Podcasts about cognitive model

Chris continues the series on striving to equip you to treat yourself by discussing the Cognitive Model. It's true that it's a basic concept ... and that OCDST has presented long presented the idea. BUT, that doesn't mean that you have worked to apply the model in real-time to your symptoms. Gotta do it! Map it out. Dissect your symptoms. You can't directly stop your thoughts; neither can you snap your fingers and change your feelings. But you CAN choose to not engage certain behaviors. That's your choice. But you need to find them first. Go get 'em. Feel free to reach out with any questions you might have to chris@kentuckyOCD.com. If you've found the podcast helpful, consider giving it a 5-star rating.

Ask David The fear of ghosts; the truth about nutritional supplements; the fear of fear; how does anxiety treatment work? And more.  Today, David and Rhonda answer six cool questions submitted by podcast listeners like you! Joseph asks: How would you use exposure to confront your fear of ghosts? Salim asks: What herbs and supplements will help me become more zen and relaxed? Peter asks: How do you stop fearing the fear and discomfort of anxiety? Jillian asks: How does cognitive therapy work to help reduce anxiety? Sanjay asks: How do you give up wants, needs, and desires? Dana asks for help with the Disarming Technique. In the following, David's reply was David's email response to the person prior to the podcast, just suggesting some directions we might take on the podcast. The Rhonda comments were based on notes she took during the live podcast. For the full answers, make sure you listen to the podcast! Joseph asks: How would you use exposure to confront your fear of ghosts? Hi David and Rhonda, Thank you again for your wonderful replies and the amazing podcast. If you would humor me, I have another question -- I know David talked about exposure therapy in overcoming fears, but I wonder how this could apply to some fears like the fear of ghosts where it is caused by an over-active imagination (in which case, what should one be exposed to?) Regards Joseph  David's reply Cognitive flooding would be one approach. Will give details on podcast. Thanks! David  Rhonda's notes Find out what is happening in the person's life, and treat that specific problem. Maybe someone developed a fear of ghosts after the death of a loved one, so the idea of being around death or dead things may also cause intense anxiety. Going to a cemetery may be part of their exposure. Other examples of exposure for overcoming the fear of ghosts could be: Approaching a scary, abandoned house Watching a scary movie about ghosts Fear of darkness may accompany fear of ghosts so staying in the dark may be part of your exposure. Fear of sleeping alone may also accompany fear of ghosts so sleeping alone in your home may be part of your exposure. Salim asks: What herbs and supplements will help me become more zen and relaxed? Hello Mr. David D Burns, I want to tell you that i loved "Feeling Good", your book helped me a lot in improving my life, I have a question, can you recommend herbs or supplements that help me be more Zen and more relaxed? I would be eternally grateful.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.06.23.546250v1?rss=1 Authors: Miller, K. J., Eckstein, M., Botvinick, M. M., Kurth-Nelson, Z. Abstract: Computational cognitive models are a fundamental tool in behavioral neuroscience. They instantiate in software precise hypotheses about the cognitive mechanisms underlying a particular behavior. Constructing these models is typically a difficult iterative process that requires both inspiration from the literature and the creativity of an individual researcher. Here, we adopt an alternative approach to learn parsimonious cognitive models directly from data. We fit behavior data using a recurrent neural network that is penalized for carrying information forward in time, leading to sparse, interpretable representations and dynamics. When fitting synthetic behavioral data from known cognitive models, our method recovers the underlying form of those models. When fit to laboratory data from rats performing a reward learning task, our method recovers simple and interpretable models that make testable predictions about neural mechanisms. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

Smashing Shyness-- Shame-Attacking and Beyond Come to our Full-Day Workshop on Sunday, October 2, 2022 For therapists and lay people alike Click here for registration and more information Today we interview our beloved Jill Levitt, PhD who will be joining me in teaching the upcoming social anxiety workshop on October 2nd. Jill is the co-leader of my weekly psychotherapy training group at Stanford, and is the co-founder and Director of Training at the Feeling Good Institute in Mountain View, California. Social anxiety was one of the most frequent problems that patients sought help for when I was in private practice in Philadelphia. Because of my own severe and persistent social anxiety since childhood, it's my favorite problem, too. Whatever you've had, I can tell you that I've had the exact same thing, too, and know how sucky it can be. I can show you the path to freedom from that affliction, and what a joy that will be! According to the DSM5, there are at least five types of social anxiety: Shyness Public Speaking Anxiety Performance Anxiety. This a broad category that can include athletic or musical performance, or any time you have to demonstrate your skills in front of people who might judge you. For example, I had a severe camera phobia since I was a child, and only got over it a couple years ago! Test Anxiety Shy Bladder / Bowel Syndrome In addition, other negative feelings typically go hand-in-hand with social anxiety, such as shame and loneliness, as well as depression and feelings of inferiority and even hopelessness. This workshop will focus on therapists looking for training. However, the general public are also included, since you will get the chance to practice and work on your own fears during the workshop. I (David) have noticed that feelings of social anxiety, especially performance anxiety, are almost universal among therapists, at least judging from those who attend our weekly TEAM-CBT training group at Stanford. So, come to heal yourself AND to learn how to heal your patients and loved ones. We will be covering not one, but four treatment models for social anxiety in the workshop: 1. The motivational model: Nearly all anxious individuals resist exposure, which is a crucial part of the treatment. Most therapists also resist exposure for a variety of reasons, thinking the patient is too fragile, or the technique will be too dangerous or upsetting for their patients. This is unfortunate, since this pretty much dooms the treatment to failure, especially if you are aiming for a “cure” rather than endless talk and hand-holding. 2. The Cognitive Model. Although usually not completely curative, the Daily Mood Log is essential to treatment, so you can find out exactly what patient are thinking and feeling at one specific moment when they were feeling anxious. I present the case of Jason, a young man feeling shy and anxious while standing in line to check his groceries one Saturday morning at the local grocery store. Many cognitive techniques are incredibly important and useful in the treatment of social anxiety, including Explain the Distortions, the three types of Downward Arrow (uncovering) Techniques, the Double Standard Technique, Externalization of Voices, the Feared Fantasy, and more. Although these methods are helpful and illuminating, they will rarely or never be quite enough for a complete cure. For that you will need: 3. The Exposure Model. In the workshop, we will be teaching: Smile and Hello Practice: In today's podcast Jill discussed the purpose of this technique, how to introduce this technique to your patients, and how to implement it. This is an example of the many techniques we will teach on October 2. David provided a dramatic example of how this humble technique changed the life of a young man from India. Flirting Training Talk Show Host Rejection Practice Feared Fantasy: We role-played how I used this humor-based technique in my work with Jason Self-Disclosure Survey Technique Shame-Attacking Exercises. We will also explain how to use several techniques crucial to the reduction of the patient's resistance: Dangling the Carrot Gentle Ultimatum Sitting with Open Hands Fallback Position However, many therapists have intense resistance to making patient accountable with these techniques that are absolutely central to TEAM-CBT, thinking they are cruel or crude or narcissistic, or some such thing. In the podcast, Jill illustrates a beautiful and gentle but firm way of introducing these techniques to patients, and emphasizes that they are actually ethical, therapeutic, and necessary for a good outcome. She also emphasizes, and I totally agree, the importance of going with the patient into the real world to do the Exposure Techniques. I have used extreme exposure techniques on hundreds of occasions when treating anxious colleagues on Sunday hikes for example, urging them to stop hikers we meet and disclose their own shyness, for example. The advantages of doing this type of thing in the real world include the ability to coach the “patient” with the best examples of how to use whatever technique you're advocating, and to be there to support the patient during and after the experience. 4. The Hidden Emotion Model. This technique is often extremely helpful in the treatment of any form of anxiety, but is perhaps less often used in the treatment of social anxiety. I can think of one example when it was extremely helpful. This was a woman whose boss kept pressuring her to give presentations about their company locally and to groups in other locations as well. She opted out because of her social anxiety. But lurking behind her symptoms were her feelings of resentment about being asked to do too much. Once she brought these feelings to conscious awareness, she decided to discuss his expectations, her feelings, and her compensation with her boss. This worked well, and her public speaking anxiety magically disappeared. Although this pattern is not common, it is always worth consideration in your treatment plan, because family and friends often pressure people with social anxiety to confront their fears, and this typically does trigger feelings of resentment and resistance. We also discussed two Self-Defeating Beliefs that are nearly universal in individuals with social anxiety: the Spotlight and Brushfire Fallacies. In the podcast, I give examples of several techniques that were life-changing for patients. Jill emphasizes that one of the underlying treatment themes is how to “wake up” from your trance so you can learn not to take yourself so seriously and begin to have fun and enjoy yourself and others way more. Improvement is not the goal of treatment. The goal of treatment is word that many mental health professionals fear and resent: CURE! In the podcast, I describe the difference between a 100% cure for any form of anxiety, and a 200% cure. Do you know the difference? I give an example of my own fear of heights when I was in high school. Of course, that's a phobia, and not a form of social anxiety, but you can also have a 200% cure for social anxiety, too! In a 100% cure your fears go to zero. You are no longer particularly anxious about talking to strangers, or public speaking, for example. In a 200% cure, you come to LOVE the very thing that terrified you in the past. Rhonda, Jill and I think this will be a powerful one day experience. We will focus on a common problem that is usually treatable fairly quickly, and often with fabulous and life-changing results. We hope you can join us! For registration information, please go to: CBTforSocialAnxiety.com Thanks! Jill, Rhonda, and David

Chris deals with a common question in therapy: What do I do: I have anxiety, not OCD. The Cognitive Model provides a useful roadmap for understanding anxiety-related symptoms; and it offers a practical, step-by-step guide for beginning to change their severity. Feel free to reach out with any questions you might have. Chrisleins04@gmail.com If you found OCD Straight Talk helpful, consider giving us a 5-star rating and supporting the podcast to help us produce more content. --- Support this podcast: https://anchor.fm/chris-leins/support

Chris discusses the Cognitive Model and how it applies to depressive and anxious symptoms. Distinguishing between symptoms that we can directly control and symptoms that we can't is an essential first step to making progress. The questions become, Where do you have control? and, What are you doing to feed the bear? Feel free to reach out with any questions you might have to chrisleins04@gmail.com; or message Chris on Instagram @ocdstraighttalk. If you've found OCD Straight Talk helpful, consider giving us a 5-star rating, and supporting the podcast to help us produce more content. --- Support this podcast: https://anchor.fm/chris-leins/support

Chris sits down with Dr. Robert Hindman, a trainer at the widely respected Beck Institute, and specialist in the treatment of clinically significant anxiety problems. Chris and Dr. Hindman discuss issues spanning from the concept of the Cognitive Model to the application of that model to beating your OCD-system. Feel free to reach out with any questions you might have to chrisleins04@gmail.com. If you've found OCD Straight Talk helpful, consider giving the podcast a 5-star review or supporting us to help us produce more content. --- Support this podcast: https://anchor.fm/chris-leins/support

Chris discusses CBT-theory, which is based on "the Cognitive Model," and raises the question of how we can methodologically weaken the strong and habitual connection between these triangulated, and interconnected pieces of our experience. Feel free to reach out with any questions you might have to chrisleins04@gmail.com --- Support this podcast: https://anchor.fm/chris-leins/support

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

Do you know what an Idealized Cognitive Model is? Do you think you have one? Does it affect how we do church, or how we view other churches? I think the answer is yes. I want to talk to you about this topic today, and hopefully, challenge you to think about how you view the church and the world around you. Want to support the work that I am doing on this podcast? I would appreciate it very much! Go to www.patreon.com/thispoorpastor to see the options that are available. --- Support this podcast: https://anchor.fm/thispoorpastor/support

Chris discusses two kinds of patients: one comes to the game to watch from the sideline while the others fight the battle, the other comes to fight through the stages of adversity to win with his teammates at the end. Which kind of patient are you? I'll let you in on a secret: your therapist can't get you better - at least not all by herself. She needs you to get some skin in the game. You need you to get some skin in the game. And I'll tell you something else. If your therapist is working harder than you are to get you better, you're likely both wasting your time. Fight hard; get better. Feel free to reach out with any questions you might have to chrisleins04@gmail.com --- Support this podcast: https://anchor.fm/chris-leins/support

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

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

In this episode, Drs. Ali and Mark Novitsky explore common marriage pet peeves and open up about a few of their own. They use the Cognitive Model to help couples realize that these pet peeves are generally not “deal breakers” - and emphasize that “All-or-Nothing Thinking” is a cognitive distortion that can allow these pet peeves to fester and negatively affect our emotions and behaviors. Dr. Ali coaches you on how to focus your attention on your significant other’s positive attributes and ultimately, reframe these behaviors as cute nuances.

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

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

Hey folks! This week we continue our discussion on major depressive disorder. We spend some time covering Aaron Beck‘s Cognitive Model of Depression as well as describe how Cognitive-Behavioral Therapy (one of the empirically-supported interventions) works. Then we take what we learned and apply it to none other than Barbara Gordon, the Batgirl! You can … Continue reading Jedi Counsel Podcast 38 – Major Depressive Disorder and Batgirl, Part 2

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

Vorlesung vom 22.11.06