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

Today, Rhonda and David answer three great questions submitted by listeners like you.

1. I am confused about the terms, negative and positive distortions. Help!
2. “How do you treat an “existential crisis?”
3. Can you use the Five Secrets with someone in a hypo-manic state? Won’t agreeing with their accusations just make things worse? 

1. I am confused about the terms, negative and positive distortions.

Dear Dr. Burns,

I do have one question about terms I have heard on the podcast. The terms that confuse me are "negative distortions" and "positive distortions." I think I understand that they are both "bad" distortions, but the  positive distortions are distortions related to moods or thoughts that are unhealthily high or "up," such as in mania or narcissism. And negative distortions are the ones related to lower mood states/depression. Is this correct? I don't know if it is a brain thing, but even though I think I understand the concepts, my brain still seems to automatically think of positive distortions as good, and so I become quite confused when trying to understand how to fight them or help someone else fight them . . .

Thank you again, so much, for all of your hard work on the podcast, as well as your diligence in training therapists in your TEAM model. I am a super-fan of the model already after only a week or so of listening! And the Five Secrets have challenged me to examine my communication abilities much more honestly and helped me in several important interactions already (even as a novice making many mistakes😬).

Thank you, thank you, thank you!

Please also tell Fabrice and Rhonda many thanks for all of their hard work and excellence as well. They both bring such gifts and refreshing honesty, brilliance  and genuineness to the discussions. I especially admire Rhonda for sharing her personal work. Such powerful and transformative stuff! It gives me hope that someday I might be a fraction as brave to DO that kind of work, much less share it openly with others for their benefit. What a generous as well as brave thing to do! I feel so hopeful and encouraged to know there are therapists like you, Fabrice, and Rhonda helping people to heal from vast amounts of mental and emotional suffering. I can't wait for TEAM to be as commonly known everywhere as CBT is now. Sign me up to volunteer for any promotional efforts if that is ever needed! For now, I will continue to tell everyone, including quite a few other counselor friends, about the podcast and the TEAM model.

Sincerely,

A new super-fan podcast listener,

Holly Miller

Hi Holly, Many people are confused, so this is a great question! Rhonda and I will gladly discuss this on our podcast. And thanks for your kind words!

david 

2. Can you use the Five Secrets with someone in a hypo-manic state? Won’t agreeing with their accusations just make things worse?

Hi David and Rhonda,

Thank you so much for the podcast. I have been an avid listener since the early days of the podcast, and it has helped me through very difficult times and still is.

My question is related to my relationship with my future to be divorcee. She is at times in a hypo mania state due to her bipolar illness (which is diagnosed and treated).

Is it possible to use the five secrets of effective communication with someone who is in a state of hypo mania? I feel that agreeing with unreasonable accusations and complains is not helping at all and only causes her to hold to these claims.

I know that you usually like to relate to specific correspondence but it is more of a general question.

I hope you can give me some guidelines on what works and what doesn’t.

Thanks!

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:

1. 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.
2. You will have a much deeper understanding of how TEAM-CBT actually works.
3. You will be able to deliver faster and deeper therapy to your patients.
4. 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!”
5. Those who observe the therapy develop a greater understanding of how the fine points of effective therapy.
6. When the person in the “patient” role has a profound change, we all share that joy and feel inspired by the miracles that can often be accomplished in a relatively short period of time. As they say, “seeing is believing.”

Rhonda recently surveyed some of our listeners about live therapy we sometimes offer on our podcasts—do you prefer to have the live therapy presented all at once, in an extended, two-hour podcast, or split up over two or more podcasts with expert commentary along the way?

Our listeners were split on this. So today we are presenting an actual and dramatic therapy session in its entirely. If you don’t have two hours to listen all at once, you can stop after an hour or so, and then return to the last portion when you have more time.

And please let us know what you think of this live therapy podcast format!

In today’s session, we are very grateful to Sarah, a certified TEAM-CBT therapist, for allowing us to share her very personal and powerful session with you. Sarah was having intense anxiety during her sessions with patients, and her anxiety was bordering on panic.

This is actually not unusual. In my experience, most shrinks struggle with feelings of insecurity from time to time. But when we shrinks experience insecurities, we often feel strong shame as well, telling ourselves that we “should” have it all together because we are supposedly “experts.”

I’m no exception! I can remember how anxious I used to feel on Sundays when I was starting out in private practice. I’d tell myself, “Wow, I’m going to have all of these high-powered patients tomorrow, and what if they notice that I don’t actually know what I’m doing half of the time!?”

But then, halfway through Monday morning, it would dawn on me that my patients didn’t seem to notice or care about my flaws, and I’d relax!

Although Sarah brought a Daily Mood Log to the session, listing all of the negative thoughts that were triggering her anxiety, along with many other intense negative feelings, the session took an unexpected turn in the direction of the Hidden Emotion Model.

We’ve done several podcasts on this powerful technique before, and now you have the chance to see how it works first-hand! Instead of challenging Sarah’s negative thoughts, as we usually do, we asked whether there was something bothering Sarah that she wasn’t telling us about, due to her arguably excessive “niceness.”

I think you’ll enjoy listening, and you may learn a little, too! My co-therapists for this session included Dr. Rhonda Barovsky, my beloved and brilliant podcast host, as well as Kevin Cornelius, MFT, a fabulous TEAM therapist whom I’ve recently featured in a recent blog!

Rhonda and I want to thank you, Sarah, once again, for your tremendous courage and generosity!

David and Rhonda

Rhonda and David 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,

1. 1. The definition will apply to all human beings.
   2. The definition will apply to no human beings.
   3. The definition does not apply to him.
   4. The definition does not make sense.
   5. 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, a

People in the featured photo for today's podcast. Back row: Amir, David, Rhonda, and Dave. Front row: Steve and Barb

This will be our first podcast of 2020, so we wanted to make it a really good one!

Rhonda, Dave and I are very proud to welcome Steve Reinhard and his wonderful wife, Barb, on today’s podcast. Steve and Barbara flew in from Colorado to join the Sunday hike and do this podcast in the “Murietta Studios” following the hike. Steve is a former electrical contractor and lay minister, and is the first certified life coach to be admitted into the TEAM-CBT certification program at the Feeling Good Institute in Mt. View, Ca, (link).

The following is a heart-warming email I received from Steve prior to the show.

Subject: Re: looking forward

Hi David,

Woohoo! We are partners in crime! I'm feeling super comfortable now.

Thanks David for your generous invitation! I'm happy to jump on any of the 3 options you suggested for the show. I'd love to hear your stories, especially those of undistorted sadness where you celebrated with tears, aware of the suffering we folks tend to keep hidden.

I cry a lot these days, laugh a lot too. In that regard I'd love to have my own personal Ask David session. David, I love the old, demented, weak human guy, while admiring the pioneering, genius who teaches so clearly & humanly. My questions wouldn't be so much for me to learn or be taught but to connect with you. I'm crying as I write. As a listener I want to connect with the human, David. May or may not be something you want to do. We have loads to interact with.

Yep, I take a "spiritual " approach & would love to interact with you being anti-religious. Listeners might find this helpful & it sounds fun to me. A great opportunity for me to experience a death of the ego & the acceptance paradox which I have found liberating before I knew what it was called.

I'd love to talk about what it's like to be diagnosed with blood cancer and holey bones & some of the nutty things we say to each other when we don't know what to say. Empathy in the Five Secrets way is extremely rare from my distorted perspective. Aging & being willing to challenge the many shoulds & shouldn'ts that accompany things being different than they were last year would be fun to talk about.

I can't keep track of the # of times folks repeat "getting old is hell", same with cancer, vision problems, walking problems, drug side effects. I would love to hear your stories & experience as an old demented guy who can't walk as fast as he did a couple years ago.

Thanks for your generous invitation. I still find it surprising that I get to have this experience with you all. I'm really looking forward to today’s show.

Steve

We began the podcast with a discussion of the role of lay therapists in the field of mental health. Coaching is newly emerging field of counseling that does not require graduate work in psychiatry, psychology, social work, or counseling. In the past, coaches have not been permitted to enter the TEAM-CBT certification program. However, Dr. Angela Krumm, who is the head of the FGI certification program changed that policy specifically so that Steve—and now, other certified coaches as well--can be certified in TEAM-CBT, and I applaud this change.

The role of lay therapists has always been highly controversial. I can recall that when I was in college in the 1960s, there was a lively debate about so-called “lay psychoanalysts.” Previously, you had to be an MD to be a psychoanalyst, but over time, non-MDs were permitted to become psychoanalysts. To my way of thinking, this debate

Happy Holidays to everyone! Today's podcast is nestled between Hanukkah (on the 22nd) and Christmas Eve (on the 24th.) We send our warmest greetings to all of our listeners of all religious faiths.

Today, Rhonda, Dave and David discuss three questions you have submitted:

• Does emotional trauma cause brain damage?
• Do you have to have a good cry when something traumatic happens?
• Why does avoidance make anxiety worse?

1. Is it true that emotional trauma affects the brain?

Hi again Dr Burns,

I love the 5 secrets, and have had great success in my new job by implementing them! I keep listening to all the 5 secrets podcasts over and over to keep it fresh for me and really loved the podcast on advanced techniques.

My question today is about how trauma affects the brain. ‘Trauma’ is the new buzz word in education, and psychologists are creating presentations geared for teachers and other school professionals that claim the “trauma-affected brain” is altered and cannot learn as easily. They allege imaging technology can prove this.

Do you know if PTSD/trauma actually impacts a person’s ability to learn? I thought that it was the negative thoughts that interfere with attitudes toward learning, not an actual brain impairment.

Another term that is used frequently is “intergenerational trauma”, meaning if my parent experienced trauma, it could be passed down to me and therefore impact my ability to cope with life stressors. Any thoughts? Any credible research you are aware of?

In the Ask David, could you also include your opinion on how Adverse Childhood Experiences impact people's mental health and ability to cope?  There are a range of experiences cited in studies from moving around a lot in childhood to witnessing a murder to molestation.  After listening to your podcast episode 147 (Garry with PTSD) I was satisfied with the effectiveness of TEAM to treat trauma rapidly.  But then I remembered a documentary I had seen about 'feral children' who were extremely neglected as children, and I wondered if there are some cases where the psychology or potential of a person is forever impacted by an adverse childhood experience.  Your take?

All the best,

Jackie

Educational Consultant

Mountaintop School Division

Answer

David finds these buzzwords and buzz-theories somewhat misleading, and sometimes even pseudo-scientific. He has treated large numbers of patients struggling with the effects of severe trauma, and has found that trauma patients are usually the easiest to treat and the quickest to learn. David like to focus on rapid healing, using TEAM-CBT, rather than sending people the message that they are impaired, damaged or defective because of some emotionally traumatic experience.

In fact, nearly all humans have experienced quite a lot of traumatic events, which can range from mild to extreme. And lots of us have some degree of brain damage. My brain (David Burns) was squashed at birth, for example, and there are certain cognitive functions that I’m not very good at. For example, for some reason, I can't often find something that's right in front of me, and I have lots of trouble remembering names and faces.

I just try to accept my many shortcoming and work around them. The problem is rarely our flaws or imperfections, but rather the distorted negative messages we give ourselves; messages that generate anxiety, fear, inadequacy, shame, and so forth.

Of course, animals and humans with traumatic experiences at a young age, or any age, may struggle with fear and may seem, as you say, "feral." My wife and I (David) have adopted many feral cats, and have found that consistent warmth and love can lead to dramatic changes and the development of trust. We all have a history, and every person's story and suffering deserve respect and profound compassion.

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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

In today's podcast, David and Rhonda answer two questions about suicide submitted by podcast fans.

Question 1. Why do shrinks kill themselves?

Dear Dr Burns,

Before I get to my question (which I hope you will consider addressing in your 'Ask David' segment of the podcast), I would like to extend my gratitude to you. Your book, Feeling Good, came to me at a time when I was struggling to make sense of my depression and anxiety, and it has been a vital part of my recovery journey. The exercises and the podcast have been such lifelines, and I am grateful to you for the incredible and life-changing work that you do.

I know you have addressed the topic of suicide in a previous episode, but I recently was struck by a piece of news from my alma mater, the University of Pennsylvania, where a senior member of the college's counselling services (CAPS) died by suicide. Here was someone who had spent his life's work on promoting suicide prevention, and had a great deal of knowledge on resilience. How can we process/understand the decisions that someone like this might make to take his life. How can I arrive at the understanding that his decision doesn't necessarily spell doom for the rest of us? What TEAM-CBT exercises can we do to make sense of the world when it might not make much sense at first glance, during situations like these?

Thank you very, very much,

Sindhu

Dr. David's Answer

Thanks, Sindhu, this is a really great question.

I’ll put this in the Ask David folder. Should I use your name?

Here’s the short answer. It’s a lot like saying that an infectious disease expert shouldn’t get pneumonia, or that an orthopedic surgeon shouldn’t have back pain, or a broken leg. I know of at least three mental health professionals who have committed suicide, but my knowledge based is tiny. I’m sure there are thousands of mental health professionals who have committed suicide.

People can commit suicide for many reasons, and I can only mention a few here, as my knowledge, like yours, is limited.

1. Hopelessness is one of the most common causes of suicide in depressed individuals. Hopelessness always results from cognitive distortions, and never from a valid appraisal of one’s circumstances. Depressed people often turn to suicide, thinking (wrongly) that it is the only escape from their suffering.
2. You may have done something that you are profoundly ashamed of, and fear it is about to be made public. Like the fellow in New York arrested for child abuse who hung himself just a few weeks ago.
3. I am convinced that sometimes people commit suicide to get back at someone they are angry with, someone perhaps who rejected them.
4. Physician-assisted suicide. I believe that physician assisted suicide is absolutely indicated and compassionate if someone is in excruciating pain from an irreversible terminal illness.
5. The Achievement Addiction. Feelings of failure and worthlessness. In our culture, we sometimes (wrongly) base our feelings of self-esteem on our success in life, our income, or our achievements. And so, if your achievements are only “ordinary,” you may feel worthless, like “a failure,” and kill yourself.
6. The Love Addiction: Many people (wrongly) tell themselves they must be loved to feel happy and worthwhile, and then kill themselves when they are rejected by someone they thought they loved and “needed.”
7. Drug and alcohol abuse: These habit, when severe, can greatly disrupt a person’s life. They can also make someone more impulsive, and more likely to jump or pull the trigger when intoxicated.

There are likely way more causes than just these common ones. For example, a psychotic process like schizophrenia might sometimes play a role as well.

I suspect you may have a hidden “Should Statement,” telling yourself that a mental health professional “should not” ge

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 ha

Introducing Brandon Vance, MD  & Heather Clague, MD

This podcast features the music of two beloved colleagues, Brandon Vance, MD and Heather Clague MD. Brandon and Heather are both certified TEAM-CBT psychiatrists practicing in Oakland, California. Brandon is a brilliant multi-instrumentalist and singer / song writer / performer who has transformed his vision of TEAM-CBT into music! Heather is brilliant and fun improv acting teacher and performer who is quick in her mind and on her feet! Brandon and Heather have performed at David’s annual South San Francisco psychotherapy intensive for the past several years, and we are delighted to bring them to you up close and personal today!

In today’s podcast, they’ll bring you their songs and amazing personal stories. And what is super cool is that you can follow the words for the music right here in the show notes.

Song #1

 Heather and Brandon begin with music about a familiar but painful theme for nearly all of us—the feeling of failure, and the belief that we are somehow defective or just “not good enough.” Brandon and Heather are extremely talented and successful individuals, but they are not immune from suffering. During the podcast, they describe their own painful personal experiences with depression, anxiety, shame, and defectiveness.

Most therapists, including David, were trained in the psychoanalytic tradition and told that we should NEVER disclose or reveal our own personal feelings or experiences to patients. But we believe that some personal disclosure can be very healing for patients if done with skill and compassion. Most patients want to hear this type of message from a therapist:

“I’ve been there myself, and know how much pain you’re in. And I can show you the way out of the woods, so you can experience feelings of joy and self-esteem again. And what a joy that’s going to be!”

So, with no further ado, Brandon and Heather perform their first song:

The Feel of Failure

Lyrics by Heather Clague and Brandon Vance
to the tune of “The Sound of Silence” by Paul Simon

Hello failure my old friend

I’ve come to talk with you again

Because my ego softly creeping

Infects my thoughts while I am preaching

And that vision that was planted in my brain

Still remains; becomes the Feel of Failure

 

Fool, said I, you are so lame

Done something wrong to feel this shame

Perfect is the way that you should be

Self-blame coming like a tsunami

Negative thoughts one hundred - percent on my DML

I was in hell

Suffered the Feel of Failure

 

My self-esteem had turned to shit

I needed the magic button hit

Something told me my feelings weren’t lame

Began to do a positive reframe

Maybe my feelings say something about me that is pretty fly

I set the bar high

So I have a Feel of Failure

 

I saw that I was not alone

Dared go beyond my comfort zone

I took pride in my humility

Welcomed my faults as my humanity

And in a moment of enlightenment I cried and then I laughed

I’d finally grasped

The wisdom... of the Feel... of Failure

Song #2

 The next song is on social anxiety. Brandon explains:

“I wanted to introduce this song I wrote with Amy Specter who was on your podcast on August 5th #152 a month or so ago. It’s called, “Negative Thoughts Shut your Piehole Tonight.” And it’s about social anxiety and the idea that when you’re upset, it’s not the event or the other person who’s “making you” feel upset, it’s your own negative thoughts.

“Where it gets personal for me is that I was bullied in elementary school by a group of my former friends who made up a story that I was gay - as if

One Student’s Experience

In today’s podcast, Rhonda and I are super-pleased to interview Kyle Jones again. For some time now, Kyle has been telling me that he wants to talk about his psychotherapy training experiences on a podcast. This subject is near and dear to my heart, since I do a great deal of training, so Rhonda and I decided to do this second interview with Kyle, and it’s a good one, I think! You may recall our recent interview with Kyle on his interesting research and perspective on the treatment of LGBTQ individuals several weeks ago.

Kyle is a brilliant and super-friendly 5th year graduate student in clinical psychology at Palo Alto University, and has been a member of my Tuesday evening psychotherapy training group at Stanford for the past four years as well. Kyle now sees patients at the Feeling Good Institute in Mt. View, California. He has also been promoted to small group leader in our Tuesday group, and does superb work as a teacher.

During today’s interview, Kyle, Rhonda and I focus on many critically important training and treatment issues. Kyle states that he has been exposed to many fine teachers promoting a wide variety of popular treatment “packages” at the Palo Alto University and at his practicum sites, including traditional CBT, ACT, EMDR, psychodynamic therapy, and more. However, in all cases, the therapist was encouraged to “sell” this or that approach to the patient. Unfortunately, this has a tendency to trigger resistance, and is the main cause of therapeutic failure in clinical settings as well as controlled outcome studies as well.

Paradoxical Agenda Setting, which is the secret spice of TEAM Therapy, was never mentioned in his training at Palo Alto University. When you do Paradoxical Agenda Setting, you bring the patient’s subconscious resistance to conscious awareness, and then you melt it away with a variety of innovative techniques like the Magic Button, Positive Reframing, Magic Dial, Acid Test, Gentle Ultimatum and more. The rapid reduction the patient’s resistance often leads to the high-speed, mind-boggling recoveries we frequently see in TEAM-CBT.

Kyle emphasized that he has not see a single teacher or therapist even use the simple Invitation Step in therapy, in spite of the fact that it is so incredibly basic. Essentially, after empathizing with your patient, you ask if there is something she or he wants help with during the session, or if the patient needs more time to talk and get support. Most therapists wrongly believe that this question is unnecessary since the patient is coming to therapy, so he or she MUST want help.

But in fact, nearly ALL patients have some degree of ambivalence about recovery, and if this ambivalence is ignored, the patient may, and probably will, resist the therapist’s efforts to “help.” Rhonda enthusiastically agrees that the Invitation Step is incredibly powerful and admits that it took her several years to “get it,” and that she also resisted using the Invitation Step it at first, thinking it wasn’t needed. But she failed her Level 3 Certification Exam in TEAM-CBT because she didn’t know how to do it! Once she began using it, her practiced changed dramatically. And then she easily passed her exam with flying colors!

Intense therapist resistance to these new techniques is extremely common. I once supervised a clinical psychology post-doctoral fellow at Stanford who resisted using the Invitation Step with her patients for the first two months of our supervision. All she did was schmooze with her patients.

Finally, I asked her why she wasn’t using the Invitation Step. She told me she was afraid her patients would say, “Yes, I DO want some help with problem X, Y or Z.” And then she might not know how to help them solve whatever problem they had! She said, “As long as I just schmooze with my patients, I know that nothing will change, but they’ll think it’s good therapy!” Fortunately, afte

Plus, Thomas Szaas, TV Shrinks, and more!

David and Rhonda are joined today by David's neighbor, friend, and hiking buddy, Dave Fribush. He has incredible technological skills, and wisdom.  We thank Dave for his support of our podcasts!

We open the podcast with a wonderful email from a fan named Sushant who listened to Feeling Good Podcasts for nine hours during a rigorous hike to the "Tiger Monastery" in Bhutan. You can see Sushant and his phone, showing the podcast icon, just in front of the monastery.

Rhonda encourages podcast fans from around the world to send photos of yourself listening to the Feeling Good Podcast in additional unusual or exotic locations! Might be fun to see what you send to us! 

Here are the questions for today's program:

Ann asks: Loved your podcast (on the exposure model, #26)! But I do have a question - I have suffered from panic attacks for years - the past 2 years I've become agoraphobic and don't want to be far away from my house. So, my phobia is now "having panic attacks." Does that mean I just need to go out and have a bunch of panic attacks in public to get over my fear? The thought seems terrifying.

Also, I am severely claustrophobic which affects me anytime I feel trapped (elevators, small cars, traffic, tight spaces, etc.) Is there a protocol you used to treat patients with this? Just wanted to suggest perhaps a podcast on this subject, or agoraphobia, as it does affect many people worldwide.

Nathan asks: Dear David, Love your podcasts. I am currently preparing a lecture for psychology honors students here at Monash University on assessment of depression and anxiety. In your podcasts you mention that you conducted a "study on the psychiatric inpatient unit at the Stanford Hospital, in which I evaluated how accurate therapists’ perceptions of patients were after an interaction. Student researchers interviewed patients for several hours as part of a research study on psychiatric diagnosis."

I was wondering if you could provide me with a reference to this study? I could not find a specific reference in your website and I would like to be able to highlight to student's the results of your research.

Richard asks: I listened to your podcast on being worthwhile and found it interesting. You say all people are worthwhile. This may be true but does the whole world think this?

If a person is worthwhile but the world thinks they are not worthwhile, isn't this almost as bad as not actually being worthwhile. Don't we have to play by the world’s rules, however bad, instead of our own or the Platonic rules? What do you think?

Robert asks: Dear David. I am up to podcast #108. I am heading to India next month for a three-week trek and am going to download the rest onto my phone. Perhaps by the time I get back, I will be up to date!

I have never heard you mention Tom Szasz, who, as I am sure you know, was making some of the same observations about the constructs of medicalizing you make back in the 1960s and maybe even in the 50s. In particular, his criticism of the psychiatric industry giving the names of diseases or syndromes to behavioral issues was very consistent with yours.

Robert also asks: My other question is an idea for future podcasts and it is...How about critiquing the therapeutic approach we see so often on television and in the movies? For the lay audience, these are probably the source of much of what they know about therapy. And because these therapists are well-known and fictional, it would give you an opportunity to make critiques without having to criticize an actual person. And it could introduce some levity into what can often be quite heavy.

Some of the Hollywood therapists people know best are:

• Judd Hirsch as the shrink in Ordinary P

The Story of Lorraine and “Anna”

In today’s podcast, David and Rhonda interview Dr. Lorraine Wong, a board-certified clinical psychologist, and her patient, “Anna,” who sought treatment recently for depression, anxiety, and self-image / self-esteem issues. But first, David and Rhonda answer a question submitted by Estafonia, a “public image consultant,” who asks about the treatment of a woman who sees herself as “fat.”

Estafonia wrote:

“Hi Dr. Burns,

“I am learning TEAM, CBT and implementing your techniques to help my clients change or improve their self-perception. In most cases, your techniques have been very effective. I am very grateful to you and I will happily join your list of fans!

“My question is this—What would be the best method to change someone’s self-image? How can you help people change the idea that they are fat for example?

“I have a patient who can't defeat the thought, ‘I am fat.’ We tried the method called Examine the Evidence,” and she has already found 20 people who see her as thin. So, the evidence clearly did not support her belief that she is fat. But this did not help.

“We also tried the method called Let’s Define Terms, and we both concluded that she is not fat. But now she tells me, ‘I know I am not fat, but I can't stop thinking about it.’

“We also did the Downward Arrow Technique to probe her deepest fears and Self-Defeating Beliefs, but that didn’t seem to help, either, and she keeps ruminating about being fat. I would greatly appreciate your guidance on how to help her overcome that thought!

“Thanks in advance! Estefania”

Lorraine, Rhonda, David and Anna quickly diagnose the most likely cause of Estefania’s stuckness—she is trying to “help” her patient without first melting away her patient’s resistance. This is the cause of practically all therapeutic failure, and you’re not really doing TEAM-CBT if you don’t know how to eliminate the patient’s resistance.

That’s because most people are ambivalent about change. As the Jesuit mystic, Anthony DeMello, has said: “We yearn for change but cling to the familiar.” Recognizing and modifying this inherent ambivalence is the heart of A = Paradoxical Agenda Setting, but you can also think of the A as standing for “Assessment of Resistance.”

How could we melt away this woman’s ambivalence / reluctance to stop bombarding herself with the message, “I’m fat”? It is important to realize that this self-critical thought, and, in fact, all of her negative thoughts and feelings have huge advantages for her, and also indicate some really beautiful and awesome things about her and her core values.

For example, telling herself “I’m fat” may motivate her to diet, to exercise, and to make extra sure that she doesn’t get complacent and gain a tremendous amount of weight. In addition, the thought, “I’m fat,” shows that she has high standards, and her high standards have probably motivated her success in many areas of her life. For example, she probably works really hard to stay in good health and in good physical condition.

The thought, “I’m fat,” also shows that she’s humble, and on and on and on. And that’s just one negative thought. But this woman probably has many negative thoughts and feelings, like anxiety, shame, inferiority and depression, and they ALL have tremendous advantages, and they ALL reveal what is beautiful and awesome about her and her core values.

In addition, the thought may be protecting this patient from things she fears, like intimacy. As long as she tells herself, “I’m fat,” she does have to risk trying to get close, or having sex, or risking rejection. So the thought, in a way, is a form of self-love and self-protection.

Once Estafonia and her patient list all these positives, Estafonia could ask her patient, “Given all these advantages and positive qualities, m

Ask David Five Secrets Relationship Questions

Kate asks: I love listening to your podcasts and am currently reading my way through your book, Feeling Good. I appreciate that you have written and spoken about relationship problems at length, but in what I have read and heard so far I do not see how this can apply to the current climate of casual dating and hook up culture which is fueled by apps such as Tinder.

I don't know how it's possible to build relationships when the dominant mentality is that people are disposable. It feels like no matter how much I find truth in what my date says, stroke them and empathize with them, that they will disappear ('ghost') at the drop of a hat.

I think this may be a significant problem for many of your listeners, and would greatly appreciate your thoughts, as well as any practical steps on how to date in today's world.

* * * 

Eli asks: Your work has helped me tremendously over the past 2 years. However, recently I’ve discovered something about myself that I don’t know how to change. I’d be really curious to hear your thoughts.

For some reason, when it comes to sex, it seems that I have a lot of self-worth wrapped up in my sex drive. I’m realizing when my wife and I have sex I feel like I’m on top of the world afterwards. I feel so positive the following few days and I feel mentally and emotionally healthy. But it’s devastatingly real that the reverse is true as well... when we don’t have sex (and particularly when I reach out and she’s not in the mood) and when a week or so passes that we don’t have sex, I find myself feeling very insecure. I feel ugly, unlovable and generally less valuable as a person.

Is there an exercise you would recommend for me to discover possible hidden thoughts/emotions that could be causing this? Is it possible to change this about myself?

I want to have a close, intimate relationship with my wife (sexually and non-sexually) but I also want to feel valuable and positive whether or not we’re sexually active.

PS - If, by chance, you address this on the podcast, could you refer to me as “Eli” or something else anonymous as you usually do.

Thank you for all you have do!

* * * 

Susan asks: You seem like a good person to ask this question partly because you are a man. Someone I know, I won’t say whom, told me he felt emasculated when I asked him to take my car to the gas station to get the wipers replaced.

He said that he should be able to replace them himself but doesn’t actually know how, so he would prefer if I took the car to the service station. I said that was stupid, granted not very diplomatic, and he said that’s what he gets for expressing his feelings, which I frequently complain he does not do.

To me “emasculated“ is more of a concept or a thought. I will not get into toxic masculinity and the patriarchy, but I am curious what you think. By the way, this person and I have benefited a lot from your relationship journal exercise, thankfully we did not need it this time :-)

* * * 

Knaidu asks: Here’s a specific example which occurred whilst I was trying to use the disarming technique. It is one where I failed to use the technique.

Anyway, I was meeting a friend of mine, and was a running a few min late for our lunch appointment. I couldn't send her text to let her know as I was driving. I arrived at least 5 min late. When I arrived she immediately said

"I knew it all along, you really don't want to meet with me or actually have lunch with me!”

I tried to explain that I was stuck in a traffic jam and couldn't text, but it didn’t work. Here’s what I said:

 “Please Mrs. X, I was stuck in a traffic jam and that's why I am late. Have I ever said I don't want to meet with you? And if I didn't why have I bothered t

New Ask David Questions

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

Are there some special techniques therapists need
to use when working with LGBTQ patients?

Does the therapeutic approach have to be different?

In today’s podcast, Rhonda and David interview Kyle Jones, a brilliant 5th year PhD student at Palo Alto University. Kyle has been a member of David’s training group at Stanford for the past four years, and now sees patients at the Feeling Good Institute in Mt. View, California. Today’s program is based on Kyle’s doctoral research on the treatment of LGBTQ patients.

To get the interview started, Kyle defines LGBTQ:

L = lesbian

G = gay

B = bisexual

T = transsexual

Q = questioning, or queer.

Then Rhonda asks the obvious question: How does the treatment of LGBTQ individuals differ from the treatment of individuals who are heterosexual? What are the key differences? What special techniques or procedures should therapists use? And what does Kyle’s research reveal about the important factors in the treatment of gay individuals?

Kyle emphasizes that most important factor is the therapist’s attitude toward the patient, as opposed to any special techniques or procedures that are unique to the treatment of the gay population. Sensitivity to and awareness of the unique challenges this population faces in terms of hatred and prejudice are tremendously important. Kyle points out that some therapists place an excessive focus on the patient’s gayness, while some tend to sweep this “uncomfortable” issue under the rug.

Kyle emphasizes that the therapeutic approach is largely the same for gay and straight patients. In TEAM, we first provide strong empathy, so the patient feels understood and accepted. This, of course, is crucial for all patients. Then we set the agenda, asking the patient if she or he wants help, and if so, what is the problem that he or she wants help with?

In other words, there is no special “agenda” that the therapist should impose on the treatment simply because the patient is gay. Kyle mentions that this is not a trivial point, because many therapists will try to set the agenda for the patient, thinking there is some “correct” way one should treat gay people, or some “correct” set of issues that must be addressed. David points out that thinking there is a special approach to gay patients could actually be viewed as a type of bias, thinking that the treatment of members of the LGBTQ community must be somehow “different” or special.

In TEAM, we do NOT treat disorders, diagnoses, or “types” of patients. We treat humans in a highly individualize way, using the fractal approach described in a previous podcast. In other words, we ask the client to describe one specific moment when he or she was upset and wants help. Then the treatment flows from the exploration of that specific moment, because all the patient’s problems will be encapsulated in how she or he was thinking, feeling, and behaving at that moment. The treatment might then focus on depression, anxiety, a relationship problem, or a habit or addiction.

Rhonda, Kyle and David discuss the problem of therapists who have a strong anti-gay bias. David talks about his father's work, trying to convert gay students at the University of Arizona after he retired from his work as a Lutheran Minister in Phoenix, and how much shame and anger David felt about this. David described his positive bias toward LGBTQ individuals, because of the suffering most have had to endure due to hatred and prejudice.

David asks whether gays therapists are obligated to announce their sexual orientation to their patients, and Rhonda and Kyle come up with some pretty cool answers! Rhonda points out that when and how to do self-disclosure is a question all therapists face, and that the goal of self-disclosure in therapy should be on how best to help the patient, not the therapist. Again, this question of the

What can you do when you can’t identify your negative thoughts? Is it really true that our feelings always result from negative thoughts? How can I get over my public speaking anxiety?

Rubens, a faithful and enthusiastic Feeling Good Podcast fan, sent me an email with a terrific question that has both  practical and theoretical implications. He wrote:

Dear Mr. David,

I've read "Feeling Good" and I'm reading "When Panic Attacks" now. Both have and are helping me immensely.

However, the one thing I have never understood is that my anxieties and worries often don't come as a thought. For instance, I have an academic presentation tomorrow, and I'm suffering from much anxiety because of that. But the symptoms did not appear because I thought in my mind the sentence "you are going to fail!". In my case, it is usually silent. I just remember that I have a presentation tomorrow, then I immediately feel worried. My chest hurts before any thought. How do I counter-argument my thoughts, if I have none?

Thank you for replying, Mr. David!

 In today's podcast, Rhonda and I address this question and explain what to do when you can't pinpoint your negative thoughts. There are  two really good methods.

We will also demonstrate how to deal with some of the negative thoughts that typically trigger public speaking anxiety. The cure involves changing the way you think, and changing the way you communicate with the people in your audience. If you've ever struggled with public speaking anxiety, this podcast may be helpful for you!

Thank you again, Rubens, for your excellent question!

David D. Burns, MD / Rhonda Barovsky, PsyD

 

How would you overcome the fear of aging? Can you use TEAM for sports psychology? Describe your typical day, David--
do you ever get down or anxious?

Hi Listeners:

Thanks for your many and awesome questions. I love to answer them! And there will be more to come in future podcasts. Your questions are GREAT! 

1. Vipul: Tell us about your new book, Feeling Great. How will it be different from Feeling Good? And can people with schizoaffective disorder be helped? (story with Stirling Moorey)
2. Guy: What’s a nervous breakdown?
3. Rob: How would you treat a field goal kicker who’s afraid of missing the winning field goal? Would you use positive visualizations?
4. Michael: How would you treat someone with the fear of aging? I turn 60 in a few months, and have been experiencing anxiety around not be able to do some of the things I love as I age.
5. Hidem: How fast is fast? I notice your frequent use of the term "High Speed Recovery" (and even Warp Speed) when describing the benefits of TEAM CBT. How rapidly does the average patient recover?
6. Brittany: I had an idea that I think would benefit a lot of us. I’d like you to do a podcast on a week or a day in your life. The ups & downs of your moods, triggers, etc., & most importantly how you deal with them. Do you write out your own Negative Thoughts a Daily Mood Log?

Thank you for all of your great questions, comments, and testimonials! Rhonda and I really appreciate that!  

David and Rhonda

PS Here's a great question we did not get to today. We'll do it in a future Ask David, as it's really important. 

1. Rubens: What can you do when you can’t identify your negative thoughts? I get anxious, but don’t seem to have any negative thoughts. Is it really true that our feelings always result from negative thoughts?

 

Is it REALLY Possible? And Can the Effects Last?

Rhonda and David interview Garry, a veteran who David treated for PTSD several years ago at a trauma workshop in Michigan. Garry describes how a repressed horrific memory from his childhood suddenly and forcefully re-emerged when he smelled some Queen Anne’s Lace that were in blossom. He suddenly remembered how a school bus he was riding home on hit a horse with a boy, Tommy, who was riding bareback, when the horse suddenly lurched in front of the bus. Tommy was Gary’s classmate.

The bus driver said, “Don’t look!” But Garry watched as his friend, who was trapped under the dead horse, “bled out” and died.

Once this totally forgotten memory re-emerged decades later, roughly 18 months prior to Garry’s session with David, it constantly intruded into Garry’s every interaction for the next year and a half. Garry says,

“I was seeing Tommy all the time, and having symptoms of anxiety, intrusive memory and dissociation experiences. I would often see the image of Tommy lying on the pavement superimposed over conversations I was happened with people in an intimate way. It was quite disturbing and anxiety provoking.”

Garry tearfully describes what he experienced during his TEAM-CBT session with David, including his dissociation at one point during the session, and the profound changes he experienced by the end of the session.

Can severe PTSD be treated in a single therapy session? Did Garry really improve? Were the changes real? Did they last? And how did the therapy work?

You’ll find out when you listen to this amazing and inspiring interview! We are incredibly indebted to Garry for his courage and openness to share this experience with all of you!

 

 

Hi Listeners:

Many of our podcasts are inspired by listeners like you who send us really cool emails with show ideas. Sometimes the emails are from people wanting self-help with emotional or relationship conflicts. And sometimes, they are from therapists wanting more training and information about TEAM. Rhonda and I love your emails!

Yesterday, I got the following email from Dipti Joshi, one of our listeners and TEAM-CBT therapists from India. Dipti flew all the way from India to Canada with her lovely daughter last summer for my Intensive in Whistler, Canada. I am hopeful that Dipti will one day create the first TEAM Treatment and Training Center in India. How cool would that be!

Here’s the email that Dipti sent me:

Dear David,

I am really enjoying all the educational materials available on your website. Thank you! I will soon be taking my Level 3 TEAM certification exam, and am seeking your kind blessings for the same!

Also, I have a special request for you. Is it possible to have a workshop or podcast on “paradoxical techniques?” I feel this is a very challenging area, and that a lot of skill is needed. Perhaps you can also talk about why paradoxical techniques can be so effective.

Meanwhile can you suggest me something to read or listen to for this?

Regards, Dipti 

Thanks, Dipit! Today’s podcast will be an introduction to the use of paradox in TEAM therapy, a kind of overview. When my new book, Feeling Great, comes out, I am hoping to do a series of workshops on a variety of powerful paradoxical techniques. And of course, the new book will have a great deal of instruction on paradoxical techniques as well.

These are the four key components of TEAM:

T = Testing

E = Empathy

A = (Paradoxical) Agenda Setting

M = Methods

In today's podcast, Dr. Rhonda and I will explain why each of these components is inherently paradoxical. For example, when you do the T = Testing, you assess changes in the patient’s symptoms from the start to the end of the session, and the patient rates you on the Empathy and Helpfulness scales as well, When you look at the ratings, you will probably discover that you aren’t helping your patient much, if at all. You may also discover that your perxceptions of how the patient feels, and how the patients feels about  you, are off-base, and sometimes alarmingly so.

This can be very disturbing, especially if you’re not use to this kind of information. However, in TEAM, we are actually hoping for failure, and welcome that kind of "disturbing" information. Why is this? Isn’t therapy all about recovery and making positive changes? Why in the world would the therapist want to know that he or she is not helping?

It's because many of the most important breakthroughs in therapy come from the therapist's discovery that he or she is failing. We WANT to fail! Why? 

David illustrates this paradox by describing his discovery that he was not actually helping a patient he thought he’d helped enormously. David explains how and why this shocking information led to a tremendous breakthrough.

When you review how your patient rated you at the end of the session, you may discover that your patient gives you failing grades on the E = Empathy scale. The patient’s ratings may indicate that he or she didn't experience you as sufficiently warm and caring, or completely trustworthy, and that you didn’t really “get” how she or he was feeling inside.

Once again, as TEAM therapists we welcome failing grades on the Empathy Scale. Why? It’s because your worst therapeutic failure will nearly always be your greatest success in disguise.

How can this be? It seems absurd, or impossible. Karl Rogers told us that empathy is the necessary and sufficient condition for personality change. So why would a TEAM therapist hope to discover that he or she is failing in this category?

Y

My wife claims that I never listen! How can I possibly agree with her?  My wife left me! How can I correct the distortions in her criticisms? How can you deal with people who constantly wallow in self-pity? And more!

Hi podcast fans,

Today we've got some terrific Five Secrets questions that you have submitted.

1. Mike #1: I love your Five Secrets of Effective Communication. Why does secret #4, “I Feel” Statements, not include Thought Empathy?
2. Mike #2: I have seen communication models that include expressing and listening for needs. Aren’t needs and wants important and important to express?
3. Al: How can I help my wife recognize her many cognitive distortions, like All-or-Nothing Thinking? It seems hopeless!
4. Guy: If a loved one says, “You never listen,” how could I possibly find the truth in this statement? How could you genuinely agree with an All-or-Nothing statement such as, “You never ….”?
5. Both Sonja and Eileen asked: How can you deal with someone who constantly wallows in self-pity and plays the role of victim. It's exhausting!

Thanks for tuning in, and keep the great questions coming!

David and Rhonda

Do I have ADHD? Is it a real disorder? 

Hi podcast fans,

Today we've got some terrific questions that you have submitted.

General Questions

1. Jose and Bri both asked: How would you treat hypochondria?
2. Christian: How would you treat an abuse survivor? I’ve heard that talk therapy is inadequate for healing trauma!
3. Ted: Is there such a thing as healthy euphoria?
4. Hillary: Would you do a podcast covering the treatment of mania?
5. Jim: I think I have ADHD, but some doctors claim it’s not a true diagnosis. What do you think?
6. Dan: What your thoughts are on LSD in the treatment of depression and anxiety?

I could not get to all of your excellent questions in the time provided. The next time we do Ask David with general questions, we will include these:

1. Guy: What’s a nervous breakdown?
2. Rob: How would you treat a field goal kicker who’s afraid of missing the winning field goal? Would you use positive visualizations?
3. Michael: How would you treat someone with the fear of aging? I turn 60 in a few months!
4. Hidem: How fast is fast? You seem to get super-fast recoveries from your patients most of the time. How about other therapists? How rapidly does the average patient recover> 
5. Rubens: What you can do when you're upset but can't identify any negtaive thoughts?

Next week, our Ask David will focus on questions about relationship conflicts and problems. Rhonda and I have lots of other cool programs planned in upcoming weeks.

Thanks for tuning in today, and over the past months. We will hit one million downloads in a week or two (this is April, 2019). Rhonda, Fabrice, and I deeply appreciate your support!

David and Rhonda

Rhonda, Fabrice and I received a number of thoughtful emails following our recent podcast on mindfulness meditation, which seems to be quite popular these days, but there some push-back from listeners who all did not agree that mindfulness is an effective way of combating negative thoughts and feelings.

Email from Jeremy

Hi David,

I listened to the Feeling Good Podcast on meditation this morning and had some thoughts I wanted to share. For context I've been meditating daily for about 3 months.

First - I personally think that if someone is struggling with depression or anxiety, TEAM-CBT is a dramatically faster acting and more powerful tool than mindfulness. I've never seen or heard about someone having a dramatic recovering in just a few hours due to mindfulness. I've never seen the idea of resistance explored in any kind of mindfulness book or article.

I also don't really think much of mindfulness as a "method" in the TEAM model, because compared to the other methods for removing negative thoughts it's extremely weak. I imagine that with hundreds of hours of mindfulness practice you might reach a point where it's easier to let go of negative thoughts. (There are a lot of reports like that/) However, it's a very slow way of dealing with negative thoughts compared to externalization of voices etc. 

I think for a therapist who knows TEAM to suggest mindfulness as a key practice to their patient is almost negligent, since TEAM is so much more effective.

That said, I've sensed a few benefits of mindfulness which is why I've been investing my time in it:

- I think you can view meditation as concentration practice, and I've found that meditation increases my ability to concentrate 

- You can reach a very calm and relaxed state in meditation where you cease to have thoughts, and this state is extremely pleasurable

- I've noticed that mindfulness increase my ability to enjoy experiences, including experiences I might enjoy less if I was having even positive or neutral thoughts. As an example, after about 30 minutes of meditation the other day I went for a walk in the woods and stop for about 10 minutes to look at a ridge. My visual experience was completely immersive and I even started to feel like the trees were breathing with me. It was one of the high points of my week. I suspect that even someone who had no negative thoughts might be flooded with positive but irrelevant thoughts (like a yummy meal they might be headed to eat later) would have enjoyed this scene much less. 

I've also run an experiment using the PAS and CBT to remove the motivation to have distracting thoughts. (ie write down the advantages to having distracting thoughts and disadvantages of focusing on the breath, and then talk back to those) I would classify it as a highly successful experiment, after talking back to all the good reasons to think about something besides my breath my focus got dramatically better. I wonder if this technique could be used to either improve meditation or even supplant the need for it. (because it gets rid of distracting thoughts directly, while meditation is basically practice for having fewer distracting thoughts) 

Anyway, just thought I would share some thoughts and ideas with you. 

Best, 

Jeremy

Email from Paul

Hey, Dr. Burns!

I am with you in terms of the skepticism of mindfulness as a panacea. I also am not sure how particularly effective it is even as a tool in the fight against negative thoughts. I personally cannot seem to get anything out of it, but I am trying to make sense out of how so many people can find it useful.

Perhaps you could put it like this: Mindfulness is not a specific technique for specific problems, but a general method for psychological health. If you have a specific medical condition, you'll want to get a specific treatment. Sometimes specific conditions can be alleviated by tak

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