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

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You Can Change the Way You Feel! This podcast features David D. Burns MD, author of "Feeling Good, The New Mood Therapy," in conversation with Fabrice Nye, PhD, describing powerful new techniques to overcome depression and anxiety and develop greater joy and self-esteem. For therapists and the gene…

David Burns, MD


    • Nov 29, 2021 LATEST EPISODE
    • weekly NEW EPISODES
    • 49m AVG DURATION
    • 279 EPISODES

    Listeners of Feeling Good Podcast | TEAM-CBT - The New Mood Therapy that love the show mention: fabrice, feeling good, cbt, david burns, burns', distortions, generalized anxiety, rhonda, nye, workbook, depression and anxiety, general public, psychologist, also please, therapists, anxiety and depression, fantastic resource, resistance, drs, cognitive.



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    Latest episodes from Feeling Good Podcast | TEAM-CBT - The New Mood Therapy

    270: Losing Weight vs Gaining New Habits

    Play Episode Listen Later Nov 29, 2021 69:26

    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 If you click on it, you'll receive two unpublished chapters from my most recent book, Feeling Great, with crystal clear instructions on the methods you'll learn about in today's podcast.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!

    269: "I want to be a mother!" (Part 2 of 2)

    Play Episode Listen Later Nov 22, 2021 95:01

    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

    268: "I want to be a mother!" (Part 1 of 2)

    Play Episode Listen Later Nov 15, 2021 69:06

    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

    267: How to Talk to Loved Ones Who Criticize Your Sexual Orientation

    Play Episode Listen Later Nov 8, 2021 70:10

    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? And more!

    Play Episode Listen Later Nov 1, 2021 62:08

    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

    265: Loving Luscious Leeches, Featuring Drs. Danielle Kamis and Matthew May

    Play Episode Listen Later Oct 25, 2021 59:57

    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

    264: How to Get Laid! (With a Little Help from the Five Secrets of Effective Communication)

    Play Episode Listen Later Oct 18, 2021 69:13

      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

    263: OCD in Kids, Featuring Dr. Taylor Chesney

    Play Episode Listen Later Oct 11, 2021 74:56

    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

    262: A Country Doctor, Part 2 of 2: "Nothing I do makes a difference!"

    Play Episode Listen Later Oct 4, 2021 111:33

    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

    261: A Country Doctor, Part 1 of 2: "Nothing I do makes a difference!"

    Play Episode Listen Later Sep 27, 2021 45:47

    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

    260: TEAM-CBT Games, featuring Amy, Heather, and Brandon

    Play Episode Listen Later Sep 20, 2021 63:21

    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

    259: TEAM-CBT for Eating Disorders, featuring Donna Fish, LCSW

    Play Episode Listen Later Sep 13, 2021 71:55

    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.

    258: Doctor, I know you're secretly sexually attracted to me!

    Play Episode Listen Later Sep 6, 2021 59:29

    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.

    257: What's an "Intensive?"

    Play Episode Listen Later Aug 30, 2021 53:18

    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.

    256: Intense Performance / Public Speaking Anxiety, Part 2 of 2

    Play Episode Listen Later Aug 23, 2021 99:23

    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

    255: Intense Performance / Public Speaking Anxiety, Part 1 of 2

    Play Episode Listen Later Aug 16, 2021 58:47

    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 Dr. Rutherford Knows)

    Play Episode Listen Later Aug 9, 2021 67:18

    #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

    Play Episode Listen Later Aug 2, 2021 64:37

    #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

    Play Episode Listen Later Jul 26, 2021 46:38

    #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 Dr. Rutherford Knows)

    Play Episode Listen Later Jul 19, 2021 31:23


    #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: Ask Matt, Rhonda, and David (with Dr. Rutherford Knows)

    Play Episode Listen Later Jul 12, 2021 38:24

    #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)

    249: Report on the Amazing Feeling Great Book Clubs!

    Play Episode Listen Later Jul 5, 2021 57:43

    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

    248: David and Rhonda Answer Your Questions about Exercise, Empathy, Euphoria, Exposure, Psychodynamic Therapy, and more!

    Play Episode Listen Later Jun 28, 2021 57:16

    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

    247: The Night My Childhood Ended, Part 2

    Play Episode Listen Later Jun 21, 2021 74:07

    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

    246: The Night My Childhood Ended, Part 1

    Play Episode Listen Later Jun 14, 2021 73:44

    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

    245: Tips for Joy, Should Statements, and more, Featuring Matthew May, MD

    Play Episode Listen Later Jun 7, 2021 60:16

    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

    244: The Paradoxical Nature of TEAM, Featuring the Fabulous Matthew May, MD

    Play Episode Listen Later May 31, 2021 60:09

    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

    243: Ask David: What's the Role of Hope? Moral scrupulosity, how do you positively reframe suicide, and more!

    Play Episode Listen Later May 24, 2021 53:41

    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

    242: Professor Yehuda’s TEAM-CBT Israeli Initiative!

    Play Episode Listen Later May 17, 2021 55:57

    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

    241: “I’m tired of being terrified. I want to be at peace!” Elizabeth, Part 2

    Play Episode Listen Later May 10, 2021 90:55

    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

    240: “I’m tired of being terrified. I want to be at peace!” Elizabeth, Part 1

    Play Episode Listen Later May 3, 2021 63:01


    “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

    Play Episode Listen Later Apr 26, 2021 71:30

    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: What Happened In the first Feeling Great Book Club?

    Play Episode Listen Later Apr 19, 2021 69:40

    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!

    237: The Gentle Ultimatum: Can We Make Our Patients Accountable?

    Play Episode Listen Later Apr 12, 2021 63:42

    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

    236: Ask David: Does "objective truth" exist? Is TEAM as effective as you say? Shame Attacking, Codependency, and More!

    Play Episode Listen Later Apr 5, 2021 55:25


    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: The Five Secrets Revisited

    Play Episode Listen Later Mar 29, 2021 80:52


    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


    234: How To Deal with Whiners and Complainers

    Play Episode Listen Later Mar 22, 2021 39:55


    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!”


    233: Five Secrets and Schizophrenia, featuring Phillip Lolonis, Part 2

    Play Episode Listen Later Mar 15, 2021 54:24

    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.

    232: Ask David: Ego Strength; Panic Attacks; Habits / Addictions; High Blood Pressure: and More!

    Play Episode Listen Later Mar 8, 2021 58:51

      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.

    231: Hiking with Phillip Lolonis, LCSW

    Play Episode Listen Later Mar 1, 2021 56:00


    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. 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 4 TEAM therapists who is a member of Rhonda's new Feeling Great Therapy Center in Berkeley. 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 X 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. He pointed out that these days, a great many individuals 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 one of his close family members 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.        I would also encourage you to take a look at this incredibly cute video of "talking turkey" on one of his hikes! Phillip's turkey video.MOV


    230: Secrets of Self-Esteem—What is it? How do I get it? How can I get rid of it once I’ve got it? And more, on Ask David!

    Play Episode Listen Later Feb 22, 2021 47:09

    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

    229: The Five Secrets at Home

    Play Episode Listen Later Feb 15, 2021 58:17

    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

    228: Reflections on the Evolution of TEAM

    Play Episode Listen Later Feb 8, 2021 45:56

    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

    227: Echoes of Enlightenment

    Play Episode Listen Later Feb 1, 2021 43:36

    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!”

    226: The “Great Death” in a Corporate / Institutional Setting

    Play Episode Listen Later Jan 25, 2021 55:45

    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

    225: The Self-Centered Podcast Featuring Special Guest, Dr. Jill Levitt!

    Play Episode Listen Later Jan 18, 2021 78:24


    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


    224: Ask David: TEAM Treatment for Stress, Severe OCD, "General" Depression, and more!

    Play Episode Listen Later Jan 11, 2021 63:51

    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.

    223: The Jealousy Addiction: What Can You Do When Good Things Happen to Bad People?

    Play Episode Listen Later Jan 4, 2021 77:46


    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


    222: Ask David: Personality Disorders, Buddhism, the "Great Death," the Magic Button, perfect empathy, and more!

    Play Episode Listen Later Dec 28, 2020 63:00


    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


    221: Ask David: What's Your Definition of a Violent Person? Five Cool Questions from Listeners Like You!

    Play Episode Listen Later Dec 21, 2020 61:11

    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

    220: An Interview with Dr. Steven Hayes, Creator of ACT!

    Play Episode Listen Later Dec 14, 2020 68:40


    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


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