Podcasts about daily mood log

304: TEAM-CBT, Spirituality, and Beyond: Featuring Angela Poch Rhonda begins today's podcast, as usual, by reading two touching emails from podcasts fans, including Coach Teddy, who said that Podcasts 295 and 296 featuring live work with Zeina were incredible, and Carol who was equally enthusiastic about Podcast 297 (on “Homework—Yuck!). Carol also strongly recommends David's book, Ten Days to Self-Esteem which is a simplified version of Cognitive Behavioral Therapy that can be used as a manual for therapy or self-help groups. https://www.amazon.com/Days-Self-Esteem-David-Burns-M-D/dp/0688094554 Today, we interview Angel Poch, a certified life coach, registered professional counselor, and certified Level 4 TEAM therapist and trainer. She lives two hours north of Glacier National Park in British Columbia, but teaches therapists and treats people virtually from around the world. Her new booklet, “The Truth Shall Set You Free,” integrates TEAM-CBT with a Christian perspective and is available for free on her website. https://www.angelapoch.com/. She is a regular in David's weekly virtual psychotherapy training group at Stanford and assists in the teaching. She has also worked tirelessly and selflessly behind the scenes making David's work way more accessible to lay people as well as mental health professionals wanting to learn more about TEAM-CBT. For example, she adds links to every new Feeling Good Podcast on David's website, so you can easily find and link to more than 300 podcasts. Check it out! She has also transformed a massive amount of David's work into electronic tools for shrinks, accessible in David's online shop: Recently, she has created two amazing new documents you can link to. One is a spreadsheet that lists 138 of David's TEAM-CBT tools and techniques, like the “Anti-Procrastination Sheet” and many others, with page links to the descriptions of how to use each tool in David's books, like Feeling Good, Feeling Great, David's TEAM-CBT therapist eBook, and many others. Check it out! This data base will be invaluable to interested lay people, therapists, and teachers who want clear instructions on how to use the Daily Mood Log, Relationship Journal, and numerous additional tools and techniques. Derek Gurney and Angela are working on an equally awesome database for the Feeling Good Podcasts: Check it out as well! Angela begins her personal statement in today's podcast by describing her struggles with depression and irritability, including some very dark days in 2006. Her doctor recommended an SSRI antidepressant, and she went to integrative health program, “Depression: the Way Out” that required participants to read Feeling Good https://www.amazon.com/Feeling-Good-New-Mood-Therapy/dp/0380810336 Although she didn't love the book, she resonated with the idea that all of our feelings, positive and negative, result from our thoughts, or perceptions, and her depression cleared up. She liked that when she read Feeling Good, she got many new tools she could use to change her negative thoughts and feelings. She also appreciated the ideas in the book didn't go against her belief system, which many fear about psychology. David pointed out his own father, a Lutheran minister, worried about this, and was very suspicious of psychiatrists. Angela's thinking, which resonates with David's, is that the core ideas of religion and psychotherapy are actually high compatible, and even synergistic. Angela explains that when she was a young child, she didn't fit in socially or even in her own skin. “I felt like I was a boy in a woman's body. I felt like I was in the wrong body, and prayed for help.” She started to see in a very limited, childlike way, her thoughts were distorted, that a body was just a body and she could trust God wouldn't give her more than she could bear. These new realistic, counter thoughts relieved the negative body dysmorphia she'd been struggling with. She reports, “I decided it was okay to be flawed and not fit in.” The rest of her young childhood was mostly joyful. In middle school she was the target of mean-spirited bullying because she was a tomboy. She developed intense social anxiety and was relieved when her mom took her out of school. She was homeschooled for a few years and studied Karate to exercise and develop some confidence. High school brought new challenges. She describes responding with her version of the Five Secrets of Effective Communication to an aggressive bully who threatened her with brass knuckles and challenged her to fight her. However, the girl backed off and started telling people that Angela was her friend! After a bad relationship, Angela started to struggle with depression and described her suicide attempt when she was 18 because “I wanted the pain to stop.” She explains that: I met my husband, moved home, and started reading the Bible. I was impressed by the passage, “the truth shall set you free.” I realized I had to control my own thoughts rather than look for the approval of others, but she still didn't totally recovery from my anxiety. The cognitive piece in Feeling Good helped Angela a lot. She states, “I pursued a lot of careers, never holding down a job for more than 6 months, and one day someone asked if I'd considered a career in counseling. . .” She went on to take one of David's four-day live intensives in Whistler BC where she learned TEAM-CBT and hasn't looked back since! After learning and applying TEAM, Angela was able to crush her social and other anxieties. Angela has a deep love for her Creator and has done a great deal of thought about the integration of her Christian faith with TEAM-CBT. David also has a strong interest in the overlap between TEAM-CBT and virtually all religions and spiritual paths. He described an unusual and overpowerful spiritual experience he had as a medical student crossing the Nevada desert that made a strong impact on him. Angela would like to mention, “I have a profound gratitude for David's work. He makes things so clear and relatable. His approach is applicable to all faiths or no faith if one is truly ready to give up their negative thoughts and feelings. As we aim for the truth, and let go of the so called “self,” we find peace and joy. I will forever be indebted to him because I would not be able to help people without TEAM and that brings me joy every day!” I, David, would like to thank Angela for her intense and tireless devotion to helping spread the “gospel” of TEAM-CBT in so many ways! Thanks for listening today! Angela, Rhonda, and David I

Today, you will hear the the second half of the live therapy session that Dr. Jill Levitt and I did with Nazli, a young woman from Turkey, at our recent “David Burns Live” workshop on May 22, 2022. Nazli has been struggling with intense performance anxiety and generalized anxiety, and generously who volunteered to be a “patient.” Jill and I are very grateful for Nazli's courage in sharing herself so courageously with all of you, and hope you enjoy the session and learn from it. Last week, we played the first half of the therapy session, including the initial T =Testing and E = Empathy. Today, you will hear the exciting conclusion, including A = Assessment of Resistance and M = Methods, and final T = Testing. As a reminder, you can review the Daily Mood Log and Brief Mood Survey (BMS) that Nazli filled out at the start of the session. Part 2 of the Nazli Session: A = Assessment of Resistance and M =  Methods After a period of empathizing, Nazli gave Jill and David an A in Empathy, so we moved on to the Assessment of Resistance portion of the session. This often involves the following steps: Invitation Step Miracle Cure Question Magic Button Positive Reframing Pivot Question Magic Dial Jill issued a Straightforward Invitation, asking Nazli if she was ready to get down to work, or if she needed more time to vent. She said she was ready to go to work, so Jill asked what changes she was hoping for during the session. This is the so-called “Miracle Cure Question.” This helps to focus the session on something specific. Nazli said that her hope was to reduce or eliminate the negative thoughts and feelings that were making her clinical work so stressful. And like nearly everyone, she said she'd eagerly press the Magic Button. Then Jill and David pointed out that although we didn't have a Magic Button, we did have some powerful techniques that could help, but it might not be the best idea to use them. That's because there might be some positives hidden in her negative thoughts and feelings, and perhaps we should first take a look. David and Jill asked Nazli these three questions: 1. Given your circumstances, why might this negative thought or feeling be totally appropriate and understandable? 2. What are some benefits, or advantages of this negative thought or feeling? 3. What does this negative thought or feeling show about you and your core values that's positive, beautiful, or even awesome? This technique is called Positive Reframing. The goal of Positive Reframing is to reduce the patient's subconscious resistance to change, along with their feelings of shame about their symptoms.. Paradoxically, the moment patients see the beautiful and awesome things about their negative thoughts and feelings, their resistance to change typically disappears. Positive Reframing is one of the unique features of TEAM-CBT and it opens the door to the possibility of rapid change. As an exercise, see if you can find some positives in five of Nazli's feelings, Anxiety Ashamed, bad Inadequate Hopeless Angry Please do this on paper, and NOT in your head, using the blank Positive Reframing Tool you'll find at the end of the Daily Mood Log. Getting it “right” isn't important. What is important is trying. This will get your brain circuits firing in a new way. Then, when you see the work that we did with Nazli, you might have your own “ah-ha” moment, as well as a powerful new skill that may be helpful to you as well. Okay. Did you do that yet, or do you plan to look at the answer without doing the exercise? Oh! I see! You're planning to look at the answer. If you want to learn at a deep level, whether you're a therapist or lay person, do the exercise first! It may be challenging at first, but it will fire up your brain circuits, so when you look at the answer, you'll suddenly have a new and deeper understanding of Positive Reframing. When you're done, you can check this link to see the work that Jill and I did with Nazli. But either way, I'm grateful that you're listening to these podcasts and reading the show notes! If you click on this link, you can find the Emotions table from Nazli's Daily Mood Log showing her goals for each negative feeling after we use the Magic Dial. After we finished the Magic Dial, we went on to the M = Methods portion of the TEAM-CBT session, and helped Nazli challenge some of her negative thoughts using a variety of techniques including Explain the Distortions, the Externalization of Voices, Examine the Evidence, the Acceptance Paradox, and more. One of the thoughts she wanted to work on first was this one: “If I don't fix this patient or make him/her satisfied, then she/he will judge me and think poorly about me.” Together with Nazli, we identified a number of distortions in this thought, including a couple more that popped into my mind while doing the show notes: Fortune-Telling: Making a negative prediction without good evidence. Mind-Reading: Assuming that I know how my patients are thinking. Hidden Should Statement: Telling myself I should be doing better. Mental Filtering: Selectively noticing the times sessions have not gone well. Discounting the Positive: Overlooking the positive feedback I typically get from patients and supervisors. Magnification and Minimization: Magnifying the importance or “awfulness” of negative feedback from patients, and overlooking the potential value of processing their negative and positive feedback with them at the next session. Emotional Reasoning: Thinking that my feelings of inadequacy and anxiety mean that I really am screwing up with patients Self-Blame: Beating up on myself constantly when I'm seeing patients. Nazli's belief in this thought went down from 80% to the range of 10% - 20%, since there was some truth in the thought. Sometimes you'll want to smash a negative thought, so your belief in it goes all the way to zero. Sometimes, it's okay just to reduce your belief in a thought substantially, but not all the way to zero. We also encouraged Nazli to begin using the Brief Mood Survey (BMS) and Patient's Evaluation of Therapy Session (EOTS) with every patient at every session so she can get immediate and accurate feedback of how she's doing, and so she can fine-tune her therapeutic strategies based on this information. This practice is vastly more effective than Mind-Reading, since therapists' perceptions of how patients feel tend to be wildly inaccurate most of the time. If you are a therapist, T = Testing at start and end of every  is a vitally important key to personal and professional growth, although it takes courage because sometimes—or even often—you will have to confront some information that may threaten your feelings of pride! You can see Nazli's final ratings of her feelings on the Emotions table her Daily Mood Log at the end of the session. Since the changes in all of her negative feelings were dramatic, we asked Nazli two questions: 1. Are these ratings valid, or are you just trying to please David and Jill? 2. If so, what were the effective ingredients of your session. What, more than anything else, accounted for the significant and rapid changes you experienced? You will hear how she answered these vitally important questions on the podcast, and you can see Nazli's BMS and EOTS after her session if you click the link. Thanks for tuning in last week and today! Once again, Rhonda, Jill and I want to thank our wonderful and courageous Nazli from the bottom of our hearts! We hope you enjoyed this session, and the chance to look behind closed doors to see how psychotherapy actually works in a real session with a real human being who, like nearly all of us, struggles at times with that ancient belief that “I'm just not good enough!” In fact, we're all, in many ways, “not good enough,” and will probably never be “good enough.” But that is never the cause of our problems, especially our lack of self-esteem. Do you know what the actual cause is? Do you know what the solution is? Take your best shot, make a guess, and then you can click on this link. Thanks! Rhonda, Jill, Nazli, and David

In the next two podcasts, you will hear the live therapy session that Dr. Jill Levitt and I did with Nazli, a young woman from Turkey, at our recent “David Burns Live” workshop on May 22, 2022. Nazli has been struggling with intense performance anxiety and generalized anxiety, and generously who volunteered to be a “patient.” Jill and I are very grateful for Nazli's courage in sharing herself so courageously with all of you, and hope you enjoy the session and learn from it. Although the facts of your life are probably quite different from Nazli's, you may be able to identify with the almost universal theme of feeling like you are not “good enough.” The ultimate antidote to this type of suffering is simple, but so basic that you may not “see it” at first, especially when it comes to your own negative thoughts and feelings. Although we all have many flaws and shortcomings, our inadequacies are rarely or never the cause of our emotional distress. Our emotional distress, in terms of anxiety, depression, inferiority, loneliness, hopelessness, and anger, nearly always results from our thoughts, and not so much from what's actually happening in our lives. In addition, the thoughts that trigger those kinds of feelings are almost never valid. Instead, they are loaded with cognitive distortions. As you probably know very well, I have often said that depression and anxiety are the world's oldest cons. And here's the really good news. The very moment you change the way you THINK, you can change the way you FEEL! Sounds wonderful. But isn't it just a little, or a lot, too good to be true? And can you really trigger real change at the gut level by changing the way you think? Let's find out! In today's podcast, you'll hear the first half of Nazli's session, including T = Testing and E = Empathy. Next week, you'll hear the exciting conclusion of her session, including the A = Assessment of Resistance and M = Methods, followed, of course by the final of T = Testing so we can see if Nazli really changed, and if so, by how much. We'll also see and how she rated Jill and David on Empathy, Helpfulness, and more. If you've followed the Feeling Good Podcasts, you know that doing live therapy to challenge your own demons is part of therapist training in TEAM-CBT This experience greatly deepens your understanding of team and allows you to give this message to your ow patients: “I know how you feel because I've been there myself. And it will give me great joy to show you how to CHANGE the way you FEEL, too!” I think of this personal step as the transition from technician to healer. But you cannot take this step with credibility if you haven't yet done your own “work.” At the start of the session, Nazli explained that she's struggled with anxiety ever since she was a child, and that's what triggered her interest in a career as a clinical psychologist. In my experience, this is true of many if not most mental health professionals. Although the general public often have the impression that shrinks have it all together, nothing could be further from the truth. Most went into the field hoping to find a solution to their own suffering, and a great many—probably nearly all—are still searching and hoping to find a their “cure.” After completing her master's degree in counseling 10 years ago, Nazli got a job at a counseling center, and in spite of the fact that she received consistently good feedback, she quit after 2 and 1/2 years and took a job in administration. This was because of the intense anxiety she experienced during sessions, resulting from the constant and relentless bombardment with negative thoughts that popped into her mind when treating  patients. However, she still yearned to do clinical work, so she decide to go back to clinical work several years ago and has been doing therapy for patients being treated for cancer. But the negative thoughts and feelings still continued to haunt her. You can review them on the Daily Mood Log that Nazli showed us at the start of her session. As you can see, when she's treating patients, she feels severe depression, anxiety, shame and inadequacy. She also feels humiliated, hopeless, and discouraged, along with some moderate feelings of anger and resentment. Nazli explained that she has no fear of public speaking, but said that when she's working with a client, she constantly criticizes herself for fear of making a mistake and tell herself: I'm not doing a good job. This job is not for me. Should I just quit? My friends are at a better place in life. I'm 38 years old and missing out on a lot. Why am I like this? Recently, she went to visit one of her patients, a young woman struggling with lung cancer; but when Nazli entered the room, her patient said: “I don't want to talk to you!” Nazli said, “I was devastated and felt like crying.” When you review Nazli's Brief Mood Survey (BMS) at the start of the session, you'll see that the only feeling that was elevated was anxiety, and that was minimal. However, her score on the Happiness Test was only 8 out of 20, indicating that she didn't feel very worthwhile, happy, hopeful, motivated, or satisfied with her life. This meant that her negative thoughts and feelings when she was seeing patients were making a huge impact on her capacity for happiness and self-esteem. Her minimal scores on the depression, anxiety, and anger scales on the BMS also reflect the fluctuating nature of anxiety and other feelings for many people. For example, you may have little or no anxiety most of the time, and when you're having a session with your shrink you may not feel especially anxious, either. But when you encounter the situation that triggers your anxiety, the feelings suddenly spike tremendously, along with a host of other negative feelings, and then the emotional discomfort can be overwhelming. End of Part 1 of the Nazli Session: T = Testing and E = Empathy. Next week, you will hear Part 2: A = Assessment of Resistance and M =  Methods. Thanks! Rhonda, Jill, Nazli, and David

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

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

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

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

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

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

287: Ask David, Featuring Matt May, MD: Acceptance. Irritating Questions. And More! Today, Rhonda, Matt and David answer several challenging questions submitted by fans like you. William asks: How would the TEAM-CBT model look with an addiction or a habit like procrastination? Robin asks: What's the difference between a habit and an addiction? Edwin asks: What's the best treatment for internet surfing? It feels like my actions operate below the level of consciousness! Matt asks: What's the full list of questions that David finds irritating? Matt also asks: How do we help patients who don't “get” the Acceptance Paradox? Phil asks: Hey David, Rhonda and Mark, Can't thank you enough for all your hard work and effort! Where do you guys get all your energy?! Note: The answers below were generated prior to the podcast, and the information provided on the live podcast may be richer and different in a number of ways. 1: William asks: “How would the T.E.A.M. model look with addiction and procrastination?” I have a question about your recent podcast on weight loss with Dr. Angela Krumm. She is doing a great job … but did not need any help from others. About the T = Testing part of TEAM, you could say that Angela had lost her kilo's. But I am not recognizing the testing in the form of a depression / anxiety test or something alike. With the E = Empathy part, it is even more strange. Where is the Empathy section? How would the T.E.A.M. model look with addiction and procrastination? Anyway, I assume you can't expect that addiction and procrastination issues will be solved in a single therapy session? I realize that Dr. Burns empathized in the podcast, but then the ‘work' already was done. Thanks a lot, William David's reply Thanks, William, for your thoughtful questions. I will probably make this an Ask David, but here's the short answer. Yes, empathy must always come first. As you point out, Angela was simply discussing the methods she used for weight loss. This was not a live therapy session. And yes, in therapy sessions I always start with T = Testing, but often add the Temptations Scale as well. And yes, procrastination can usually be cured in a single (two-hour for me) session, and sometimes addictions too, but severe addictions might need ongoing support, as with AA for example. Rhonda and I did a free two-hour workshop on Habits and Addictions on January 26th, 2022, sponsored by PESI. To view it, you can click on the link and download the entire video. Then you can watch it locally on your devise. On the bottom of my homepage on www.feelinggood.com, you'll find an offer for two free unpublished chapters on habits and addictions. D 2: Robin asks: What's the difference between a habit and an addiction? No email, just the question. David's reply You could check with a dictionary. I think Shakespeare said that a rose by any other name is still a rose! Technically, an addiction is associated with physiologic dependence and withdrawal symptoms during discontinuation. But once again, if “yearning” is a withdrawal symptoms, then habits, too, could be seen as addictions of sorts. You might also think of habits and addictions as two points on a continuum, with addictions being on the more severe side of the bell-shaped normal distribution curve. But all these definitions are, to some extent, arbitrary. Does “alcoholism” exist? Or just people who are drinking excessively? 3: Edwin asks: What's the best treatment for internet surfing? It feels like my actions operate below the level of consciousness! Dr. Burns, I am a huge fan of your books and podcast, and I enjoyed your talk today on Habits and Addictions as well as your “Feeling Great” bonus chapter on the same. I struggle with a habit of internet surfing (news, social media, etc.) when I'm avoiding boring or unpleasant tasks at work. Do you feel that motivational and cognitive techniques are sufficient for addressing this habit when it often feels like my actions operate below the level of consciousness? For example, I often start surfing the internet before I even consciously realize what I'm doing! Additionally, I've found stimulus control to be difficult for this habit given that I work on the computer all day. Any advice on addressing this particular habit, or similar ones, would be much appreciated. Thank you for all of your work helping people! Edwin David's reply Check out the free chapter(s) offer at bottom of my homepage. Read, do then exercises, then you can ask your question. Also, it depends on how far “below consciousness” your habit is. If it is only a couple inches below, you should be fine! D 4: Matt asks: What is the full list of questions that David finds irritating? David's reply Good question. Most of the time, I really appreciate the comments and questions from our many fans around the world, but there are, in fact, some questions that I find irritating. This may not be the “full list,” but these are some questions that could use, perhaps, a bit of fine tuning! Some people ask vague, “help me” questions, and like “I've always struggled with anxiety. What should I do?” There are two problems with this question. First, I spent most of my life answering this question with inexpensive paperback books, free podcasts, free anxiety and depression classes on my website, and more. So, I don't want to have to repeat all of that for this or any person who writes to me. Perhaps you can tell me which resources you've already tried, and where you're stuck, specifically. Sometimes, I list the resources, like the “Search” function on every page of my website, www.feelinggood.com, or the list of books there, or the list of podcasts, with links, or the free classes, and more. In addition, those of you who are familiar with my work understand that I never try to help anyone on a “general” level. I can only help you at a specific moment in time. When was it? Where you when you felt anxious, or whatever? What was going on? What were you thinking and feeling at the moment? Record it on a Daily Mood Log, and highlight the Negative Thought you can't successfully challenge. What are the distortions in that thought? Then I can give you all kinds of help! Perhaps in a future Ask David I can list some more types of problematic questions. Thanks! But while we're at it, here's another. Sometimes, people will ask a question that was answered 40 years ago, and ever since, as if they've come up with something new. In addition, if they ask questions with a kind of “gotcha” arrogance, I sometimes feel annoyed. Here's an example. People sometimes say, “Oh, I can see that my negative thought is irrational, but it still upsets me. That shows that cognitive therapy doesn't actually work!” Here's what I'm thinking when I hear that: “Aren't you special! My goodness, no one ever thought of that before!” In fact, you may be able to identify some of the distortions in your negative thought, but you DON'T see that it's “irrational.” You STILL BELIEVE IT! I'll say it again. Let's say you're trying to challenge a Negative Thought on your Daily Mood Log, like, “I'm a failure” or “I'm defective,” and you believe that thought 100%. Obviously, you'll feel pretty bad. There are two requirements for an effective Positive thought: It must be 100% true. It must drastically reduce your belief in the Negative Thought, perhaps all the way to 0%. The very moment you stop believing the Negative Thought, your feelings will instantly change. This is not “easy,” like so many people seem to think. That's why I've developed more than 100 methods for challenging distorted thoughts. You won't need them all, and perhaps you'll only need a few, but it's great to have so much firepower available to relieve people of the suffering they experience from feelings of depression, panic, guilt, shame, inadequacy, loneliness, hopelessness, anger, and more. I have wondered if it would be helpful to have a place on my website where I could give the instructions for asking really good Ask David questions. Then I could require people to read it prior to submitting questions. 5: Matt also asks: How do we help patients who don't “get” the Acceptance Paradox? I have a question about one moment in time, the actual moment of recovery. I'd like to better understand what's happening, in that moment, and why some folks, especially those with hopelessness and a strong desire to 'be better' get stuck at the brink, during 'externalization of resistance', for example, and respond in ways like, 'I'd love to accept myself, I just don't know how' and 'it's too hard to accept myself.' I have felt frustrated with clients when they say this and find it challenging to disarm. I feel tempted to disagree and argue that it's far 'harder' to criticize ourselves than to simply *not* do that. I will think, 'it's hard to put down the whip? It's hard to lower the bar? wouldn't it be harder to continue to carry the whip and keep the bar raised?'. I can see how disagreeing and arguing, here, risk empathy and agenda-setting errors. I suspect my resistance has to do with not wanting to collude with the patient's hopelessness/avoidance. I then wonder, perhaps getting hypnotized, whether there is some real difficulty, other than resistance, that I'm not understanding. I am entering these conversations with a set of assumptions, which may be incorrect, regarding what is happening in the moment of recovery: My assumptions are that the cognitive and motivational models are correct and that self-criticism, and the desire to criticize oneself (high-standards) are what result in low self-esteem and feelings of worthlessness. Hence, to make the transition from depressed to recovered, the process would start with approving of our depressed self. Putting this another way, we can't recover, before we recover ... so in the actual moment of recovery, we will be accepting our self-critical, depressed 'self', flaws-and-all, including the 'flaw' of being self-critical. Positive Reframing and successfully 'talking back' to our resistance catalyzes this change and allows us to use methods like, 'Acceptance Paradox' successfully, leading to elimination of worthless feelings, in that moment. Anything either of you would disagree with, there? If so, when a patient says, 'I want to accept myself, I just don't know how' or 'it's just too hard to accept myself', especially coupled with, 'I don't have resistance, I just can't do it', what is the best response? Thanks, Matt David's reply The word “acceptance” has no set meaning, so I would want to start by asking the patient what they think “acceptance” is—what is it that they think they can't or don't want to do? Also, what time of day did you want to accept yourself, and what were you doing at that moment. What were you thinking and feeling, and who were you interacting with? What did they say and what did you say next? Interpersonal acceptance means accepting your role in a conflict, using the Relationship Journal, instead of blaming the other person. I am thinking of making a list on the various “types” of acceptance, and what methods we can use to enable each type. Acceptance might be different for depression vs anxiety vs a relationship problem vs habits and addictions, and recovery from each is associated with one of the four Great Deaths of the “self.” For example, emotional acceptance has to do with seeing the positives in all of your negative emotions, fairly easily accomplished via Positive Reframing. Specific Acceptance has to do with moving from Overgeneralizations and Labels (e.g. “I'm a failure”) to the specific: what, exactly, did I fail at? Then you can accept that specific failure and make a plan for change if you want. Then you can have Existential Acceptance, where you accept that you are a “failure” or a “worthless human being” on a general level, and this can be accomplished with Let's Define Terms as well a sense of humor. You can also do two CBAs on the Adv and DiSalvo of Self-Acceptance vs Self-Condemnation. You can also use the Double Standard / Paradoxical Double Standard. What would you recommend to someone else with self-critical or self-condemning thoughts? And what does their Double Standard say about them that's positive and awesome? Just some rambling thoughts! Another solution has to do with recognizing the nonsensical nature of the notion of the “self.: Fabrice says the magic mushroom therapy helps with this, as you finally “see” that the idea of the “self” is just a kind of illusion. I'm just babbling. This can be a vexing problem for sure. The buddha had little luck on it 2500 years ago, as his followers couldn't “get it” either. Let's add this to our Q and A list? Finally, role reversal in Ext of Voices can often help, and also “seeing” someone else discover self-acceptance in a group setting can help, too. I learned it from my cat Obie. Neither of us weas “special,” but we sure had fun hanging out! The six months I spent taking 20 hrs a week of table tennis lessons helped too. I improved but remained sucky compared to the pros, but it was tremendous fun trying! Does any of this make sense or help? David 6: Philoma asks: Hey David, Rhonda and Mark, Can't thank you enough for all your hard work and effort! Where do you guys get all your energy?! David's reply For me, I get excited about what I'm doing. Also, when I do my "slogging" (= slow jogging), which I hate, I have learned just to try to go about 20 feet at a time, like seeing if I can make it to that tree. This helps a lot. Also, I am very lucky to be doing mainly things I totally love and find exciting. That helps enormously. Finally, I am surrounded by people who are very positive and supportive, which makes things non-burdensome. Conflict can be fatiguing! Good relationships can be energizing. And oh, I forgot the main key to energy. One big cup of coffee in the morning! Warmly, david Phil's reply to David: Words of wisdom, for sure! Happy slogging and all the best for a great 2022! Thanks for listening and reading today! Rhonda, Matt, and David

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

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

The Sara Session—Total Blow Away! (Part 2 of 2) Last week, you heard the first part of the session with Sara, a woman haunted by feelings of anxiety and inferiority from the time she grew up in a village in Mexico. Because she received a great deal of mean-spirited put-downs, she same to see herself as an "outsider" who wasn't good enough. She has finally decided to challenge this crippling and disturbing mind-set, and in today's podcast you will witness her metamorphosis. She will also join us for the fascinating follow-up to her amazing treatment session. If you click here, you can see Sara's Brief Mood Survey at the end of the session, along with her Evaluation of Therapy Session. As you can see, the changes in her mood scores were profound, and her ratings of Jill and David on “Empathy” and “Helpfulness” were excellent. If you click here, you can see Sara's Daily Mood Log at the end of the session. By the end of the session, all of Sara's negative emotions had gone down dramatically, to zero or near zero levels. However, one negative feeling, jealousy, only went down to 30%, and this feeling was still nagging at her. She said she still felt inadequate and jealous of people who had accomplished more, since she'd been procrastinating for years at promoting and developing her private practice. I don't like to leave people with loose ends, if at all possible, and Sara clearly wanted to zap the feelings of jealousy if we could, since we hadn't focused on this emotion at all during the session. You may be fascinated by the surprise ending to the session, and the method that allowed Sara not only to blow away her feelings of jealousy, but a discovery of how she could use those feelings to connect more deeply with her childhood friends, including those who had accomplished a lot! There were quite a few teaching points, including but not limited to these: Rapid, profound, and lasting change is possible, even when people have been struggling for years or decades, or even since childhood, with feelings of depression and inadequacy. The goal of therapy is not just a reduction in depression, but a total elimination of depression along with being catapulted into a state of enlightenment, joy or even ecstasy. Sometimes Positive Reframing can blow away a negative thought, as you'll discover in the surprise ending to her session. Sara totally threw herself, body, heart and mind into this work. That commitment is a vital ingredient of success. Several days after the session, Sara sent this beautiful note to the Tuesday group. Hello, Tuesday Group! I apologize for just now sending this email. I had told David I would email the group this past weekend with an update, but I have been TOO busy dancing away (more about this in a second).

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

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

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

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

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

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

#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

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

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

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

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

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

  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.

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

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.

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

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

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

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

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

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

Do you ever procrastinate? If you’re looking for a way to finally stop putting things off - and get them done - then today’s episode is for you. As a follow-up to a session with me on being overwhelmed, David Burns has returned for a session to help me with my own procrastination. You’ll get to hear what works, what doesn’t, and - if you’re a therapist or coach - how to help other people with their procrastination. David Burns is the author of the newly released Feeling Great, which contains all the improvements in his methodology over the decades since his classic bestseller Feeling Good was written. David’s TEAM-CBT approach to therapy is a powerful way to stay centered and positive, no matter what’s going on in your world. This session with David Burns was a follow-up to our session on Overwhelm back in Episode 228. And, as always, I’m looking forward to your thoughts on this episode and what revelations and questions it creates for you.  Join us in the Relationship Alive Community on Facebook to chat about it!  Sponsors: Find a quality therapist, online, to support you and work on the places where you’re stuck. For 10% off your first month, visit Betterhelp.com/ALIVE to fill out the quick questionnaire and get paired with a therapist who’s right for you. Resources:  Check out Dr. David Burns's website Read David’s classic books, Feeling Good or Ten Days To Self-Esteem Order David’s newest book: Feeling Great - The Revolutionary New Treatment for Depression and Anxiety FREE Relationship Communication Secrets Guide www.neilsattin.com/feelinggood5 Visit to download the transcript, or text “PASSION” to 33444 and follow the instructions to download the transcript to this episode with David Burns, along with the Daily Mood Log. Amazing intro/outro music graciously provided courtesy of: The Railsplitters - Check them Out Transcript: Neil Sattin: Well, I've been doing well. It's been interesting to have now a couple days of waking up and feeling that overwhelm feeling start, and then to actively be engaged in some dialogue around that. Basically, I don't have to listen to you and this is bullshit, I'm going to do what I need to do, and the overwhelm isn't helping. And it's interesting that that's been... That's been pretty effective, actually. David Burns: Oh. That's great. Neil Sattin: Yeah. David Burns: Let's do a quick tune-up thing here and then we'll push forward. Neil Sattin: Great. David Burns: See how good you are at all of that. Now, let's see. Here we go. I'm actually starting my own little anti-procrastination for the week. I'm getting organized on my paperwork, and I put a staple through my notes which made it possible for me to find them forever - quickly. Neil Sattin: Oh, great. David Burns: What's your name? Neil Sattin: Neil. David Burns: What's my name? Neil Sattin: You'll be Neil. Right? David Burns: Yeah, that's right. Neil Sattin: All right. David Burns: And I just wanted to remind you, once again, that the fact is you're failing. Neil Sattin: Yeah, I don't have to listen to a thought like that right now. David Burns: You don't, but it is factually true. That's all I'm saying. Neil Sattin: It's not true that I'm failing. It's true that I have a lot to do and I'm going to figure out what's most important, and I'm going to do what's most important right now. And overall, the trajectory of my life is pretty good. I've gotten a lot accomplished and there's plenty of evidence to support that I'm actually doing fine, that I'm not failing. David Burns: Who won? Neil Sattin: I won. David Burns: Big or small? Neil Sattin: Big. David Burns: Big or huge? Neil Sattin: I would say not quite huge, but pretty big. David Burns: Okay, great. Do a role reversal. I thought it was quite strong, but do a role reversal. Neil Sattin: Okay. Hey, Neil, just... David Burns: Hey. How are you doing big guy? Neil Sattin: Well, I could be doing... David Burns: I was getting a little lonely without you. Neil Sattin: I could be doing better. The problem is that you're failing. David Burns: Well, you know, I've failed at many things throughout my life and I've succeeded at many things throughout my life and... But I'm not quite sure what you're referring to. Are you referring to the fact that I'm procrastinating at some things, or is there something else you're suggesting? Neil Sattin: Yeah. I would say that, right now, it's that there's a lot that needs to get done and you're not doing enough of it. David Burns: Well, you're right about that, and actually I don't intend to. Neil Sattin: You don't intend to? David Burns: No. I'm not going to try to take on all that stuff and listen to your bullshit. I might take on one thing, get started on one thing I've been putting off, but the idea that somehow I have to do all of this, that just makes me feel - It's just the kind of a stupid thing that you're saying, because when you say I'm failing, it's just like I'm some failure, there's some grandiose failing going on. There are people all over the world right now who are cooped up with coronavirus, and procrastinating a little bit, and feeling down. And I wouldn't go about telling them that they're failing, that would be ridiculous. I don't appreciate it when you do that to me either. Interested in reading the transcript for the rest of this episode with David Burns?  Click here to download the full transcript of this episode!

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

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

If you’ve got big feelings going on - overwhelm, anxiety, depression, sadness, anger - how can you discover the valuable messages they contain, and then transform them rapidly into feeling good - or even great? In today’s episode, you’ll get to listen in as David Burns helps me bust through feelings of overwhelm - teaching me powerful techniques to dissolve negative thoughts. Along with getting an up-close and personal look at my inner world, you’ll also get to hear a master guide me through the process of silencing the inner chatter that gets in my way. David Burns is the author of the classic bestseller Feeling Good, and the soon-to-be-released, Feeling Great. His TEAM-CBT approach to therapy is a powerful way to stay centered and positive, no matter what’s going on in your world. If you want to listen to our first episode together, where David Burns and I spoke about how to apply his work in relationships (based on his book Feeling Good Together), here is a link to Episode 98: How to Stop Being a Victim - Feeling Good Together - with David Burns If you want to listen to our second episode together, where David Burns and I spoke about how to recognize and deal with cognitive distortions, here is a link to Episode 133: Change Your Thoughts, Change Your Life - Cognitive Distortions with David Burns And our most recent episode together, Episode 226, covers What Matters and What Doesn’t when it comes to making positive changes in your life and relationships. And, as always, I’m looking forward to your thoughts on this episode and what revelations and questions it creates for you.  Join us in the Relationship Alive Community on Facebook to chat about it!  Sponsors: Find a quality therapist, online, to support you and work on the places where you’re stuck. For 10% off your first month, visit Betterhelp.com/ALIVE to fill out the quick questionnaire and get paired with a therapist who’s right for you. Resources:  Check out Dr. David Burns's website Read David’s classic books, Feeling Good or Ten Days To Self-Esteem Pre-Order David’s newest book: Feeling Great - The Revolutionary New Treatment for Depression and Anxiety FREE Relationship Communication Secrets Guide www.neilsattin.com/feelinggood4 Visit to download the transcript, or text “PASSION” to 33444 and follow the instructions to download the transcript to this episode with David Burns, along with the Daily Mood Log. Amazing intro/outro music graciously provided courtesy of: The Railsplitters - Check them Out Transcript: David Burns: So tell me about... We'll start out with some team therapy here... And you've got the things I sent you? Neil Sattin: I did, yeah. And can you turn your video on so I can see you? David Burns: Oh, yeah. Oh, yeah. I don't know it wasn't on. Oh, yeah. Here we go. Yeah. There we go. Great. Neil Sattin: There you are. David Burns: Yeah. Okay. Tell me how you've been feeling? Neil Sattin: So I've been noticing that I've been feeling... I would characterize it as feeling overwhelmed, that there are too many things to organize. There's even a little bit more chaos in my life now with being confined, more or less to my home and having responsibility to homeschool my children. On top of that, there are a lot of projects that I'm trying to manage and those could be in my business and the podcasts and all of that. Or they could be personal projects like organizing my home or making sure I stay well-nourished and get enough exercise. So lately, I've been noticing that it just feels like the volume has become really loud and I would say that I've never been necessarily the most organized person from... If you had the perspective of organization, meaning everything is neat and tidy and you have your days planned out exactly how they're going to go, that's not me or my approach to organization. It's been generally a little bit more organic in how it unfolds. And that can work up to a certain level of complexity. But once things start to get more complex, I've been... Especially with the state of the world over the past few weeks, I've been just noticing that I want to shut down, instead of feeling like I'm really rising to that complexity with more resourcefulness. Yeah. David Burns: Before we go on, let me see if I got it right, because it sounds like what I was telling you, I have been confronting... Neil Sattin: Oh, yeah. David Burns: Recently. Neil Sattin: Yeah. David Burns: That you've been feeling overwhelmed, because you're just getting too many things that have to be organized. And now that you're confined to home, you've got homeschooling, which it takes a lot of energy and effort and personal projects and business projects, many of which are probably fun and exciting. But it just feels like the volume has become loud. You're... There's too much stuff happening. And then on top of that, you're feeling like you're not organized, that you don't work in that kind of obsessive manner, but at an intuitive organic manner. Just like today, for example and I do the same thing. I'm supposed to work on my app with some colleagues. I told them, "Well, I've got something really great going on here with Neil but I'll pick up with you later in the day". But that... And so I don't like to have a schedule. I like to work intuitively. In my office, I have things piled up all over in here. Neil Sattin: Out of view of the camera right now. Just... [chuckle] David Burns: Yeah, yeah. I could show you stacks, this high, on my desk of stuff but it's quasi organized, but I let it get disorganized and then once a week, I try to force myself to file things and then I feel much, much better. But I like to make things happen and just set things down, when I'm done with them. It sounds like a little of that is happening to you. You like things to unfold organically. Then when there's too much and everything gets complex and too demanding to keep up on top of all of these multiple things happening, at the same time, you feel like you just want to maybe shut down and escape. And maybe a little like myself. Sometimes I think, "Gee, do I need a nap? Do I need another fantastic podcast or a good podcast, or whatever"? Little Misty, a feral cat we adopted, she'll swing by and rub up against my legs and give me a meow saying, "Time for some candy or some lovees. Do you have some time, daddy"? I find myself feeling really torn and wanting to spend more time on some things of that level. Did I get it right so far? Neil Sattin: Yeah, yeah. Definitely. And right down to the... It ends up feeling a little bit like procrastination or the... Here's an example and this is just one of many things. I did two live events last year, that I mentioned to you. One: Terry Real came here to Portland, Maine and the other John and Julie Gottman came here and both of them I filmed and I've been wanting to get the films... The videos edited and out the door so that people can see them. Honestly, that could be a source of revenue for me to make up for the cost of filming both of those things. David Burns: Yeah. Neil Sattin: And the Gottman event... That's two-and-a-half hours. So really all I've needed to do is take two-and-a-half or three hours and sit down and watch it and come up with some notes and send them to my video guy. I've had that sitting on my desk, so to speak... My virtual desk since October, when the event happened. Obviously, I've had three hours, but I can think of a million other things I've done with my three hours. And I think when the volume increases like I was talking about, then so does the visibility of all the things that aren't getting done, like I start... And then it becomes really hard to prioritize because each thing calls loudly to me. Neil Sattin: Oh, there's this thing you haven't done that you could have done three months ago, and then there's this other thing, and for me, I end up just doing what I need to do. So every week I need to create a podcast. That's important to me and I've managed to do that, more or less, except for in the depths of when my marriage was ending. I had to stop for a minute or two there. But for the most part, I'm getting that done, but all the ways that I want to grow my practice and my work and just myself as a human, I end up feeling like I'm falling short. David Burns: Right. I'm sorry to hear about your marriage ending. I can imagine that was a source of angst and stress, but you're saying that in a way you feel like you're procrastinating, but what the issue is, is that you have all these creative things that you could do, like listen to the Gottman event up in Maine so that you could think about how to edit it and maybe market it, get some extra revenue. Could be exciting, generate interest among your fans, generate more fans. But there's so many of these maybe cool exciting things that you could be doing, you're noticing all these things that you could be doing there that you say they shout out to you, they're all worthwhile and interesting. But you find that you have to take what energy you have just to do the things you have to do, like doing the essentials, doing a podcast every week, and you're not feeling the motivation, or maybe even having the time and resources, to do probably a significant list of really cool things that you could be doing, probably most of which would be reasonably successful if not tremendously successful. Neil Sattin: Yeah, that's the dream, is that each of those things, they come with the allure of the impact that it could make or the... I think when I look at everything that I'm doing... I used the word "organic" earlier, and my life has evolved organically in a way that generally I look at and I think, "Wow, this is beautiful," and I look back at everything that's come together and woven its way together to create what happens now. I worked in technology for a long, long time, and so much of what I do now would have been a lot more challenging if I didn't have that background. And I can also look at each of these ideas and think, wow, that could be amazing or that could be a piece of this puzzle, and the puzzle starts to take shape in front of me, and that gets exciting. David Burns: I have an idea, let's not work together on any project, because that's what's happening to me too. And these things expand exponentially. All of your skills start coming together, and then you start thinking, wow, I could do this and I could do that and I could do this and I could do that. What you're saying is that there's an allure, a dream that your life has evolved organically and it's kinda coming to fruition on many different levels, and the things that you worked hard to learn are now available to be creating things that would just have a tremendous beneficial impact on others and benefits for yourself. But maybe you're saying, "Oh my gosh, do I really want to have to do all of that right now?" Neil Sattin: Right. There's some... Well, you know what, the voice that actually... That I hear is something like... I've never been able to be that organized, and so... It's like... I'm not sure I can. So it's almost like there's that hesitation... I'm trying to think of what the image is that's coming to me, but it's like... There are any number of starting gates, like there's the starting gate of finishing the projects or there's the starting gate of, let's just create a meal plan so that I'm a little... I feel a little bit more organized around my nutrition and nourishment. Any one of those starting gates, I find myself caught a moment before that where I'm like, wow, I could go that way, I could go that way... And even when I step up to one, I'm often hearing the call of the others. Neil Sattin: You talked about the magic button earlier in our conversation and for me, the magic button would be like the elf that somehow knows exactly where this is all going and just shows up every day with my daily agenda, and says, "You just do these things, and trust me, and it's all going to work out just fine." Neil Sattin: And all I would have to do is those things and everything that I wanted to get done would happen, and the structure to support my personal wellness, as well as the wellness of my clients and listeners and the wellness of my business and my children and that would just ripple out just from taking those actions. And what's funny is that I know that it all boils down to what you do in any given moment like, that's what life is, life is how you... What you do in this moment and then in the next moment. Sometimes that just feels like the biggest hurdle to me and it matters more now than ever because of that additional chaos that's in the system. David Burns: Yeah. So, in an ideal world that you're having a little elf bring you a Do-list every day, and the elf has figured out what are the essentials and the order in which to do them in order to fit everything in, and then it's all going to kind of ripple out and all these wonderful things are going to happen. But then you're saying, life is a Series of Moments and it's kind of hard for you to get on board and feel motivated to tackle all these things, because once you think of... Well, let's work on the starting gate, or let's create an eating plan. And then once you think about stepping up and working on that, you start hearing the call of all these other things that you should be doing and maybe end up feeling or getting a bit paralyzed. Can I suggest we switch just temporarily to The Daily Mood Log? Do you have one there? And at the top it says, "upsetting event" and that could just be like, could be this morning or right now or you know. Neil Sattin: Yeah, I would, for an upsetting event let's just say, an upsetting event would be a day that's gone by where I didn't... Where I feel like I didn't get enough done. David Burns: Okay, okay, so is that right now, feeling like yesterday, you didn't get enough done? Neil Sattin: Sure. David Burns: Okay, so put that on the upsetting event, day when I didn't, I didn't get enough done and just write that down. Neil Sattin: Yeah, I'm actually... David Burns: You did already? Neil Sattin: I didn't yet, but I'm opening this in a little PDF editor things that I can... David Burns: Oh, okay. Neil Sattin: Edit and write on the document, so... David Burns: Okay, great. Neil Sattin: Yeah. David Burns: And then, do you see... That's an obviously upsetting event but now we want to see what your emotions are, and the first category is sad, blue, depressed, down, unhappy. Were you feeling some of those? Neil Sattin: Definitely. David Burns: Tell me me which ones and I'll circle them or maybe you can circle them or highlight them. Neil Sattin: Yeah, I would say kind of down and unhappy. Those... David Burns: And how strong are those between zero and a hundred? Neil Sattin: So yeah, at the end of a day, I'd say it's like an 85 or 90. David Burns: Okay then, put 85-90, in the "percent now column." Neil Sattin: Okay. David Burns: And see that's important because, just a minor point, you're such a warm, upbeat person. Neil Sattin: Yeah. David Burns: So people interacting with you wouldn't know that you're feeling that unhappy inside, that's why it's great to measure 'cause that's almost, most intense unhappiness a human being can have. Do you feel anxious, worried, panicky, nervous or frightened? Neil Sattin: Yes. [laughter] David Burns: Okay. All of them? Neil Sattin: Yeah. I mean, if I touch in to worried, maybe a little less worried a little more on the panicky side, a little more on the nervous side a little less on the frightened side. David Burns: Yeah. Neil Sattin: But it's all definitely there. David Burns: And anxious? Neil Sattin: Yeah, anxious for sure. David Burns: And how strong does that get between the 80... Zero and a hundred? Neil Sattin: I would say... Well, if I compare that to sadness, I would have actually said that that's a little bit more. David Burns: Sure. Neil Sattin: So maybe the sadness is more like 80 to 85 and then the anxious is more like 85 to 90, but... David Burns: Okay. Neil Sattin: At the end of the day when I'm feeling that feeling of like, "Oh I didn't get enough done." Then yeah, there's kind of, the sadness that comes with that and then, yeah, there's the anxiety of like, "I work for myself and I'm also in charge of my own showing up for my life." And yeah, there's that sense of like, "Oh, if I don't do this, no one's going to do this for me." So it's all dependent on me. Yeah. So right, that was a long-winded way of saying 85 to 90 as well. David Burns: Great, great! Now, do you feel guilty, remorseful, bad, or ashamed? Neil Sattin: Yeah, I would say... Probably, mostly... Yeah, there's definitely... You're a capable person, you should be able to do this and figure this out. David Burns: By the way, I'm also writing down negative thoughts in the negative thought column and I just wrote down, "I should be able to do this and figure this out." And when that thought goes through your mind, how strongly do you believe it between zero and 100? Neil Sattin: That I believe I should be able to figure this out? David Burns: Mm-hmm. Neil Sattin: That's a 100, yeah, for sure. David Burns: Okay, so I'm going to put 100 in the percent now column, the belief column. And again, you were about to tell me how guilty, remorseful, bad or ashamed, do you have those feelings. Neil Sattin: I'm starting to feel guilty that these are also high. But yeah, I would just put that all, again, in 85 to 90. David Burns: Okay, great. Neil Sattin: I always feel like I've got the glimmer of... There is always that piece of me that's like, "It's all going to be okay, you're fine." So that still lives in those moments. David Burns: Sure, sure. But that's really intense, the guilt and shame and feeling bad. And then, do you feel inferior, worthless, inadequate, defective or incompetent. Neil Sattin: Shit, yeah, I do. David Burns: All of them or some of them or... Neil Sattin: No wonder this is so horrible. David Burns: Yep. Neil Sattin: Yeah, I wouldn't say worthless. I would say, it's probably inadequate, defective, not incompetent, yeah. David Burns: Okay. Neil Sattin: Somewhere in there. David Burns: How strong are those? Neil Sattin: That's more probably like the 65% to 70% range. David Burns: Okay, and do you feel lonely, unloved, unwanted, rejected, alone or abandoned? Neil Sattin: That, I do not feel as much. David Burns: Okay, we'll put a zero there. Do you feel embarrassed, foolish, humiliated or self-conscious? Neil Sattin: I would make that a 50. David Burns: Which feelings? Embarrassed, foolish, humiliated, self-conscious? Neil Sattin: Well, it's only in my own eyes. I don't think anyone else really... Except now, of course, everyone who's listening knows this is what Neil goes through at the end of a day where he hasn't got enough time... David Burns: This is very courageous... Neil Sattin: Yeah, this is the reality... David Burns: What you're doing. It'll be interesting to see what kind of feedback you get... Neil Sattin: Yeah. David Burns: I bet you'll get an overwhelming number of fan responses. Neil Sattin: We'll see. Yeah, so I would say embarrassed, not foolish, not so much self-conscious, but humiliated. Yeah, that's why it's sort of in that range. David Burns: Okay 50. Neil Sattin: Yeah, I'd say 50, yeah. David Burns: You feel hopeless, discouraged, pessimistic, despairing? Neil Sattin: Yeah, definitely not despairing, discouraged for sure. That's the one that jumps out of me most and... David Burns: How strong is that? Neil Sattin: I would say that's an 85. David Burns: Great, great. Neil Sattin: Yeah. David Burns: And then, do you feel... Oh, by the way, I could have recorded this at my end. Neil Sattin: I'm recording. David Burns: Okay. Then I could have sent you my recording, so you would have a local, higher quality. Neil Sattin: No, we're good, we're good, I think. David Burns: Okay, that's great. Neil Sattin: You're coming through loud and clear. David Burns: Oh, good. Do you feel frustrated, stuck, thwarted or defeated? Neil Sattin: That's probably like a 95%. David Burns: And all of those are... Neil Sattin: All of them, yeah. David Burns: Yeah, and do you feel angry, mad, resentful, annoyed, irritated, upset or furious? Neil Sattin: I'm annoyed and irritated. Yeah, and those are probably in the 70% range. David Burns: Right. Any other emotions that I haven't asked about? So far, we got sad and down and unhappy. We've got the whole anxiety cluster, intense. We've got the guilty and shame clusters, intense. A little inadequate and defective and a little embarrassed and humiliated quite a bit, actually, and very discouraged, 85 and frustrated, 95 and annoyed and irritated, 70. Anything else like overwhelmed? Neil Sattin: Yeah, I mean if we add overwhelmed in there, that would be super high if it gets its own category. David Burns: Yep. Neil Sattin: Yeah, I'd put that at 95%. David Burns: 95, great. Now, let me ask you what some of your negative thoughts are when you're feeling this way or even at this moment like you said, "I should be able to figure this out." And you believe that 100. You also said "No one will do this for me." That's probably not a distorted thought. I jotted it down. And then "I'm not sure I can be that organized." That's a good negative thought. How much do you believe that one? Neil Sattin: I would put that at probably 85%. David Burns: 85, great. And what are some more of your negative thoughts when you're feeling down, guilty, anxious, defective, embarrassed? Neil Sattin: Yeah, it would be things like I'm failing. David Burns: Failing, yeah. Neil Sattin: Yeah. David Burns: How much do you believe that one? Neil Sattin: In those moments? David Burns: Mm-hmm. Neil Sattin: That would be 90%-95%. David Burns: 95 and I wrote that down. "I'm failing." That's an excellent one. What are some more negative thoughts, things that you tell yourself? Neil Sattin: Oh good. I'm seeing, this goes on to another page. I was like "I'm going to run out of space." David Burns: We got more Daily Mood Logs too. Neil Sattin: Time. Like there's not enough time, or there's no way that I can... There's no way I will be able to do this is maybe. There's not enough time. They kinda overlap with each other a little bit. David Burns: You'll make that one thought, "There's not enough time and no way I can do all of this." How is that? Neil Sattin: Yeah. David Burns: And then how much do you believe that one? Neil Sattin: Yeah like 100. David Burns: Hundred. Sure. Neil Sattin: 100%. [chuckle] David Burns: Sure. And what are some more... That's kind of the discouraged thought and the frustrated thought. What's the inadequate and defective thought? Neil Sattin: Well, that I'm not capable of doing this, that's definitely the defective there is. David Burns: Yep, sure. Neil Sattin: Yeah. David Burns: Let's write that down number... That's thought number five I think. Neil Sattin: Yeah. David Burns: I'm not capable of doing this. And then, what is this defined as? Neil Sattin: This is... Okay, so this could be two things. This could be getting organized and executing on that. David Burns: Yeah, okay. Neil Sattin: Or this could be sort of the result, like I'm not capable of the success or the goals that I want. David Burns: Achieving my goals. Neil Sattin: Yeah. David Burns: Okay, great. And then that's a really well-stated one. And how much do you believe that between zero and 100, "I'm not capable of getting organized. I'm not capable of achieving my goals." Neil Sattin: In those moments, it's not how I live my day. Though I guess I do come in and out of that. It's so wild to just really kinda see that in front of me that way. I would put that in an 85 or 90. David Burns: Yeah 90. By the way, it's like going in and out of a trance. Like when you get in there it seems totally true. Neil Sattin: Yeah. David Burns: And then when you recover, it's such a radical shift. It's like you're in almost, you're in a different reality. Neil Sattin: Yeah, that makes sense to me. David Burns: Any other negative thoughts? We've got some super ones here. Neil Sattin: Let me just see if anything else jumps out at me. I don't know, this one feels kind of risky to say. My father was right. David Burns: Great, okay. And tell us what that means, how you're feeling right at this moment. Neil Sattin: Well, I can hear his voice at a young age accosting me around like, "You gotta figure this out. You gotta clean your room. You gotta get organized. You'll never succeed if you can't figure this out." I hear that. And on the flip side of it, there's a part of me that would love his blessing in terms of what I do with my life. And it might shock people to learn that I don't... I definitely haven't gotten it explicitly. Whether he does feel it and he's just keeping it to himself, that's possible. But my father, his career, he was a clinical psychologist, and there have just been a lot of times where I have wished that he could also see the value in what I do, and how I'm showing up in the world and how I'm contributing. David Burns: Is he still alive? Neil Sattin: He is. Yeah. David Burns: Do you feel sad when you think about that or angry or... Neil Sattin: Yeah, we could do a whole nother mood log on that one. [chuckle] David Burns: Sure. Neil Sattin: But yeah for sure, it's a source of sadness and anger that I've dealt with for most of my adult life. And because he's alive, I hold out the hope that at some point there will be some sort of redemption in that way, but it hasn't happened yet. David Burns: Yeah. Yeah. Neil Sattin: Yeah, there's a lot about... And just to be clear, I think I said this one other time when I talked about my dad on the show, I love him dearly, and then there are things about him that I just don't understand and that aren't... I may never understand them. There's a level of opaqueness in terms of how he lives his life and his choices and I guess I'm just... I would just like a little bit more from him, a little more engagement and support. David Burns: Well I feel sad and really close to you based on what you're saying right now, what you said the entire time we've been talking. And I can identify with it on a personal level too because I've been experiencing a little conflict with my own son. Just yesterday kind of erupted a little bit and we were both pretty angry with each other and feeling unappreciated and unloved and we're trying to talk it out a little bit. But there was such an explosive level of anger, like it wasn't working. And he also loves me a lot and really admires what I've done, but maybe doesn't always feel like his dad appreciates him. Very, very similar to what you're saying. And I was kind of at wits' end and very anxious and feeling kind of ashamed too and hurt. And he was sitting at the dining room table doing some work with a colleague and on an impulse, I know he likes physical touch, and so I just went up and started massaging his shoulders and he indicated he was really loving that and then I just kind of leaned over on his back and hugged him, and then he got up and turned around gave me a wonderful hug. David Burns: It was really a beautiful moment. And sometimes I think that out of intense anger, if you hang in there in a relationship, then really, really beautiful things can happen. But I'm sure it was so painful for him and has been painful for him to feel like his dad doesn't really appreciate him. And I'm so filled with admiration for him and his ethical qualities, his idealism, his incredible, technical skills, his love, his work ethic. But it's so easy for fathers and sons to disconnect and sometimes never connect. My dad was a Lutheran minister and he was... I just admired him when I was little and loved him so much and thought I'd be a minister. And then we kind of drifted apart and I began to see things that really hurt me and turned me off and so, we never really did reconcile. I felt kind of judged, and he was very rigid. And if you don't believe in Jesus, you're going to go to hell, and stuff that seemed harsh to me. But I'm sure you'll find a way to connect with your dad. But I can certainly identify with how incredibly painful that is for you and you have achieved such a fantastic amount - if a father could ever have a son to be proud of, you're the son and I can see you're hurting an awful lot. Neil Sattin: Thank you. Yeah. I just want to say too that the space exists between you and your son to be able to do that and that you would recognize his love language and show up in that way is such a gift. And it was really moving to hear you describe that. David Burns: I felt really lucky that that happened. Generally, there's a path to intimacy when you're upset with people. I have the philosophy, the more angry or hurt you feel with someone, the more fantastic potential for a loving connection and reconciliation and more, but it's like, what is the path? That's a conversation for another day. But, "My father was right," when you say that, how much believable is that? [laughter] Neil Sattin: Yeah, so in those... David Burns: Let me unplug my phone here. Sorry. I've just unplugged it. Yep. Neil Sattin: In those moments, "My father was right," that's 85 or so. David Burns: 85, sure. Yeah, I feel so close to you right now and I think many people are going to be touched by the reality and the openness and vulnerability you're bringing to this and probably to all of your podcasts. Any other negative thoughts? Neil Sattin: Well, the only other one that really jumps out for me would be something like, I'm going to be... I'll be unhealthy, weak and broke. That that's what's going to happen. David Burns: Oh great, and then how much do you believe that one? Neil Sattin: That's less. So, I would say, that's in the 60%-65%. David Burns: 65. So just to review your negative thoughts in reverse order, "I'm going to be unhealthy, weak and broke. My father was right about me. I'm not capable of getting organized and achieving my goals. There's not enough time and no way I can do all of this, all the things I have to do and all the things I want to do. I'm failing. I should be able to do this and figure this out and I'm not really sure I can be that organized, organized enough to do all the things on my plate." And then, perhaps the "No one will do this for me." You had mentioned zero on lonely, unloved, unwanted, rejected, alone and abandoned. But when you say "No one will do this for me," does that cause some feelings of being alone at all or not? You gave a zero... Neil Sattin: Yeah, I guess so. I guess it's true. Yeah, there's that sense of like, "I'm in this by myself." Yeah. David Burns: Yep. Neil Sattin: Yeah. David Burns: And then, when you have that thought, then how alone would you be feeling? Neil Sattin: Yeah, like an 80. David Burns: An 80. Neil Sattin: Yeah. David Burns: Okay, good. And so, you're feeling overwhelmed, irritated, frustrated, discouraged, embarrassed, alone, inadequate, guilty, ashamed maybe, intensely anxious and very sad, down and unhappy. So how am I doing right now in terms of getting you an understanding how you're thinking and how you're feeling? And to what extent are you feeling the sense of compassion or acceptance, if you were to grade me on empathy, so far, would you give me A, a B, a C, a D? Neil Sattin: I'd give you an A for empathy, yeah. I feel like going through this, it helps me see myself for one thing and what's happening in those moments and the attention that you're giving to the language that I'm using, and encouraging me to get specific and telling me about your experience with your son and your dad, and really kind of pausing with me in that. Yeah, I feel seen. David Burns: Okay, we've kind of... Just from a brief teaching point of view. We've done the T, because we've done testing. We know exactly how you're feeling and we'll do that again at the end of the session, and we've done some empathy. Now, we want to take a look at A: Assessment of resistance, and let me ask you this question. You've talked about some things that are very powerful, and very personal and very important. And there's something here that you would want help with. And is this a good time for us to get to work or do you need more time to talk and have me listen and provide support? Because that's important and I don't want to jump in prematurely. Neil Sattin: I think that both my excitement for being able to do this with you and my frustration at how persistent this has been, leads me to want do the work. David Burns: Okay. Now, let me ask you this question, suppose at the end of our session today, you say, "Well, that was better than French fries," or something like that, and a miracle happens. What miracle would you be hoping for? What change... If this was a really wonderful experience, what would change by the end of our session? Neil Sattin: Okay, if a miracle were to happen, then I would feel totally capable. I'd have a sense of how to prioritize and where to start. And I would feel like a certain measure of trust in the path and the unfolding that I could see it... I could see how it's all going to work, how it's all going to be okay, yeah. David Burns: Okay, that's a good goal. Now, let me ask you to imagine that we have a magic button. I can send you a nice red magic button if you want for your show notes. Someone in my Tuesday class, her husband is a graphic guy and he made a magic button, a red magic button for me. It's very neat looking. But if we have this magic button, let's say, if you pressed it, all your negative thoughts and feelings would instantly disappear in a flash. And you become euphoric and you'd feel joy and confidence and trust and you'd feel totally capable. Would you press the magic button? Neil Sattin: Yeah, I definitely would. David Burns: Oh, okay. That's what most people say. And I don't have a magic button but I've got some really wonderful techniques. But I'm not sure it would be a good idea to use those techniques and cause all these negative thoughts and feelings to disappear, that there might be some unanticipated losses there. And so, if you can take a piece of paper and put positives on it and we're going to make a list of positives and we're going to ask two questions about each negative feeling, or negative thoughts as well as you like, and we're going to ask two questions about it. David Burns: What are some benefits or advantages of this type of negative feeling, like feeling sad, feeling anxious, feeling guilty, whatever? And the second question is, What is this kind of feeling show about me and my core values as a human being, that's a beautiful and awesome and positive? So this is the opposite of the way most mental health professionals and people look at it. We say, "Oh, Neil has this defect this problem that that has to be fixed. This is all the stuff that's wrong with you." And I'm going to go in the opposite direction here and see what this shows about you, that's really quite the opposite of defective. Let's just start out with sad, down and unhappy. You're feeling 85% sad, down, and unhappy. So, what does that show about you that's beautiful, positive and awesome? Show about you and your core values? You're sad because... Neil Sattin: Yeah. David Burns: You have a lot of exciting projects that you're not getting to, among other things. Neil Sattin: Right, I mean... Sorry, I'm just making a note here. That... For me, that shows that I... Well, on one level that I'm ambitious. David Burns: Okay, so let's just stop for a second. Neil Sattin: Okay. David Burns: Put down ambitious. Neil Sattin: Okay. David Burns: The sadness shows that... Is that real? Is that true? Are you ambitious? Neil Sattin: Yeah. I am ambitious. Yeah. David Burns: Is that a good thing? Neil Sattin: I think so, yeah. David Burns: Is that important? Neil Sattin: It's super important. David Burns: Is that powerful? Neil Sattin: It's part of what drives me. David Burns: Yeah it's part of what... And you've achieved a lot. Could we add that too? Neil Sattin: Add what? David Burns: Your ambition has caused you to achieve. Neil Sattin: For sure. Yeah. David Burns: Is that important? Neil Sattin: Very important. David Burns: Okay, let's add, have achieved a lot. And just to bracket it, for our listeners because this is so new to people even mental health professionals, some have not been able to learn how to do this, they're so used to thinking about these things as bad. But notice if you press the magic button, you'll become euphoric, euphoric about the fact that there's all these projects you're not getting to. You see what I mean? Sadness... Neil Sattin: Right, 'cause I feel excited. I would just feel like, "Okay I'm going to... I will, I am going to do these things." David Burns: Right, and that's a benefit. But at the same time if you weren't feeling sad, it would be like you didn't value these things. Neil Sattin: Right. NOTE - This transcript, like this episode, is very LONG. The rest of the transcript is available for download by clicking the button below (or visiting the webpage that this episode is on, and clicking the button to download the transcript).

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

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

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

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

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

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

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

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

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

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

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

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

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

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.    

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

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

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

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

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

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

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

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

The way that you think creates the way you feel. If you have great thoughts then no problem, but if your thoughts are a little distorted, then...look out! Wouldn’t it be great if there were an easy way to look at your thoughts...and change them? As it turns out - there is! In today’s conversation we are going to show you how to identify the kinds of thoughts that lead to depression, anxiety, shame, anger, and self-doubt - and talk about the process that you can go through to eliminate those thoughts for good. Our guest is Dr. David Burns, author of the acclaimed bestseller Feeling Good and one of the leading popularizers of Cognitive Behavioral Therapy (CBT). He is also the creator of TEAM therapy, which takes CBT to the next level. Today, David Burns and I are tackling the topic of “cognitive distortions” - the messed-up thinking that can get you stuck in negative emotions. By the end of today’s episode you’ll not only be able to spot the times when your thinking gets distorted, but you’ll know what to do about it so that you can “feel good”. If you want to listen to our first episode together, where David Burns and I spoke about how to apply his work in relationships (based on his book Feeling Good Together), here is a link to Episode 98: How to Stop Being a Victim - Feeling Good Together - with David Burns And, as always, I’m looking forward to your thoughts on this episode and what revelations and questions it creates for you. Join us in the Relationship Alive Community on Facebook to chat about it! Resources: Check out Dr. David Burns's website Read David’s classic books, Feeling Good or When Panic Attacks FREE Relationship Communication Secrets Guide www.neilsattin.com/feelinggood2 Visit to download the transcript, or text “PASSION” to 33444 and follow the instructions to download the transcript to this episode with David Burns Amazing intro/outro music graciously provided courtesy of: The Railsplitters - Check them Out Transcript Neil Sattin: Hello and welcome to another episode of Relationship Alive. This is your host Neil Sattin. On today's show, we're going to cover ways that your thinking can be distorted. And, by being distorted can impact the way you feel, the way you behave, the way you interact with other people, and basically get in the way of you being an effectively functioning human being. Neil Sattin: I'm talking about cognitive distortions and they've been mentioned a little bit on the show before, but I wanted to take this opportunity to dive deeply into the ways that our thinking can just be messed up. From that messed upness - and no that is not a technical term -  comes all sorts of problems. Neil Sattin: From today's show, what my hope is for you is that you understand these things well enough so that you can spot them happening in your own thinking and perhaps in the thinking and reasoning of those around you. We're going to talk about effective strategies for changing the pattern. Neil Sattin: In order to do that, we have with us today a fortunate return visit from Dr. David Burns who was on the show back in episode 98 where we talked about how to stop being a victim in your relationship. This was an episode that was all based on David's work in a book called Feeling Good Together. Neil Sattin: If you're interested in hearing that, you can go to neilsattin.com/feelinggood. What I wanted to talk about today relates to some of the pioneering work that David did in popularizing cognitive behavioral therapy primarily through his book Feeling Good which has sold millions of copies all over the world and has been prescribed and shown to actually help people with depression simply by reading the book and going through the exercises. Neil Sattin: I'm very excited to have David with us today, we're going to talk about cognitive distortions, we're probably going to touch on TEAM therapy which is his latest evolution that's attacking some of the problems with cognitive behavioral therapy. And hear about some of the amazing results that that's getting and get some insight into how that even works. Neil Sattin: Without any further ado, let us dive right in. David Burns, thank you so much for joining us again here on Relationship Alive. David Burns: Thanks Neil, I'm absolutely delighted to be on your podcast for two reasons. First, I think you're a tremendous host. You know your stuff both technically and you know my background, you do your homework, that's very flattering to me being interviewed, but also you seem to exude a lot of warmth and integrity, just a pleasure to hang out with you a little bit today and your many, many listeners. Neil Sattin: Thank you. Thank you so much. I appreciate your saying that. This stuff is important to me. I'm hoping that this podcast makes a big difference in the world and the way that we do that is through being able to feature amazing work like what you do. I don't want to forget to mention that you also have your own podcast, the Feeling Good Podcast that has amazing insight into the work that you're doing. Neil Sattin: In fact, you record sessions with people so people can actually hear you working with clients and then explaining how you did what you did and also getting direct feedback from the people that you're working with. That's a fascinating show and how many episodes have you put out at this point? David Burns: I think Fabrice and I are up to roughly 60, in the range of 60. One really neat bit of feedback we're getting is that a lot of therapists now are requiring their patients to listen to the Feeling Good podcasts. There's been a lot of research on my book Feeling Good: The New Mood Therapy and studies have shown that if you just hand the book to someone with moderate to severe depression, 60% of them ... 65% of them will improve dramatically within four weeks. David Burns: That's really, really good news. It's called bibliotherapy or reading therapy, but now we're getting this ... I'm getting the same kind of feedback from people who are listening to the podcasts and saying that just listening to the Feeling Good Podcast had a dramatic effect on their depression or their obsessive compulsive disorder or whatever is bothering them. I'm hoping that that trend will continue. Neil Sattin: Yeah, someone's going to have to study podcastio-therapy. David Burns: Yeah, right. You may be having the same thing Neil on your relationship broadcast from people with troubled relationships following the information and the techniques you're providing and perhaps experiencing genuine improvement in their relationships, greater intimacy and love. Neil Sattin: Absolutely. I'm getting that kind of feedback all the time from listeners and I also hear that therapists, particularly couples therapists are having their clients listen to the show and even sometimes prescribing specific episodes for them to listen to. It feels really good to be able to be an adjunct part of people's progress and therapy. David Burns: Congrats. That's great. That's a real credit to the quality of what you're offering. Neil Sattin: Thank you. Thank you. Well, let's dive in. Enough kudos although it does feel really good, though I guess that doesn't surprise me considering you're the author of Feeling Good. Quick point of clarification. Is it the just handing of the Feeling Good book that has a 60 to 65% improvement rate or did the people actually have to read some of it to get that? David Burns: All they have to do is touch it. The improvement comes through osmosis and many of those who have read it have gotten worse. They don't have good data on that in the studies. It's people coming to a medical center for the treatment of depression and in the original studies, they said that they had to be on a waiting list for four weeks and during the four weeks, read this book. David Burns: Then they continued to test them every week with various depression tests and half the patients went to some kind of control group who were on a waiting list control for four weeks or they gave them some other book to read like Viktor Frankl's book Man's Search for Meaning and in all of the studies, the patients who were given a copy of Feeling Good, two thirds of them had improved so much within four weeks that they didn't need to have treatment anymore at the medical center. David Burns: They never got antidepressants or psychotherapy. Then they've done follow up, up to two year follow up studies on these patients as well. For the most part, they've continued to do well or even improve more and have not had significant relapses. The alternative groups who got Victor Frankl's book did not show significant improvement or people on waiting list control. David Burns: They were pretty well done studies sponsored by research from ... sponsored by National Institute of Mental Health and other research groups. Forrest Scogin is a clinical psychologist at University of Alabama and he pioneered a lot of these studies, but there have been probably at least a dozen replications of that finding that have been published now with teenagers, with elderly people and with people in between. Neil Sattin: Yeah, I want to just say, your book despite having been published a little while ago now is eminently readable and I did read it a while ago. In fact, I think it was one of the first "self-help books" that I stumbled across probably around when I was graduating from college. In sitting down and revisiting it in preparation for our conversation today, I was just struck by how personable, for a book that's about cognitive behavioral therapy which is something that I think just calling it that probably turns a lot of people off. David Burns: You bet. Neil Sattin: The truth is that reading it through, it just makes so much sense and I love how you bring humor into the subject and in many ways talk about yourself as an author in some of the quizzes around the kind of thoughts that undermine our self-esteem. Anyway, I definitely recommend it. Neil Sattin: If you're not one of the millions of people who have already read it, you should pick it up and if you are, I would suggest picking it up again to just glean again what more is there. We're going to talk about one of the central topics in the book which is how our thinking affects the way we feel. Neil Sattin: Maybe we just start there because that was one place where I even in upon revisiting, I got a little confused and in the past, that's made total sense to me. Yeah of course, I make something mean something and that gives me an emotional response to it which ironically makes me think of Victor Frankl's work. Neil Sattin: At the same time, I know that we have feelings that just our bodies kick in with emotional responses in a split second when something happens. That seems to precede thought. How do you parse that apart in a way that makes sense? David Burns: Well, the basis of cognitive therapy and we've moved on to something new called TEAM therapy or TEAM CBT, but I think the basis of cognitive therapy which as far as it goes it's still pure gold goes back to the Buddha 2,500 years ago and to the Greek philosophers like Epictetus 2,000 years ago that humans are disturbed not by things, but by the views we take of them that you have to interpret an event in a particular way before you can have an emotional reaction to it. David Burns: This thought is so basic that our thoughts create all of our moods. We create our emotional reality at every moment of every day by the way, we interpret things, but that's such a basic idea that many people can't get it or they don't believe it. I had an example of this at my workshop in the east coast recently - I was in a hotel. David Burns: I've had many afflictions myself in my life. I love to treat people with depression or anxiety because whatever they have I could say, "Oh, I've been there myself." I can show you the way out of the woods, but when I was little, I had the fear of heights and then I got over it completely as a teenager through a high school teacher who had me stand on the top of a tall ladder until my fear disappeared and took about 15 minutes and it was dramatically effective. David Burns: Suddenly, my anxiety went from 100 to zero and I was free, but it crept back in because I stopped going up on heights not out avoidance, just I had no reason to and then suddenly I realized it had returned. I was on a hotel on one of these glass elevators and I was going up to the 14th floor and I was looking down into the elevator and I had no emotional reaction whatsoever and it was because I was telling myself and this was automatic I guess, but you're safe. David Burns: However, if there hadn't been that glass there and it would have been the same elevator going up and looking out, I would have been paralyzed with fear and terror and it would have been a total body experience that I can feel in my whole body this extreme terror. That's the first idea that you can't have an emotional reaction without having some kind of thought or interpretation. David Burns: You feel the way you think - your thoughts create all of your moods. After Feeling Good came out, I got a letter from a therapist in Philadelphia. He was a student therapist at the Philadelphia Marriage Counsel I believe and he said he had read my book Feeling Good: How Your Thoughts Create All of Your Moods. David Burns: He said, "Well, that's a great idea, but how can it be true? If you're on a railroad track with a train coming and you're about to get killed, you're going to feel terrified. You don't have to put a thought in your mind, it's just an automatic reaction." He said, "I don't believe your claim that only your thoughts can create your moods." David Burns: I got that letter and I started thinking, I said, "Gosh, what he's saying is so obvious, how could I have missed that when I wrote that book?" I felt embarrassed and ashamed. A couple days after I got that letter, I was in a taxi coming home from the airport and at a certain place on River Road, you go over this railroad track. David Burns: I looked down the railroad track, I saw there was a car driving on the railroad track at about two miles an hour. Bumpety-bumpety-bump. I looked then in the other direction and this is ... Freight trains come through here, they never stop, they come at 65 miles an hour. I saw one about a mile and a half in the other direction. David Burns: I said, "Man, that guy is going to get smashed by the train." I told the taxi driver, "Stop, I got to try to get that guy off the railroad tracks." I ran up and knocked on the window and he rolled down the window and there's this older man there and he said, "Can you please direct me to City Line Avenue?" David Burns: I said, "City Line Avenue is 10 miles in the other direction, but you're on the railroad tracks and there's a train coming. You've got to back up. Back up to get to the road." Because he was beyond the road, where you know how they have a pile of rocks at the railroad tracks, that's where he was and I said, "Back up, I'm going to get you off the railroad tracks." David Burns: He backed up and he kept ... When he got to the road, I said, "Now turn, turn your car." Finally I had them positioned to where just the nose of the car, the front part of the car was over the tracks and I was standing in front of it. Now the train was about maybe 20 seconds from impact and they had their whistle on. David Burns: I was waving my hands like, "Back up, back up. Just back up five feet and it will save you." Instead, the guy started creeping forward very slowly. Neil Sattin: Oh no. David Burns: The train smashed into him at the side of his car at about 60 miles an hour. Neil Sattin: Oh my goodness. David Burns: Actually ripped the car in half. The front compartment was thrown about 30 feet from the tracks. They had their brakes on, the train was skidding to a stop and I ran over again to the driver's compartment and looked in, it was all smashed windows and I thought I'd see a decapitated corpse, but it hit probably an inch behind his head and it hit so fast it had just cut the car in half and he didn't seem to be that injured or anything. David Burns: He looked at me and smiled and said, "Which way exactly did you say now to City Line Avenue?" I said, "You got to be kidding me." I said, "You were just hit by a train." He said, "I was not." He says, "That's ridiculous." I said, "Oh yeah, what happened to the windows of your car?" David Burns: Then he looked and he noticed all the windows were smashed and there was glass all over. Then he says, "Gosh, it looks like somebody broke my windows." I said, "Look, where's the back seat? Where's the back half of your car?" He turned around and he saw the back half of his car was missing. David Burns: He looked at me and he says, "I think you're right. Half of my car seems to have disappeared." He says, "Where is this train?" I said, "Look, it's right there, it's 20 feet from here." Now the conductors were rushing up and the engineers and he looked at me and he says, "This is great." David Burns: I said, "Why is that? Why is this great?" He says, "Well, maybe I can sue." I said, "You'll be lucky if they don't sue you. You were driving down the railroad tracks." I couldn't understand it and at this point, the police cars came, the ambulance, they put him in an ambulance, I gave my story to the police, he looked just fine and they took him to the Bryn Mawr Hospital. David Burns: I was just scratching my head and I got in the taxi, it was just a mile from home, the taxi driver took me the rest of the way home. I was saying, "What in the heck happened?" The next day I was jogging around that same corner, of course, there was all this litter from the car or broken pieces of metal and glass all over the place and there was a younger guy maybe 50 years old or something like that going through the rubble. David Burns: I stopped there and asked him who he was and he says, "My father was almost killed by a train here yesterday and somebody saved his life and I was just checking out the scene." I said, "Well, that was me actually." I said, "I didn't understand it -  he was driving down the railroad track and if I hadn't gotten there, I think he would have been killed." David Burns: I said, "Why was he driving down the railroad track?" He says, "Well, my father has had Alzheimer's disease and he lost his driver's license 10 years ago, but he forgot and after dinner, he snuck out. He grabbed the keys and snuck out, decided to take the car for a drive." Here is the same situation, a train about to kill somebody on a railroad track about to smash into you and I had the thought this guy is in danger he could be killed. David Burns: I was experiencing 100% terror and anxiety and fear, but his thought was different. His thought was, "This is great. I might be able to sue and get a great deal of money." Therefore he was feeling joy and euphoria. Same situation, different thoughts and radically different emotions. David Burns: That's what I mean and that's what the Buddha meant 2,500 years ago when we say that only your thoughts can create your emotions. It's not what happens to you, but the way you think about it that creates every positive and negative emotion. Neil Sattin: Did you ever write back to that person who wrote you? About that train - to tell him what had happened? David Burns: I don't remember it because this was way back in 1980 shortly after the book came out. I probably did because in those days, I was so excited to get a fan letter. I never had any idea that the book would become popular, it didn't hit the best-seller list until eight years after it was published because the publishers wouldn't support it with any marketing or advertising because they thought no one would ever want to read a book on depression. David Burns: When I got a letter in the days before email, I would get so excited and I would try to contact the person and sometimes talk to them for an hour or two on the telephone thinking this might be the only fan I'll ever have. I'm sure I did write back. Neil Sattin: Speaking of that, this might be a good chance to start talking about the cognitive distortions and like the idea that this might be the only fan that you ever have, what are we talking about in terms of now we've established pretty well. The way I think about things is going to determine how I feel. Neil Sattin: Yet, there are these distorted ways of thinking about the world that really have an enormously negative impact on our ability to function and interact. David Burns: This is one of the amazing ideas of cognitive therapy that at first I didn't quite grasp, but the early cognitive therapists like Albert Ellis from New York and then Aaron Beck at University of Pennsylvania who I learned it from were claiming not only do your thoughts create all of your moods, but when you're upset, when you're depressed, when you're anxious, when you feel ashamed or excessively angry or hopeless, not only are those feelings created by your thoughts and not by the circumstances of your life, but those negative thoughts will generally be distorted and illogical so that when you're depressed, you're fooling yourself, you're telling yourself things that simply aren't true and that depression and anxiety are really the world's oldest cons. David Burns: Beck - when I first began learning about cognitive therapy from him when I was a psychiatric resident and postdoctoral fellow, he had about four distortions as I recall and he had big names for them and then I added some to those and I used to talk to my patients about all-or-nothing thinking and overgeneralization and self-blame and the different ones. David Burns: Once, I was having a session with a patient and he said, "Why don't you list your 10 distortions and hand it out to patients?" He said, "It would make it so much easier for us." I thought, "Wow, that is a cool idea." I ran home that night after work and I made the list of the 10 cognitive distortions and that's what led to my book Feeling Good. David Burns: My list of 10 cognitive distortions, it's probably been reproduced in magazines and by therapists all over the world, I would imagine easily millions of times and probably tens of millions of times, but there are 10 distortions. Number one is all-or-nothing thinking, black or white thinking. David Burns: It's where you think about yourself in black or white term, shades of gray don't exist. If you're not a total success, you think that you're a complete failure or you tell yourself you're defective. I gave a workshop with Dr. Beck at one of the professional conferences like the Association for Behavioral and Cognitive Therapies, cognitive therapy had just come out and Beck is not a very good public speaker. David Burns: I was a novice also at the time and we had a half day workshop and there were a few hundred therapists there and it was okay, but it wasn't great and they started challenging us because nobody liked the idea of cognitive therapy initially, it was scorned and looked down on. We got defensive and then afterwards Dr. Beck looked at me and said, "David, you look like you're feeling down. What's the problem?" David Burns: I said, "Well, to tell you the truth Dr. Beck, I thought we were below average in this presentation and I'm feeling upset about that." He said, "Oh, well you should, if we were below average, you should thank your lucky stars." I said, "Why should I thank my lucky stars if we were below average?" David Burns: He said, "Because average is the halfway point. By definition, we have to be below average half the time. We can thank our lucky stars we got the below average one out of the way and we look forward to an above average one the next time we present." Suddenly, my discouragement disappeared. David Burns: He was just modeling thinking in shades of gray whereas I had been thinking in black and white terms. All-or-nothing thinking is very common in depression and it's also the cause of all perfectionism - thinking if you're not the greatest, second best or average just is not good enough, it's either the world or nothing, perfection or failure and it creates tremendous problems. Neil Sattin: Yeah, I could see that also coming up in terms of comparisons like if so and so is already doing this thing, I can't possibly do that because it's so and so's domain. As if one person could own the domain for the entire world in any particular area. David Burns: Well yeah, that's another mental trick that we play in ourselves with the distortions I call mental filtering and discounting the positive. You see this all the time when you're feeling inferior and comparing yourself to other people. Mental filter is where you focus on all of your flaws thinking about all of your errors. David Burns: You don't think about what's good about you or what's beautiful about you. I did a TV show finally when the book gained popularity in Cincinnati and it was a morning show and they had a live audience and a band and he was interviewing me. It was exciting for me because it was still the first time I had any media exposure. David Burns: Then after the show, the host said, "Dr. Burns, could I talk to you for a minute?" This often happens to me when I'm on a radio or TV show because the people in the media have tremendous pressures on them and they often also feel that they're not good enough. I said, "Sure. I'd love to. What's the issue?" David Burns: He says, "Well, after every morning show, I get about 350 fan mails, fan letters or calls or whatever." He said, "They are 99.9% positive, but everyday I'll get one critical letter. One critical feedback and I dwell on that one constantly and make myself miserable and ignore all the other positive feedback." That's called mental filter because you filter out the good stuff and you've just focused on your flaws. David Burns: A lot of the people listening to the show right now do that. Then an even bigger mental error is called discounting the positive - when you say that the good things about you don't even count. You may have done this to yourself when someone gives you a compliment, you might tell yourself, "Oh, they're just saying that to be nice to me. They don't really mean it." You discount that positive experience. David Burns: I had a colleague who got upset when he recently won the Nobel prize, one of my college roommates, and the reason he got upset is he said they haven't recognized my best work yet. So those are three of the 10 distortions. Neil Sattin: Yes. One of my favorites I think comes next on your list, at least the list I'm looking at after discounting the positive which is the ways that we jump to conclusions. David Burns: Right. There's two common patterns here, jumping to conclusions that aren't warranted by the facts and mind-reading and fortune-telling are two of the commonest ones. Now, fortune-telling is when you make a prediction about the future, an arbitrary prediction about the future and all anxiety results from fortune-telling, telling yourself that something terrible is about to happen - like when I get on that plane, I just know it will run into turbulence and crash. You feel panic and anxiety. David Burns: Depressed people do fortune-telling as well. Hopelessness results from predicting that things will never change, my problems will never get solved, I'm going to be miserable forever. Almost every depressed patient thinks that way and that's actually why many people with depression commit suicide because they have the illogical belief that their mood will never improve, that they're the one untreatable person. David Burns: Mind-reading is the other common form of jumping to conclusions and this is real common in social anxiety, but Neil, I'm sure you see it in a lot of people with relationship problems. Neil Sattin: Absolutely. David Burns: But mind-reading is where you assume you know how other people are thinking and feeling without any evidence, without any data. I used to struggle with intense social anxiety among my many other fears and phobias that I've had and overcome over the years, but the anxious person - say you're at a social gathering and you think, "Oh, these people won't be interested in what I have to say and they never feel anxious. I'm the only one who feels insecure." David Burns: Then you also may have the thought, "Oh, they can see how anxious I am and they're going to be real turned off by me." Then what happens is that when you start talking to someone, you get really busy worrying about how they're not going to be interested in you. You try to think of something clever or interesting to say while they're talking. David Burns: Then when they're done, instead of repeating what they said and expressing an interest in what they said, you make the little speech you had prepared. That turns the other person off because I think, "Wow, David doesn't seem interested in me. I was just telling him about my son, he was just accepted to Harvard and now he's talking about something else." David Burns: That person pretty quickly loses interest in you and says, "Oh, I have to talk to so and so on the other side of the room." Then you, the shy person get rejected again which is what you thought was going to happen. Although these are distortions, you're thinking in an unrealistic way, they sometimes feel like self-fulfilling prophecies so you don't realize that you're fooling yourself. Neil Sattin: Right, because when you're in it, then you seem to be getting plenty of evidence that it's true. David Burns: Yes, and another form of evidence comes to another distortion. One name I made up called emotional reasoning where you reason from your feelings. You see this in angry interactions, you see that in anxiety and in depression. The depressed patient is giving themselves all these messages like I'm a loser, I'm no good and beating up on yourself and then you feel ashamed and guilty and worthless and inferior and inadequate. David Burns: Then you say, "Well, I feel like a loser, I must really be one." Reasoning from your emotions, thinking your emotions somehow reflect reality. That thought by the way is one we skipped over - overgeneralization. That's number two on the list actually, right after all-or-nothing thinking. David Burns: Overgeneralization, this is a Buddhist thing, really overgeneralization. It's where you generalize to yourself from some specific event. For example, I have a free training for Bay Area psychotherapists every Tuesday evening at Stanford and you don't have to be a Stanford student to come,  I give unlimited free psychotherapy training to therapists who can come to my Tuesday group and any of the listeners or therapists near in the Bay Area on a Tuesday email me and you're welcome to attend my Tuesday training group. David Burns: Then I also have free hikes every Sunday morning and we go out hiking for maybe three and a half hours on the trails around my home and I treat people for free on the hikes. We do training and one of the women on the Sunday hike, I'll keep it vague to protect her identity, but she just had a problem with her boyfriend and they broke up and then she was telling herself, "I'm inadequate ... I'm unlovable" kind of thing. David Burns: "This was my fault and I must have been doing something wrong." You see, when you think like that and most of us do when we're upset, she's generalizing from this event, that it didn't work out with her boyfriend to then this global idea that "I'm inadequate. There's something wrong with me" - as if you had a self that wasn't good enough. David Burns: Then people also say, "I'll be alone forever. I'm unlovable. This is always happening to me." That's all over generalization where you generalize from a negative event and you see it as a never-ending pattern of defeat. You also see it as evidence that you're somehow defective or not good enough than when you're thinking these things, they seem so true - just as believable as the fact that there's skin on your hand. David Burns: You don't realize that you're fooling yourself, the pain that you feel is just incredible. I know that of the many people listening to this show right now, I'm sure you can identify this with this that you've had thoughts like that and you know how real and painful these feelings are. David Burns: It's one of the worst forms of human suffering, but the good news is and we haven't gone around to that, but not only are there fantastic techniques, cognitive therapy techniques that we've been talking about from my book feeling good described in there or my feeling good handbook so that you can overcome these distorted thoughts and get back to joy and self-esteem quickly, but also my group at Stanford over the 10 years, the past 10 years, we've created even more powerful techniques and to help bring about really high speed recovery for people struggling with depression and anxiety. David Burns: The new techniques are way more powerful than the original cognitive therapy although those methods are still fabulous, but maybe we'll have time to talk about some of these. David Burns: But there's more distortions to cover. Neil Sattin: Yeah. Maybe what we could do because I'd love to balance this out and I want to ensure that we cover the other distortions. We have maybe four more. At the same time, maybe let's break from the distortions just to change things up a bit and start entertaining that question of, "Alright, yeah. I relate to some or all that we've even listed so far." Neil Sattin: What are some of the initial steps that someone could talk because where I tend to go with this is like, "Well, these belief patterns like you talked about, "I'm unlovable" as one, those seem to emerge from a place that's immutable. It's something that's really deep in someone's psyche and yet, you're suggesting that there's ways to transform that that are really quick and direct and give someone a felt experience of the truth that's not that thing. David Burns: Yeah, that's right. You can group the techniques into cognitive techniques to crush these distorted thoughts and motivational techniques to get rid of your ... To bring your resistance to change to conscious awareness and melt away the resistance. The patients become incredibly motivated to crush their thoughts. David Burns: An example of the way the cognitive techniques work, what is crucial and this is one of the first things when we first created cognitive therapy in the mid 1970s was to write the negative thoughts on a piece of paper. It's a very humble thing to do, but it can be dramatically effective because then you can look at the list of 10 distortions and immediately, pinpoint the distortions and that makes it much easier to talk back to these disruptive thoughts and poke holes in them. David Burns: I'll give you an example of my own personal life because I've used these techniques myself and if they hadn't worked for me, I never would have become a cognitive therapist and now a TEAM CBT therapist, but when I was a postdoctoral fellow, I used to go to Dr. Beck's weekly seminars and I would present all my most difficult cases and get tips from him on how to treat these people with what was then the rapidly emerging brand new cognitive therapy and it was an exciting time, but one day, I talked to him about a patient that wasn't paying the bill, that I've had a bad session with this patient and asked him for some guidance. David Burns: He actually was pretty critical of the way I had dealt with this patient. I became awfully upset, I got depressed and anxious and I was riding home on the train and my head was filled with negative thoughts and negative feelings. Then when I got home, I told myself, "Well David, you probably better run, go on a long six mile run and get your brain endorphins up so get over your depression" because those were the days when everyone was believing the phony baloney that somehow exercise boosts brain endorphins and will reduce depression. David Burns: I went out on this long run and the longer I ran, the more believable my negative thoughts became. I said, "David, what are you telling yourself?" I said, "Oh, I'm a worthless human being. I have no therapeutic skills, I'm going to be banned from the state of Pennsylvania and they'll take away my medical license, I have no future in psychiatry. I'm a worthless human being, I'm a bad person." Stuff like that. David Burns: It seemed overwhelmingly true. I said, "Are there some distortions in your thoughts David? Look for the distortions like what you tell your patients." I said, "No, there are no distortions in my thoughts. This is just real." I was telling myself it's so weird to hear, you're something like 30 years old or however old I was, 31, it took you all of this time in your life to realize what a horrible loser you are. David Burns: It's as if I had seen the truth for the first time and it was devastating. Then when I got home, I said, "David, why don't you write your thoughts on a piece of paper? That's what you make all of your patients do." I said, "Oh no, no, my thoughts are real, that won't do any good." Then I told myself, "But isn't that the same way you're whining just like your patients whine and resist? And you force them to write their thoughts down on a piece of paper. You tell them they have to do that. Why don't you try that David?" David Burns: I said, "No, no, it wouldn't do any good. I really am a worthless human being. This is true." Then I said, "No David, you're still resisting. Take out a piece of paper and do what you tell your patients to do." I said, "Oh okay, I'll do it just to prove that it won't work." I wrote my thoughts down. Number one, I'm a worthless human being, number two, I have no therapy skill. David Burns: Number three, I screwed up with this patient. Number four, they'll take away my medical license, stuff like that. I wrote down four or five thoughts. Then I said, "Now, are there any distortions?" I looked at my own list of 10 distortions. I said, "Wow, those thoughts are pretty distorted. It's all-or-nothing thinking, black and white thinking like I'm not allowed to make a mistake with a patient. It's overgeneralization, I'm generalizing from the fact that I screwed up with this patient in a session to, "I am a worthless human being," it's fortune-telling, "I have no future in psychiatry." David Burns: Jumping to conclusions, self-blame, hidden "should" statements, that's another distortion. I shouldn't have screwed up, I should always be perfect. It was emotional reasoning, I feel worthless, I must be worthless. I suddenly saw those distortions and then I said, "Now, can I write a positive thought to challenge these negative thoughts?" That's the other part of the exercise. First you write the negative thought, then you identify the distortions, then you write a positive thought. David Burns: The positive thought has to be 100% true. Rationalizations and half truth will never help a human being. I came up with this positive thought. I said, "David, you're just a beginner. You have the right to make mistakes. In fact, even when you're 75 years old years from now, you might be a great therapist, but you'll still make mistakes and learn from them. That's part of the territory." David Burns: "You're absolutely permitted to do that. Instead of beating up on yourself, why don't you talk it over with your patient tomorrow and tell him that you made a mistake and see if you can repair that rupture in your relationship with the patient." All of a sudden, I said, "Is that true?" "Yeah, that thought is 100% true." How much do I believe this rubbish that I'm a worthless human being and all of that and my belief in those negative thoughts went to zero and my negative feelings just disappeared in a flash entirely. I said, "Wow, this shit is pretty good. This really works." Hope you don't have to edit out that word. Neil Sattin: No, that's fine. That's fine. David Burns: Then the next day I saw the patient, I said, "You know Mark, I've been feeling terrible since last session and ashamed because I don't think I treated you right." I was putting pressure on you because of the unpaid balance and I didn't put any emphasis on your suffering and what's going on with you as a human being I just imagine you felt so hurt and angry with me and discouraged and I'm just overjoyed that you came back today rather than dropping out of therapy so we can talk it over and see if we can deepen our relationship. David Burns: He just loved that and we had the best session ever, he gave me perfect empathy scores at the end of the session, but that's just an example from my personal life and I'm sure the people here can relate to that, but I've developed probably 50 or 100 techniques for crushing negative thoughts and I've made it sound easy, but it isn't always easy because you might be very, very trapped in your negative thoughts. David Burns: You might have to try several of the different techniques before you find the one that works for you. I want to be encouraging to the listeners and to therapists who may be listening, but I also don't want to make it sound like something overly simple or overly simplistic because it's really a pretty high-powered, sophisticated type of therapy. David Burns: Fortunately, many people can make it work on their own, but anyway, that's the half of the treatment breakthroughs and that was called the cognitive revolution and my book Feeling Good really helped usher that in when feeling good came out in 1980, cognitive therapy was virtually unknown and they were just a handful of cognitive therapists in the world. David Burns: Now, it's become the most popular form of psychotherapy in the world and the most researched form of psychotherapy in all of the history of psychology and psychiatry. Neil Sattin: I wonder if we could emphasize because I'm thinking about how we talked about the technique for identifying a negative thought, identifying the cognitive distortion or distortions that are happening and just to talk about the importance of actually going through that exercise and writing it down. Neil Sattin: Maybe you could just talk for one more minute about why that part is so important. Why is it important to actually write that stuff down versus to do it in your head? David Burns: I think that the negative, the power of the human mind to be negative is very profound. The negative thoughts are like a snake eating its tail, they go round and round and one leads to the next. David Burns: In the early days, I used to try to do cognitive therapy without the written exercise and to this day, new therapists still try to do that. They think they're too fancy that writing things down is too simplistic or something like that and they're going to be deep and just do verbal, deep stuff with people, but the problem is, the human mind is so clever. David Burns: Each distortion reinforces another one and each negative thought reinforces another one and you go round and round and round. That's why doing it verbally or in your head when you're alone is rarely going to be effective, but when you write the negative thoughts down one at a time and number them with short sentences, that makes it much easier to identify the distortions in them and turn them around. David Burns: There are three rules of thumb. There's an art form to writing them down. Everything is more sophisticated than I make it sound in a brief interview. There's a lot of rules of the game. For example, when you're writing down negative thoughts, you should never put an emotion or an event. David Burns: People have a negative thought like Trisha rejected me and I feel terrible. Well, that's not a negative thought. That's an event. Trisha rejected me and I use a form called the Daily Mood Log and at the top you put the event and then you circle all of your emotions and put how strong they are between zero and a hundred. David Burns: These emotions might be feel guilty, ashamed, lonely, depressed, worthless and then the negative thought would be the interpretation of that event like I must be unlovable, I'll be alone forever. Then those are things that have distortions. A second rule is don't ever put rhetorical questions in the negative thought column. David Burns: If you say something like, "Oh, why am I like this? Why am I so anxious in social situations?" Or "What's wrong with me?" You can't disprove questions so instead you can substitute the hidden claim behind the question which is generally a hidden should statement like I shouldn't be like this or I must be defective because I'm so anxious in social situations or some such thing. David Burns: There are probably one or two other rules of the game and my book When Panic Attacks which is one of my newer books on all the anxiety disorders, Feeling Good is on depression. When Panic Attacks is on all of the different kinds of anxiety. I think the third chapter shows how to fill out the Daily Mood Log and what the rules are to follow to enhance the effectiveness of it so you'll be more likely to have a successful experience. Neil Sattin: Great. The idea is that it's simply by doing this process that the things shift. It's not like there's ... You go through the process and then maybe you would track your mood afterwards and see, "Wow, I'm actually feeling better than I was before" just by simply doing that? David Burns: Well, a lot of people can feel better just by doing it, but the research has shown that two thirds of people just by reading Feeling Good, they can improve a lot in depression, but some people need the help of a therapist and it isn't true that everyone has to do it on your own, sometimes you need another person to get that leverage to pop out of it. David Burns: Another thing that's helpful when you're writing down your negative thoughts is Beck's theory of cognitive specificity. You see, Buddha said our thoughts create our emotions, but Beck took it to the next level and said different patterns of thoughts create different types of emotions. David Burns: If you're feeling guilty, you're probably telling yourself that you're a bad person or that you violated your value system. If you're feeling hopeless, you're definitely telling yourself that things will never change, something like that. I'll be miserable forever. If you're feeling anxious, you're definitely telling yourself something awful is about to happen. David Burns: "When I get on that show with Neil, I'll screw up, my brain will go blank." That type of thing. When you're feeling sad, you're telling yourself... or depressed, that you've lost something central to your self-esteem. When you're feeling angry, you're telling yourself that someone else is a loser that they're treating you unfairly, that they shouldn't be that way. David Burns: These rules can also help individuals pinpoint your negative thoughts. Once you see what the emotions are, then you know the kind of thoughts to look for. One last thing is sometimes people say, "Oh, I don't know what my negative thoughts are." I just say, "We'll just make some up and write them down and number them." David Burns: Then I say, "Are your thoughts like this?" They say, "Oh, that's exactly what I'm thinking." Those are a few tips on refining the part with the negative thoughts. But now we have even more powerful techniques that have evolved in my work with my training and development group at Stanford. Neil Sattin: Yeah, before we talk about those, which I hope we will have time to do - there are a couple of things that jumped out at me. One was as you were describing the distortions that we've already talked about, it popped into my head that this is often at the source of most conflict that happens in couples - that either one person is having distorted thinking or one person is protecting themselves from their own distorted thinking. Neil Sattin: For example, your partner says something and you have this feeling like, "Well, that's not true. I got to defend myself from that accusation." David Burns: That's right yeah. Neil Sattin: You jump into this place of conflict that's all about proving that this negative concept you suddenly are perceiving about yourself isn't true. When that negative concept in and of itself might be an example of you just having a distortion - like for instance, "my partner is mad at me, that must mean they think I'm a horrible human being." David Burns: Yeah, what's huge what you just said, when we're in conflict with people, there's a lot of inner chatter going on in addition to the verbal altercations, the arguing, the escalation, the defensiveness - and some of the distortions will be focused on the other person and some of the distortions will be focused on yourself. David Burns: You see all of the 10 cognitive distortions in relationship conflict, but they have a little bit of a different function I would say. Now, let's say you're angry, Mary is angry at her husband Sam, she's ticked off and then if you look at her thoughts, they have all 10 distortions. David Burns: She'll tell herself things like, she might be thinking, "Oh, he's a loser. All he cares about is himself. The relationship problems are all his fault, he'll never change." That type of thing. You sell all-or-nothing thinking, mind-reading, imagining how he's thinking, you see blame, you see hidden should statements, he shouldn't be like that, he shouldn't feel like that. David Burns: You see discounting the positive, mental filtering, overgeneralization, magnification, minimization. You see all the same 10 distortions. The only difference is that when you're depressed and I can show you that your thoughts about yourself are distorted and that's not true that you're a loser, you're going to love me, the therapist, you're going to appreciate that and you're going to feel better and you're going to feel better and recover from your depression. David Burns: When people are in conflict and we're having distorted thoughts about the other person, we're generally not motivated to challenge those distortions because they make us feel good. We feel morally superior to the other person. I don't generally work with people too much on changing their distortions about others because they don't want to hear it. David Burns: If the therapist finds out that this woman, that her thoughts about her husband are causing her to be upset, not her husband's behavior, and in addition that her thoughts about her husband are all wrong, wrong, wrong, they are all distorted, she'll just fire the therapist and drop out of therapy and she'll have two enemies, her loser of a husband and her loser of a therapist. David Burns: That's why I developed some of the techniques we talked about in the last podcast we did on relationships. I used slightly different strategies, but you're right, those distortions are incredibly positive and the other kind of distortion you have when you're in conflict if someone's criticizing you, again you may start thinking, "This shows that I'm a loser, I'm no good. I should be better than I am. If you're criticizing me, that's a very dangerous and terrible situation." David Burns: By attending to those kind of thoughts that make you feel anxious and ashamed and inferior and guilty and inadequate, then you can modify those and then do much better in the way you communicate with the other person because your ego isn't on the line. An example with me is in my teaching, I always get feedback from every class I do, every student I mentor or supervise from every workshop and I get it right away, I don't get it six months from now, I get it the very day that I'm teaching. David Burns: I get all kinds of criticisms on the feedback forms I've developed even if I have a tremendous teaching seminar, I'll get a lot of criticisms especially if they feel safe to criticize the teacher. I find that if I don't beat myself up with inner dialogue, then I can find the truth in what the student is saying and treat that person with warmth and with respect and with enthusiasm even. David Burns: Then they suddenly really love the way that I've handled their criticism and it leads to a better relationship and that's true between partners or in families as well. That inner dialogue that's where we're targeting ourselves and making ourselves needlessly anxious and defensive and hurt and angry and worthless when we're in conflict with someone - that can be adjusted and modified to really enhance relationships. Neil Sattin: The two distortions that we hadn't really covered yet, you just mentioned them and I thought ... We've mentioned them all at this point, but some of them like blaming, whether it's blaming yourself for a situation or blaming others for a situation, that seems a little self-evident. Neil Sattin: I'm curious if you could talk for a moment about labeling and then also magnification and minimization just because I think those are the two that we listed, but didn't really cover. David Burns: Did we mention shoulds? Neil Sattin: Let's mention them and I think again, that might be something that's a little more understandable for people, but yeah, let's do this. David Burns: Oh yeah, okay. Yup. Well, labeling is just an extreme form of overgeneralization where you say I am a loser or with someone else, "He is a jerk." Where you see yourself or another person as this bad glob so to speak. Instead of focusing on specific behaviors, you're focusing on the self. When you think of yourself as a loser or a hopeless case, it creates tremendous pain. David Burns: When you label someone else as a jerk or a loser, it creates rage and then you'll often treat them in a hostile way and then they treat you in a hostile way and you say, "Oh, I know he was a loser." You don't realize you're involved in a self-fulfilling prophecy and you're creating the other person's, you're contributing to or creating the other person's hostile behavior. David Burns: Magnification or minimization is pretty self-evident - where you're blowing things out of proportion - like procrastinators do that. You think about, "All you have to do, all the filing that you're behind on." It feels like you have to climb Mount Everest and you got overwhelmed and then minimization, you're telling yoruself, "Oh, just working on that for five or 10 minutes would be a drop in the bucket. It wouldn't make a difference." You don't get started on the project. David Burns: We've done those two. The should statement say I think is very subtle and not obvious to people at all that we beat up on ourselves the shoulds and shouldn'ts and oughts and musts and we're saying, "I shouldn't have screwed up, I shouldn't have made that mistake. I should be better than I am."   David Burns: That creates a tremendous amount of suffering and shoulds go back - if you look at the origin in the English dictionary, maybe we did this in our last podcast, I don't recall that if you have one of these thick dictionaries, you'll find the origin of the word should is the Anglo's accent word scolde, S-C-O-L-D-E where you're scolding yourself or another person, where you're saying to your partner, "You shouldn't feel that way." Or, "You shouldn't believe that." David Burns: We see that politically, two people are always blaming someone they're not in agreement with and throwing should statements at them. Albert Ellis has called that the "shouldy" approach to life which is a cheap joke I guess, but it contains a lot of truth. The feminist psychiatrist Karen Horney who actually I think was born in 1890s did beautiful work on shoulds - when my mother, when we moved to Phoenix from Denver, I think my mother got depressed and she read a book by Karen Horney on the Tyranny of the Shoulds, how we give ourselves all these should statements and make us feel like we're not good enough and we're not measuring up to our own expectations and create so much suffering. David Burns: I think that book was very helpful to her and then Albert Ellis in New York saw that, he argued and I think rightly so that most human suffering is the result of the shoulds that we impose on ourselves or the should statements that we impose on others. Neil Sattin: Well, if that's true, then maybe that should be what we take a moment to attack and I'm wondering if you have a powerful crushing technique that works with shoulds whether it's and maybe it would be a little bit different, the ones that we wield against ourselves versus so and so should know or should have done this differently. David Burns: Right. Well, a lot of the overcoming has to do with the mystical, spiritual concept of acceptance, accepting yourself as a flawed human being is really the source of enlightenment, but we fight against acceptance because we think it's like giving in and settling for second best. We continue to beat up on ourselves thinking if we hit ourselves with enough should statements, we'll somehow achieve perfection or greatness or some such thing. David Burns: One thing that I learned from Ellis that has been really helpful to my patients is that there's only three correct uses of the word should in the English language. There's the moral shoulds like the 10 commandments, thou shalt not commit adultery, though shalt not steal or thou shalt not kill. David Burns: There's the laws of the universe should where if I drop a pen right now, it should fall to the earth because of the force of gravity and then there's the legal should. You should not drive down the highway at 90 miles an hour because that's against the law and you'll get a ticket. Now, I had a colleague who came on one of the hikes who has a developmentally challenged child, say a son just to disguise things a little bit and she's from a very high achieving family, Silicon Valley family just to say the least. David Burns: She and her husband are giants, geniuses and then she went to the grammar school for the parent's day and they had all the kids and they have their daughter in some very expensive private school. The kid's pictures were up on the wall and then she saw her son's picture and it was just very primitive compared with the other children who are real high-powered children from high powered families. David Burns: Her son struggles severely and then she saw that and she felt the feeling of shame. Then she told herself, "I should not feel ashamed of my son." That's hitting herself with a should statement which it's like she doesn't have permission to have this emotion and that's what we do to ourselves.   David Burns: That's not a legal should, it's not illegal to feel ashamed of yourself or your son. She then was also of course feeling ashamed of herself. It's not immoral and it doesn't violate the laws of the universe. A simple technique that Ellis suggested and it's so simple it goes in one ear and out the other instead of saying, "I shouldn't, you can just say it would be preferabe if or I would prefer it if or it would be better if." David Burns: You could say it it would be better, it would be preferable if I didn't feel ashamed of my son, but that's the human feeling and probably other parents feel upset with their children, they feel ashamed sometimes of their kids or angry with their kids. It's giving yourself permission to be human and that's called the acceptance paradox. David Burns: The paradox is sometimes when you accept your broken nature, accept your flaws and shortcomings, you transcend them. I've often written that acceptance is the greatest change a human being can make, but it's elusive and Buddha tried to teach this 2,500 years ago when I saw on TV and I don't know if was just a goofy program, but it was on PBS that he had over 100,000 followers in his lifetime and only three achieved enlightenment. David Burns: I think it was frustrating to him and disappointing, but I can see it clearly because what he was teaching was so simple and basic and yet it's hard for us to grasp it and that's why I love doing therapy because we've got powerful new techniques now where I can bring my patients to enlightenment often in a single therapy session if I have more than an hour. David Burns: If I have a two hour session, I can usually complete treatment in about a session and see the patient going from all the self-criticism and self-hatred and misery to actually joy and euphoria. It's one of the greatest experiences a human being can have because when my patient has a transforming experience, then it transforms me at the same time. Neil Sattin: Can you give us a taste of what some of the more powerful new techniques are and how they might work in these circumstances? David Burns: Yeah, they're pretty anti-intuitive and it took me many years of clinical practice before I figured it out and before it dawned on me. I would say very few therapists know how to do this and it's absolutely against the grain of the way therapists have been trained and the general public have been trained to think about depression and anxiety as brain disorders. David Burns: The DSM calls them mental disorders. We've gone in the opposite direction and I'll just make it real quick because we're getting long on people's time here I'm afraid, but when I am working with a person, like last night at my Tuesday group, we were working with a therapist and someone who's in training to become a therapist and she was being very self-critical and telling herself she wasn't smart enough and just beating up on herself and saying that she was defective and she should be better at this and she should this, she shouldn't that. David Burns: She was feeling like 90% depressed and 80% ashamed and intensely anxious. One thing I do before I ... She had all these negative thoughts, "I'm defective" and I don't have the list in my hand, but she had about 17 very self-critical thoughts. After I empathized and my co-therapist was Jill Levitt, a clinical psychologist who I teach with at Stanford and Jill is just a gem, she's fantastically brilliant and kind and compassionate and humble. David Burns: After we empathized with this individual and I'll just keep it vague because most therapists feel exactly the same way so I won't give any identifying details, but we asked this young woman, "Would you like some help today?" With her depression and anxiety. If we had a magic button on the table and she pressed it, all our negative thoughts and feelings would instantly disappear. David Burns: Would she press the magic button? She said, "Oh yeah, that would be wonderful." I guess she's felt this way on and off throughout her life since she was a little girl that she is somehow not good enough. Then we said, "Well, we have no magic button, but we have amazing techniques." But before we use these techniques, maybe we should ask, "What are your negative thoughts and feelings show about you that's beautiful and awesome?" David Burns: Also, "what are some benefits to you in having all of these negative thoughts and feelings?" She was very puzzled by that at first as most therapists are like, "How could there be benefits from having depression? We learn that's some kind of mental disorder or major depressive disorder, dysthymic disorder, all these fancy names pretending that these are mental illnesses of some kind. David Burns: But then she got in the flow, we primed the pump a little bit and she was able to come up with a list of 20 overwhelming benefits to her and beautiful things about her that were revealed by her negative thoughts and feelings. For example, when she says, "I'm defective." She will say, "Well, it shows that I'm honest and accountable. Because I do have many flaws." David Burns: Then a second benefit was "it shows that I have high standards." I was able to say, "Do you have high standards?" She said, "Absolutely." I said, "Have your high standards motivated you to work hard and accomplish a lot?" She says, "Oh yeah, absolutely." That was the third benefit. Then the fourth benefit is her self-criticism showed that she's a humble person. That was the fourth benefit, the fourth beautiful thing it showed about her. David Burns: Then we pointed out that humility is the same as spirituality. Her self-criticism shows that she's a humble and spiritual person and then her sadness showed her passion for what she hopes to achieve which is a role as a therapist and a good therapist and her self-doubt keeps her on her toes and motivates her to work really hard. David Burns: Her suffering shows enhances her compassion for others and her shame shows that she has a good value system, a good moral compass and on and on and on, then we came up with a list of when we got to 20 benefits of her negative thoughts and feelings, then we simply said to her, "Well, maybe we don't want to press that magic button because when your negative thoughts and feelings disappears, then these other good things will disappear as well. Why in the world would you want to do that?" David Burns: We have become the role of her subconscious mind and the therapist is paradoxically arguing for the status quo and not arguing for change. The therapist's attempt to help or change the patient is actually the cause of nearly all therapeutic failur

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

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

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

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

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

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

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

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

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