describe what happened when David used them during his session with Jason.

Mission Accomplished! Dear Feeling Good Podcast fans, I am profoundly sad to say goodbye to my beloved friend and terrific podcast host, Dr. Fabrice Nye, who is leaving the podcast to start his own show this spring. I wish him well on his new podcast he'll be releasing soon. I'll share the specifics when they become available so loyal fans can tune in and follow him! What a joyous experience it has been working with Fabrice for the last three years. He proposed the idea of a weekly podcast in the fall of 2016 and we produced episode #001 on October 27 of that year. Together we have been able to share TEAM-CBT with many enthusiastic listeners, and just exceeded more than 70,000 downloads monthly. Please join me in wishing him well! My feelings of profound loss are comforted by welcoming another dear friend and colleague, Dr. Rhonda Barovsky, our new host. Rhonda and I look forward to creating many more fabulous podcasts for all of you. Rhonda received her doctoral degree in Forensic Psychology from the Eisner Institute for Professional Studies in 2013. Throughout her career, she has been a champion of women’s rights and defender of the victims of childhood sexual abuse. Rhonda is the founder of the San Francisco Juvenile Sex Offender Treatment Program and has served as Director of San Francisco Family Court Services. She has also worked at the San Francisco Rape Treatment Center, providing crisis and short-term counseling for adult survivors of sexual assault and their families. Rhonda is a certified TEAM-CBT therapist and esteemed teacher. In her clinical practice, she focuses on TEAM-CBT for adults struggling with depression, anxiety disorders, and relationship problems. She brings warmth, enthusiasm and brilliance to her new role as host of the Feeling Good Podcasts: "I am extremely honored to be invited to host the Feeling Good Podcast with Dr. David Burns. Fabrice Nye has been a visionary, and his shoes will be impossible to fill. I hope to add to the joy and excitement of learning and teaching TEAM-CBT along with David and having lively and productive discussions.” Dr. Rhonda Barovsky Rhonda and I will be posting two surveys shortly on my website, www.FeelingGood.com, to find out more about you. I want to find out if you are a therapist or non-therapist, and what kinds of topics might interest you the most. And unlike some tech giants, we promise to keep your information totally confidential. We don’t sell information; we just want to do the best job we can for therapists and non-therapists alike, for free. If you are a "patient," we want to accelerate your learning and your recovery as well. If you are a "therapist," we want to help you improve you skills and your joy in your clinical work.  I put the words, "patient" and "therapist" in quotes, because the line between the two is very narrow indeed! As "therapists," most of us struggle at times with the same human dilemmas that our patients face. And as we do our own personal work, as therapists, we bring far more healing and compassion to our work with our "patients!" On the show, Fabrice and David share fondest memories of the show, and Rhonda talks about new directions as she becomes the host of the Feeling Good Podcast. Fabrice also gives some hints about his new show, which will be broadcast in French and English. Fabrice will describe and translate new developments in psychology research and relate the findings to our daily lives.  Thank you so much for your awesome support over the past 2 ½ years!

Today’s Ask David questions. Do depression and anxiety result from medical illnesses, like thyroid problems? Do we REALLY create our own interpersonal reality? What if you’re being raped? Are you saying that’s your fault? How can that be? I struggle with anxiety. Why is it a mistake to try to “calm down?” How do you deal with entitlement? I think my patients should do what I tell them to do! After all, I’m a highly trained professional! How do you deal with racism, sexism, and other societal barriers? What if the injustice is real and it isn’t “all in your head?” And here are the longer versions. Fabrice and I hope you enjoy these thoughtful questions submitted by listeners like you! 1. Barbara asks: 1) How are hypothyroidism, depression, anxiety, and bipolar disorder related, and (2) how are heart disease, depression, and anxiety related? 2. Mark asks: I'm one of your most avid listeners to your podcasts. I've listened to most of Feeling Good Podcasts as well as the recordings of your Facebook live broadcasts with Jill. I absolutely love your content and extremely grateful for your insights and the material you put out for free. I've heard you say numerous times how in interpersonal relationship problems we create the poor behavior we see in the other. At what point though, is a threshold crossed and you acknowledge the other in the relationship is creating problems? For example, if your client is being raped by their partner and is being threatened with violence if they dare leave, you wouldn't say to your client you're creating that kind of treatment from your partner. Obviously the above is a very extreme example, but what if its scaled back in terms of severity of abuse, stopping short of physical attacks and threats? Where does a line in the sand get drawn where you acknowledge the client is not creating the problems themselves? I'd deeply appreciate your reply! 3. Angela asks: I was intrigued by your comment in your podcast #88 on Role-Playing Techniques that “trying to calm down is a big mistake. . . then your emotions become your enemies,” but then you said, “that’s a good topic for another podcast.” I hope you do a podcast on that topic!!! I’m eagerly waiting to hear more about that! 4. Julio asks: I’d like to share my experience. I am a therapist and I suffered from, and am still working on, feeling inadequate. I frequently questioned “am I good enough to be a therapist?” “How can I help others if I have issues of my own?” After reading Feeling Good I realized I frequently jump to conclusions, engage in mind reading, and labeling whenever there is some uncertainty with my clients. At times I might even have blamed them when things didn’t go the way I thought they should go. I believe I do that to protect my ego, and I might have developed some cognitive distortions related to entitlement such as “I’m a therapist, people are supposed to do what I say” “I worked too hard and too long and potential employers better give me what I deserve” “Because I practice evidence-based therapy, I’m better than 99% of all therapists.” These entitled thoughts led me to become irate whenever someone didn’t act according to my expectations. I would vacillate between feeling angry and feeling depressed. I guess when I initially emailed Fabrice I was confused as to how my entitlement develops, but now I’m realizing that it comes from the same distortions that can cause depression. I didn’t know that distortions could produce depression and entitlement. I’m curious what you and Fabrice think about this. I thoroughly what you and Fabrice think about this. I thoroughly enjoy your podcast and often find myself re-listening to earlier episodes. 5. Holly asks: “ Burns: I have found tremendous value in your books and podcast. I have noticed that you discuss some emails/letters/etc. on your podcast and I have one I'd like to hear you discuss. What are your thoughts on dealing with racism, sexism, and other societal barriers? For example, it is not uncommon for people with dominant identities (white, male, physically able) to tell women, people of color, or those with physical challenges that their issues are all in their minds and that if they thought differently, then they would have different outcomes. I am an African-American woman and I don't believe this (the statistics on access to education, employment, and justice all suggest otherwise). What are you saying (if anything) in your writing, practice about thoughts related to injustice? Best, Holly So there you have it! Great questions, and keep them coming! Thanks, David and Fabrice

Debbie asks: Can you use TEAM-CBT to help people with medical disorders, such as Parkinsonism or Cancer? Here is the promised link to Stirling Moorey's book on Cognitive Therapy for cancer patients. Here is the link the first episode of live therapy with Marilyn, a woman who was diagnosed with Stage 4 lung cancer a couple days before her session with David and Dr. Matthew May.  You may also want to listen to podcasts 50 to 52 and 59, which also feature David and Matt working with Marilyn. Marilyn described these inspiring podcasts as mind-blowing! Mark asks: How can I help a depressed family member or friend who is passive and doesn’t want to do anything? Paul asks: How can I get over death anxiety? Sune asks: If you're super-shy, does this mean you have “Avoidant Personality Disorder?” What's the difference between garden variety shyness and a personality disorder? Sly asks: “Do you believe in the big five personality traits model? And will your therapy tools change these big five traits? I got a score of 67 on neuroticism, which means I am more prone to anger, depression, anxiety, and vulnerability, and tend to think about things in a pessimistic way. If I do the exercises in your books, and develop a more realistic outlook on myself and others, does it follow that my “personality traits” will get more or less changed?” According to Wikipedia, the “Big Five” are O = Openness to experience, C = Conscientiousness, E = Extraversion, A = Agreeableness, and N = Neuroticism, often represented by the acronym, OCEAN. Here's an important point I forgot to make on the podcast. According to Wikipedia, here's  the definition of "Neuroticism:" People with high neuroticism indexes are at risk for the development and onset of common mental disorders. . .  such as mood disorders, anxiety disorders, and substance use disorder, symptoms of which had traditionally been called neuroses." Can you see that this is a tautology? In other words, they ask you if you tend to have these kinds of symptoms, then they tell you this is "due to" some "trait" you have called "neuroticism." But they are defining "neuroticism" as people who tend to have more of these kinds of symptoms! It's circular reasoning.  I hope you can "see" this! The reason I mention this is they make it sound like they discovered some "trait" you have which causes you to have depression, or anxiety, and so forth. But they haven't! It's just a word game. In fact, scientists don't yet know the causes of any of these problems, and "traits" do not actually "exist."  Haike asks: What if you’ve battled your negative thoughts and self-defeating beliefs and still don’t feel happy? An absence of depression and anxiety does not necessarily mean more joy in life. How can you help people find out where they want to go in life, who they want to be, and what it is that brings them happiness?”

If you’re my patient, and you want help, I will ask you what specific problem you want help with. These are the four most common problems I see: depression, anxiety, relationship conflicts, or habits and addictions. Then I’ll ask you to zero in on one specific moment when you were struggling with that problem. For example, if you want help with depression and low self-esteem, I’ll ask you to describe one moment when you were feeling down. It could be any moment at all—it might even be right now, sitting in my office (or reading this text). Then I’d ask you to tell me exactly what you were thinking and feeling at that moment. You might be telling yourself, “I’m no good. I shouldn’t have screwed up! I’m always doing that! I’ll feel like this forever.” These thoughts actually cause the feelings of depression, shame, inferiority, and hopelessness. In contrast, if you want help with anxiety, I will ask you to identify one specific moment when you were feeling anxious, worried, nervous, frightened or panicky. For example, you might have been feeling shy and insecure at a party, or terrified just before you had to take a test or give a talk at work. Or it might have been a moment when you were having a panic attack and feeling like you were on the verge of passing out or losing control and going crazy. If you’ve been having trouble getting along with a friend or family member, I would ask you to describe one brief interaction you’ve had with the person you’re at odds with, and I’d ask you to write down one specific thing they said to you, end exactly what you said next. For example, a podcast fan told me that his wife said, “You never listen.” He responded by saying, “That’s not true! I’m listening to you right now.” He was puzzled when she got even more upset and then the argument escalated! I recently did a one-day workshop on the treatment of unwanted habits and addictions, like procrastination, overeating, excessive cell phone use, or drinking too much. I encouraged the audience members to focus on one specific moment when they felt tempted to procrastinate, binge, or have a drink, or give in to their habit / addiction, and to write down all the Tempting Thoughts that were going through their minds, like: Oh, that beer looks SO GOOD! I’ve had a hard day, I deserve it. I’ll just take one little sip. That can’t hurt! There’s a good basketball game on TV. It will be way more fun to watch if I enjoy a few beers! In each case—of depression, anxiety, a relationship problem, or a habit / addiction—I focus on one brief and specific moment when my patient was upset and having that problem. There are two reason for this concept of Specificity: When we understand what was happening at that one brief moment, we will understand everything of importance about that problem. As it turns out, all of your suffering will be encapsulated in that one brief example. So, when you understand why you were feeling depressed or panicky or whatever at that specific moment, you will understand everything you need to know about why you get depressed, or panicky, or whatever at any moment of your life. In addition, the moment you learn how to change the way you were thinking, feeling at that one brief moment, you will become enlightened, and you will suddenly grasp the solution to all of your problems. That’s because that one specific problem will simply repeat itself over and over, in slightly different disguises, every time you are depressed, or anxious, or arguing with a friend or family member, or struggling with temptations. So, once you understand the solution to that problem at one specific moment, you will understand the solution to that type of problem at any time in your life. For example, if you were having a conflict with a loved one, you will not only learn how to resolve that conflict at that specific moment, but you will learn how to resolve any conflict you have with that person, or with practically anybody. Fabrice and David link this Specificity concept to the amazing insights of the new branch of “fractal geometry.” Fractal geometry is a revolutionary form of mathematics in which a very simple formula, or shape, gets reproduced an infinite number of times. In the process, it morphs from a simple geometric shape and suddenly becomes a complex picture. For example, it may turn into a stunning green fern, or a gorgeous, multi-colored parrot, or a breathtaking landscape. But if you zero in on the tiniest piece of the picture, it will always look exactly the same—the same simple design that started the process. Similarly, in “fractal psychotherapy,” we zero in on one very brief moment of your life, but the formula—or error—that caused you to become upset at that moment will always be the very same error you make every time you feet inferior or anxious or angry or tempted. And once you’ve changed at that one brief moment, you really will experience enlightenment! And your entire universe will become enlightened as well! Fabrice provides another metaphor, that of a hologram. A hologram is a photograph that allows to display a fully 3-dimensional picture of an object. The hologram works differently from a regular photograph. Citing from Wikipedia, “When a photograph is cut in half, each piece shows half of the scene. When a hologram is cut in half, the whole scene can still be seen in each piece.” This remains true as you fragment the hologram into smaller and smaller pieces. So you could say that your problem is a kind of hologram of all the problems in your life, in a single moment so you can see the pattern that is repeated in many other situations. David provides an example of how this works, using an example provided by a podcast fan we'll call Janine. Janine was convinced that her husband couldn’t deal with feelings because he had “Asperger's / high level autism.” David asked Janine for a brief simple exchange between Janine and her husband. what, exactly, did he say to her, and what exactly, did she say next? That brief moment is all we need to understand her problem; and things suddenly began to look radically different when we examined how she responded to her husband! You can see the first two steps of Janine's Relationship Journal if you can click here. It turned out she was right--someone definitely WASN'T dealing with feelings? But who? You'll see two spiritual principles brought to life in the Relationship Journal. We create our personal reality at every moment of every day. We like to blame others for the problems in our relationships instead of pinpointing our own role in the problem. Intimacy, and enlightenment, require a painful death of the ego, or self. When you "look inward" for the cause of the problem, instead of blaming, you will find the answer you've been looking for--but the answer can sometimes be pretty painful. If you're willing to let your ego, or "self," die, you will receive a pretty awesome reward in heaven. But this heaven occurs when you are still alive! You'll see Rhonda model a more effective response using the Five Secrets of Effective Communication, as well as one of the advanced communication techniques called "Multiple Choice Empathy."  

In this role-reversal of the traditional Feeling Good Podcast, Dr. David Burns and his special guest, Dr. Rhonda Barovsky, interview Dr. Fabrice Nye, your beloved podcast host, on the topic of Mindfulness and Meditation, which are currently popular with the therapeutic community. Fabrice answers questions like these: What’s mindfulness? How does it differ from meditation? What’s the history of mindfulness as well as meditation? Did it originate with the Buddha, or did it date back even earlier? What are some of the goals and potential benefits of mindfulness? Why specific exercises can you do to develop greater mindfulness ? Why is mindfulness helpful? How does it work? Some people meditate in silence for prolonged times, like ten days, for example. What is the goal here? Are there any dangers of meditation? How does mindfulness differ from yoga, relaxation training, and self-hypnosis? Some people seem to love and benefit from meditation, and others find it uninteresting or even annoying. Why is this? What's the difference in these two groups of people? Is it okay not to be interested in meditation, or is something that everyone “should” do? The goal of mindfulness seems to be learning to deal more effectively with stressful thought and feelings. Does it deal with motivation and the resistance to change? TEAM-CBT makes us aware of the incredible importance of resistance, and provides many methods for reducing or eliminating resistance before you try any Method to “help” the patient. Does Mindfulness Meditation deal with resistance, or would it best be viewed as a method that can help individuals who are already strongly motivated to invest time and effort in their personal growth?

You CAN Defeat Shyness! Lately, I've gotten lots of emails from podcast fans who struggle with shyness, which is categorized in DSM5 (The Diagnostic and Statistical Manual of Mental Disorders) as "Social Anxiety Disorder." This is one of my favorite things to treat, since I struggled with practically EVERY type of social anxiety early in my life, so I really know how it feels and how to defeat it. It's incredibly common. In fact, when I give workshops for mental health professionals, I sometimes ask how many of them have struggled with shyness or public speaking anxiety, and nearly all the hands go up. This podcast will be the first of several on this topic, because it's so common and relatively easy to overcome--IF you have the courage! Here the are several different "flavors" of social anxiety recognized by the American Psychiatric Association, including: Shyness Public Speaking Anxiety Performance Anxiety (such as intense anxiety during a musical or athletic performance) Shy Bladder (or Bowel) Syndrome. This is the fear of peeing or pooing in a public restroom, for fear you'll freeze up or make too much noise and others will notice. Test Anxiety One common theme is the fear that others will notice your anxiety or poor performance and judge you. Another common source of suffering is shame of feeling like you are inherently flawed and will be seen as defective or even as insane by others. Sometimes, these fears become so extreme that they can significantly interfere with relationships and leisure-time activities as well as work. Dan is a podcast fan who courageously immigrated to the United States from Iran as a young man. When he arrived in America, he had little education and almost no knowledge of English. He also suffered from an extreme case of acne, which eventually cleared up, but left him with severe social anxiety. In spite of these problems, Dan worked hard, learned English, and became a top student in college and in graduate school as well, and went on to develop an excellent career. But in certain performance situations, such as public speaking or interacting with strangers, he panics and trembles and his heart races; his mouth twitches and his voice gets shaky, and he has thoughts like these: I'm about to lose control over myself. Others will see my symptoms and think I'm mentally insane. In spite of making Herculean efforts to control these symptoms, I have failed. I will never overcome this. I am defective for life. I will lose my job. David and Fabrice remind listeners that they cannot treat anyone through a podcast, and that there are large numbers of treatment techniques that can be extremely helpful in the context of a compassionate and skillful therapeutic relationship. Since Dan is seeing an excellent therapist, they suggest and illustrate five powerful Interpersonal Exposure Techniques that Dan might want to do under the supervision of his therapist, including: The Survey Technique Self-Disclosure The Experimental Technique Shame Attacking Exercises The Feared Fantasy Technique David and Fabrice also discuss how to address patient and therapist fears of using powerful exposure techniques, and how the avoidance of exposure can sabotage the treatment. They describe four techniques David as developed to help therapists with this, including: Dangling the Carrot The Gentle Ultimatum Sitting with Open Hands Fallback Position David describes "Reverse Hypnosis." This is where the patient hypnotizes the therapist into giving up on exposure thinking that it is "too dangerous," or that the patient isn't "ready" or is "too fragile." And speaking of anxiety, listeners might want to consider the upcoming workshop by David and his colleague, Dr. Jill Levitt, on the treatment of anxiety disorders on May 19, 2019. Check it out below! Also, I promised to post my list of 100 Shame Attacking Exercises, so here it is! It's not perfect, so please have low expectations. It does have some value.

Can the Five Secrets of Effective Communication Help Us in this Era of Intensely Polarized Politics? Clearly, the nation is intensely divided, and passions on both sides of the political divide are characterized by hostility, frustration, and mistrust. Can the Five Secrets of Effective Communication help us communicate with colleagues, friends and loved ones who may have radically different political beliefs? Find out on this edition of the Feeling Good Podcast, as the David and Fabrice respond to Eileen, a podcast fan who kindly allowed us to share her intensely painful conflict with her mother with all of you. Eileen’s mother is an ardent Trump fan, and Eileen is an equally ardent anti-Trumper, and there have been plenty of tears on both sides of the aisle! Eileen wrote: “How can you talk to someone with whom you fundamentally disagree? My Mom is a big fan of the current regime (Trump) and I’m horrified by what’s happened in the past two years and what’s coming. It’s hard for me to get past my rage at her. . . intensely distorted and not-reality based beliefs, fed by right-wing media. To be clear, she thinks exactly the same about my beliefs and information sources. I feel so stuck. . . and I would love to repair this relationship with her before she dies.” Can you identify with similar conflicts in your own family or circle of friends? I know that I can, and it’s quite painful. Fabrice and I will give you our take on a new approach to this widespread problem this Sunday! While you're listening, you can take a look at Eileen's Relationship Journal. You may also want to review the Five Secrets of Effective Communication as well as the three advanced communication techniques we discussed in last week's podcast. Let us know what you think after you've listened to the podcast!

Learning to use the Five Secrets skillfully requires strong motivation and lots of practice, but the benefits can be tremendous. The Five Secrets have transformed my clinical work as well as my personal and professional relationships. And they’ve also had a huge impact on my teaching. But there are even more communication techniques that can be immensely helpful. In this podcast, we discuss three advanced techniques: Changing the Focus. This technique can be tremendously helpful when there’s an “elephant” in the room. Multiple Choice Empathy. This technique can be transformative when you’re trying to connect with a teenager, friend or loved one who refuses to talk to you. Positive Reframing. This technique can be invaluable when you’re fighting with a colleague, patient, friend or family member, and you’re both feeling frustrated, angry, and upset. David emphasizes that these techniques may look easy, but they are actually difficult to learn and require lots of practice as well as the mindset of humility, as well as a strong desire to develop a more loving relationships with the person you’re not getting along with. People who are serious about learning can read Feeling Good Together and do the written exercises while you read!

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

I hope you've enjoyed these episode on Common Therapist Errors, and I apologize in advance if any of the ideas I'm proposing in today's podcast seem "over the top" or simply off base. I teach with great passion, but I'm not always right! Fortunately, my esteemed host, Dr. Fabrice Nye, challenges me quite a bit, and he is almost always right. Hopefully, you will enjoy our dialogue and the chance to think a bit more critically about psychotherapy.  And when you find I've made an error, or said something offensive to you, I hope you will put it in perspective. I'm kind of a mixed bag, to be honest. I believe I have a lot to offer, but I've got tons of flaws, too! I fight my flaws, but not always with success. For better or worse, here are today's therapist errors!  1. Confusing psychoeducation with psychotherapy. Pyschoeducation can be helpful, but it's rarely curative. Effective psychotherapy requires much more. Here are some examples of helpful psychoeducation: Teaching people about the list of ten common cognitive distortions from David's book, Feeling Good: The New Mood Therapy Teaching people how to pinpoint their negative feelings at any moment in time using David's Daily Mood Log Teaching people that your thoughts, and not external events, create all of your positive and negative feelings Explaining the Five Secrets of Effective Communication etc. etc. etc. Psychotherapy means helping people CHANGE the way they think and feel, or helping people develop more loving and satisfying personal relationships. That requires a great deal of therapeutic skill and hard work on the part of the patient--during sessions and between sessions. it also requires a warm and trusting therapeutic alliance. 2. Belief in Gurus. Believing that the individuals who start schools of therapy are nice and well-balanced individuals! David describes conversations with the late Albert Ellis, PhD, who argued that many, and arguably most, are incredibly narcissistic and manipulative. Sometimes, individuals who appear incredibly charming and brilliant and inspiring have a dark underbellies they are keeping hidden! David argues that it might be more desirable to have a science-based, data driven, systematic approach to psychotherapy, as opposed to a field dominated by therapeutic schools, which sometimes function almost like competing cults. 3. Reverse / “backward” statistical reasoning. Most therapists who work with patients with Borderline Personality Disorder as well as Multiple Personality Disorder, as well as patients who are prone to violence, believe that childhood trauma, deprivation, or abuse is the main cause of these problems. They believe this because patients with those diagnoses frequently describe traumatic experiences in their past, so they assume those experiences caused the patient's disorder.  This is a statistical and conceptual error, because most individuals who experienced traumas when growing up never developed Borderline Personality Disorder or Multiple Personality Disorder. This is not to say that traumas are unimportant—traumatic experiences at any phase of life can be very damaging. What this DOES mean is that most psychiatric problems have other causes.  What are those other causes? They are not known, for the most part. This information is not easy for many people to accept. For example, I just found this statement on WebMd: “As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood (usually before age 9)." Here’s another web comment: “Several studies have shown that a diagnosis of BPD is associated with child abuse and neglect more than any other personality disorders [7, 8], with a range between 30 and 90% in BPD patients [7, 9].” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5472954/ The same source also stated that: “. . . Widom and collaborators [12] followed 500 children who had suffered physical and sexual abuse and neglect and 396 matched controls, and they observed that . . . the presence of a risk factor, such as adverse childhood events, was not necessary or sufficient to explain the reason why some individuals developed BPD symptoms in adulthood, whereas others did not.” If you are interested, you can find the references to these studies at the end of this blog. Here is one way of understanding this error. Childhood sexual abuse is far more common in the population (typically estimated in the range of 15% of men and 25% of women), and if you add childhood trauma or neglect, these percentages in crease even more. AT the same time, the incidence of Borderline Personality Disorder or Dissociative Identity Disorder are typically estimated around 1%. That means that most individuals who have experienced childhood sexual abuse, neglect or trauma do not develop these disorders.  I do not in any way mean to minimize the importance of trauma, sexual abuse or neglect. The impact of these experiences can be profound and can include physical as well as psychological problems. My only point, and perhaps it is an overly humble one, is that we simply do not know the causes of most (or any) of the problems listed in the DSM5 (Diagnostic and Statistical Manual of the American Psychiatric Association.) I think it is great that we have many treatments that can be helpful and effective for individuals, but it might not further our cause to jump to conclusions about the causes of things based on what we see before our eyes when we are doing clinical work. Sometimes, seeing is believing, but sometimes, our "seeing" can be misleading.  I hope I have not offended anyone!  4. Believing in Mental Disorders. Do the so-called Mental Disorders” described in the DSM actually exist? Or are they simply the fabrics of our imagination? Years ago, Thomas Szasz, a psychiatrist and psychoanalyst, wrote a popular and controversial book called The Myth of Mental Illness, in which he claimed that mental disorders do not exist. David argues that Szasz was only partially right. Most of what we see in the DSM are simply arbitrary constructs, and not real "disorders." For example, most people worry about things from time to time. Worrying is unpleasant but normal, and there is a wide range of worrying in the population. Some people rarely worry, and some people almost constantly worry, and most of us are in-between.  The American Psychiatric Association will take the group who worry the most, and give them a label of "Generalized Anxiety Disorder." But there is no such "thing." It is not a real brain disorder. The same problem afflicts a great many of the so-called "disorders" listed in the DSM. These are problems, not brain disorders. However, there are several real brain disorders, such as schizophrenia, Bipolar I Manic-Depressive Illness, and Alzheimer's Disease. These are disorders of brain tissue or wiring, and are not simply variants of normal human behavior or experience.  When I work with individuals, I measure the severity of symptoms and say things like this, "Jim, I can see you tend to be very shy (or depressed or anxious, or whatever.)" I do not say, "Jim, I want you to know you have a brain disorder called "Social Anxiety Disorder," because I feel that is potentially upsetting to the patient and not really "true." In addition, shyness can be fairly easily treated in most cases without medication. Most non-MD therapists do not make the mistake of confusing symptoms with "mental disorders." It seems likely to me (David) that psychiatrist are more likely to make this mental error, since psychiatry, as I understand it, is emulating the medical model of diagnosis followed by medication treatment or some other kind of biological intervention.  5. Ignoring a Diagnostic Evaluation. Most therapists skip a formal diagnostic evaluation, because the DSM is so difficult to work with, and since a formal diagnostic interview can be frustrating and time-consuming. And, as I pointed out in my discussion of the previous error, it is somewhat misleading to tell patients they have mental disorders, like "Generalized Anxiety Disorder" or "Social Anxiety Disorder," when, in reality, the patient is simply shy or has a tendency to worry a lot. And yet, there can be significant negative consequences of NOT doing a thorough initial evaluation of the patient's many symptoms, since you can easily overlook something important, like drug or alcohol abuse, or suicidal or violent urges in new patient. The EASY Diagnostic Survey provides a fresh and helpful option. patients can complete it on their own, between sessions, and it automatically diagnoses more than 50 of the most common "disorders" in DSM5. Then the therapist can review it during a session and assign the diagnoses in less than ten minutes in most cases. This provides the therapist with an accurate map of the patient's problems. You do not have to think of them as a variety of "mental disorders," but rather as areas of suffering and difficulty. I don't tell myself I'm treating "Generalized Anxiety Disorder," but rather treating a human being who is troubled by constant and excessive worrying--and fortunately, that is very treatable! Therapists who are interest in purchasing a license to use the EASY in your clinical work can check this link.   

I was concerned that our recent “Ten Most Common Therapist Errors” show might antagonize people, but we got quite a lot of positive and encouraging feedback from listeners, which was surprising to me. As a result, Fabrice and I decided to take a chance and publish two more shows on common therapist errors this week and next week. We hope you like these shows! Make sure you let us know what you think, and let me apologize in advance if I come across as annoying or overly cynical. All of the errors I describe are correctable; the goal is to improve the treatment of individuals struggling with depression, anxiety, troubled relationships, or habits and addictions. Thanks! Here are the five errors discussed in today's show. 1. Failure to hold patients accountable. Example, the therapist may let the depressed patient slip by without doing psychotherapy homework, since the patient insists he or she doesn’t have enough time or motivation to do the homework; or the therapist may agree to treatment an anxious patient without using exposure, since the patient may resist exposure; or a patient may treat someone with a relationship conflict without exploring the patient’s role in the problem, and so forth. David argues that this rarely or never leads to significant change, much less recovery. However, many therapists, and perhaps most, get seduced into this error for a variety of reasons. 2, The “corrective emotional experience.” This is the belief that the patient’s long-term relationship with the therapist will be sufficient for growth and recovery, without having to do any psychotherapy homework or be accountable. Therapist may imagine himself or herself as the loving and nurturing parent the patient never had. David argues that this caters to the therapist’s ego and feeds into what the patient wants as well—a long-term relationship built on schmoozing. But does it lead to recovery? Here’s David’s short answer: Nope! Warmth, empathy, and trust are necessary ingredients for good therapy, but they are simply not sufficient. Your patient may think you’re the most wonderful and supportive listener in the world, but that will rarely or never lead to recovery from depression, an anxiety disorder, or an addiction, and it will not lead to the skills to heal troubled relationships, either. 3. Responding defensively to patient criticisms. David argues that therapists almost always react defensively to criticisms by patients, such “you don’t’ get me,” or “you aren’t helping,” or “you don’t really care about me.” He describes an interesting five-year study of psychoanalysts in Atlanta, Georgia, sponsored by the National Institute of Mental Health (NIMH), to find out how the analysts responded to patient criticisms. You may find the results surprising! He gives an example of defensive responding during a workshop he conducted at a hospital in Pennsylvania. Therapists can learn to correct this error with lots of practice with the Five Secrets of Effective Communication, but this requires several things: Using the Patient’s Evaluation of Therapy Session after each session so can quickly pinpoint empathy / relationship failures. Lots of practice with the Five Secrets. Humility, and the willingness to see the world through the eyes of the patient. This requires the “Great Death” of the therapist’s ego! 4. Joining a school of therapy and treating everything with the same method or approach. Can you imagine what it would be like if medicine was organized like this, with “schools of therapy,” like the “penicillin school”? David apologetically argues that the abolition of all schools of therapy would be a good thing. Fabrice disagrees, and argues that the treatment of psychological problems is inherently different from the treatment of medical disorders. Let us know what YOU think! 5. Confirmation paradox. I (David) majored in the philosophy of science in college, and this was one of the first topics, and it definitely applies to our thinking about the causes of emotional problems. I’ll try to make it really simple and understandable. Here’s the essence of this error. If I have a theory that predicts the patient’s behavior you may conclude that your theory is correct. But this logic can be very misleading. Here’s a general science example Your theory: the sun circles around the earth. Your prediction: if my theory is true, the sun will come up in the east each morning and set in the west each evening. Your observation: the sun DOES come up in the east and set in the west, exactly as predicted. Your erroneous conclusion: the sun circles around the earth. Now let’s consider a psychotherapy example. Many therapists believe that perfectionism and insecurity result from growing up with parents who emphasized hard work and high standards as a precondition for being loved. Now let’s assume that you have a perfectionistic and insecure patient who remembers feeling like s/he wasn’t good enough when growing up. So, you conclude that the patient’s interaction with demanding parents caused the perfectionism and insecurity. But the perfectionism and insecurity may not have resulted from any childhood experiences or interactions with parents. It may have been strongly influenced by genetic factors, or social / environmental pressures. We can put this in the same framework as the example about the sun: Your theory: Perfectionism and insecurity result from growing up in unloving families that emphasized high standards and achievement rather than unconditional love and nurture. Your prediction: Insecure, perfectionistic patients will report childhood experiences with unloving parents who pushed them to work harder, etc. Your observation: Your insecure, perfectionistic patients DO describe their parents as demanding and lacking in love and support. Your erroneous conclusions: The patient’s childhood experiences caused the perfectionism. 2. The patient will have to “work through” these childhood experiences if s/he wants to overcome the feelings of perfectionism and insecurity.  

Do you have trouble saying "no"? Lots of people do—and it can sometimes get you into trouble. In spite of many best-selling books on assertiveness, like Manuel J. Smith’s classic book, “When I Say No I Feel Guilty,” many people still have trouble saying no. For example, you may have led someone on in a romantic relationship because you were afraid of saying no and breaking the other person’s heart. Or, you feel burned out, because you're always giving, giving, giving because you can’t—or won’t—say no. Or, you may end up hopelessly over committed at work, putting in long hours and feeling secretly used and resentful, because you don't know how to say no. Sound familiar? In this Podcast, Fabrice and David interview Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mt. View, California. Jill confesses that she sometimes has trouble saying no—to new referrals when her practice is full, to her family, who she loves tremendously, as well as colleagues who request this or that. David admits he sometimes has similar problems. There are lots of reasons why you may have trouble saying no. Some are negative, but some are actually positive, including: Conflict phobia. You are afraid that if you say no, the other person will get angry and annoyed with you. Fear of disapproval or rejection. You are afraid that if you say no, the other person will judge you, disapprove of you, or reject you. Perceived narcissism. You believe that other people will lash out if you don’t give in to their demands. Submissiveness. You believe that your role in relationships is to make others happy, even at the expense of your own needs and feelings. Joy / Love. Jill confesses that she often says yes to this or that request because she feels it will be fun, or because she doesn’t want to let the other person down. One example would be baking brownies for her sons when she’s exhausted. One consequences would be giving in, but resenting the person she’s saying yes to. Guilt. You may feel that if you say no, it means that you are somehow “bad,” and that it’s your duty to please other people. Achievement addiction. You say yes to almost everything because you think this or that activity will make you more productive and successful. Fabrice, Jill and David discuss many strategies for overcoming this problem, including: Empathy--as a therapist, you always want to start with empathy, without trying to "help." Motivational strategies such as the Paradoxical Cost-Benefit Analysis, Positive Reframing, or even the Straightforward Cost-Benefit Analysis. This is crucial to find out if patients really want to change before using methods to help them become more assertive. Punting. This is a delay strategy that David uses to get himself off the hook when feeling ambivalent about a request. For example, you can say, “I’m really pleased and honored that you’ve invited me to do X. I’m going to check with my schedule and see what might be possible, and I’ll get back to you.” Then, he has a day or two to work up the courage to say “no” in a kindly way. Write down your Negative Thoughts. when you're feeling compelled to say yes because you're feeling anxious or guilty, Ask yourself, "What am I telling myself?" Those thoughts will nearly always be distorted. Then ask yourself how you could challenge and talk back to those thoughts. Fabrice, Jill and David also discuss how to say no effectively and demonstrate this skill in a role-play with Jill that is surprisingly challenging! They also demonstrate the Feared Fantasy, a powerful technique to help patients say no, using Jill’s example. Her worst fear is that if she says no to colleagues, they will: Feel disappointed. Become angry and demanding. Will say they won’t work with her in the future if she says no. Will say they’ll get someone else to do whatever it is, and that Jill will miss out on all the fun. David and Fabrice play the role of colleagues from hell who put demands on Jill to do another podcast and then get upset when she tries to say no. The dialogue is quite entertaining and dynamic, and Jill finds it helpful, though anxiety-provoking. They also describe the importance of giving patients homework to actually say no between sessions to requests that are excessive or inappropriate.

Answers to Great Questions from Listeners Like YOU! Dylan asks: Do you believe in Freud’s “secondary gain,” in which patients resist change because they benefit from their symptoms? Juleann asks: Is Seasonal Affective Disorder (SAD) a real thing? Ismail asks: Should I use the Daily Mood Log just when I’m upset, or at the end of the day, or when? Do I have to stop what I’m doing when I get negative thoughts so I can write them down and work on them? Abe asks: What about negative thoughts that are valid? For example, I was interested in astronomy and physics as a teenager, but my SAT scores showed I had no aptitude for a career in these areas. Kevin asks: Can positive flooding be used to change the object of our desires—for example, our sexual desires, like the man in one of your books who had lost sexual interest in his wife? Valentina asks: Where do cognitive distortions come from? Our parents? Our genes? Societal messages?  

This is David and Fabrice's top ten list for the worst errors therapists make. 1. Failure to Measure (symptoms, empathy and helpfulness). Research shows that therapists’ perceptions of how their patients feel, or feel about them, are not accurate. TEAM therapists measure symptom severity at the start and end of every therapy session with brief accurate scales that assess depression, suicidal urges, anxiety, anger, relationship satisfaction, and happiness. This allows therapists to see, for the first time, exactly how effective or ineffective they are in every single therapy session. This can be threatening to the therapist’s ego, but has revolutionized clinical practice. In addition, TEAM therapists assess the patient’s perception of therapist warmth, empathy, understanding, and helpfulness after every single session. The scales are extremely sensitive to therapist errors, and most therapists receive mostly failing grades from their patients initially when they use these scales, which can be a shock to the system! But dialoguing with the patient about the scores at the next therapy session can lead to breakthroughs in the clinical work and dramatic improvements in the quality of the therapeutic alliance. 2. Trying to help, “save,” “rescue” or “reassure” patients. Most therapists are addicted to this, but it simply triggers resistance. When therapists push in their efforts to help, most patients will push back. No one likes to be “sold” on anything. When patients are hurting, they want to be heard, not saved. In TEAM we do Paradoxical Agenda Setting before trying to “help.” We emphasize, in a respectful way, all the really GOOD reasons NOT to change. We also highlight what the patient’s symptoms, such as shame, depression, panic, defectiveness, hopelessness and anger, show about him or her that’s positive and awesome, Then we raise the question: “Given all those positives, why in the world would you want to change?” This strategy has led to breakthroughs in treatment, and I now see recovery from depression and anxiety at rates I would have impossible ten or fifteen years ago. 3. Reverse Hypnosis. Depressive hypnosis. The patient persuades the therapist that s/he really is worthless, inferior, and hopeless, and the therapist false into a trance and believes it! This dooms the therapy. Anxiety hypnosis. The patient persuades the therapist that s/he is to fragile to use exposure, or that the exposure is too dangerous, and the therapist buys right into it! This also dooms the therapy. Recovery from anxiety is more or less impossible without exposure. Relationship hypnosis. The patient persuades the therapist that s/he is the victim of some other person’s bad behavior, and that the other person is entirely to blame for the relationship conflict. Therapists almost always buy this message, and this also dooms the therapy. 4, Believing therapy must be slow and last a long time. This is taught in most graduate school programs, and tends to function as a self-fulfilling prophecy. I met a famous psychoanalyst who was proud that most of her patients had been in therapy for more than ten years, and a few were just now making baby steps, she said, toward change. With TEAM, I usually see a complete elimination of symptoms at the first therapy session, although it has to be a double session (two hours). In addition, the recover usually occurs in a burst, all at once, in just a few seconds, or in several sudden orbital leaps during the session. 5. Believing that the purpose of therapy is to get in touch with your feelings (Emotional Reasoning). This message has been pushed for years, and was the basis of my training. The idea was that people bottle up their feelings, like anger, and then it comes out as depression. The message is still pushed today! I’ve never seen much validity in this point of view. People can express their anger, their panic, and their feelings of worthlessness until the cows come home, but they’ll still be just as angry, panicky, and they’ll still feel worthless! There is at least one notable exception to this rule. Most anxious patients are exceptionally “nice” and sweep their feelings under the table. Then the feelings come out indirectly, as OCD, panic attacks, GAD, or a phobia, or even as somatic complaints such as chronic pain, fatigue, or dizziness. Bringing the suppressed feelings to conscious awareness and expressing them is the basis of my Hidden Emotion Technique, and it often leads to a sudden and complete recovery from any form of anxiety. 6. Confusing your own feelings for how the patient feels. This is a psychoanalytic error. I read an article on the psychoanalytic view of empathy, which was defined as the analyst’s feelings when in the presence of the patient. This is a misguided and almost delusional notion. The analyst’s feelings are the complete creation of the analyst’s thoughts! And those thoughts will often be distorted and completely misleading. Therapist’s perceptions of how their patients feel are less than 10% accurate if you put it to an empirical test! If you ask patients, “How are you feeling right now,” and you ask therapists the exact same question, “How is your patient feeling right now,” the therapist’s answer will usually be way off base. The only way to find out is to use assessment instruments at the start and end of each session, like I described in the first answer above, on failure to measure. 7. Believing therapists should never express their feelings. I was trained never to reveal how I was feeling. But when you think about, that’s nutty! How can we validly encourage our patients to be more genuine and open with their feelings if we are hiding our own at the same time? Of course, there is an art form in how to share your feelings during therapy. It is a high skill, requiring training, and one that can lead to more human and effective treatment. 8. Believing that you are an expert and know the causes of things, and why patients think, feel, or behave as they do. The causes of all psychiatric disorders are unknown. End of discussion. And yet, almost all therapists promote some fraudulent theory about causality. For example, what is the cause of depression? There are lots of theories, but none has been confirmed, and almost all have been disproven. For example, there is no evidence whatsoever that depression results from a “chemical imbalance in the brain,” or from “anger turned inward,” and so forth. Those are just theories that someone made up. I simply tell my patients that we don’t yet know the causes, but have really terrific treatment tools now for rapid recovery. That’s more than enough for the people I treat! 9. Confusing the process of therapy with a good outcome. For example, as a therapist, you could be doing really great job of listening, and give yourself high marks as a therapist because you believe in the importance of empathy, even though your patient is not improving. Therapists have all kinds of things they’ve been trained to do, like hypnosis, or EMDR, or cognitive therapy, exposure therapy, or meditation, or an exploration of childhood traumas, or whatever it is you do and believe in. But if you’re not seeing rapid and dramatic recovery in your depressed and anxious patients, as documented with session by session testing, you’re not really “helping.” 10. Believing that insight will lead to change. This has only happened once in my career! It was a woman who discovered that she thought she always had to be submissive servant in intimate relationships. Not surprisingly, she always felt burned out and broke up with her partners after a while. She said that the discovery of this pattern when we did the Interpersonal Downward Arrow Technique during our first and only session transformed her life. But usually, much more will be required. That’s why I have developed 50 methods to help patients change the way they think, feel, and behave. Correction—I have recently developed 51 additional powerful techniques, so now we have 101 ways to untwist your thinking so you can enjoy greater happiness, intimacy, and productivity! Now, here's the 60 thousand dollar question. Can therapists learn to stop making these errors? In most cases, the answer is NO! It's not so much a problem with intelligence or aptitude, although those are important factors, but it has to do with motivation. Many therapists simply do not want to change, and are committed to what they're already doing, in much the same way that people are committed to their religious beliefs, which they are unwilling to challenge. That's why it is so much easier to train young therapists, whose minds are still open, as well as lay people who do not have so much prior "training" they have to overcome. Well, that's my cynical side coming out, and I apologize! Still, I think I'm right for the most part. Hey, if you liked my rant, I have at least five more common therapeutic errors on my list, so let Fabrice and me know if you'd like to hear about therapist errors in a future podcast. In addition, if you'd like to add to our list of therapist errors, let us know what your "favorite" (or most annoying) therapist error is!  

How can you get rid of Self-Defeating Beliefs? Although any of the 100 + TEAM-CBT methods can be used to modify an SDB, four methods will be highlighted in today's show. Cost-Benefit Analysis Semantic Method Experimental Technique Feared Fantasy For more information on how to change SDBs, you might want to watch the extremely popular David and Jill  FB Live show on Overcoming Perfectionism (recorded on November 11, 2018). What research has been done on SDBs? This topic was not discussed in the show, but individuals with an interest in research might want to read David’s study with Dr. Jackie Persons on the causal connections between depression and SDBs about dependency (attachment) as well as achievement (perfectionism) in several hundred patients in Philadelphia during the first 12 weeks of their treatment at David’s clinic. The study confirmed That both types of SBS were significantly correlated with depression severity at intake and at the 12-week evaluation. In addition, changes in depression were correlated with changes in SDBs. However, a sophisticated statistical analysis with structural equation modeling techniques did not confirm that SDBs had causal effects on depression, or that depression had causal effects on SDBs. Instead, SDBs and feelings of depression appeared to share an unknown common cause. Persons, J. B., Burns, D. D., Perloff, J. M., & Miranda, J. (1993). Relationships between symptoms of depression and anxiety and dysfunctional beliefs about achievement and attachment. Journal of Abnormal Psychology, 101(4): 518 - 524.  

Rajesh asked: Is it possible to change an SDB? Does the mere knowledge of an SDB change it? How long does it take to change an SDB? How do you change SDBs? Nikola asked: Aaron Beck said the SDBs never really go away. They just get activated and deactivated and activated again. Does this mean that depression is an incurable disease that will keep coming back over and over again? What’s the point in battling against a core belief if it cannot be changed? Fabrice and I appreciate your questions--they often give us ideas for shows! In today’s Podcast you'll learn the answers to several questions about Self-Defeating Beliefs. What’s the difference between Self-Defeating Beliefs (SDBs) vs. Cognitive Distortions? The thoughts that contain cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, Discounting the Positive, and Self-Blame are distortions of reality, they are the cons that trigger depression and anxiety. When you're upset, these thoughts will flood your mind. These thoughts can be show to be false, and when you crush a distorted negative thought, you'll immediately feel better. Self-Defeating Beliefs are stipulations, values that you've set up for your self. For example, you may base your self-esteem on your accomplishments due to your belief that people who accomplish more are more worthwhile as human beings. SDBs like this cannot actually be shown to be false--they are simply your personal, subjective values, and they are thought to be with you all the time, and not just when you're depressed, anxious, or angry. The question with an SDB is this: What are the advantages and disadvantages of having this value system? How will it help me--what are the benefits--and how might it hurt me? What's the downside? Why are Self-Defeating Beliefs thought to be important? When you challenge and defeat a distorted thought, you feel better in the here-and-now. When you challenge and change an SDB, you change your value system at a deep level. This is thought to make you less vulnerable to painful mood swings and relationship conflicts in the future. What are the different kinds of SDBs? David’s list of 23 Common SDBs is attached. This list is not comprehensive, as there are many more, but the ones on the list are very common. There are several categories of SDBs. Individual SDBs are often “Self-Esteem Equations” Perfectionism Perceived Perfectionism Achievement Addiction Approval Addiction Love Addiction Interpersonal SDBs are expectations of what will happen in certain kinds of relationships, or relationships in general What’s your understanding of the other person’s role in your relationship? What adjectives describe him or her? What’s your understanding of your person’s role in the relationship? What adjectives describe you? How would that kind of relationship feel? What rules connect the two roles? Other kinds of SDBs Anger / conflict cluster Entitlement Truth Blame Anxiety cluster Niceness Conflict Phobia Anger Phobia Emotophobia Submissiveness Spotlight Fallacy Brushfire Fallacy How can you identify your own, or a patient’s, Self-Defeating Beliefs? Look at the list of 23 individual SDBs (easiest). You might want to do that right now. Review the list, and you'll probably find many of your own beliefs! Individual Downward Arrow Interpersonal Downward Arrow  

I recently did two terrific interviews (Podcasts #92 and #111) with Stephanie James on her superb radio show and podcast, The Spark. Today, Fabrice and I are bringing you my third and final interview with Stephanie, as we describe how to convert conflicted relationships into loving, rewarding ones. Stephanie said it was her favorite interview, although all three were really fun for me. Today you will once again hear how dynamic, warm and positive she is! My first interview with Stephanie was on the amazing inner power we all have to change our thoughts, feelings, actions, and lives. We talked about how to transform your automatic negative thoughts and create a more joyful present and a more fulfilling future. My second interview with Stephanie was on the evolution of traditional Cognitive Behavioral Therapy (CBT) into the new TEAM-CBT. We highlighted the amazing new motivation-busting techniques that can lead to extraordinarily rapid recovery. Stephanie also recently interviewed our beloved colleague, Dr. Matthew May, a psychiatrist who is a phenomenal TEAM therapist. Click here if you'd like to take a look and listen. Matt has worked with Fabrice and me on our podcasts--you may remember the amazing and inspiring podcasts featuring live therapy with Marilyn. Stephanie is a outstanding therapist and radio personality from Colorado. It was an honor to be on her show on three occasions. Stephanie is co-authoring a book on how to live a “spark-filled life.” It should be completed soon, so you’ll likely be hearing much more from Stephanie during 2019!

This dynamic interview covers the integration of TEAM-CBT with Christianity as well as Judaism, Buddhism, Hinduism, the Muslim faith, and more. Mike, Fabrice and I describe many areas of overlap, as well as some potential conflicts, between the teachings and methods of TEAM-CBT and religious beliefs. Mike and I suggest that religion and TEAM-CBT are, in fact, attempting to do the exact same things using slightly different language and symbolism. We strongly agree that at the moment of recovery, a person’s religious beliefs are nearly always strengthened and deepened, and never challenged or belittled. Mike, Fabrice and I also discuss topics like religious scrupulosity, religious obsessions, cognitive distortions (John 8:32: “The truth will set you free”), and the so-called “dark night of the soul” described by Christian and Buddhist mystics. We also talk about the spiritual and psychological aspects of enlightenment (e.g. salvation), Should Statements, the Disarming Technique, forgiveness, repentance, the death of the ego, pride vs. humility, and more. If you have an interest in religious or philosophical topics, you will love this podcast! You might also enjoy the podcasts with Marilyn on what to do when you've lost your belief in God and find yourself in darkness and intense suffering! Mike Christensen treats individuals throughout Canada via teletherapy and also offers online training for mental health professionals throughout the world. If you have a question for Mike, or wish to contact him, you can find him at www.FeelingGoodInstitute.com.

Fabrice and I were thrilled to interview our dear friend and colleague, Stephen Pfleiderer, who is the first therapist in the world using TEAM-CBT techniques in the treatment of habits and addictions, including life threatening addictions, like intravenous heroin or meth marijuana alcohol binge eating procrastination smoking internet porn and more Stephen begins with his personal story of excessive beer drinking starting in high school through his junior year in college when he hit a personal crisis, telling himself, "My life sucks. I can't live like this. I'm a loser." He decided to enter a 12-step recovery program, which helped tremendously, and eventually joined David's weekly TEAM training group at Stanford because of his dream of becoming a professional addiction therapist and interventionist.

Rebroadcast of a fabulous interview David did recently for “The Upgrade” Podcast (sponsored by the popular Life Hacker website with hosts Melissa Kirsch and Alice Bradley on a range of topics, including: Why did you write Feeling Good: The New Mood Therapy? Is depression caused by a chemical imbalance in the brain? What’s your experience with electro-convulsive therapy (ECT)? Why did you give up your research career in biological psychiatry? How can you tease out your negative thoughts when you know you're depressed but you just can’t think of any thoughts? How does TEAM-CBT differ from conventional CBT? Can you use TEAM-CBT with severe problems, or is it only for individuals with mild mood disturbances?

1. Steven asks about the best route to take if you want to learn and practice TEAM-CBT? Is the degree important? What's the best degree? Should you go to school to become a psychologist,  clinical social worker, addiction counselor, psychiatrist, professional counselor, pastoral counselor, marriage and family therapist, life coach, or what? There are so many degrees and potential paths that my head is spinning! 2. Sandy asks how to overcome long-standing, entrenched perfectionistic tendencies. 3.  Rin asks about the Burns Depression checklist and the criteria for depression in the DSM. He is (understandably) confused about the so-called "somatic" symptoms of depression, like insomnia or changes in appetite. For example, some “experts” would argue that the following are all symptoms of clinical depression: insomnia or the opposite—sleeping too much; increased appetite or the opposite--decreased appetite; loss of interest in sex, or the opposite, sex addiction; loss of interest in work, or the opposite, being a workaholic. How can opposite symptoms be symptoms of depression? Does this make sense? Are these really the symptoms of depression, or simply non-specific symptoms? What are the five key symptoms of real depression? 4. Kevin is a therapist with a simple question: How do I get over my desire to help? 5. Amanda asks how to use the Disarming Technique with a patient who thinks he or she isn’t making any progress in the therapy.

One of the goals for our Feeling Good Podcasts is to bring the TEAM-CBT techniques to life for mental health professionals, patients, and the general public as well. I (David Burns) use more than 50 Techniques when I'm working with individuals with depression, anxiety disorders, relationship problems, or habits / addictions. Today we will compare and contrast the four Truth-Based Techniques, including: Examine the Evidence The Experimental Technique The Survey Technique Reattribution These were among the first cognitive therapy techniques ever developed, and they were based on the work of Dr. Aaron Beck, from Philadelphia, as well as Dr. Albert Ellis, from New York. Dr. Ellis is the Grandfather of Cognitive Therapy, and he described many of these techniques in the 1950s. He called his treatment Rational Emotive Therapy, and it's still popular today. During the 1960s, Beck, who is considered the Father of Cognitive Therapy adapted the ideas of Dr. Ellis to the treatment of depression, and called his version of the treatment Cognitive Therapy. Beck emphasized that depression results from a negative view of the self, the world, and the future. In other words, the patient may think: I'm a loser. (negative view of the self) Nothing i do will be successful or rewarding. (negative view of the world) Things will never change. I'm hopeless. (negative view of the future) Beck claimed that the negative thoughts of the depressed individual are the actual cause of the depression. He also emphasized that the disturbing negative thoughts of depressed patients are nearly always distorted and illogical; however, depressed individuals don’t realize that they’re fooling themselves, so they think their negative thoughts are absolutely valid. Beck also claimed that depression could be treated without drugs in many cases, and focused his treatment on challenging the patient's distorted negative thoughts. Beck often compared depressed patients to scientists who have a theory about the world that simply isn’t true. That's why scientists learn to test their theories by examining evidence and performing experiments. Beck suggested that depressed patients could also test the validity of their negative thoughts and beliefs by examining the evidence for and against what they're telling themselves, as well as by doing actual experiments to test their thoughts and beliefs. David and Fabrice bring the four basic truth-based techniques to life with actual patient examples. They answer the question, "What's the difference between Examine the Evidence and the Experimental Technique?" And "How does the Survey Technique work?" They emphasize the tremendous importance of warmth and empathy, as well as melting away patient resistance, before trying to implement any of these techniques. They also emphasize that these techniques, like all of the techniques, are powerful, and must be used with skill and compassion, or else they can backfire.

This is the second of three interviews with Stephanie James on her superb radio show and podcast, The Spark. Stephanie is an experienced therapist and dynamic radio personality from Colorado. She is co-authoring a book on how to live a “spark-filled life.” This interview with Stephanie focused, in part, on the evolution of the new TEAM-CBT from traditional Cognitive Behavioral Therapy (CBT). Stephanie asks Dr. Burns questions on a wide range of topics, including: How would you treat a case of social anxiety? What is “therapeutic whitewashing” and how can therapists get over it? What should therapists do instead? How would you work with violent incarcerated teenagers, such as gang members? Why is it so important for therapists who are learning TEAM-CBT to check their egos at the door? After you published your first book, Feeling Good, and the first research study on CBT was published, cognitive therapy swept the world. After your initial euphoria, your enthusiasm dimmed somewhat. Why? And what new direction did your research lead? What are the most common errors that therapists make in thinking about the causes of therapeutic resistance? How can you overcome a patient’s resistance to change? Can TEAM-CBT work rapidly for someone with horrific abuse and decades of failed therapy? How can you prevent relapses following the patient’s initial recovery? Dr. Burns' third interview with Stephanie will be on the interpersonal TEAM model—how to convert conflicted relationships into loving, rewarding ones.

Fabrice and David address several challenging questions submitted by individuals who listen to the Feeling Good Podcasts. Richard: Do you have to get along with everybody? How do you deal with a sociopath? Dave: Positive distortions can trigger mania, addictions, narcissism, and violence--but how can you get rid of them? Julia: What can you do if you've been depressed all of your life and wake up every morning with your mind flooded with negative thoughts? I spend two hours trying to dispute them, but they just keep coming back the next day. Omhur: How would you treat "Reading OCD?" I feel compelled to read every sentence and paragraph carefully and repeatedly so I won't miss anything! Unnamed fan (who left a negative review on iTunes): Isn't your concept of the death of the ego potentially dangerous to people with low self-esteem who are being abused? Thank you for your terrific questions, your frequent praise, and your occasional criticisms and challenges. They keep us on our toes, and we deeply appreciate all of you. So keep your comments coming, as well as your suggestions for shows and topics you want to hear more about! We are receiving more than 50,000 downloads a month. Please tell your friends about us so we can continue to build our audience. Thanks! We really enjoy doing these shows for you.  

A podcast listener asked about what techniques David is the most proud of. We briefly discuss each one on today’s podcast. So here they are! The list of Ten Cognitive Distortions The Disarming Technique and Law of Opposites The Externalization of Voices plus Acceptance Paradox The two classic Uncovering Techniques: the Individual and Interpersonal Downward Arrow The Feared Fantasy and Acceptance Paradox The Experimental Technique for extremely rapid treatment of patients with Panic Attacks My published research with colleagues in the mid-1970s did not support the popular notion that depression results from a chemical imbalance in the brain Brief Mood Survey Positive Reframing The use of extended, two-hour therapy sessions  

David emphasizes that there are two issues. First, can your “self” be validly judged as not good enough, as inferior or even worthless? Or, can your “self” be validly judged as more worthwhile, or even superior? And is it really true that some people are more worthwhile, or less worthwhile, than others? Do more worthwhile, or less worthwhile human beings exist? Second, do we even have a “self?” Fabrice talks about the history of the concept of ego. For example, Freud divided the human mind into three parts: the id, ego and superego. Do these really exist as “things,” or are they just concepts, or metaphors for talking about the mind? When you try to think about the “ego” or the “self” as a thing, that’s when you get in trouble. David argues that if you believe that someone people are “more worthwhile” or “less worthwhile,” you’d have to define what a of worthwhile human being is.

Fabrice and David are pleased to chat with Dr. Taylor Chesney who is an expert in the treatment of children and teenagers with TEAM-CBT. Taylor was a member of Dr. Burns’ Tuesday group at Stanford and his Sunday hiking group for two years before returning to her home in New York in 2014. She opened the Feeling Good Institute NYC, where she and her colleagues offer individual and intensive treatment as well as training for mental health professionals (in person and online). Today she reveals the inside scoop on how to use TEAM-CBT with children and teenagers, and their parents.

This is the second podcast on relationship problems. with Dr. Helen Yeni-Komshian. In today's podcast, we address four questions from listeners like you: Our marriage lacks intimacy. What can I do? A podcast fan named David explains that his relationship with his wife is no longer intimate; he complains that they only talk about day to day things on a superficial level. David wants to know if he needs to inject some conflict into the relationship to make it more meaningful or exciting. Why is my wife so critical of me? David wants to know why his wife constantly peppers him and batters him with critical questions, and what he can about it. Why is my friend so critical and dogmatic? Rajesh describes a friend who argues endlessly and accuses Rajesh of being irritating. His friend says, "Anyone would be upset when they try to talk to you!" What's up? Why is this happening? Who's really to blame? Adarah feels lonely and tells her husband what he can do to make her feel loved--but it just doesn't seem to work! Why? And what CAN she do to improve her marriage? I think you will enjoy the lively dialogue between Fabrice, Helen and myself and see us struggling and making some mistakes, too, when we try to model more effective responses based on the Five Secrets of Effective Communication! We also stress, once again, the importance of Interpersonal Decision-Making any time you run into a conflict with a friend, colleague, or loved one. For more information on healing troubled relationships, you can read my book, Feeling Good Together, which is available as a paperback on Amazon. In addition, you can listen to our previous podcasts on the Five Secrets of Effective Communication, beginning with Podcast #65 (Enjoy Greater Intimacy) and several of the podcasts that follow.

We have invited Dr. Helen Yeni-Komshian to join Fabrice and me for two consecutive podcasts on questions listeners have asked about troubled relationships. In today's podcast, we address a question from Mary about how to deal with a husband who constantly complains and exaggerates how awful things are at work, in politics, and in the world. But when Mary tries to dismiss his statements in an effort to "keep the peace," it just gets worse. His complaints escalate! This is a common problem and you may have run into it as well. Do you have a friend or family member who loves to complain? And have you noticed that your attempts to help or point out the irrationality of his or her complaints are futile? So what SHOULD you do? What's the secret of dealing with a whiner or a complainer? Is it even possible. Helen and David provide a myriad of information and describe techniques such as Forced Empathy, Interpersonal Decision Making, Changing the Focus, and the Five Secrets of Effective Communication. You'll LOVE this lively dialogue!

David describes research on the relationship between physical pain and negative emotions such as depression, anxiety, and anger. Does pain cause depression? Or does depression cause or amplify pain? And what can we do to help patients with physical pain and intense negative emotions? In addition, why do so many individuals struggle with somatic problems, such as physical pain, dizziness, or fatigue, when there is no apparent organic cause for the pain? Is there any hope?

Today we answer six questions submitted by listeners like you: Harald: How can I find the Show Notes for the Feeling Good Podcasts? Kristin: How do you help patients who obsess about past traumatic events, with intrusive thoughts about a cruel ex-lover or bullying by classmates? These thoughts can feed into the idea that their life is miserable and  they can’t move forward because they feel blocked by these harmful memories. Valentina: How are cognitive distortions, self-defeating beliefs, and feelings of depression transmitted? What you describe in your books seems to describe my mother’s behaviors when I was growing up? Could it be that depression is transmitted by the family? Alicia: How would you treat someone with cyclothymic disorder who cycles between euphoria and suicidal depression? He’s happy now, so how do I get him to fill out the Daily Mood Log? Kathy: I’m a big fan, and I have a question about “bibliotherapy.” What’s the best way to use your books and other materials to help yourself? Matthew: Do you ever use drugs in the treatment of depression? Are medications sometimes necessary or helpful?  

Suicidal thoughts and urges are very common among depressed patients. The vast majority of depressed individuals have thoughts of suicide from time to time, and some struggle with serious suicidal urges. The experts tell us that 10% to 15% of chronically depressed individuals do eventually commit suicide, even if they are receiving treatment for depression. It is hard for me to believe that suicide is that common, but even if it is only 2% or 3%, that’s still very significant, especially if you have a large clinical practice and you treat lots of depressed individuals. Suicide attempts are shocking and devastating for the patient, for the family, and for the therapist as well. The loss of a patient through suicide is the dark side of our profession. The loss of life is a horrible and unnecessary tragedy, since the feelings of hopelessness that trigger suicidal urges are always the result of cognitive distortions; the belief that you are hopeless and cannot improve is never valid. Yet, the depressed patient does not realize this, and sometimes turns to suicide as the only way out of the suffering. Sadly, clinicians' capacity to assess suicidal urges in patients they are treating is very poor, and not significantly different from zero. In this podcast, I describe how you can solve this problem with the use of the EASY Diagnostic System and suicide interview at the initial evaluation, and the use of the Brief Mood Survey at all subsequent sessions, with no exceptions. In this podcast, I focus on two things. First, how can the clinician identify and evaluate a new (or old) patient who is struggling with suicidal thoughts and fantasies and determine if the patient is at risk for a suicide attempt? Second, how can the therapist make the patient accountable and guarantee that the patient will not now, or ever, make a suicide attempt? The “defensive psychotherapy” I recommend will sound unfamiliar to many therapists but can save lives and make your practice far more peaceful and rewarding! The approach to the suicidal patient involves Paradoxical Agenda Setting techniques, including the Gentle Ultimatum and Sitting with Open Hands.

The famed neuroscientist, Dr. Mark Noble, from the University of Rochester, has developed a strong interest in TEAM-CBT and has visited our Tuesday group and Sunday hikes on three occasions this year. I (David) feel very fortunate to have his collaboration and interest! Mark is a Stanford-trained geneticist and molecular biologist who is considered one of founders of the field of stem cell research. He has been developing a model of how TEAM-CBT affects the brain, and graciously agreed to present his model at our Tuesday evening Stanford TEAM-CBT seminar last week. Although his model is not yet fully polished and refined, and involves considerable speculation, it is an exciting first step, kind of like the time when astronomers broke away from the Catholic church and started trying to make sense of the universe. In this instance it is the “inner universe” Dr. Noble, all of us, are trying to understand. His model will evolve and get more and more refined over time. The participants in the seminar really liked his concept that we are doing micro-neurosurgery for depressed patients with TEAM-CBT! He is convinced that the rapid recovery we see with TEAM-CBT will probably never be equaled by medication, since the brain circuits that modulate happiness and unhappiness tend to use the same neurotransmitters. But with language, you can affect brain circuits far more selectively and effectively, almost like a micro-neuro-surgeon. Dr. Noble describes brain function in terms of the SNEFF model. This stands for Structures, Networks, Emotions, Frames and Filters, and links these concepts to the prefrontal cortex, amygdala and sympathetic nervous system. Then he describes the four steps of TEAM (T = Testing, E = Empathy, A = (Paradoxical) Agenda Setting, and M = Methods), and links each step to the SNEFF model, making interesting speculations on how TEAM works and what makes it so effective. Dr. Noble also discusses David’s “fractal” theory about psychotherapy and relates that to brain function as well as to the mathematics of complex structures. He describes how and why some people get stuck in the “homeostasis” of chronic, refractory depression and explains why TEAM-CBT is usually able to trigger sudden and dramatic changes in the brain, as well as in the way the depressed and anxious individual thinks, feels, and behaves. He also explains why conventional talk therapy is unlikely to be helpful for individuals struggling with depression and anxiety, and may, in some cases, make the depression worse. This is because neurons that “fire together wire together.” In other words, if you go to therapy and complain or emote about your life and your problems over and over, without taking action to change, the circuits in your brain that support complaining and feeling depressed will just get more and more intensely wired together. Dr. Noble also speculates on why Paradoxical Agenda Setting is such an important key in ultra-rapid-recovery and in the sudden transformation of brain function as well. Years ago, when I was kid on vacation in Minnesota, I saw an article in a small newspaper published in a rural area. A local scientist had speculated that one day we would have guided missiles and satellites and drew a simple diagram for the newspaper of how they would work. At the time it seemed a bit like science fiction, and I wondered if an unknown scientist from a small rural Minnesota town could actually predict a major scientific development. But now we see that he was right. Will we someday think about Dr. Noble in the same way? Listen to this exciting podcast, and you can decide for yourself!

Lisa Nicole Bell is the host of the highly regarded podcast, Behind the Brilliance. In this lively interview, Nicole and David talk about David’s path into the mental health field the difficulties and rejections David faced getting his first book, Feeling Good, published David’s advice to listeners interested in therapy how he approaches perfectionism, depression, and anxiety with patients the joys of a life free from the need to be special— and much more! Lisa's show delivers a smart and funny take on pursuing ambitions, designing a life, and living joyfully. Lisa’s most recent media work includes producing an Australian documentary on identity and gender politics within sports and a digital docu-series produced by Academy Award-winning actress Viola Davis.

David and Jill do M = Methods, and show Lee how to respond to his wife more skillfully, using the Five Secrets of Effective Communication (link). Like everyone who is trying to learn the Five Secrets, Lee struggles with several blind spots: “I Feel” Statements. Lee has tremendous difficulties sharing his feelings openly, in a respectful manner. He seems indoctrinated with the cultural idea that men should not be vulnerable and express feelings. Lee makes the common error of “problem solving” instead of asking his wife to share more of her feelings. Lee makes another common error of apologizing and using the trite phrase “I’m sorry” instead of encouraging his wife to open up. David discusses the different between dysfunctional and effective apologies. David and Jill do lots of role-play practice with Lee and give him a homework assignment. T = Testing. After the session is over, Lee completes the Brief Mood Survey again. His scores indicated that his feelings of  anxiety and anger have completely disappeared, and he also has a perfect score  Positive Feelings Survey and the Relationship Satisfaction Scale. He also gave David and Jill perfect scores on the Empathy and Helpfulness scales and wrote what he liked the best about the session: “My epiphany came at the moment I realized I had been afraid of emasculating myself and realizing that my vision of what a “man” should be was completely inaccurate.” At the end, Jill reads an emotional email from Lee describing how he relapsed and started arguing with his wife, and then remember to empathize use the Five Secrets instead, with an amazing result!

David and Jill do A = (Paradoxical) Agenda Setting with Lee, starting with the Invitation: Jill asks Lee if he wants help with the relationship conflict, and if this would be a good time to roll up our sleeves and get to work. Lee indicates that he does want help. They review the first two steps of his Relationship Journal, where Lee had recorded one specific thing his wife said to him, and exactly what he said next. Here’s what he wrote down: Step 1 – She said: Write down exactly what the other person said. Be brief: I was trying to convince my 18-month-old daughter to put her pajamas on. I was calm. Eventually, I raised my voice an octave or two and in a stern voice I told my daughter to put her pajamas on. Afterwards, Liza said, “I don’t think you need to use that tone with a small child.” Step 2 – I said: Write down exactly what you said next. Be brief: I said, “I don’t think there was anything wrong with what I did. You can be stern without losing your shit*. There are times when she needs to know I am serious and not messing about anymore.” It then devolved into a debate over a clash of values on how to raise our daughter. * Transcribed as-is from Lee’s Relationship Journal. Lee also circled all the emotions he thought she was having, along with all of the emotions he was having. He thought she was feeling: Sad and unhappy Anxious and worried Rejected and alone Discouraged, pessimistic, and despairing Frustrated and stuck Angry, annoyed, irritated and upset Other feelings: troubled, defensive, dismayed, downhearted, and disconnected Here’s how he was feeling: Unhappy Anxious and worried Guilty, remorseful, bad and ashamed Inferior, inadequate, defective and incompetent Embarrassed, foolish and self-conscious Hopeless, discouraged and despairing Frustrated Angry, mad, resentful, annoyed, irritated, upset and furious Other feelings: hostile, loud, critical, agitated, defensive, stubborn, exasperated, sarcastic, powerless, diminished, low, resistant, confused, judgmental, vulnerable, inept Step 3. Good vs. Bad Communication. When David and Jill ask Lee to examine his response to his wife, he had to admit that his response in Step 2 had all the characteristics of bad communication—he did not acknowledge any of her feelings, he did not share his own, and he did not convey love and respect. This was disturbing and surprising to Lee. Step 4. Consequences. When David and Jill asked Lee to examine the impact of what he said to his wife, they suddenly ran into a wall of resistance, which is almost universal in relationship work. The Relationship Journal is an incredibly powerful tool, and it can be extremely painful because you have to stop blaming the other person and examine your own role in the relationship. Lee suddenly and painfully discovered the answer to his question of why his wife was so controlling and critical of him—it was NOT because of the influence of her mother, but rather because he was forcing her to treat him like that almost every time he interacted with her. This insight cannot be denied when you do the Relationship Journal, and it’s potentially incredibly empowering, but it can be incredibly painful at the same time. You will also hear a masterful and paradoxical response by Dr. Levitt when Lee resists—and as a result, his resistance suddenly disappears, and he jumps on board!

For the past couple months, Fabrice has asked me to set up a live therapy session to illustrate how to treat troubled relationships using TEAM-CBT. I was fortunate to get an email request from a colleague named Lee who wanted help with his marriage. He explained that his wife was very controlling and critical of him and attributed this to the fact that she had a controlling mother. This is very typical in troubled relationships, most of us are convinced that the problem is the other person’s fault. Of course, Lee told us that his wife, in turn, blames back and feels that Lee is the one who needs to change. Lee initially thought we’d do couples therapy, but in TEAM-CBT we actually prefer to treat just one person in a troubled relationship. Two weeks ago, Jill and I sat down with Lee on a Saturday morning, linking to each other on the internet since he lives abroad, for a three-hour treatment session. The session has been broken down into three separate podcasts plus commentary from Fabrice, Jill and David on each of the three segments. By way of disclaimers, Lee is a colleague who does coaching for individuals with alcohol addiction problems. We are not entering into a formal treatment relationship with Lee. Instead, he has offered to help us illustrate a therapy technique, using a real person problem, as part of his training and personal growth. We are deeply grateful to Lee for letting us share his intensely personal “session” with you! Today, you will hear the first segment on T = Testing and E = Empathy. Lee will tell his story. Jill and I will listen without trying to “help” or “rescue” Lee. On the Brief Mood Survey, he indicated no depression or suicidal urges. He was mildly anxious and slightly angry. His Positive Feelings Survey indicated that he was quite happy except in two areas: He felt only moderately close to people and only slightly connected to others. You will also hear him say that he felt like one of the loneliest people we would ever meet toward the end of the empathy phase of the session.

How to select the techniques that will be most helpful for various kinds of problems, and how to individualize the treatment for each patient.

For a long time, Fabrice has wanted to do a show on my list of "Fifty Ways to Untwist Your Thinking" called "Fifty Ways in Fifty Minutes." So we finally did it, and it was fun! If I'm helping you overcome depression or anxiety, I'll ask you to fill out a Daily Mood Log, so you can list your negative thoughts and feelings at some specific moment when you were upset. You may be thinking, "I'm a failure," or "I should not have made that mistake," or "I'm unlovable." Your negative thoughts will nearly always be distorted, but you'll still believe them, and that's why you're feeling depressed and anxious. And the moment you discover that your negative thoughts aren't true, you'll immediately feel better. But that's not going to be easy, because you've probably been giving yourself the same negative messages for years, or even decades.  And friends and family members, and even your therapist, may have been trying, unsuccessfully, to talk you out of them. That's why I've developed more than fifty methods to help you crush the negative thoughts at the heart of your suffering. So today, you'll take a look at the landscape!

For a long time, Fabrice has wanted to do a show on my list of "Fifty Ways to Untwist Your Thinking" called "Fifty Ways in Fifty Minutes." So we finally did it, and it was fun! If I'm helping you overcome depression or anxiety, I'll ask you to fill out a Daily Mood Log, so you can list your negative thoughts and feelings at some specific moment when you were upset. You may be thinking, "I'm a failure," or "I should not have made that mistake," or "I'm unlovable." Your negative thoughts will nearly always be distorted, but you'll still believe them, and that's why you're feeling depressed and anxious. And the moment you discover that your negative thoughts aren't true, you'll immediately feel better. But that's not going to be easy, because you've probably been giving yourself the same negative messages for years, or even decades.  And friends and family members, and even your therapist, may have been trying, unsuccessfully, to talk you out of them. That's why I've developed more than fifty methods to help you crush the negative thoughts at the heart of your suffering. So today, you'll take a look at the landscape!

I recently did the first of three interviews with Stephanie James on her superb radio show and podcast, The Spark.  Here’s how Stephanie described the interview (with minor changes): We have amazing power within us to change our thoughts, our feelings, our actions, and our lives. This episode is an inspirational way to take control of your automatic negative thoughts today and transform them in order to create a more joyful present and a more fulling future. Join us as we talk with the legendary Dr. David Burns about how we can break through the old thinking habits that bind us and begin to live a more happy, harmonious life where we can feel good now. Stephanie is a superb therapist and dynamic radio personality from Colorado. It was an honor to be on her show. She is co-authoring a book on how to live a “spark-filled life.” It should be completed soon, so you’ll likely be hearing from Stephanie a lot next year! Following the interview, Stephanie visited my Tuesday training group at Stanford and participated in one of our Feeling Good Podcasts with some students in the group. She suggested we might want to broadcast the Tuesday group live so that therapists from all over the world could join us. We are thinking about that, but will have to check with the powers that be to see if we could get permission to broadcast from Stanford, as well as our Tuesday group members who may have mixed feelings, due to the intensely personal nature of the training. Let me know what you think about this idea! My second interview with Stephanie was on the evolution of traditional Cognitive Behavioral Therapy (CBT) into the new TEAM-CBT. Fabrice and I will publish it for you shortly. My third interview with Stephanie will be on the interpersonal TEAM model—how to convert conflicted relationships into loving, rewarding ones.

I had a magical fantasies of what would happen once I was an “author.” The reality was quite the opposite and quite painful, with almost endless rejections accompanied by feelings of self-pity and defeat. For example, soon after publication, I learned my book was at the top of my publisher's "loser list." Then I discovered that magazines, newspapers, and TV and radio shows had no interest in it whatsoever. I hope you enjoy the story. It’s all about the celebration of failure and the conversion of failure into success.

I was recently interviewed by author, professor, and documentary filmmaker Roy Germano for his outstanding Other Side Podcast. Fabrice and I thought you might enjoy this interview, and Roy graciously gave us permission to share it with you. You will get some personal glimpses into the early days of my career, including why I left academics to pursue a full-time private practice, along with some of controversies about antidepressants. You will also hear a story of what happened when I was trying, rather unsuccessfully, to get my first book, Feeling Good, published. It wasn’t easy, and it almost didn’t happen! Roy is terrific and his podcasts cover a wide range of topics. You can find his podcasts on iTunes.

David and Fabrice answer five intriguing questions submitted by listeners: Joshua: How can I cope with panic attacks during job interviews? Dan: I feel traumatized by criticisms from my boss at work. what can I do? Susan: How fast can you taper off of anti-anxiety drugs and antidepressants? Ross: What if a patient who's been the victim of trauma or abuse asks for a male therapist? Isn't this a form of avoidance? Should patients be matched to therapists based on gender? Isn't it best to avoid the situations that trigger you? Sumit: I think I have "endogenous depression." Can TEAM-CBT help me? Or will I have to rely on medications? What is endogenous depression? If you have a question, make sure you email david and we will try to answer your question on an upcoming Ask David Podcast!

The Devil’s Advocate Technique is another one of the role-playing techniques in TEAM-CBT. You can use this technique for any habit or addiction, such as: Drug or alcohol abuse Overeating / binge eating Shopping addiction Internet addiction And procrastination, which is our problem for today. David and Fabrice are joined by Sara Shane, a member of David’s Tuesday evening psychotherapy Stanford training group for northern California mental health professionals. Sara has volunteered to demonstrate the technique to see if she can get some help with procrastination.

David describes watching Dr. Maxy Maultsby do a demonstration of the Double Standard Technique when he was a psychiatric resident in the 1970s at the University of Pennsylvania medical school. He was quite surprised when the patient, who was severely depressed and suicidal following a break-up with her boyfriend, improved dramatically within an hour. David modified the technique in several ways, and tonight will present what is probably the most powerful way to use this technique. The technique is based on the idea that most of us operate on a double-standard. When we are upset about some failure, mistake, or inadequacy, we tend to beat up on ourselves mercilessly. But if we were talking to a dear friend with the exact same problem, we'd be far more compassionate and realistic. Once you make the patient aware of this double-standard, you ask if he or she would be willing to talk to himself or herself in the same way he or she would talk to a dear friend. But the unique feature of the way David does it, is that you, the therapist, "become" a dear friend of the patient, kind of like a long-list identical twin who is actually virtually identical to the patient, but a different person. Then the therapist (playing the role of the friend) describe the problem the patient is struggling as if it is your own problem.

David's explains that he began developing role-playing techniques in the early days of cognitive therapy because many of the Beckian techniques, such as Examine the Evidence and the Socratic Technique--while sometimes very helpful, were sometimes a bit dry, and he wanted to include punchier and more powerful and dynamic techniques in his therapeutic toolkit. These role-playing techniques are just one part of what sets TEAM-CBT apart from traditional, Beckian CBT. Today, he explains and demonstrates the Externalization of Voices, which is always combined with the Self-Defense Paradigm and the Acceptance Paradox. He is joined by Fabrice, of course, and "Sarah," one of the members of his Tuesday training group at Stanford. Sarah has volunteered to use a personal example in the podcast to help demonstrate the Externalization of Voices.

This interview was first published on Neil Sattin's highly regarded Relationship Alive Podcast. Although some of the material may be familiar, there's much that's new, and you will enjoy the chemistry between Neil and David as they discuss each of the ten cognitive distortions and raise many challenging questions, such as: Is it really true that only our thoughts--and NOT external events--can change the way we feel? If someone has the belief, "I'm unlovable," isn't that type of thought immutable? How could you possibly change or modify a thought that may be rooted in traumatic experiences and so deeply embedded in a patient's psyche? Should we try to change other people's cognitive distortions, or just our own? How can we challenge each of the ten cognitive distortions? And much more! David's first interview with Neil received more than 25,000 downloads in the first month, and this riveting interview promises to be every bit as popular. If you want to download a transcript of this exciting interview, you can do so at www.neilsattin.com.

In this podcast, David and Fabrice answer five challenging questions submitted by listeners: Galina asks whether we always have to face our fears? Isn't it okay to be anxious sometimes? Courtney asks how to find the supplemental written materials, tests, and diagrams if you have purchased the eBook or audio-book copy of Feeling Good: The New Mood Therapy. Carlos asks about the best treatment for smoking cessation. During the discussion, Fabrice asks if Paradoxical Agenda Setting is important for therapists using hypnotherapy. Avi asks whether humans have a dark side, with dark negative motives that sometimes compete with positive, loving motives. And if so, how do therapists help patients deal with their own negative motives? Ben asks what to do if you're very anxious but simply can't pinpoint your negative thoughts.

In this podcast, David and Fabrice answer several fascinating questions submitted by listeners: Jackie asks where our distorted thoughts come from, since they are so often irrational and distorted, and inconsistent with the facts. Why do we sometimes beat up on ourselves relentlessly with negative thoughts? Tyler asks if it possible to do TEAM-CBT in conventional, 45 minute sessions. And if so, how? It seems my patients are just warming up by the end of the session, and then we have to start all over again the next week. Jess asks if it is possible to use the Five Secrets of Effective Communication in non-therapy settings. For example, if you are in a position of authority, like a high school teacher, will your students lose respect for you if you use the Five Secrets? Could you use the Five Secrets if you are working with violent gang members?  

"I'm a failure. . . I'm not good enough. . . My life will be empty and meaningless without . . . " Sound familiar? Sometimes, the messages we get from society, and the impossible standards that we accept, can lead to enormous, intense suffering. Several months ago I received a compelling email from a young woman named Daisy who asked about the message we get from society that lead to suffering. Fabrice and I were so inspired that we devoted an entire Feeling Good Podcast to it (Podcast 038: Negative Messages from Society) The theme of the podcast, as well as the three subsequent podcasts, was how to pinpoint and modify the Self-Defeating Beliefs (SDBs) that lead to depression, anxiety, and relationship problems. Today, Fabrice and I are thrilled and honored to present an entire TEAM-CBT therapy session with Daisy, along with her husband Zane.

Let's face it--nearly all of us fall into the black hole of depression, anxiety, shame, and self-doubt at times. Then it's time to ask yourself what you're telling yourself, write down your negative thoughts, identify the distortions in them, and substitute thoughts that are more positive and realistic. Sound too easy? The results can be mind-blowing! David and Fabrice discuss a therapy session with a woman who had been hiding something about herself for nearly ten years due to feelings of shame. When she receives a phone call from someone in her church, her feelings of anxiety and shame hit the ceiling. Learn how she overcomes her feelings of angst and self-doubt using TEAM-CBT. David hopes to make the actual video of this dramatic therapy session available soon right here at www.feelinggood.com in his new Feeling Good Store! (still under development at the time of this write-up.) While listening, you can download pdfs about each of seven steps to help you break out of bad moods and boost your self-esteem.

Procrastination is one of the most common causes of unhappiness, and this bad habit is almost universal. We all put off the tasks we dread because they make us anxious, and because we're tempted to do other things that are way more rewarding. But the longer you procrastinate, the worse you feel, and this robs you of motivation. As a result, you fall into a vicious cycle where procrastination triggers negative feelings like depression, anxiety, and guilt, and your negative feelings, in turn, reduce your motivation and trigger more procrastination. A vicious cycle. Fabrice and I are going to show you how to break the cycle and boost your happiness. To get started, please think of ONE thing you've been procrastinating on. It could be anything, such as working on your taxes, cleaning your garage, filing papers, working on a paper or presentation you've been avoiding, reading something you have to read for school or work--anything at all. Now I want to ask you a question. Would you like to overcome the procrastination so you can get started on that task? If your answer is no, you can come back and listen later when you do want to solve this problem. If the answer is yes, then I have a second question for you. WHEN would you like to overcome your procrastination and get started? Today? Or later on? If your answer is today, then we're ready to rumble. If you say, "tomorrow," or some later time, then I'd encourage you to come back to this podcast when you are ready to solve the problem. I can ONLY help you overcome your procrastination today! NOT tomorrow. Finally, I want to know if you'd be willing to devote a very small amount of time to getting started TODAY. I'm asking you to invest something like five minutes, and I'm also asking you to agree to limit your work this small amount of time. This is crucial, because if you tell yourself you have to do the entire job, that may take hours, and you'll probably feel so overwhelmed that you won't do a thing! Finally, I want to know if you'd be willing to get started for five minutes even if you're not "in the mood," and even if you're completely unmotivated, and EVEN if the very thought of the task makes you anxious and guilty. If the answer is YES, then we've got a deal. But if you want to wait for the motivation, I urge you to turn off the podcast and come back to it at some later time. One philosophical principle is the approach we're going to teach you is NOT to wait for motivation. Most procrastinators think that motivation comes first, followed by productive action, but this is an illusion, because you'll probably NEVER feel motivated to do some awful task you've been putting off. If you're waiting for motivation, you'll be waiting forever! As I wrote in my first book, Feeling Good: The New Mood Therapy,  highly productive people know that ACTION comes first, followed by motivation. In other words, you have to get started on some task before you'll feel motivated. You're not entitled to feel motivated until you've start accomplishing something! Waiting for motivation is the trap that keeps your procrastination alive and prospering. I'm going to make things simple for you using a tool I created years ago called the Anti-Procrastination Sheet! To make this podcast experiential, think about the specific task you've been putting off, like filing papers, preparing your taxes, cleaning the garage, a paper or report you have to prepare--anything at all. Now take a look at the Anti-Procrastination Sheet. As you can see, it has five vertical columns, but they're different from the columns on the Pleasure Predicting Sheet that we discussed in last week's podcast. In the first column you break the task into small, or even tiny, steps, and number them. Make sure that each step can be completed quickly and easily--for example 30 seconds, or a minute or two. You don't have to outline the entire task, just the first four or five steps. And make sure the steps are small enough so you can complete all or most of them in five minutes or so. The philosophy behind this is called "little steps for big feats!" If you aim to do just a little, you may end up doing a great deal. But if you aim to do it all at once, the odds are high that you'll just end up procrastinating, because the task will seem overwhelming. After you've outlined the first few steps, predict how satisfying or rewarding each step will be in the second and third columns, on a scale from 0% (not at all satisfying) to 100% (tremendously satisfying.) Make sure you complete this column before you do the activity. And make sure you do it on paper, and not just in your head! Now complete the first step, and indicate how satisfying and rewarding it turned out to be on the same scale, from 0% to 100% in the fourth and fifth columns. That's all there is to it! Now do the same thing for the second step of the task.

David begins with a brief discussion of the philosophy of happiness, including the ancient Buddhist idea that everything in the universe is transitory and constantly changing, including our positive and negative moods, so the idea that you will be hopelessly depressed forever, or endless happy, are both illusions. Happiness, or pleasure, are transitory, and can only be achieved at specific moments. However, you can significantly increase the number and duration of the happy periods in your life. David briefly discusses research evidence that simply doing potentially satisfying and rewarding activities, whether or not you're "in the mood," can reduce depression and enhance feelings of happiness and joy in daily living. This simple treatment method, called "Behavior Therapy," was pioneered by Dr. Peter Lewinsohn, from the Oregon Research Institute, and has been shown to have significant anti-depressant effects. One way of doing this is with David's famous "Pleasure-Predicting Sheet." It's pretty simple to use. As you can see from the link, it is a sheet with four vertical columns. In the first column, you schedule activities with the potential for pleasure, learning, personal growth, or helping others. You can include activities that are not overly time consuming or burdensome. In the second column, record who you plan to do each activity with. If you do the activity alone, put "self" in the second column, since you're never truly alone. You're always with your "self." In the third column, predict how satisfying or rewarding the activity will be, on a scale from 0% (not at all satisfying) to 100% (tremendously satisfying.) Make sure you complete this column before you do the activity! And make sure you do it on paper, and not just in your head! Once you've completed each activity, indicate how satisfying and rewarding it turned out to be on the same scale, from 0% to 100%. That's all there is to it! Then you can compare the last two columns (the predicted and actual satisfaction). Sometimes, depressed individuals think that things they used to enjoy will be boring or unrewarding, so they give up on things, fail to answer the phone, and mope around at home in a state of hopelessness and self-pity. Of course, that's a self-fulfilling prophecy and a vicious cycle, because when you stop doing things, you will probably become more depressed, and then you'll be even more likely to give up doing things for pleasure. In contrast, when you do things, you may discover that many activities are more rewarding than you anticipated. You can also compare the satisfaction you experience when doing things by yourself versus the activities you do with others. Many depressed people with the Love Addiction believe they cannot be happy when they're alone, thinking they must be loved to feel truly happy and fulfilled. David describes a woman who tested this belief, and made an unexpected discovery, after her husband rejected her for another woman. You can see her Pleasure Predicting Sheet if you click here. Finally, David gives an example of how a depressed, perfectionistic medical professor made another unexpected discovery with a modified version of the Pleasure-Predicting Sheet. The Pleasure-Predicting Sheet is one of only 50 to 100 methods that David has learned or created for defeating depression and anxiety. He doesn't see it as a complete treatment for depression, but it usually has some nice mood-elevating effects. Fabrice and I encourage you to try it this week, so you can let us know how it works for you! Next week, we'll have another cool tool you can use to boost your happiness by overcoming procrastination!

We address five questions submitted by listeners who listened to the recent series of podcasts on the Five Secrets of Effective Communication.

You definitely do NOT want to lose weight. You probably DO want to be thin and attractive, and in great physical condition, but you DON'T want to lose weight. Do you know why? There are only two things that you can do to lose weight--diet and exercise. And they both suck! David describes two new, powerful techniques he has created for resolving this dilemma--the Double Paradox and Devil's Advocate Technique. David and Fabrice bring these techniques to life for you. If you are interested in losing weight, make sure you do the two exercises on paper while listening to this podcast.

What do I do if I am using the Five Secrets and I feel angry? If I use the Disarming Technique, isn't there a danger that I might not express my own feelings? And isn't this the same as your "Hidden Emotion" Model, where we don't express our feelings due to excessive niceness? How would you use the Five Secrets if you're attacked in public by a narcissistic boss? Should you use the Disarming Technique? Won't that make you look weak? Should you only use the Five Secrets in one-on-one situations? Why is the Self-Monitoring technique rarely effective? How would you help young people who are being bullied in social media?

David and Fabrice discuss Inquiry, the third of the Five Secrets of Effective Communication. Inquiry means asking gentle, probing questions to learn more about what the other person is thinking and feeling. David encourages listeners (that includes you!) to try using Inquiry five times each day, even in superficial interactions with people in any setting, such as the grocery store, and gives examples of how to do this. Although this will not be the deepest application of Inquiry, the practice will give you a clear understanding of how this technique works.  

David addresses a question submitted by a listener after he heard the introductory podcasts on the Five Secrets of Effective Communication. He questioned the value of the Disarming Technique, and protested that every time he "turned the other cheek" he simply ended up with two sore cheeks! A great question, and David and Fabrice share their thinking. Many people, including therapists, are afraid of the Disarming Technique, thinking that something terrible will happen if they agree with someone who is criticizing them. They emphasize the value of questions submitted by you, the listeners, and also suggest giving specific examples when they are having trouble using the Five Secrets. Specifically, if you write down exactly what the other person said to you, and exactly what you said next, David and Fabrice will gladly analyze the interaction and show you what errors you made that caused a bad outcome, as well as how to correct those errors! David and Fabrice then discuss Thought and Feeling Empathy, the second of the Five Secrets of Effective Communication. The definition of Thought Empathy is repeating or paraphrasing what the other person is saying, so he or she will see that you listened and got the message. Feeling Empathy, in contrast, involves acknowledging how the other person is likely to be feeling, given what he or she just said. You can often follow this with Inquiry, asking if you got it right, and inviting the other person to tell you more about what he or she is thinking. Although David does not like formulas, they can sometimes help you get started. So here's the formula: Thought Empathy: Let me see if I got what you just said. You told me that A, B, and C. (A, B, and C would be what the person said to you, using his or her words.) Feeling Empathy: Given what you just said, I can imagine you might be feeling X, Y, and Z. (X, Y, and Z would be words from the Feeling Words list.) Inquiry: Did I get that right? Can you tell me more about what you've been thinking and feeling? These techniques are invaluable in therapy, and go back to the pioneering work of Karl Rodgers, who argued that therapist empathy is the necessary and sufficient condition for personality change. Although subsequent research did not confirm this idea, there is still little argument that empathy is absolutely necessary for good therapeutic work. In addition, skillful empathy is for everyone, and can greatly enhance your relationships with family members, friends, and colleagues, and strangers as well. For example, if you have a family member or friend who is feeling anxious, down, angry, or depressed, the skillful use of Thought and Empathy will almost always be far more effective than trying to help, rescue, or "fix" that person.   David brings Thought and Feeling Empathy to life with an example of a patient who criticizes his therapist, and then asks listeners, including you, to pause the podcast briefly so you can write down, from memory, what the patient just said. Most therapists who try this end up "forgetting" or editing out important portions of what the patient said. This irritates the other person, because you clearly did not "get it," and his or her attack or complaining will usually escalate. David and Fabrice discuss common errors therapists and general public make when trying to use Thought and Feeling Empathy. The most common error involves using the techniques in a robot-like manner, parroting back the other person's statements repeatedly, without using "I Feel" Statements. They illustrate this error with a humorous example. Other common errors when using Thought and Feeling Empathy include: Helping Rescuing Giving advice Correcting distortions Making interpretations Failing to acknowledge the other person's anger   David encourages listeners (that includes you!) to try using Thought and Feeling Empathy three times each day, even in superficial interactions with people in any setting, such as the grocery store, and give examples of how to do this. Although this will not be the deepest application of these techniques, the practice will give you a clear understanding of how these techniques actually work. David and Fabrice end this podcast with a powerful example of Thought and Feeling Empathy during an actual therapy session in David's weekly psychotherapy training group. The "patient" in the therapy is a TEAM-CBT therapist named Rhonda who became depressed and anxious after receiving some critical therapy from a participant in a therapy group she was teaching. Even if you are not a therapist, you can perhaps identify with the "ouch" we all feel when we are criticized by someone, and it hits a vulnerable spot. This is an almost universal human concern. It is so easy to feel hurt, depressed, ashamed, anxious, inadequate, and perhaps even a bit angry! David invited one of the therapists in the group to empathize with Rhonda, as a part of his training, but he ended up with a less than stellar grade. David, Fabrice and Rhonda explain the errors he made--which actually made her feel worse. Making errors is totally okay in a training and learning situation, as well as in real therapy sessions--as long as you get feedback and try to correct your errors with humility. This can actually deepen the therapeutic relationship. David then asked Dr. Jill Levitt to try to model empathy again, and to address Rhonda's concerns. Jill hits the ball out of the park and gets an A+ on empathy. David and Fabrice explain why her intervention was so effective, and why the Five Secrets have to come from the heart if they are to be maximally effective. Jill is a master therapist and co-teaches the weekly TEAM-CBT training group, along with David and Dr. Helen Yeni-Komshian. If you would like to hear more of Jill's fabulous empathy work, make sure you listen to the live therapy podcasts with Mark, the physician who felt like a failure as a father! Next week, Helen returns for the remaining Podcasts on the Five Secrets!  

David, Helen and Fabrice focus on the Disarming Technique, which is the first of the Five Secrets of Effective Communication. The definition of the Disarming Technique is finding truth in what the other person is saying, even if it seems blatantly wrong, or illogical, or exaggerated. And it's based on the Law of Opposites.  

Is there someone in your life who just  won't listen? won't open up? always has to be right? always has to get his or her way? doesn't seem to understand how you feel? doesn't seem to care? is relentlessly critical? whines and complains endlessly, but always ignores your attempts to help? Would you like greater intimacy and respect, and more rewarding relationships with the people you care about? If so, this podcast series on the Five Secrets of Effective Communication will be right up your alley. Although the Five Secrets have been introduced in previous podcasts, David and Fabrice will bring them to life with clear explanations and vignettes, and will give you homework assignments so you can practice them, one at a time, between podcasts. In the first two Five Secrets podcasts, David and Fabrice will be joined by Helen Yeni-Komshian, MD. Helen was David's student during her psychiatric residency training at Stanford roughly 15 years ago, and she now teaches David's at weekly psychotherapy training group at Stanford, and is on the adjunct faculty there. David, Helen, and Fabrice begin with a brief definition of each of the Five Secrets of Effective Communication. They emphasize the importance of intense desire if you really want to learn and master these techniques. They compare the Five Secrets to the notes on a musical instrument. Lots of dedication and practice will be necessary if you hope to use them skillfully and effectively in your relationships with the people you care about. The goal is to help you develop greater  satisfaction in your interactions with others and to resolve conflicts and arguments with others. Helen emphasizes that these techniques must be applied in a genuine fashion if they are to be effective. If they are used simply as techniques to manipulate another person, they will not be effective. David mentions that the Five Secrets exist on two levels. One the one hand, they are sophisticated and powerful psychological techniques that can change your life and your relationships with others. But on the other hand, they are profound spiritual techniques that require the death of the ego. And they also require us to relearn our usual knee-jerk habits of arguing, blaming, and defending ourselves when we're at odds with another person. These podcasts will be for mental health professionals and for the general public. We will give vignettes illustrating challenging therapeutic logjams that were resolved with the skillful use of the Five Secrets, as well as examples  how you can use the Five Secretes with loved ones, friends, colleagues, customers, and even aggressive or irritating strangers. The Five Secrets require lots of hard work and practice, in much the same way that learning to play a musical instrument will require lots of practice. In addition, when you practice you may initially find them difficult to use, and you may experience some failures. David, Helen, and Fabrice emphasize the spirit of "joyful failure" or "learning through failure," and urge you to check your ego at the door, since the rewards of the learning can be immense.  

How would you treat excessive worrying? a listener asks. David describes a new patient who had struggled with 53 years of failed therapy for excessive, relentless worrying, and describes how she was "totally and irreversibly cured" in just two therapy sessions, which was the "good news." The Hidden Emotion Technique was the key to her remarkably rapid recovery. David explains that the "even better news" was that her relentless worrying would come back over and over in the future, and that this was actually a really good thing! David also emphasizes the importance of using all the four models, along with a Daily Mood Log, when treating any form of anxiety: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. To learn more about how these four powerful treatment models work, you can listen to Podcasts 022 through #028. The DSM5 is the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. It is used to assign diagnoses to patients. David critiques the DSM5  diagnostic criteria for "Generalized Anxiety Disorder" (GAD) and emphasizes that while worrying exists, and can easily be treated in most cases, the "mental disorder" called Generalized Anxiety Disorder does not exist, and is simply a fantasy made up by the psychiatrists who have created the DSM. Soon, David and Fabrice will launch a series of five podcasts on the Five Secrets of Effective Communication, focusing on one technique each week. Say tuned, because these podcasts could change your life and show you the road to more loving and satisfying relationships with friends, patients, colleagues, and family members--and "enemies" as well!  

Is there anything positive about hopelessness or an addiction ? What does it take to be a "worthwhile" human being, or to have a valuable life? In today’s podcast, David and Fabrice address three questions submitted by listeners: Avi asks another great question about the importance of Positive Reframing in TEAM-CBT. But how can we possibly find something positive in the feeling of hopelessness. After all, Dr. Aaron Beck has taught us that it's the worst emotion of all! Avi asks a similar question about an addiction. How can an addiction possibly be a good thing? Eugene asks a tremendous question about a passage in Dr. Burns' book, Feeling Good: The New Mood Therapy, on the topic of what it means to be a worthwhile human being, and what it takes to make a life valuable. Eugene hints that Dr. Burns may have the wrong idea, and asks what he would say to a patient who doesn't "cry uncle!" David and Fabrice love your questions so keep them coming!  

Will people manipulate you if they catch on to the fact that you're using the Five Secrets of Effective Communication? Is it fair to ask depressed patients to do psychotherapy homework between sessions when they're already struggling with a loss of motivation? In today’s podcast, David and Fabrice address two questions submitted by listeners: Robert asks whether it would be a problem if you are using the Five Secrets of Effective Communication (the Disarming Technique, Thought and Feeling Empathy, Inquiry, "I Feel" Statements, and Stroking) with someone who is already familiar with these techniques. Isn't there a danger that they might see through you and  therefore thwart your efforts and manipulate you? Avi asks about the importance of psychotherapy homework in TEAM-CBT. He points out that the loss of motivation is one of the central symptoms of depression, so aren't we in a catch 22 type of situation since patients might not have the strength and perseverance to do their homework? David and Fabrice love your questions so keep them coming!

We address a number of excellent questions submitted by listeners: Are the scales on your Brief Mood Survey reliable and valid? How can I identify my Negative Thoughts when I'm upset but I can’t figure out what I'm thinking and telling myself? I have social anxiety and don’t want to get out of bed. I'd rather just lie in bed and watch Game of Thrones. Help me! What should I do? I saw an article in the paper that claimed that bacteria in the gut cause anxiety. Is this true? If not, what does cause depression and anxiety? Could your tools, like the Cost-Benefit Analysis, help with problems that aren’t necessarily emotional problems? Like what career to pursue, or what college to go to? What should you do if you feel great at the end of a therapy session, and then become severely upset again during the week? How does Dr. Burns deal with resistance from colleagues when he is trying to teach these new TEAM-CBT techniques? Does he run into much resistance? How does he feel about the resistance?

David describes one of the more obscure methods called “Self-Monitoring”. He thinks of it as “Meditation in Daily Life.” The whole idea is to note a negative thought that suddenly pops into your mind, and then to track it, or count it, with some type of counting device, list the wrist counters golfers wear to keep track of their scores, and then to simply let go of the thought and continue with what you were doing, instead of dwelling on the thought and getting distracted and upset. David explains that Self-Monitoring often is not effective, but occasionally it can be life changing for individuals who are struggling with anxiety, depression, or anger. He brings the method to life with the story of an eye doctor with severe OCD who recovered completely because of Self-Monitoring in combination with Response Prevention. He also explains how this technique, along with the Daily Mood Log, was curative for a retired carpenter with severe depression following a stroke. The type of stroke is called “Pseudo Bulbar Palsy,” and the symptoms include uncontrollable sobbing or laughing after the slightest sad or funny event or comment. This case was particularly interesting because the therapist for the carpenter was one of David’s students, a clinical psychologist who had raised the question, “How could cognitive therapy possibly help someone if his or her depression is caused by a chemical imbalance in the brain?” And in this instance, since we know the carpenter’s depression was caused by thousands of microscopic hemorrhages in the deep structures of his brain, how could any kind of psychotherapy possibly help?”

This podcast was recorded eight weeks after the initial session with Marilyn. As you may recall, Marilyn became severely depressed when she discovered that she had Stage 4 Lung cancer. In spite of that horrific and real trauma, she completely overcame her negative feelings in the first session, which was broken down into a series of three consecutive podcasts, with commentaries as the session unfolded. Sadly, Marilyn experienced severe pain in her left rib cage from a metastasis from her lung cancer roughly two months later. This physical relapse triggered an understandable emotional relapse as well, with an understandable return of severe depression, anxiety and anger, so Marilyn agreed to record another podcast to illustrate how a tune-up works following the initial treatment. I would like to point out that the Relapse Prevention Training was critically important, so that Marilyn would know that relapses are a certainty, and that they can be dealt with effectively using the same techniques that worked the first time. This message is important so that the patient does not feel broadsided when the negative feelings return. Some patients have the false expectation that they'll be happy forever after they've recovered. But no one is entitled to be happy all the time! If the therapist and patient know how to deal with a relapse, and have practiced ahead of time, it will still be painful, but the patient and therapist will know what to do to make sure the patient can recover from the relapse quickly, instead of getting caught in another length episode of depression or anxiety. The entire session has been included in this single podcast. That’s why we’ve offered this as a bonus session between our weekly podcasts. You will need nearly two hours to listen to it, but I think you will find it’s a great investment of your time.

David and Fabrice begin by reading several incredibly touching reader comments on the live therapy with Marilyn. Marilyn experienced a severe depression relapse eight weeks after her initial session with Matt and David, because of a painful metastasis to her rib cage which frightened and demoralized her. She graciously agreed to come in for a tune-up with David and Matt which will be published as a special podcast within the next week or so. You will not want to miss this session! David addresses two questions posed by listeners. The first question has to do with so-called “third wave” CBT as well as Mindfulness-Based CBT and other innovations in CBT. David stresses the difference between specific and non-specific therapeutic techniques. He also discusses the distressing but exciting fact that few or no therapies have proven to be much more effective than placebos in the treatment of depression, and why this is the case. Another listener asked why David did not use Exposure initially in his treatment of the woman who was afraid that her baby would be switched at the hospital, and that she’d end up with the wrong baby. David concedes that if he’d thought of using Cognitive Flooding initially, it likely would have been effective. He also argues that Exposure and Response Prevention are not treatments for OCD, or for any anxiety disorder, but are simply tools one can use in treatment. David argues that for an optimal outcome, he combines four treatment models with every anxious patient: the Motivational Model, the Cognitive Model, the Exposure Model, and the Hidden Emotion Model. These models are discussed in detail on previous podcasts.

David emphasizes that the goal of the RJ is not simply to learn how to transform troubled, adversarial relationships into loving ones, but also how to achieve Interpersonal Enlightenment, which is the empowering but shocking realization that we are creating our own interpersonal reality—for better or worse—at every moment of every day! And although the reward of the RJ is greater love and joy in your daily living, the price is steep—it requires the death of the ego, which the Buddhists have called “the Great Death!” Together, David and Fabrice walk you through the five steps in the RJ, using real examples of individuals David has worked with in his workshops for the general public or for mental health professionals. One vignette involves a woman who complained bitterly that her husband had been relentlessly critical of her for 25 years. She said she came to the workshop because she wanted to know why men are like that. She found out why her husband was so critical, but the answer was not the one she expected! The other vignette involved a minister’s wife who complained that her husband was overly “nice” and unable to deal with negative feelings. As a result, she said their marriage was superficial and lacking in intimacy. She discovered precisely why their relationship was superficial—but it wasn’t exactly the answer she was looking for!

Bob, a psychiatric resident named was treating a divorced woman who complained bitterly about her ex, and constantly argued with him whenever he came to visit with the children. Their relationship was clearly acrimonious, so Bob asked the woman if she wanted some help with the way she was communicating with her ex. She bristled and said that she was an attorney and that she could communicate just fine, thank you! Bob’s error was the same that many therapists make—of thinking that people with troubled relationships want help. Clearly, Bob’s patient was not asking for help. She just wanted Bob to agree that her ex was a bum! In many cases, and perhaps most, individuals who aren’t getting along with someone—such as their spouse, sibling, parent, colleague, or friend—aren’t really asking for help. They just want to vent and persuade you to buy into their negative view of the person they aren’t getting along with. They just want you to know what a loser the other person is! So how do we help people with troubled relationships? David emphasizes that empathy is always the first step. You try to see the world through the eyes of the patient without jumping in to try to “help.” Empathy, of course, is the "E" of TEAM therapy. Once the person feels understood and supported, the next step is called Agenda Setting. That’s the A of TEAM. One of the most important tools in Agenda Setting for individuals with troubled relationships is to first ask, “Is this relationship conflict something you want help with?” In many cases, the patient will say no, so you can ask if there’s something else he or she wants to work on. In the language of TEAM, this is called “Sitting with Open Hands.” The therapist has to let go of his or her attachment to “helping.” This is difficult for many therapists, due to the therapist’s compulsive urges to help. If the patient does want help, the next step is called Interpersonal Decision-Making. You ask what kind of help the patient wants, and make it clear that the patient has three choices. To leave the relationship. To improve the relationship. To stay in the relationship and behave in a way that will guarantee that the relationship will remain miserable. David emphasizes that the last choice is by far the most popular. The second most popular choice is the decision to leave the relationship. And occasionally, you’ll find a person who wants help improving the relationship. As you can see, Interpersonal Decision-Making is simply a more sophisticated way of asking the patient if she or he wants help! If the answer is still yes, the next Agenda Setting step is the Blame Cost-Benefit Analysis (CBA). You can ask the patient something along these lines: “Who, in your opinion, is more to blame for the problems in the relationship? You? Or the other person? And who, in your opinion, is the bigger jerk? You? Or the other person?” At least 80% of the time, the patient will say, “the other person!” You may feel the same way if you’re in a conflict with someone right now. However, blame is the most formidable barrier to intimacy, so before we can continue with the treatment, this issue must be skillfully addressed, or the treatment will probably fail. David and Fabrice guide the listener in doing a written Blame CBA, listing the advantages and disadvantages of blaming others for the problems in our relationships with them. They encourage you to pause the recording and to the written exercise during the podcast, but warn you not to do it if you are driving! Then they discuss how to process the results of the Blame CBA. If you would like to see a completed Cost-Benefit Analysis, click here. As you can see, the weightings at the bottom have not been filled out, so you can do that for yourself if you like. Make sure you put two numbers that add up to 100 in the two circles. Put the larger number in the circle under the column that feels more desirable. For example, if the advantages of blame greatly outweigh the disadvantages, you might put a 70 in the circle on the left and a 30 in the circle on the right. If the patient concludes that the disadvantages outweigh the advantages, you can proceed to the M = Methods phase of the TEAM therapy session, which involves the Relationship Journal (RF). This is a powerful tool that David has designed to create interpersonal enlightenment and the death of the ego. David and Fabrice will discuss and illustrate the RJ in the next podcast.

David describes the three assumptions of the Interpersonal TEAM Therapy: We cause the very relationship problems we are complaining about, but don’t realize this, so we blame the other person and feel like victims of his or her“badness.” David describes a man who endlessly complained about his wife during therapy sessions--she didn't like having sex with him, she spend money behind his back, and never bragged about him when they were out to dinner with friends. He had even taken notes for years on all the “bad” things his wife had been doing every day throughout their marriage, but overlooked the many hurtful and self-centered things he was doing to break her heart every single day. We do not want to have to look at our own role in any relationship conflict because it is too painful to have to confront our “shadow,” to use a Jungian concept, and because we want to do our dirty work in the dark. So we will deny our role and angrily punish anyone who tries to shed light on our role in the problem. David describes a severely depressed woman who complained that she was the victim of "loneliness in marriage," a concept she'd just read about in a popular women's magazine. She explained that her husband would not and could not express his feelings, and felt that he was to blame for their marital problems as well as the severe depression and loneliness she’d been struggling with for 25 years. And yet, in a therapy session when he tried to express his feelings, she exploded angrily and told him to shut the F__ up! When Doctor Burns asked her to reflect on what had happened in the session with her husband, she angrily threatened to fire him if he ever brought up the topic again! The first two principles paint a dark picture of human nature. The third principle is more optimistic—namely, that we have far more power to heal a troubled relationship than we realize, and this can often happen quickly, but there’s a stiff price to be paid.  First, we have to be willing to stop blaming the other person so we can examine and pinpoint our own role in the conflict. Second, we have to focus all of our energy on changing ourselves, rather than trying to change the other person. This can be extremely liberating and joyful, but it involves the exceedingly painful death of the ego. The Buddhists have called this type of enlightenment “the Great Death.’ In the next podcast, David and Fabrice will show you how to transform your own troubled relationships into loving ones--if that's what you want to do!

First in a series of podcasts on how to transform troubled relationships into loving ones—if that's what you want to do! David begins with the story of how he got into working with troubled couples as well as individuals with troubled relationships shortly after his first book, Feeling Good, was published. Because cognitive therapy was beginning to generate excitement worldwide as the first drug-free treatment for depression, everyone thought it might also be effective for other kinds of problems, including troubled relationships. And there were fairly good reasons to suspect that cognitive therapy might be helpful. When you’re in conflict with a loved one, friend, colleague or stranger who you can't get along with, you’ve probably noticed that you will usually have negative thoughts like these running through your brain: It’s all his fault. (Blame, All-or-Nothing Thinking) She’s a jerk. (Labeling, Should Statement, Mental Filter, Hidden Should Statement) He’ll never change! (Fortune Telling, All-or-Nothing thinking, Discounting the Positive, Emotional Reasoning) All she cares about his herself. (Mind-Reading, Discounting the Positive, Mental Filter, Over generalization) I’m right and he’s wrong about this! (Blame, All-or-Nothing Thinking) She shouldn’t be like that. (Should Statement, Blame) Sound familiar? And as you can see, these thoughts contain all the same kinds of cognitive distortions that depressed individuals have, as I've indicated in parentheses. If you're familiar with the cognitive distortions, you may be able to pinpoint even more than the ones I've listed. The only difference is that when you're in conflict with someone, the distortions will usually be directed at the person you’re not getting along with, rather than yourself. Although these thoughts will usually be distorted, you may not realize this (or even care) when you're upset. You'll probably be convinced that the person you're mad at really is a jerk, or really is to blame, or really is wrong. In addition, these thoughts will tend to function as self-fulfilling prophecies. For example, if you think someone is a self-centered jerk, you will usually treat him or her in a hostile or unfriendly way, and then he or she will get defensive and hostile, and will look like a jerk. Then you'll tell yourself, "See, I was right about him (or her)!" David got excited about these insights and wrote a draft of a book called Couple in Conflicts, Couples in Love, and sent it to his editor in New York to see what she thought. The new book was about how to modify the distorted thoughts and self-defeating beliefs that trigger and magnify relationship problems. David's editor called the next day with an offer of a large advance, exclaiming excitedly that the book was sure to be a #1 best seller. David was ecstatic, and set out to edit the book for publication. In the meantime, he was using the new approach with troubled couples as well as individuals with relationship conflicts. But after six months of repeated treatment failures, he concluded that cognitive therapy was not at all effective in the treatment of relationship problems. The approach sounded great on paper, but it didn't work in the real world. David sadly returned the advance to his publisher and cancelled the contract. He promised that if he could figure out why cognitive therapy didn't work for troubled relationships, and if he could find a better treatment method, he’d write another book. Figuring it out took 25 years or research and clinical experience, and the name of the book he eventually did publish is called Feeling Good Together, now available on Amazon.com. David and Fabrice then discuss some of the most popular theories about the causes of relationship problems: The skill deficit theory: We want loving relationships, but don’t have the communication and negotiation skills to get close to the people we’re not getting along with. The barrier theory: We want loving relationships, but something gets in the way, such as unrealistic expectations or distorted thoughts about the person we’re not getting along with. Other barrier theories include the idea that women are from Venus and men are from Mars popularized by John Gray, Deborah Tannen, and others. According to this theory, women use language to express feelings, and men use language to solve problems, so they both end up frustrated and not understanding one another. Another popular theory is the idea that we project childhood conflicts with our parents onto others, and thus recreate the same dysfunctional patterns repeatedly in every new relationship. The self-esteem theory: You can’t develop loving relationships with others if you don’t know how to love yourself. The motivational theory: We have troubled relationships because we WANT them! David emphasizes that the first three theories are all very optimistic--they all are based on the idea that human beings are basically good and want loving, peaceful, joyous relationships. But something gets in the way, such as a barrier of some type, or the lack of communication skills, or the lack of self-esteem. And they are all very hopeful, since we can teach people better skills, or remove the barriers to intimacy, or help people develop better self-esteem. David also emphasizes that these theories have only two problems. First, the theories that they're based on are false. Second, the treatments that have evolved from these theories are not effective. David and Fabrice describe research on the validity (or total lack of validity) for these theories as well as the effectiveness (or lack of effectiveness) of the treatment techniques and schools of therapy that have evolved from these theories. David then discusses the motivational theory which is much less optimistic about human nature, and emphasizes that humans have competing positive and negative motives. In the next podcast, they will discuss the basics assumptions of the new treatment approach David has created for relationship problems, based on the motivational theory.

A listener named Benjamin asks about procrastination. He wrote: “The live therapy with Marilyn was very interesting - like other listeners, I was impressed by her character and strength. “Towards the end of this most recent podcast, you were musing on what topics to cover in future podcasts. I would love to hear about how you treat people suffering from chronic laziness ("Do Nothingism"). In particular, there seems to be a strong potential of a Catch-22 with Process Resistance: The patient cannot find the motivation to do anything, yet they have to carry out the process (do the homework) to improve. “Even worse, in "Feeling Good", you categorize "Do Nothingism" into around 10 different categories, and suggest a different approach for each one. What should a lazy person do, who identifies with multiple categories, but is already starting to feel overwhelmed at the prospect of doing one of those activities, let alone five of them? “I would love to hear David's thoughts on this!” David and Fabrice begin by thanking Benjamin, and David emphasizes how helpful and inspiring it is to receive specific questions like this, which makes it easy to create a (hopefully) informative and interesting podcast. David says that his thinking about the treatment of procrastination has changed greatly since he wrote Feeling Good. One big change is that he no longer tries to “help” individuals who procrastinate, since this will cause them to continue to procrastinate, and the failure will now be the failure of the therapist, who’s “helping” wasn’t good enough. Instead, David outlines a multi-step approach, based on someone who has ten years of unfiled papers that have piled up in his office, so that by now 15 feet of desk space is completely covered by piles of papers roughly one foot high. Fabrice plays the role of the resistant patient, and David plays the role of the therapist. The steps include: Paradoxical Agenda Setting: David asks, “The procrastination seems to be working for you. Why would you want to change? Let’s make a list of all the benefits of procrastination, and all the reasons NOT to change.” David emphasizes that the patient has to convince the therapist that this is something he really does want to change. It’s NOT the therapist’s role to help or to convince the patient to change! Miracle Cure Question: What kind of help would you like in today’s session? Most patients say they need help with motivation. David declines to offer this, explaining that it isn’t on the therapeutic menu today—only the “Blue Plate Special!” The patient must agree to begin working on the filing in spite of having no motivation. David also explains the underlying concept behind this strategy: most procrastinators are waiting for motivation, but that never works. You’ll be waiting forever, because you’re NEVER going to feel like doing all that filing! You aren’t entitled to motivation! Productive individuals know that action comes first, and motivation comes second. Specificity: What time would you like my help in overcoming your procrastination? The patient’s requests for help yesterday or tomorrow are declined by the therapist, so they settle on 6 PM today. Little Steps for Big Feats: Let’s list the first five things you would need to do tonight at 6 PM, making sure that every step can be completed in 15 to 30 seconds. They list these steps: Walk into my office Choose one pile to start working on Pick up the top piece of paper on the pile Put it into a blank manila file folder Label the file folder Let’s Be Specific: David asks if Fabrice needs help with Step 1? Step 2? Etc. Fabrice finally admits he can do these five steps. Five Minute Rule: David asks if Fabrice will agree to do these five steps between 6 PM and 6:05 PM, and if he will agree to work on his filing for ONLY those five minutes. At the end of the five minutes he has completed 100% of the assignment. The rationale is that if Fabrice tries to do it all, he’ll get so overwhelmed that he won’t do anything. But if he agrees to ONLY five minutes, that will be do-able. And if he surprises himself, and gets motivated to do more, he can, be he only gets credit for the first five minutes. Problem – Solution List: David asks Fabrice to put a line down the middle of a piece of paper, from top to bottom, and list all the problems that will get in the way at 6 PM, and then to list convincing solutions to each problem in the right-hand column. Fabrice lists two problems: 1. I won’t feel like it. And 2. Traffic might be heavy, so I might not get home by 6 PM. “I Stubbornly Refused” Technique: David asks Fabrice to agree to an unusual phone call at 6:05 PM! TIC – TOC Technique: David plays the role of Fabrice’s “Task-Interfering Cognitions” (TICS) that will tempt him to procrastinate, and asks Fabrice to play the role of the “Task-Oriented Cognitions” (TOCS) he can use to combat the TOCs. The TICS include the familiar ones such as: Five minutes won’t help, the job is overwhelming. Even if I get started, I’ll just relapse, so there will never be a permanent solution. It’s not such a big problem, I don’t need to do my filing now. I can watch Game of Thrones on TV instead. That will be more fun. It will be too anxiety provoking to get started. It’s too late to get started anyway. Tomorrow will be a better day. David confesses the problem is one that he actually had, and describes how he solved it, using this exact approach!

The responses to the Marilyn session were extremely positive. At the start of the podcast, Fabrice reads a response from a listener who was moved and inspired by the work Marilyn did. David and Fabrice discuss two questions commonly raised by people who have seen David's live demonstrations with individuals experiencing severe depression and anxiety. Since the change in Marilyn’s scores were so fantastic, some skeptical listeners have asked, “Was this real, or was it staged?” Others have asked if patients are simply giving favorable answers on the Brief Mood Survey and Evaluation of Therapy Session forms as a way of being “nice” to the therapist. David points out that the opposite is true. If patients are in treatment voluntarily, without some kind of hidden agenda such as applying for disability, they tend to be exceptionally honest in the way they fill out the forms. In fact, most therapists find that they get failing grades from nearly every patient on every scale at every session at first. This can be very upsetting, especially to therapists who are narcissistic and defensive about criticism. But if the therapist is humble and open to the feedback, the patient’s feedback on the Brief Mood Survey as well as the Evaluation of Therapy Session forms can provide a fabulous opportunity for growth and learning. So in short, it is not true that patients fill out the forms just to be “nice” and to please the therapists. The scores are brutally real! If you are a therapist and a doubters, you can give the assessment instruments a try, and I think you’ll be surprised, and perhaps even shocked when you review the data! Still, David acknowledges that the rapid and phenomenal changes he now sees most of the time when using TEAM-CBT are hard to believe, especially when you've been trained to think that recovery is a long, slow process. David discusses a model of brain function proposed by a molecular biologist / geneticist, Dr. Mark Noble, that allows for extremely rapid change. David and Fabrice also address the question—can these kinds of miraculous results last, or are they only a flash in the pan? David emphasizes the importance of ongoing practice whenever the negative thoughts return. The “one and done” philosophy is not realistic. Part of being human is getting upset during moments of vulnerability, and that’s when you have to pick up the tools and use them again! David describes experiencing three hours of panic just a few days ago, and Fabrice asks what techniques he used to deal with his own negative feelings, including Identify the Distortions, Examine the Evidence, Reattribution, and the Acceptance Paradox. David agrees with the Dalai Lama that happiness is one of the goals of life, but emphasizes that it is not realistic to think one can be happy all the time. Fortunately, you can be happy most of the time--but you have to be willing to pick up the tools and use them from time to time when you fall into a black hole!

Crushing Negative Thoughts In this third and final podcast featuring live therapy with Marilyn, David and Matt move on to the M = Methods phase of the session along, and encourage Marilyn to challenge the Automatic Negative thoughts on her Daily Mood Log using techniques such as Identify the Distortions, the Paradoxical Double Standard Technique, the Externalization of Voices, and Acceptance Paradox. Marilyn emerges as a powerful partner and begins to crush the negative thoughts that had seemed so real and overwhelming at the start of the session. David emphasizes that the perceptions of therapists can often be way off base, so even though Marilyn appeared to change—fairly dramatically—during the session, David, Fabrice, and Matt will not know for sure until they review Marilyn’s end of session ratings on the Daily Mood Log, Brief Mood Survey, and Evaluation of Therapy Session. David defines a relapse as one minute or more of feeling lousy. Given this definition, all human beings will “relapse” frequently, including Marilyn. But relapses following recovery do not have to be a problem if the patient is prepared for them ahead of time. You will hear David and Matt doing relapse prevention using a number of techniques, including the Externalization of Voices. Fabrice, Marilyn, Matt and David discuss the session, and what it meant to Marilyn from a personal and spiritual perspective. You can view this session as a powerful psychological experience—a “mind-blowing” single session “cure,” if you will—or as a profoundly healing spiritual experience: the emergence, resurrection, or rebirth from the “Dark Night of the Soul.” And you can ask yourself—did a genuine miracle happen here today? Marilyn DML, end of session, mood only Marilyn BMS before and after, v 1 I, David, am very indebted to Marilyn for making this phenomenal and intensely personal experience available to all of us. What a gift! Thank you, Marilyn. We love you! I also want to thank my co-host, Fabrice, for making these podcasts happen! What a joy it is to work with you every week, Fabrice. And I want to thank my fantastic co-therapist, former student, and colleague, Matthew May, MD, for support and friendship over these many years! Matt, as you know, I often sing your praises in my workshops around the country, telling people how amazing you are. Now they will see what I mean first-hand! I hope that through these three podcasts, Marilyn will touch large numbers of people for years, even decades, to come. If you were touched by these recordings, please let your friends and colleagues know, so that they might have the chance to “tune in” as well. In the first session with Marilyn, I mentioned the highly controversial theory that our pain usually results from our thoughts, and not from the circumstances of our lives. What do you think now?

The Hidden Side of Depression, Anxiety, Defectiveness, Hopelessness and Rage We nearly always think about negative feelings, such as moderate or severe depression, as problems that an expert must try to fix, using drugs and / or psychotherapy. There are a multitude of theories about why humans become depressed, including, but not limited to: We get depressed because reality sucks. We believe our mood slumps result from the circumstances in our lives, such as being alone following a rejection, experiencing the loss of a loved one, not having enough money, education or resources, social prejudice, or (as in Marilyn’s case) facing some catastrophic circumstance, such as severe illness. We get depressed because of insufficient love and nurturing in childhood, or because of traumatic childhood experiences. Biological factors. We get depressed because of our genes, or diet, or because of a chemical imbalance in our brains. Certainly, there can be some truth in all of these theories. Reality does kick us all in the stomach from time to time, and the pain we feel is understandable. My wife and I lost her father to Parkinson’s Disease a few years ago. We loved him tremendously, and his loss was extremely painful for everyone in our family. And most of us have experienced less than ideal circumstances when growing up, and many have even been victimized by horrific and tragic circumstances, such as child abuse. And clearly, some severe psychiatric illnesses, such as schizophrenia, do result from some kind of brain abnormality. But the problem with all of these theories is that they put us at the mercy of forces that are largely beyond our control—since we often cannot do much to change reality, rewrite our childhoods, or modify our brains short of taking this or that medication. In this podcast, Matt and David take a radically different approach, and argue that Marilyn’s intense feelings of depression and anxiety are not “mental disorders” that reflect some defect in Marilyn, but rather the expression of what is most beautiful and awesome about her. They also argue that there are large numbers of advantages, or benefits, of feeling the way she does, using several Paradoxical Agenda Setting techniques such as the Miracle Cure Question, Magic Button, Positive Reframing, and Magic Dial. The results are stunning and unexpected. Or, as Marilyn put it, this portion of the session was “mind-blowing.” The third and final podcast next week will include the M = Methods phase of the session along with the end-of-session T = Testing and wrap-up, including Relapse Prevention Training. Marilyn DML with goal column

The Dark Night of the Soul (Part 1) The first live therapy podcasts with Mark (the man who felt like a failure as a father: podcasts 29 – 35) were enormously popular, and many people have asked for more. David and Fabrice were delighted with your responses, so the next three podcasts will feature a therapy session with Marilyn by David and his highly-esteemed colleague and co-therapist, Dr. Matthew May. These three podcasts will include the entire session plus commentary the session unfolds. We are extremely grateful to Marilyn for her courage and generosity in making this extremely private and intensely personal experience available to all of us. I believe the session will touch your heart, inspire you, and give you courage in facing any problems and traumas that you may be struggling with. According to the theory behind cognitive therapy, people are disturbed not be events, but rather by the ways we think about them. This notion goes back nearly 2,000 years to the teachings of the Greek Stoic philosopher, Epictetus, who emphasized the incredible importance of our thoughts—or “cognitions”—in the way we feel. Fifty years ago, this notion gave rise to a new, exciting, drug-free treatment for depression called “cognitive therapy,” which was based on this basic notion: When you CHANGE the way you THINK, you can CHANGE the way You FEEL—quickly, and without drugs. That’s why I wrote my first book, Feeling Good: The New Mood Therapy, because I was so excited about this notion and the powerful new “cognitive therapy” that was rapidly emerging. The idea behind cognitive therapy is simple. When you’re upset, you’ve probably noticed that your mind will be flooded with negative thoughts. For example, when you’re depressed, you may be beating up on yourself and telling yourself that you’re a loser, and when you’re anxious you’re probably thinking that something terrible is about to happen. However, it may not have dawned on you that your thoughts are the actual cause of your negative feelings. In addition, you’re probably not aware that your negative thoughts will nearly always be distorted, illogical, or just plain unrealistic. In Feeling Good, I said that depression and anxiety are the world’s oldest cons, because you’re telling yourself things that simply are not true. In that book, I listed the ten cognitive distortions, such as All-or-Nothing Thinking, Overgeneralization, and hidden Should Statements, that trigger negative feelings. In the years since I first published Feeling Good, my list of cognitive distortions has gone worldwide, and is used by enormous numbers of mental health professionals in the treatment of individuals struggling with depression and anxiety. The notion that depression, anxiety, and event anger result entirely from your thoughts, and not upsetting events or circumstances external events is enormously liberating, because we usually cannot change what’s actually happening, but we can learn to change the way we think—and feel. But a lot of people don’t buy, or understand, this notion which seems to fly in the face of common sense. For example, you might argue that when something genuinely horrible happens, such as failure, losing a loved one, or being diagnosed with terminal cancer, it is the actual event and not your thoughts, that triggers your negative feelings. And you might also argue, perhaps even with some irritation, that your thoughts are definitely not distorted, since the actual event—such as the cancer—is real. Would you agree? I know that’s what I used to think! The next three podcasts will give you the chance to examine your thinking on this topic, because Marilyn is struggling with a negative event that is absolutely real and devastating. As the session with begins, Marilyn explains that she was recently diagnosed with Stage 4 (terminal) lung cancer, which came as a total shock, especially since she’d never smoked. As Drs. Burns and May go through the T = Testing and E = Empathy phases of the TEAM-CBT session, they learn that Marilyn has been struggling with extreme levels of depression, anxiety, shame, loneliness, hopelessness, demoralization, and anger, to mention just a few of her negative feelings. If you’d like, you can review a pdf of the Brief Mood Survey and Daily Mood Log that Marilyn completed just before the session began. You will see that her negative thoughts focus on several themes, including Her fears of cancer, pain, and death. Her thoughts of spiritual inadequacy, doubting her belief in God, wondering if there really is an afterlife, feeling that she’s not spiritual enough, and thinking that she’s perhaps been duped by religions. Her feelings of incompleteness at never having had a truly loving life partner. Her feelings of self-criticism, beating up on herself for excessive drinking during her life. Click here for Marilyn's Brief Mood Survey, pre-session. Click here for Marilyn's Daily Mood Log. The next Feeling Good Podcast with Marilyn will include the A = (Paradoxical) Agenda Setting phase of the TEAM therapy session, and will include the Miracle Cure Question, the Magic Button, the stunning Positive Reframing Technique, and the Magic Dial. The third and final podcast will include the M = Methods phase, including Identify the Distortions, the Paradoxical Double Standard Technique, Externalization of Voices, and Acceptance Paradox, end of session testing, and wrap-up. Although the subject matter of these podcasts is exceptionally grim and disturbing, we believe that Marilyn’s story may transform your thinking and touch your heart in a deeply personal way. Because Marilyn is a deeply spiritual person who suddenly finds herself without hope and totally lost, we have called part one, The Dark Night of the Soul.

A reader ask how to handle relapses following recovery from depression. David emphasizes the importance of this question, since there is a 100% probably that every patient will relapse following recovery. And if the patient has not been properly prepared, the relapses can be disastrous. But on the other hand, if the patient has been prepared, the relapses do not have to be problematic. What is a relapse? David defines a relapse as one minute or more of feeling crappy. Given that definition, we all relapse pretty much every day. However, some people can pop out of a bad mood really quickly, while others can get stuck in these “relapses” for weeks, months, or even years. David describes the Relapse Prevention Training (RPT) techniques he has developed, but cautions that RPT does not make sense until the patient has experienced a complete elimination of symptoms. If the patient is being treated for depression, that means that the score the depression test has fallen all the way to zero (no symptoms whatsoever) and that the patients feel joy and self-esteem. There are four keys to David’s RPT, including: The patient must be informed that relapse is an absolute certainty. The question is not “will this patient relapse” but rather, “when will this patient relapse?” Patients have to know that the therapy technique that worked for them the first time they recovered will always work for them. It might be the Cost-Benefit analysis, Pleasure-Predicting Sheet, Acceptance Paradox, Double Standard Technique, Five Secrets of Effective Communication, Hidden Emotion Technique, or Experimental Technique, or simply recording their negative thoughts on the Daily Mood Log and identifying the distortions in them. Patients need to identify and modify the Self-Defeating Beliefs (SDBs) that triggered their depression and anxiety in the first place, such as Perfectionism, Perceived Perfectionism, or the Achievement, Love or Approval Addictions. In several previous podcasts, David and Fabrice have described the Uncovering Techniques that can be used to quickly pinpoint any patient’s SDBs. Patients need to write down and challenge the Negative Thoughts that will inevitably emerge at the time they relapse, such as “This relapse proves I’m hopeless after all,” or “This relapse proves the therapy didn’t work,” etc. David and Fabrice illustrate step #4 using a powerful technique called Externalization of Voices. David has patients record this role play procedure on a cell phone or other recording device so they can play it and listen if needed during an actual relapse. David explains that he used this approach with every patient he discharged, and encouraged them all to come back anytime they had a relapse that they couldn’t handle. In spite of having more than 35,000 therapy sessions with individuals with severe depression and anxiety, David says that he can count on two hands the number who every returned for “tune-ups” following termination of therapy, and in most of those cases, the patients were able to recover once again in just or two sessions. In the next Feeling Good Podcast, David and his highly esteemed colleague, Dr. Matthew May, will begin their live work with Marilyn, a severely depressed colleague who is facing “The Dark Night of the Soul.” Fabrice, as usual, will narrate and elicit enlightening commentaries on the therapeutic strategies that David and Matt are using as the session with Marilyn unfolds.

The title of David's TEAM-CBT eBook for therapists is Tools, Not Schools, of Therapy. David explains that the field of psychotherapy is dominated by numerous schools of therapy that compete like religions, or even cults, each claiming to have the answer to emotional suffering. So you’ve got the psychodynamic school, and the psychoanalytic school, the Adlerian school, the Beckian cognitive therapy school, the Jungian school, and tons more, including EMDR, behavior therapy, humanistic therapy, ACT, TMT, EMT, and so forth. Wikipedia lists more than 50 major schools of psychotherapy, but there are way more than that, as new schools emerge almost on a weekly basis. David describes several conversations with the late Dr. Albert Ellis, who argued that most schools of therapy were started by narcissistic and emotionally disturbed individuals. Ellis claimed that most were self-promoting, dishonest individuals who claimed to know the true “causes” of emotional distress and insisted they had the “best” treatment methods. And yet, research almost never supports these claims. David, who is a medical doctor, points out that we don’t have competing schools of medicine. Can you imagine what it would be like if we did? Let’s say you broke your leg, and went to a doctor who prescribes penicillin. You ask why he’s prescribing penicillin for a broken leg, and he explains that he’s a member of the penicillin school. He says he always prescribes penicillin—it’s good for whatever ails you! That would be like an Alice in Wonderland world. And yet, that’s precisely how psychiatry and psychotherapy are currently set up. If you’re depressed and you go to a psychiatrist, you’ll be treated with pills. If you go to a psychoanalytic therapist, you’ll get psychoanalysis. Or if you go to a practitioner of EMDR, TFT, or Rational Emotive Therapy (RET), you’ll get EMDR, TFT, or RET. David argues that this just doesn’t make sense. David argues that the fields needs to move from competing schools of therapy to a new, science-based, data-driven psychotherapy. He emphasizes that we’ve learned a lot from most of the schools of therapy, and that many have provided us with valuable insights about human nature as well as some useful treatment techniques. But now it’s time to move on, leaving all the schools of therapy behind. David acknowledges that this message may seem harsh or upsetting to some listeners, and apologizes for that ahead of time. David and Fabrice also discuss the spiritual basis of effective psychotherapy, and David describes the reaction of his father, a Lutheran minister, on the day that David was born, as well as a tip his mother gave him when he was in third grade. In the next Feeling Good Podcast, David and Fabrice will describe Relapse Prevention Training, since the likelihood of relapse after successful treatment is 100%. But if the patient knows what to do, the relapse doesn’t have to be a problem.

The Beatles tell us that all we need really need is love, and in her famous song, “People,” Barbara Streisand proclaims that “People who need people are the luckiest people in the world.” But is this really true? Fabrice asks David whether love is a human need? David describes hearing Dr. Aaron Beck proclaim that love is not an adult human need, and feeling shocked, during one of Dr. Beck’s cognitive therapy seminars in the 1970s. Although initially skeptical, David did a number of experiments to test this belief, and came to a startling conclusion. David describes the impact of needing love on his depressed and anxious patients, including lonely individuals who were constantly being rejected in the dating scene. You’ll find this podcast provocative, controversial, and hopefully interesting. We’ll also include a survey you can complete below, indicating your thoughts about this topic! In the next Feeling Good Podcast, David and Fabrice will discuss Tools, Not Schools, the title of David’s TEAM-CBT eBook for therapists, and the following podcast will discuss Relapse Prevention Training, since the likelihood of relapse after successful treatment is 100%. But if the patient is prepared and knows what to do ahead of time, the relapse, while often painful and disturbing, doesn’t have to be a significant problem.

Fabrice begins with another question on OCD—if you successfully extinguish the symptoms with Exposure and Response prevention, would they just resurface in some other form, such as worrying, or some other anxiety disorder. David agrees, and describes the solution to this problem. Then David describes his treatment of a pregnant woman with OCD who was afraid her baby would be switched at the hospital so that she’d end up with the wrong baby. Although she rationally recognized that this fear was irrational, she could not shake it from her mind, and obsessed about it constantly. After trying more than 30 CBT techniques that did not work, David used the What-If Technique to pinpoint her deepest fear, which turned out to be quite shocking, to say the least. He then encouraged her, with some reluctance, to confront this fear using Cognitive Flooding. After describing the surprising outcome, David and Fabrice discuss the fact that 75% of American therapists are afraid to use Exposure Techniques because of the fear that the patient is too fragile, or they will re-traumatize the patient. David reminds us that this is “reverse hypnosis,” where the patient hypnotizes the therapist into believing something that is not true. If the patient is successful, and the therapist agrees not to use Exposure, the prognosis for effective treatment is quite poor. David gives an example of a therapist who was afraid to ask an OCD patient to drink one ounce of coca cola—something the patient feared would drive him into insanity!

David describes his treatment of a physician with OCD who was tortured by the fear that he would impulsively throw his newborn baby over the railing of his second-floor apartment. He also describes a psychologist with OCD who washed her hands more than 50 times a day for fear of contamination. In addition, she spent hours every day making sure that nothing in her house was arranged in groups of three—including furniture, table settings, decorative objects, magazines on tables, and so forth. Arrangements in groups of 2 were okay, as were groups of 4, 5 or more objects. Why was she so obsessed? What were the hidden emotions that fueled these obsessions and compulsions? David and Fabrice will give you the chance to pause the recording on three occasions to jot down your hypotheses before they give you the answers. It won't be important to get it "right," but it is highly desirable to take a stab at it. This podcast will be of interest to you if you or a loved one is struggling with OCD, or any form of anxiety, including phobias, panic attacks, chronic worrying, and so forth. That's because the hidden emotion phenomenon, or excessive “niceness,” may be a the root of your fears as well. Bringing those feelings to conscious awareness will often lead to sudden relief, or even a complete elimination of your symptoms. In the next Feeling Good Podcast, David and Fabrice will describe dramatic examples of exposure and response prevention in the treatment of OCD, including a woman who was tortured by the fear that she’d received the wrong baby at the hospital after her first child was born. What causes these bizarre symptoms, and what’s the most effective treatment? Stayed tuned and you’ll find out!

Listeners submitted questions on OCD (Obsessive-Compulsive Disorder): Is it an organic illness? Are drugs necessary in the treatment? What’s the best book to read if you want to heal yourself? What’s the prognosis? Drs. Nye and Burns begin by explaining OCD and answering the questions. David emphasizes the importance of using four treatment models when working with OCD—the cognitive model, the motivational model, the exposure model, and the hidden emotion model if you are hoping for a rapid and complete elimination of symptoms. Treatment that focus on only one treatment method, such as exposure and response prevention, may have only limited success. He describes his treatment of a medical student named Ralph with classic OCD. Ralph was frequently plagued by the fear he was dying of AIDS; then he’d get so anxious that he’d go to the emergency room and insist on having a blood test for HIV. These always came out negative, and this brought temporary relief, but within a few days Ralph would be worrying about AIDS again and feeling the overwhelming compulsion to get yet another blood test. The case was especially curious because Ralph was engaged and faithful to his fiancé, so there was no rational reason for him to think he had become infected with the HIV virus. However, he’d tell himself, “Maybe I drew blood on a patient with AIDS and then pricked myself with the needle, and then forgot. And how can I know that this didn’t happen?” This are extremely typical of the kind of obsessions that plague OCD patients. Ralph would torture himself with these thoughts until he succumbed to the urge to get another blood test for AIDS. Although years of conventional psychotherapy had failed this patient, the Hidden Emotion Technique led to an incredible recovery in just a few minutes during a therapy session. You will find this true story inspiring and amazing! And David provides an even more amazing 40-year follow up report! In the next Feeling Good Podcast, David and Fabrice will describe more examples of patients with severe OCD who experienced dramatic relief because of David’s Hidden Emotion Technique. This technique can be helpful for all anxiety disorders, and not just OCD. However, David emphasizes that this is just one of many techniques he uses in the treatment of anxious patients. He cautions therapists against thinking three is just ONE best technique for any anxiety disorder, including OCD. See link to podcast #027: Scared Stiff — The Hidden Emotion Model.

The late Dr. Albert Ellis developed a technique to help individuals struggling with shyness. It’s called Shame-Attacking Exercises. Essentially, you do something bizarre in public to overcome your fear of making a fool of yourself; and you will probably discover that the world doesn’t come to end. When used skillfully, this method can be incredibly liberating. However, there are several ethical considerations. First, before therapists can ask their patients to do Shame Attacking Exercises, therapists have to do Shame-Attacking Exercises themselves! David explains his first, terrifying Shame-Attacking Exercise in a Chinese restaurant in New York after giving a talk at a workshop sponsored by Dr. Ellis. In addition, therapists have to be careful in the way they use Shame Attacking Exercises, and who they use them with. You have to have an excellent therapeutic alliance with your patient, and the patient has to trust you. In addition, the exercises have to be in an appropriate location—for example, it would be disrespectful to do them in a hospital. And you have to be careful that the Shame Attacking Exercises is not aggressive or frightening to other people. He also describes how Shame-Attacking Exercises helped a man and a woman he treated who were both afraid to flirt with people they were attracted to, and in both cases, he had to push fairly hard since the patients put up stiff resistance to the idea. TEAM-CBT includes many powerful techniques, and while they have the potential to bring about rapid and often fantastic change, they also have the potential to hurt if not used skillfully and appropriately. Any listeners who are interested in using these techniques should first consult with a mental health professional to make sure the techniques are appropriate and likely to be helpful to you. All that being said, you will (we hope) LOVE this podcast! In upcoming podcasts, David and Fabrice will address questions on OCD (Obsessive-Compulsive Disorder) submitted by several listeners. Is OCD an organic illness? Are drugs necessary in the treatment? What’s the prognosis? David will describe powerful, drug-free treatment methods based on the four models he uses to treat all anxiety disorders: the Motivational, Cognitive, Exposure, and Hidden Emotion Models.

The third uncovering technique is called the “What-If” Technique, developed by the late Dr. Albert Ellis. The What-If Technique can will help you identify a terrifying fantasy under the surface that fuels your fears. David brings this technique to life with an inspiring story of a woman from San Francisco suffering from more than 10 years of mild depression and paralyzing Agoraphobia—the intense fear of leaving home alone. You may be surprised when you discover the Negative Thoughts that triggered her fear of leaving her apartment alone, as well as the core fantasy at the root of her Agoraphobia. David and Fabrice also discuss the dramatic techniques that helped her completely defeat her fears and overcome her depression. Below, we have included a PowerPoint presentation for you so that you can follow along when David and Fabrice do the What-If Technique together on the podcast. In the next podcast, David and Fabrice will discuss Shame-Attacking Exercises. This is a powerful and bizarre exposure technique that can helpful in the treatment of shyness--but there’s a hook. Therapists must be willing to do Shame Attacking Exercises themselves before they can ask patients to do them! And that can be intimidating!  

The Roles and the Rules—Psychoanalysis at Warp Speed! Most of us run into conflicts with other people from time to time, or even frequently. In this podcast, you will discover precisely why this happens, and how you to change the beliefs that get you into trouble, if that’s what you want to do. Psychoanalysts sometimes help people discover what they call “core conflicts.” According to the highly regarded psychoanalytic researcher Lester Luborsky, PhD, an example of a core conflict might be, “My needs will never be met in my relationships with others.” If you believe this, it will tend to function as a self-fulfilling prophecy, so you’ll constantly feel hurt, lonely, and rejected, and perhaps resentful when you try to get close to others. And you probably won’t realize you’re creating your own painful interpersonal reality. You’ll think that this is just the way it is. Once you bring the painful system to conscious awareness, you can use a variety of powerful techniques to change your expectations and beliefs so you can enjoy far greater satisfaction and intimacy in your relationships with others. David and Fabrice will illustrate a powerful, high-speed method that to bring your own Interpersonal Self-Defeating Beliefs to conscious awareness. David has called it the Interpersonal Downward Arrow Technique. David and Fabrice will revisit the same clinical example from the last Podcast—the psychologist named Harold who felt devastated when his favorite patient unexpectedly committed suicide, but in this podcast they will examine how Harold sets up his relationships with his colleagues in a way that causes him to feel lonely, anxious, and resentful. You can use the Interpersonal Downward Arrow Technique to identify anybody's Self-Defeating Beliefs in five to seven minutes, as opposed to spending five years or more free-associating on an analyst’s couch to get the same information. Not a bad deal! During the podcast, you may want to download and print “The Rules and the Roles” form that David and Fabrice will be using during the podcast. There will be an exercise for you to do while you are listening. But don’t do the written exercise if you’re listening while driving in your car! In the next podcast, David and Fabrice will discuss a third powerful uncovering technique developed by the late Dr. Albert Ellis, a former psychoanalyst from New York who is considered the "Grandfather of Cognitive Therapy." It’s called the “What-If Technique," and Dr. Burns will bring it to life with an inspiring and dramatic story of a woman from San Francisco who had been suffering from years of mild depression and severe Agoraphobia—the intense fear of leaving home alone. So stay tuned! And feel free to comment below or ask questions. Fabrice and I greatly appreciate your feedback and guidance! If you are reading this blog on social media, I appreciate it! I would like to invite you to visit my website, http://www.FeelingGood.com, as well. There you will find a wealth of free goodies, including my Feeling Good blogs, my Feeling Good Podcasts with host, Dr. Fabrice Nye, and the Ask Dr. David blogs as well, along with announcements of upcoming workshops, and resources for mental health professionals as well as patients! Once you link to my blog, you can sign up using the widget at the top of the column to the right of each page. Please firward my blogs to friends as well, especially anyone with an interest in mood problems, psychotherapy, or relationship conflicts.  

What are the root causes of depression? Anxiety? Relationship problems? In this, and the next two podcasts, you will discover the answer! Cognitive Therapists believe that negative thoughts, or cognitions, can exist on two different levels. When you’re upset, you’ll have Automatic Negative Thoughts (ANTs) in the here and now, and they’ll usually be something like this: Depression: You may be telling yourself that you’re a loser, or a failure, or that you’ll be miserable forever. Anxiety: You’re probably telling yourself that you’re in danger, and that something terrible is about to happen. “When I get up to give my talk at my church group, my mind will probably go blank and I’ll make a total fool of myself!” Relationship conflicts: You may be telling yourself that someone you’re ticked off at is a self-centered jerk who only cares about himself or herself and shouldn’t be that way! Individual Downward Arrow But why do we get these ANTs in the first place? Cognitive therapists believe that Self-Defeating Beliefs, and other deeper structures in the brain, make us vulnerable to painful mood swings and conflicted relationships with the people we care about. To help you pinpoint your own Self-Defeating Beliefs, David has created two uncovering techniques called the Individual Downward Arrow and the Interpersonal Downward Arrow, and Albert Ellis, the noted New York psychologist, created a third called the “What-If” Technique. In today’s podcast, Drs. Burns and Nye illustrate the Individual Downward Arrow technique, using as an example a psychologist named Harold who was understandably devastated when his patient unexpectedly committed suicide. You can follow along on this PowerPoint presentation starting with Harold’s Daily Mood Log with David and Fabrice while they illustrate the Individual Downward Arrow technique. [office src="https://onedrive.live.com/embed?cid=4C33CD5BBD389DD2&resid=4C33CD5BBD389DD2%21158&authkey=AMjeMe-n6Qmswxc&em=2&wdAr=1.3333333333333333"] Once they come to the “bottom of the barrel,” they will ask you to pause the recording, and see if you can pinpoint five or six or more of Harold’s Self-Defeating Beliefs, using the list of 23 Common Self-Defeating Beliefs. David emphasizes that we create our own emotional and interpersonal reality at every moment of every day, but we aren’t aware of this, so we often feel like victims of forces beyond our control. We are really talking about emotional and interpersonal enlightenment, and the uncovering techniques will make this ancient Buddhist concept more understandable for you. If you’d like more tips on precisely how to do the Individual Downward Arrow Technique, you can read David’s recent Feeling Good Blog on this topic! In our next Feeling Good Podcast, David and Fabrice will illustrate the Interpersonal Downward Arrow Technique, which will allow you to complete a course of psychoanalysis in just 5 to 7 minutes, rather than the 5 to 7 years free associating on the couch. It is truly psychoanalysis at warp speed, and is pretty amazing! And when you change the beliefs that trigger interpersonal conflicts, you can change them and enjoy greater satisfaction in your relationships with the people you care about. But sometimes, that requires a little bit of courage! And in the third Feeling Good Podcast on the uncovering techniques, David and Fabrice will illustrate Dr. Albert Ellis' famous "What-If Technique." If you struggle with any type of anxiety, including fears and phobias, this technique can help you uncover the feared fantasy at the root of your fears, so you can challenge the monster and attain freedom from the fears that hold you back!  

A listener named Daisy describes her despair at being unable to have a baby, despite intensive efforts at a fertility clinic. She gets well-meaning messages from friends, family and support groups that she really needs a baby in order to feel truly happy and fulfilled, and these messages make her feel anxious and depressed. But she wonders whether this is really true. Does she really need a baby to feel happy? In fact, we we get all kinds of messages from society that we need certain things in order to feel worthwhile, including: Achievement / Success / Wealth Intelligence Perfection Love Approval Popularity Good looks Are these things really needs? Listen to today’s podcast and you may be surprised by the answer! In the next three podcasts, David and Fabrice will discuss three powerful uncovering techniques that can help you pinpoint the Self-Defeating Beliefs that may be at the root of your own unhappiness and anxiety. These include the Individual Downward Arrow Technique, the Interpersonal Downward Arrow Technique, and the What-If Technique. After that, David and Fabrice will also describe some powerful techniques to help you change the way you think and feel!

“My problems are real! The world really IS screwed up! And that’s not a distortion. So what can I do about my severe depression and anxiety?” David and Fabrice discuss two questions submitted by Feeling Good Podcast listeners. #1. Shari writes: “I read your book Feeling Good and now I am reading your book When Panic Attacks--thanks to April's podcast with you. I still struggle but recently our current political situation and environmental research about our negative impact on earth—has triggered severe anxiety and depression again. The problem is that I don't think my thoughts are distorted—it certainly seems logical to assume that life on earth is threatened. So I am not sure how to do this. How can I make progress with my mental and emotional health while being aware of situations around the world? Any advice or thoughts would be deeply appreciated.” This is a wonderful note, and I’m sure that huge numbers of people feel the same way, in varying degrees. So how can we attend to our own emotional well-being in the face of genuine adversity? Dr. Burns discusses this from the perspective of Paradoxical Agenda Setting, which is the key component of TEAM-CBT, and emphasizes the most common therapeutic error of all—jumping in to try to help, without seeing all the really GOOD reasons for the patient NOT to change. From this perspective, Shari’s question becomes the most important question in all of psychiatry and psychotherapy—how do we help patients who may not want to change? #2. After listening to the A = Agenda Setting portion of the live therapy with Mark, Paul submitted this question: “Hi David, Thanks to you, Fabrice and Jill for this episode - as with the previous episodes with Mark, this has really helped in bringing the TEAM approach to life. As I have been using your books in the past few years to self-treat feelings of anxiety and depression, I was very keen to hear how the new agenda setting step works. I am wondering what your thoughts are on how effectively the "A" step can be carried out by a patient on his/her own (i.e. without someone else verbalizing the reasons not to change / playing the part of the patient's sub-conscious)? Do you have any tips? I think I heard Mark say something to the effect that, on his own, he wouldn't have thought of all the positives that you came up with in the session. Thanks again for sharing these great tools and techniques - looking forward to the "M" step soon. Paul” This was another terrific question on a topic of great importance. David explains that it is actually easier for patients to learn to use Positive Reframing and the other Paradoxical Agenda Setting techniques than for therapists to learn them. Because of his excitement over this prospect, David has just begun a new book which will show depressed and anxious individuals exactly how to do this on their own in a step-by-step manner. He is optimistic that the new TEAM-CBT techniques, in book form, may be even more helpful to patients than his first book, Feeling Good: The New Mood Therapy. Research studies indicate that 65% of patients with moderate to severe depression improve substantially within four weeks of receiving a copy of Feeling Good, even without any other treatment. Dr. Burns is hopeful that his new book will provide the answers for the 35% who were not helped by Feeling Good. So the answer is yes, I think many individuals WILL be able to do the “A” step on their own, and I am hopeful the positive impact will be great! If you would be interested in David's new book, please indicate this in the Survey attached to this podcast. David and Fabrice have exciting plans for upcoming podcasts. They will be addressing these two questions in one or two podcasts: Is it possible to measure our “worthwhileness” or “worthlessness” as human beings? Do we even have a “self”? These two questions have been discussed by experts for thousands of years, going all the way back to the Buddha, and most recently by the incredible Austrian philosopher, Ludwig Wittgenstein. And although the answers are tremendously simple, people can’t seem to “get it.” The issues are not simply philosophical, but eminently practical, since most depression and anxiety result from the perception that one is “worthless,” or “inferior,” or simply “not good enough.” In addition, David and Fabrice are hoping to create a second live therapy session broken into smaller podcast chunks, but featuring David and a totally awesome former student and now highly esteemed colleague, Matthew May, MD. For the past ten years, David has been telling workshop audiences that Matt is one of the finest therapists in the world. So this is an event you won’t want to miss! Click here to listen to Fabrice being interviewed on Dr. Carmen Roman's podcast.

A blog reader made a fairly strong and impassioned comment that sometimes asking the patient to examine ways she or he may be contributing to the problem may be a mistake when the patient really IS a victim, and cautioned against blaming the victim. David’s goal is never to blame patients, but rather to empower you. David and Fabrice begin by discussing the fact that sometimes people vacillate between other-blame (it’s all his/her fault) and self-blame (it’s all my fault), and emphasize that neither approach is helpful. If you blame the other person, the problem escalates and may turn to violence, but if, instead, you blame yourself, you’ll probably end up feeling worthless, guilty, unlovable, and depressed. So what’s the solution to this dilemma? Dr. Burns encourages patients to use the Five Secrets of Effective Communication and make a radical change in the way they communicate with others, along the lines of EAR. E stands for Empathy, A stands for Assertiveness, and R stands for Respect. You can examine each of the Five Secrets if you CLICK HERE. David gives five compelling examples of how to deal with people who REALLY ARE violent and abuse, including a raging psychiatric patient who was threatening the staff and on the verge of exploding, a serial killer who kidnapped a social worker who had attended one of David’s communication workshops, some drunken, abusive teenagers in a huge jeep who threatened David, an insulting, demoralizing, critical boss who put down everyone who worked with him. He includes with the story of a Lutheran minister,  Dietrich Bonhoeffer, who was imprisoned and mistreated by the Nazis during world war two. This is a controversial topic that David included in the podcasts somewhat reluctantly, so give a listen and tell us what you think! Right now the world seems to be spiraling into greater and greater hostilities. Does David have a point? Or is he way off base?

This is the last live therapy podcast with Mark, the physician who was convinced he was a failure as a father because of his difficulties forming a close, loving relationship with his oldest son. Although the session appeared to go well, we can’t be sure until we see Mark’s end of session mood ratings on the Daily Mood Log and on the Brief Mood Survey and and Evaluation of Therapy Session. David emphasizes that therapists’ perceptions of patients are notoriously inaccurate, but most therapists are unaware of this because they don’t use the rigorous testing procedures at the start and end of sessions. To review Mark's partially completed Daily Mood Log, CLICK HERE. Jill and David will ask him to complete the additional negative thoughts on his own after the session. To review mark's end of session Brief Mood Survey and Evaluation of Therapy Session, CLICK HERE. After David review’s the phenomenal changes Mark reported from the start to the end of the session, David asks if the ratings were genuine, or, as some listeners might suspect, faked in order to try to please the therapists. Mark bursts into tears and says, in a choked voice, that it was a life-changing experience. After the end of the session, David and Fabrice discuss a number of highlights from the work with Mark: The testing indicated a complete or near-complete elimination of symptoms. In 2 ½ hours, Jill and David have essentially completed an entire course of psychotherapy. Although there may still be some work to be done with Mark, the hard part has already been completed. David emphasizes that he now views psychotherapy as a procedure to be done at one sitting, much like surgery, with brief follow-up visits, rather than a long, drawn out procedure meeting once pre week for months or even many years. And although a single 2 or 2 1/2 hour session may be more costly than a traditional 50-minute hour, it can be vastly more cost-effective Than dozens of sessions with little or no progress. In addition, it is vastly better for the patient who walks out feeling good today, rather than having to endure weeks, months, or even many years of traditional talk therapy or antidepressant drug therapy. David and Fabrice talk about the fact that no one is permitted to feel happy all the time, and that Mark’s negative thoughts and feelings WILL return, David defines a “relapse” as one minute or more of feeling lousy. Given that definition, we will ALL relapse forever! But it doesn’t have to be a problem for Mark if he is prepared for this, and knows how to pop out of the relapses quickly, rather than getting stuck in them. This is where Relapse Prevention Training (RPT) becomes so important following the initial dramatic recovery. RPT only takes about 30 minutes and is easy to learn, and will perhaps be the topic for a future Feeling Good Podcast if our listeners express an interest in it. David discusses the difference between an Internal Solution and an External Solution. In this session, David and Jill have guided Mark in the Internal Solution—this means crushing the negative thoughts that triggered Mark’s feelings of unhappiness, anxiety, shame, failure, and anger for years, if not decades. Now that he is feeling so much better about himself, he may want some help with the External Solution. This will involve learning how to develop a more loving relationship with his son using tools like the Relationship Journal and the Five Secrets of Effective Communication. This will be far easier now that Mark is no longer using up all his energy beating up on himself and feeling depressed and inadequate. David wraps up by talking about the true wealth we have as therapists. Although we won’t develop the riches of a Bill Gates doing psychotherapy, we do have the fabulous and precious opportunity to see people as they really are inside, and to witness miracles like the one we saw in the session with Mark. David expresses the hope that listeners have benefitted by listening. Although we are all different, most of us have had the painful experience, like Mark, of believing we were somehow failures, or inferior, or defective, or simply not good enough. We are deeply indebted to Mark’ courage and generosity in giving us the opportunity to see the solution to this ancient and almost universal human problem! There are many resources for listeners who want to learn more about TEAM-CBT, including: David’s exciting two-day and four-day training workshops, listed on his website, feelinggood.com. Tons of free resources for patients and therapists at feelinggood.com. Please sign up using the widget in the upper right hand corner of any page on his website and you will receive email notifications and links to every post. David’s psychotherapy eBook entitled Tools, Not Schools of Therapy. David’s Tuesday psychotherapy training groups at Stanford, which are co-led Jill Levitt, PhD and Helen Yeni-Komshian, MD. The training is free of charge to Bay Area and northern California therapists. You will have the chance to do free personal work, too! David’s famous Sunday hikes, also free to members of the training groups. Paid online and in-person weekly TEAM-CBT training groups, plus intensive TEAM-CBT treatment programs, at the Feeling Good Institute in Mt. View California. In addition, many TEAM-CBT training and treatment programs are now offered in many cities throughout the US and Canada. For more information, visit feelinggood.com or www.feelinggoodinstitute.com.

Using the Externalization of Voices, which is arguably the most powerful Cognitive Therapy technique ever created, David & Jill continue encouraging mark to challenge his negative thoughts. The goal of the Externalization of Voices is to create genuine and lasting change at the gut level. Although it is one of the first cognitive Therapy techniques Dr. Burns created, it is rarely used by cognitive therapists in the United States, perhaps because it is so edgy, or perhaps because it is sophisticated and requires a high degree of therapist skill. The Externalization of Voices is often paired with another technique Dr. Burns created called the Acceptance Paradox. The goal of the Acceptance Paradox is a profound and lasting change in the patient’s core beliefs and values, and it sometimes triggers spiritual enlightenment, although it is an entirely secular method. Jill and David also use the Semantic Method and Re-attribution in this segment, and end with a brief illustration of how Mark might interact differently with his son using the Five Secrets of Effective Communication. David and Jill emphasize that this is the "External Solution," and that up to this point in the session they've been working on the "Internal Solution." In the next podcast, Jill and David will return to T = Testing to find out how Mark feels at the end of the session, and how he rates Jill and David for Empathy, Helpfulness, and other measures of the therapeutic relationship. At the end of the session, Dr. Burns asks Mark if the change was real, or simply something fake for the purpose of the podcast. At that point, something stunning happens, which turned out to be the highlight of the entire session. So stay tuned! And thank you, so much, for your ongoing support of our efforts! We all greatly appreciate your many kind and encouraging comments and emails on our podcasts. That motivates us to work really hard (and joyously) to bring more of this kind of teaching to you! One quick note. I do not answer messages from Facebook, as I am getting far more than I could ever attend to. Which is great, but sad for me since I don't want people to feel ignored. The best way to contact me is to make comments at the end end of my blogs, as I often respond to those, or simply to contact me through my website, feelinggood.com.

David and Jill begin using M = Methods to challenge the Negative Thought Mark wants to work on first: “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” You may recall that Mark believed this thought 90%. Do you know what the necessary and sufficient conditions are for feeling emotionally upset? The necessary condition is that you have a negative thought in your mind, such as “I’m a failure as a father,” or “There’s something defective in my brain,” but the mere presence of a negative thought will not generally trigger shame, depression, or anxiety. The sufficient condition for emotional upset is that you believe the negative thought. And if you review his Daily Mood Log from the last session, you’ll see that Mark does have a high degree of belief in all his negative thoughts. When you’re feeling depressed, anxious, inadequate, or hopeless, I suspect that your mind is also flooded with negative thoughts that seem entirely true to you. Do you know the necessary and sufficient conditions for emotional change? The necessary condition is that you can challenge the negative thought with a positive thought that is 100% true. Rationalizations and half-truths will never help anyone, at least not in my experience. But having a valid positive thought is not sufficient for emotional change. For example, Mark could tell himself that he’s a very high powered physician in a world-famous medical center, and that thought would be 100% true. But that thought won't help Mark because he’ll still believe there’s something defective in his brain that prevents him from having a loving relationship with his son. The sufficient condition for emotional change is that you can generate a positive thought that is 100% true, and in addition it has to crush the negative thought. In other words, the very moment you stop believing the negative thought that triggers your angst, in that very instant you will experience emotional relief, and the change will usually be dramatic. But how can we challenge Mark’s belief in the NT. Remember, he is incredibly intelligent, and he’s been hooked on this NT for decades. So we can’t just tell him to cheer up, or encourage him to think more positively, or reassure him that his brain is A-Okay. Not only will those simplistic approaches fail, they would likely annoy him because they sound patronizing and might convey the message that’s he’s an idiot for believing something so ridiculous. Instead, as a TEAM-CBT therapist, I think of 15, 20 or even more powerful and innovative techniques that I can use to gently guide the patient to his or her own discovery that the negative thought is simply not true. That's what we do during the M = Methods portion of a TEAM-CBT session. You will listen as David and Jill generate Next, Jill and David generate a Recovery Circle, selecting 16 techniques they could use to help Mark challenge the Negative Thought in the middle of the Recovery Circle. To see the Recovery Circle, CLICK HERE. David and Fabrice discuss the rationale for the Recovery Circle--you never know what technique is going to work, since people are quite different. One of the many unique and arguably powerful aspects of TEAM-CBT is the use of more than 75 techniques drawn from more than a dozen schools of therapy. One of the first methods we use is so basic that it is programmed right into the Recovery Circle, and it’s called Identify the Distortions. Fairly early in today's recording, Jill and David will ask Mark to identify the distortions in his Negative Thought (NT), “There must be something defective in my brain that prevents me from forming a loving relationship with my oldest son.” At that point, Fabrice will ask you to pause the recording and see how many distortions you can identify in the thought. You can write them down on a piece of paper, or simply print the linked PDF and identify them with check marks on the list of 10 cognitive distortions from my book, Feeling Good: The New Mood Therapy. CLICK HERE FOR TEN COGNITIVE DISTORTIONS After Mark identifies the distortions in his Negative Thought, Jill and David encourage him to challenge it, using a variety of techniques on the Recovery Circle, starting with the Paradoxical Double Standard Technique. This is a gentle technique that is often effective for people who are compassionate. Because this technique seems to be helping,  they ask Mark to record his positive thought in the Daily Mood Log, and to indicate how strongly he believes it. Then you will see that Mark's belief in the Negative Thought is reduced to zero if you CLICK HERE. In the next podcast, David and Jill will continue with the Methods portion of the session using additional techniques on the Recovery Circle. This will be a unique opportunity to hear many of these techniques in real time with a real person, as opposed to simply reading about them in a book. So--stay tuned to our Feeling Good Podcasts--and thank you so much for your enthusiastic support!

Jill and David encourage Mark to develop his list of positives. Mark draws a blank at first. This is very common among patients and therapists alike. Most of us have not been trained to think about depression, anxiety, shame, defectiveness, hopelessness and anger as being good or positive. In fact, we think of them as symptoms of “mental disorders,” according to the DSM (Diagnostic and Statistical Manual of the American Psychiatric Association.) So we think of them as bad, something to get rid of, something needing treatment. But after David and Jill prime the pump, Mark is surprised that they quickly come up with a list of 16 positives that are real and powerful. At this point, they ask Mark why in the world he’d want to press the Magic Button and have all of his symptoms suddenly disappear--given all these positives. This is called the Acid Test and it's also paradoxical. David and Jill have now become the resistant part of Mark's subconscious mind--the part that clings to these symptoms. And when the therapists become the voice of the resistance, the patient will nearly always become the voice that argues for change. The paradox is resolved with the Magic Dial. Toward the end of this podcast, you will want to review Mark’s Daily Mood Log, with the Goal column filled out on the table of negative emotions. David points out that there is no single tool or technique that triggers recovery in patients. Instead, each component of T E A M contributes in radically different ways to the substantial or even dramatic improvement the therapists are hoping to bring about it today's session. In the next Podcast, David and Jill will begin the M = Methods portion of the session.

In the early days of my career, I (Dr. Burns) would have assumed that Mark definitely wanted to change--after all, he'd been in a lot of pain for a long time, and he came to the session because he wanted help. So, following the empathy phase of the session, I would have jumped in with a variety of cognitive therapy techniques to help Mark challenge his Negative Thoughts, such as “I’ve been a failure as a father,” or "my brain is defective." Although this might have been effective, there’s a good chance that it might not have worked. That's because Mark might have “yes-butted” me or insisted that he really was a failure and that I just wasn’t “getting it.” In fact, the attempt to help the patient without first dealing with the patient’s resistance is the cause of nearly all therapeutic failure. But most therapists make this mistake over and over--and don't realize that their well-intentioned efforts to help actually trigger and reinforce the patient's resistance. Instead, TEAM Therapists use a number of Paradoxical Agenda Setting (PAS) techniques designed to bring the patient’s subconscious resistance to conscious awareness. Then we melt the resistance away before attempting to change the way the patient is thinking and feeling. I (DB) have developed 15 or 20 PAS techniques, and Jill and I  used several of them in our session with Mark: The Invitation Step The Miracle Cure Question The Magic Button Positive Reframing The Acid Test The Magic Dial When Jill and I use Positive Reframing, we are hoping that Mark will make an unexpected discovery--that his negative thoughts and feelings, such as his sadness, shame, discouragement, and inadequacy actually reflect his core values and show what a positive, awesome human being he is. In other words, he will discover that his core values are actually the source of his symptoms as well as his resistance to change. This approach represents a radical departure from the way many psychiatrists and psychologists think about psychiatric symptoms as well as resistance.  When I was a psychiatric resident, I (DB) was trained to think about resistance as something negative. For example, we may tell ourselves that resistant patients cling to their feelings of depression and worthlessness because they want attention, because they want to feel sorry for themselves, because they fear change, or because they are afraid will lose their identity if they recover. While there’s some truth in these formulations, they may not be helpful because they tend to cast the patient in a negative light, as if their symptoms and their resistance to change were somehow bad, or childish, or based on some kind of chemical imbalance in their brains. As you will see, the TEAM-CBT approach approaches resistance is radically different manner. We will give you the chance to pause the podcast briefly and try your own hand at Positive Reframing before you hear it live during the session. Specifically, we will ask you to review Mark's Daily Mood Log, and ask yourself these two questions about each of his negative thoughts and feelings: What does this negative thought or feeling show about Mark that is beautiful, positive, and awesome? What are some benefits, or advantages, of this negative thought or feeling? Are there some ways that this thought or feeling is helping Mark? As you so this, make a list of as many Positives as you can on a piece of paper. See what you can come up with. I want to warn you that it may be difficult to come up with your list of Positives at first. If so, this is good, because when you hear the next podcast, you'll have many "ah ha!" moments and it will all become quite obvious to you. Then you will have a new and deeper understanding of resistance--an understanding that can help you greatly if you are a therapist or if you are struggling with your own feelings of depression and anxiety. Jill gives a great overview of why the paradoxical approach is necessary during the Paradoxical Agenda Setting phase of the session. To learn more about Paradoxical Agenda Setting, you can read David’s featured article in the March / April 2017 issue of Psychotherapy Networker entitled "When Helping Doesn’t Help." You will see how he helped a woman struggling with intense depression, anxiety and rage due to decades of horrific domestic rape and violence.

After reviewing Mark’s scores on the Brief Mood Survey, the Empathy phase of the session unfolds. During this phase of the session, David and Jill will not try to help, rescue, or save Mark. They will simply try to see the world through his eyes and provide some warmth and compassion. Mark explains that he had two goals in life when he was a young man. He hoped to have a large, loving family; and wanted to become a skillful and compassionate physician. Although he has achieved the second goal, he has felt sad and guilty for decades because of his failure to develop a loving relationship with his oldest son from a previous marriage. While Mark tells his story, David and Jill encourage him to record his negative thoughts and feelings on a form called the Daily Mood Log, and to rate how strong each feeling is, on a scale from 0% (not at all) to 100% (the most extreme). Click here and you will see Mark's Daily Mood Log. As you can see, Mark has many different kinds of negative feelings ranging in severity from 30% (moderate) to 80% (severe). If you've been listening to the Feeling Good Podcasts, you know that negative feelings do not result from what’s actually happening in our lives, but rather from our negative thoughts about what's happening. David and Jill encourage Mark to record his negative thoughts on the Daily Mood Log as well, and to indicate how strongly he believes each one on a scale from 0% (not at all) to 100% (completely). You can also see that Mark is telling himself that he's been a failure as a father, that his brain is defective, and that he is not doing a good job for David and Jill. These thoughts all involve self-blame. You'll notice that he also has two other-blaming thoughts. This is not unusual. When you’re not getting along with someone, you may spend part of your time telling yourself that the problem is all your fault, and part of your time telling yourself that it’s someone else’s fault. As a result, your negative feelings may shift back and forth from guilt and shame to anger and resentment. Most therapists would not interrupt and ask their patients to record their negative thoughts and feelings while they are venting. However, this information will prove to be incredibly valuable later in the session. Jill and David ask Mark how they’re doing on empathy. If Mark gives them a high rating, they will go on to the next phase of the session, called Paradoxical Agenda Setting. That’s where they will find out what, if anything, Mark wants help with, and see if he has any conscious, or subconscious, resistance to change.

This is the first in a series of podcasts that will feature live therapy. As you listen, you’ll have the opportunity to peak behind closed doors to see how TEAM-CBT actually works in a real-world setting, and not role playing. The patient is a physician named Mark who has been haunted for decades by a problem with his oldest son, and he feels like a failure as a father. Although the facts of your life are likely to be very different, you might understand what it’s like to feel like a failure, or to tell yourself that you’re defective, or simply not good enough. The two co-therapists include David and his highly-esteemed colleague, Dr. Jill Levitt. We have broken the session down into a number of podcasts that will include excerpts from the session along with commentaries on the thought patterns of these two master therapists as the session unfolds. Part 1—T = Testing As the session begins, David and Jill review of Mark’s scores on the Brief Mood Survey (BMS), which he completed just before the session began. The scores indicate that Mark is only feeling mildly depressed, anxious, and angry, but is extremely dissatisfied with his relationship with his son. Click here to view Mark's initial Brief Mood Survey. At the end of the session, David and Jill will ask Mark to complete the BMS again. By comparing his patient’s scores at the start and end of the session, they will be able to see exactly how effective, or ineffective, the session was. Mark will also rate David and Jill on Empathy, Helpfulness, and several other important dimensions. Testing at the start and end of every therapy session is one of the new and unique components of TEAM therapy. The testing can revolutionize psychotherapy, because therapists can fine-tune their therapeutic strategies based on the scores, and make critical important changes if the session was not particularly helpful. However, the assessment instruments are extremely sensitive and pick up the smallest therapeutic errors. This can be quite threatening to therapists who don’t want to be held accountable.

The key is bringing the patient’s subconscious resistance to conscious awareness, and melting it away with paradoxical techniques. This is absolutely critical if you are hoping to see a complete elimination of symptoms in any type of anxiety. You may recall that the Outcome Resistance for anxiety disorders usually results Magical Thinking—the anxious patient may be suffering intensely and asking for help, but secretly believes that something terrible will happen if the treatment is successful and the anxiety disappears. In other words, most anxious individuals are convinced that the anxiety is protecting him or her from some catastrophic event. David brings this concept to life with a dramatic description of his treatment of a young man named Sam who’d been struggling with intense PTSD—Post-Traumatic Stress Disorder— for six months following a traumatic interaction with two sadistic gunmen. David and Fabrice also discuss metaphors for understanding how healing actually occurs. Most therapists think of depression and anxiety as mountains that have evolved slowly, over years or decades. They sometimes also believe that treatment and recovery will also requires years and years of treatment, with very slow progress. Of course, if the therapist and patient believe this it will function as a self-fulfilling prophecy. In sharp contrast, David describes a new way to think about recovery, as something extremely rapid, a personal transformation that happens suddenly, within a very brief time period within a therapy session. But this remarkable phenomenon is only possible when the patient’s resistance to change has been skillfully and compassionately addressed by the therapist. At that point, the patient and therapist are on the same TEAM, working together collaboratively. Then, amazing changes can often unfold quickly. Plans for future Feeling Good Podcasts will include a series of fascinating podcasts that will feature an actual live therapy session, with David and his colleague, Dr. Jill Levitt, acting as co-therapists, including commentaries on how each step of T.E.A.M. is being implemented. This will give you the unique opportunity to look behind closed doors so you can observe actual healing taking place. In addition, a future “Ask David” podcast is planned, as well as a podcast on “The Truth about Benzodiazepines,” plus podcasts featuring more treatment methods for anxiety such as Interpersonal Exposure Techniques and Cognitive Flooding. Dr. Burns also promises a fascinating Feeling Good Podcast on the use of the Five Secrets of Effective Communication with violent individuals who are threatening, hostile, and dangerous.

David reminds us about the differences between healthy fear and unhealthy, neurotic anxiety, or an anxiety “disorder” like a phobia, or OCD, and so forth. He explains that negative thoughts, and not events, trigger all our emotions, healthy or unhealthy. However, healthy fear results from negative thoughts that are valid and undistorted, and does not need treatment. For example, if you are walking around Chicago in an area dominated by gangs, you may have the thought, “I could get shot. I better be careful because it’s dangerous here!” Your fear is healthy and can keep you vigilant and alive in a genuinely dangerous situation. In contrast, neurotic, unhealthy anxiety results from thoughts that contain the same ten cognitive distortions that cause depression, such as All-or-Nothing Thinking, Jumping to Conclusions (e.g. Mind-Reading and Fortune-Telling), Emotional Reasoning, Magnification, Should Statements, and more. David explains that the Hidden Emotion Model is radically different from CBT, exposure therapy, and most other current treatments for anxiety. The theory behind Hidden Emotion Technique is that “niceness” is the cause of (almost) all anxiety in the United States at this time. In other words, people who are prone to anxiety typically think they have to be nice all the time, and please other people, and not have certain kinds of forbidden feelings, such as anger, or loneliness, or even wanting something you are not supposed to want. David brings this powerful treatment technique to life with a vignette involving Terry, the woman with ten years of terrifying panic attacks described in previous podcast. When David asked about her very first panic attack, ten years earlier some amazing and illuminating information emerged. David gives tips on how therapists can use the Hidden Emotion Model, The hidden emotion or conflict is buried in the present, and not in the past. It is something very ordinary, such as not liking your job, or your major in college, or a conflict with a friend, family member or colleague. The anxiety is nearly always a symbolic expression of the feeling or problem the patient is not bringing to conscious awareness. David gives listeners an exercise to see if they can pinpoint the symbolic meaning of Terry’s panic attacks. Fabrice asks the important question—what do you do when the anxious patient insists that there aren’t any hidden feelings? David explains that most anxious individuals will say that, and describes how to bring the hidden feeling or problem to conscious awareness. He emphasizes the three things he really likes about the Hidden Emotion Model: It explains the timing of anxiety attacks, so it has tremendous explanatory power. Freud said that anxiety is the mysterious emotion, that comes out of the blue, and strikes like lightning, without rhyme or reason. David disagrees, and emphasizes that anxiety rarely or never comes from out of the blue. The Hidden Emotion Model can have powerful and rapid healing effects for patients with every type of anxiety, as well as individuals struggling with hypochondriasis and those who go to medical doctors with complaints of pain, fatigue, or dizziness that does not appear to have a valid medical cause. The Hidden Emotion Model teaches us that the ultimate cause of most anxiety is the fear of the self, of our emotions and how we genuinely feel as human beings. The Hidden Emotion Model teaches us that recovery from anxiety does not involve recovery from some “defect” or “mental disorder,” but rather the discovery of what it is like to be human being, with all of our feelings, and that it is okay to have an express those feelings. Finally, David explains that while this technique traces to the teachings of Freud, Freud might turn over in his grave and find it superficial or silly, since David simply tells anxious patients that they are suppressing or repressing something that’s bothering them, and insists they bring it to conscious awareness right away. David accepts this criticism, but also adds that the Hidden Emotion Technique works and frequently triggers complete recovery with patients who are only partially helped by the skillful use of cognitive techniques and exposure techniques. However, the “niceness” phenomenon only seems to affect about 75% of anxious patients; sometimes, a phobia is just a phobia, with no hidden feeling or conflict. Those individuals will not be helped by this technique. Fortunately, we have dozens of other powerful techniques that will be curative!  

We begin by describing the three different deaths of the ego that are required for recovery from depression, anxiety, or a relationship conflict, respectively. For depression recovery often results from the “Great Death,” A Buddhist concept that involves the discovery that there is no such thing as a “self” that could be worthless, or inferior, or judged by another person. David and Fabrice only touch on this theme and promise an entire future podcast on this fascinating and helpful spiritual notion that can lead to recovery from depression. For anxiety, the death of the ego is quite different, and involves surrendering to the monster the patient has always feared and avoided using a wide variety of exposure techniques. David traces the origin of Exposure Therapy to teachings in the Buddhist hold scriptures, the Tibetan Book of the Dead, more than 2,000 years ago. David describes the amazing and hilarious phenomenon of “laughing enlightenment,” which often happens when anxious individuals confront their fears. David describes how he used Flooding, an extreme form of exposure, to get over his own blood phobia, which he’d had since childhood. His fear of blood caused him to drop out of medical school at Stanford for a year on two separate occasions. He finally decided to confront his fear by working for a month in the Emergency Room of Highland Hospital, a major trauma treatment center, in Oakland, California. David explains what happened when a totally bloody man on the verge of death was rushed into the ER after a bomb he was building in his basement blew up. In the podcast David forgot to mention something fascinating about his experience at Highland. David had had a blood phobia since he was child, and blood phobia is thought to have genetic causes, and perhaps be inherited. And yet, David was totally cured in roughly 15 minutes without any medication at all. The important point is that even if things are biologically caused, they can often be treated with psychological techniques. Most therapists hate the word, “cure.” David explains why he sometimes uses this term when treating anxious patients, and also explains the difference between a 100% cure and a 200% cure. David emphasizes the importance of motivation and resistance in the treatment of anxiety, since few patients, if any, will want to use exposure techniques, because it is so terrifying. David and Fabrice will describe the Motivational Model in the next podcast. David and Fabrice raise questions about the mechanism of recovery during exposure. Why does it work? Is it due to the change in thinking, or is there some other healing mechanism at work? Fabrice asks about patients who resist exposure and protest that it won’t work. For example, a patient with the fear of heights might say, “Oh, exposure can’t possibly help, because every time I get in a situation where I’m exposed to heights, like when I’m in looking over a railing on the third floor of a building or hiking on a mountain trail, I get terrified. This has happened hundreds of times and it never helped!” Finally, David describes a humorous but real example of his 8-minute treatment of a therapist with 20 years of failed therapy (several times a week of psychoanalysis) for her elevator phobia. David and Fabrice end by talking about the enormous amount of information they have to share with listeners, including large numbers of creative exposure techniques that fall into three categories: Classical Exposure Cognitive Exposure Interpersonal Exposure They promise future podcasts describing these fascinating techniques with more amazing vignettes based on patients Dr. Burns has treated, as well as his treatment of his own many fears and phobias!

David answers these questions: How do you deal with a patient (or friend) who is boring? How do you deal with a patient (or friend) you don’t like? How do you get patients to do their psychotherapy homework? How do you deal with a patient (or friend) who is boring? David describes a technique he learned from a mentor, Dr. Myles Weber, during his second year of psychiatric residency at Highland Hospital in Oakland. The technique works instantly 100% of the time, and is guaranteed to make any boring interaction with any patient instantly exciting! David and Fabrice emphasize that the same technique can be used with a friend, colleague, or loved one who seems boring, including someone you are dating and can’t seem to connect with at anything other than a superficial level.David also describes powerful, shocking and illuminating experiences he had when attending psychodrama marathons sponsored by the Human Institute in Palo Alto during his medical school years, and what he learned about the differences between the off-putting “outer” selves we display to others and the more genuine “inner” selves we often try to hide. How do you deal with a patient (or friend) you don’t like? David describes a method he always used with patients he didn’t like, including one who he found intensely offensive—even disgusting. He explains that the patients he disliked the most almost always became the ones he liked the most, and ended up feeling the closest to, once he used this radical technique. The technique can also be effective with friends or colleagues you’re at odds with.Fabrice reminds us that the approaches David describes in this podcast involve several of the Five Secrets of Effective Communication discussed in previous podcasts. He warns us that they require considerable training, skill and practice, and are likely to backfire if done crudely. How do you get patients to do their psychotherapy homework? Every therapist who assigns psychotherapy homework is keenly aware that many patients, perhaps most, “forget” or simply refuse to do the homework. And these are the patients who don’t improve much, if at all. Dr. Burns explains how he tried dozens of techniques that didn’t work early in his career, and finally discovered an approach that was almost always effective.  

The cognitive model of anxiety is based on three powerful ideas: Anxiety always results from negative thought (NTs) that involve the prediction of danger. For example, if you have public speaking anxiety, you are probably telling yourself something like this: “I just know I’m going to blow it. My voice will tremble. People will know I’m anxious. My mind will go blank. I’ll mumble and make a total fool of myself.” Or, if you struggle with panic attacks, you probably have thoughts like this: “I think I’m about to die. I can’t breathe properly. I’m about to pass out!” Or, “I’m about to lose control and go crazy.” The NTs that trigger anxiety are always distorted and illogical. In contrast, valid NTs cause healthy fear. When you put the lie to the distorted NTs, the anxiety will disappear. This can sometimes happen in an instant. Dr. Burns describes his treatment of a woman named Terry who had suffered from ten years of incapacitating panic attacks and severe depression prior to contacting Dr. Burns. During each panic attack, Terry would experience tightness in her chest and tingling skin and tell herself she was about to pass out, suffocate, or die of a heart attack. Multiple emergency room visits, medical tests, and reassurances from doctors did not help. In addition, years of medication and psychotherapy were not at all helpful. After trying a number of cognitive techniques that did not help, Dr. Burns persuaded her to let him induce an actual panic attack during an office visit so he could use the Experimental Technique, which is arguably the most powerful technique ever developed for the treatment of anxiety, and he televised the session. What happened next will blow your mind! In the next podcast, Drs. Burns and Nye will describe the Exposure Model of treatment, and Dr. Burns will describe his personal struggles with his fear of blood during medical school.

There are 4 powerful treatment models for anxiety, including The Cognitive Model The Exposure Model The Motivational Model The Hidden Emotion Model Each approach has a completely different theory about the causes of anxiety and utilizes completely different treatment techniques. For example, cognitive therapists believe that distorted thoughts trigger all anxiety, and that the most effective treatment involves challenging these distortions. In contrast, exposure therapists argue that avoidance is the cause of all anxiety, and that exposure is the only effective treatment. Those who adhere to the Motivational Model emphasize the role of resistance. In other words, anxious individuals are reluctant to let go of the anxiety because they secretly believe that the anxiety will protect them from danger.  And those who adhere to the Hidden Emotion Model claim that “niceness” is the true cause of all anxiety in the United States at this time, and that hidden problems and feelings may need to be brought to conscious awareness before the patient can recover. Dr. Burns argues that, in fact, all four theories are correct, and that if you skillfully integrate all four approaches, you will often see a rapid and total elimination of anxiety in the great majority of your patients. Dr. Burns describes how he created the Hidden Emotion Model when he was treating a woman with mysterious and intractable case of Panic Disorder. Every time her boss walked past her desk, she became nauseous and panicky, and had the overwhelming urge to vomit on him. Then she would have to rush to the ladies’ room to rest until the nausea and panic diminished, and she sometimes had to go home because the symptoms were so severe. This was all the more puzzling because she insisted she had the best boss in the world and that there were no problems at work. She explained that her boss constantly praised her and gave her promotions and generous raises, and that she had no complaints whatsoever. Cognitive and exposure techniques were only partially effective, until an unexpected discovery suddenly emerged during a therapy session that led to a surprising outcome. What do you think the hidden emotion was? Tune in and you’ll find out! In the next several podcasts, Drs. Burns and Nye will bring these four models to life, using real life examples, including some of Drs. Burns’ personal struggles with anxiety early in his career.  

David and Fabrice answer these questions: What is anxiety? How does it differ from depression? Do anxiety and depression always go hand in hand? How does anxiety differ from healthy fear? What are the most common forms of anxiety? How common is anxiety? Anxiety, like depression, has been called the world’s oldest con. That’s because you are always fooling yourself, and buying into negative thoughts that aren’t true, when you’re feeling anxious and insecure. Dr. Burns highlights the most common cognitive distortions that trigger anxiety, and discusses the powerful role of shame in anxiety. In the next several podcasts, Dr. Burns will describe powerful, fast-acting, drug-free treatment methods that can help you defeat every type of anxiety, Including Chronic worrying Phobias Social anxiety Public speaking anxiety Shyness OCD (Obsessive-Compulsive Disorder) PTSD (Post-Traumatic Stress Disorder) Panic attacks Agoraphobia BDD (Body Dysmorphic Disorder) So stay tuned!

A listener with OCD is plagued with intrusive and shameful sexual fantasies. David discusses his treatment strategies for a young man from Argentina who was struggling with forbidden fantasies of Jesus having sex with the Virgin Mary in all positions of the Kama Sutra, but the harder he tried to control them, the more intense and tantalizing they became. Being a good Catholic lad, he was terrified and tearful he would burn in hell if he didn’t overcome this problem. If you’ve ever struggled with shameful sexual fantasies, you might be intrigued by this fascinating discussion of Cognitive Flooding, therapeutic resistance, and the Hidden Emotion Technique!

Discussion of recent startling and disturbing research studies by Dr. Irving Kirsch and others that suggest that the chemicals called “antidepressants” may, in reality, have few or no true antidepressant effects above and beyond their placebo effects. Dr. Burns illustrates the placebo effect with a thought experiment, and explains why it is so confusing to researchers and the general public alike. In addition, David and Fabrice discuss additional troubling research by Dr. David Healey and others that indicates that the chemicals called “antidepressants” appear to cause a doubling or tripling of the likelihood that a depressed individual will commit suicide or become actively suicidal, as compared with depressed individuals treated with placebos. David concludes with a discussion emphasizing that the needs of marketing are in conflict with the needs of sciences, and proposes some solutions to this serious problem. Dr. Burns emphasizes that he is only providing his interpretation of some extremely controversial studies, based on his research training and clinical experience. He urges listeners to do their own research and critical thinking on this disturbing topic, and emphasizes that many may come to different conclusions.

Can the EAR techniques help a listener deal more effectively with a defiant, oppositional child. Dr. Burns reveals a fantastically helpful secret that he and his wife stumbled across in raising their own children. If you have ever struggled in your attempts to deal with an oppositional child or adolescent, you will find this podcast enlightening!

David and Fabrice address this question submitted by a listener: Dear Dr. Burns, I read Feeling Good twenty years ago. It was a wonderful relief and help to me. Your book has helped me live a better and balanced life. The best part was passing the knowledge on to my daughter. I thought I read a wonderful description of how to handle death anxiety in the book. I was describing it to a friend, but could' find it in the book. Is it in another book? Your reply would be considered an act of generosity. Thank you! Mary Existential Therapists believe that the fear of death is universal and is at the root of most emotional problems. Dr. Burns argues that the fear of death is actually quite rare, but does occasionally occur and is extremely treatable. In this podcast, David’s describes his quick, three-part “cure” for the fear of death. Oddly, every patient he treated in this way insisted at the end of the session that it didn’t help. And even stranger is the fact that 100% of them returned the next week and announced that they actually had been cured and were, in fact, no longer afraid of death!

David answers a challenging question posed by a listener: Dear Dr. David: In your Feeling Good Handbook, you suggest that the reader just allows himself or herself to be an ordinary person instead of trying to be perfect. Contrary to your opinion in the book, you're an outstanding therapist in reality. You’ve studied in one of the world’s top colleges, you’re well-educated with a doctor degree, and successful in your career and life. How can I believe your claim? I'm quite confused! Sincerely, XXX David first distinguishes perfectionism from the healthy pursuit of excellence, and then describes a painful incident when he was a Stanford medical student. One afternoon, he attended an afternoon Gestalt encounter group at the home of a friend and mentor in Palo Alto. During the group he was ripped to shreds by the other participants. At the end of the group, the other participants seemed elated, but he felt intensely humiliated, ashamed, and discouraged. This led to an unexpected interaction with his mentor that helped to change his life. David also discusses his clinical work years later with a depressed and anxious professional who had never experienced even one minute of happiness in spite of a life of fabulous success and achievements. At the end, David and Fabrice promise a future podcast on this topic: “Self-Esteem: What is it? How do I get it? How can I get rid of it once I’ve got it?” 

David and Fabrice are joined by Lisa Kelley, a certified TEAM-CBT therapist and former journalist from Littleton, Colorado. Lisa interviews David about an interview / blog David has just published on this website. Lisa begins by asking how people responded to a survey on David’s website asking this controversial question: “Do you believe that a depressed individual could experience a complete elimination of symptoms in a single, two-hour therapy session?” More than 5,000 individuals completed the survey and most were extremely skeptical. David states that ten years ago, he would have felt exactly the same way, and would have dismissed anyone making such a claim as a con artist. However, he has now changed his mind and believes that sometimes it is possible. David explains that he has done more than 50 live demonstrations in workshops and other teaching settings with individuals who are struggling with severe feelings of depression, anxiety, shame and anger. Many of these individuals who volunteer to be the patient have experienced horrific personal traumas. This gives David the opportunity to demonstrate how TEAM-CBT works with someone who is really suffering, and not just a role-playing demonstration. Usually, these live demonstrations are the highlight of a workshop because they are intensely emotional and real. Surprisingly, in the vast majority of these sessions, the individuals who were in the patient role experienced a complete, or near-complete, elimination of symptoms in roughly two hours. David emphasizes that while we would not expect this to generalize to a clinical practice situation, it does seem to suggest significant improvements, or even breakthroughs, in psychotherapy. Many of the new developments have to do with helping patients overcome their resistance to change. Although David makes these techniques look easy, they are challenging to learn, and require a radically new and different way of thinking about why patients sometimes resist change and fight the therapist. Lisa, Fabrice, and David explain exactly how the new techniques work, using as an example an Asian-American woman who had experienced decades of domestic violence and rape.  

How can you help a depressed friend or family member? You may be surprised to discover that the attempt to “help” is rarely effective, and may even make the problem worse. In contrast, the refusal to help is nearly always helpful. But to understand that paradox, you’ll have to give a listen to this fascinating edition of "Ask David!" David and Fabrice also address a related problem nearly all of us confront from time to time: How do you deal with a friend who is a relentless whiner and complainer? When you try to help them or suggest a solution to the problem, they just say, “That won’t work” and keep complaining. You end up feeling frustrated and annoyed, because the other person just won’t listen! David and Fabrice illustrate a shockingly easy and incredibly effective solution to this problem. Finally, David discusses some disturbing recent research indicating that the ability of therapists—as well as friends or family members—to know how suicidal someone is, is extremely poor. David and Fabrice explain how to assess how suicidal someone actually is, and what to do if you discover that he or she really is at risk of a suicide attempt.

If used skillfully, the Five Secrets can resolve nearly any relationship conflict and transform hostility, resentment and mistrust into intimacy and warmth, often with amazing speed. And although this may seem easy when you first learn about the Five Secrets, it’s extremely difficult in real world situations. In this Podcast, David and Fabrice discuss a number of predictable emotional and mental errors nearly everyone makes when trying to use the Five Secrets to get close to someone he or she is at odds with.

Practically all of us have a friend, colleague, client, customer or family member we aren’t getting along with very well. Perhaps the difficult person in your life is excessively critical of you, complains constantly, won’t express his or her feelings, always has to be right, or never listens to you. Does anyone come to mind? In this podcast, David and Fabrice discuss five communication secrets that can rapidly transform conflict and misunderstanding into intimacy and trust. David describes an experience that suddenly changed the direction of his life and career when he was working with an insecure medical student from England early in his career. The Five Secrets of Effective Communication can be remembered using the acronym, EAR: E = Empathy The Disarming Technique: You find truth in what the other person is saying, even if it seems illogical, self-serving, distorted, or just plain “wrong.” Thought and Feeling Empathy: You summarize what the other person just said (Thought Empathy) and acknowledge how he or she is probably feeling, given what he or she just said (Feeling Empathy) Inquiry: You as gentle, probing questions to learn more about what the other person is thinking and feeling. A = Assertiveness “I Feel” Statements: You express your own feelings and ideas openly according to the formula, “I’m feeling X, Y, and Z right now,” where are X, Y and Z refer to any of a wide variety of feeling words, such as anxious, attacked, hurt, or sad. R = Respect Affirmation (formerly called Stroking): You convey warmth, caring and respect, even in the heat of battle David and Fabrice also describe the Five Secrets of Effective Communication and emphasize the incredible power of the Law of Opposites, with a vignette about a severely depressed patient who told David that he was “too young to be my doctor.”

A fan points out that many of the examples in David’s book, When Panic Attacks, are high functioning individuals with lots of education and good jobs. She asks Dr. Burns if depression and anxiety are inevitable among people who are poorly educated and without many assets. Dr. Burns again addresses the ancient but persistent question of whether our suffering results from the actual problems in our lives, or rather by our distorted thoughts about them.

Discuss of "Should" Statements, Labeling, and Blame. Dr. Burns brings these distortions to life with a case of a severely depressed woman who felt profoundly guilty and devastated after her brother’s tragic suicide.

Three common distortions: Jumping to Conclusions (including Mind-Reading and Fortune-Telling), Magnification and Minimization (also called the Binocular Trick), and Emotional Reasoning.

Common thought distortions that trigger negative feelings: All-or-Nothing Thinking, Overgeneralization, Mental Filter, and Discounting the Positive.

When we’re feeling depressed, anxious, or angry, should we accept our feelings or try to change them?

A session with a severely depressed, suicidal, hospitalized woman with rapidly cycling bipolar illness, who’d had 15 years of failed treatment with drugs and psychotherapy.

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

Responses to questions submitted by listeners: What causes an “identity crisis?” And how do you treat it? Why is it so hard to find a therapist trained in cognitive therapy? In a relationship, should you change yourself in order to get along with someone?

Dr. Burns suddenly abandons the role of healer and instead assumes the role of the patient’s angry, paranoid and defiant resistance.

What is therapeutic resistance? You will find out that therapeutic resistance is NOT what you were taught in graduate school or read about in the writings of Sigmund Freud! You will also discover why overcoming therapeutic resistance can be the key to high-speed, dramatic recovery for many depressed and anxious individuals.

How an encounter with a patient with paranoid schizophrenia dramatically changed the course of his career The 5 Secrets of Effective Communication How to talk with your EAR Dr. Burns also discusses what therapists can do when you are angry with a patient you don’t like a patient or when a patient is angry with you  

In this podcast, Dr. David Burns describes the “Testing” part of the T.E.A.M. model. Topics include: The shocking results of a study of therapist accuracy at Stanford Why therapists who don’t test usually get it wrong How session-by-session testing can revolutionize your practice

In this podcast, Drs. Fabrice Nye and David Burns discuss an exciting breakthrough in psychotherapy. Leave your questions and comments below. Also, let us know if you’d like to see certain topics addressed in future podcasts.