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

Author: David Burns, MD

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This podcast features David D. Burns MD, author of "Feeling Good, The New Mood Therapy," describing powerful new techniques to overcome depression and anxiety and develop greater joy and self-esteem. For therapists and the general public alike!
358 Episodes
Live Therapy with Veena: Part 2 of 3 Last week you heard the first half of the session with Veena, a young woman who was devastated by a medical problem that may make it difficult or impossible to conceive the child she is dreaming of. Today, you will hear the inspiring and dramatic conclusion of her story, along with the feedback comments from the individuals in David and Jill's Tuesday training group who witnessed the live work. A = Assessment of Resistance Jill asked if she felt ready to roll up her sleeves and get to work on some aspect of what she’d been telling us, and she was. Jill then asked what she was hoping to get from tonight’s session. If we could offer a “Miracle Cure,” what would that look like? She said, “I’d feel a lot less guilty and responsible, so I would no longer feel like the problem was my fault. I’d know that I did my best and that I can be okay even if people don’t like me or judge me. Jill asked the Magic Button question, and she said that she love to see her guilt go all the way to zero, but not her many other negative feelings, like depression, anxiety, inadequacy, self-consciousness, hopelessness, upset, insecurity and self-doubt. With Positive Reframing in mind, we listed many of the positives in these negative feelings, including: Sadness. This feeling shows that I care for people and want to give them the best. It shows that I also care for my own dreams of having a baby. And it shows how much I love my mother. Anxiety, worry. This is a warning signal, reminding me to be alert and do my best, and do what the doctors require. Guilt. Shows that I’m humble and willing to be accountable and examine what I’ve done and look at my own mistakes. Self-Consciousness. Protects me by making me cautious so I don’t just blurt out everything. Defectiveness. I see my flaws, and allows me to get closer to others, and to feel happy for the success of others. Hopelessness. When I told my husband I felt hopeless, he became SO supportive. Also, I gave myself some space so I could create an action plan. You can see the goals Veena set for each emotion on her Daily Mood Log if you click HERE. Veena with her in-laws M = Methods During the methods phase of the session, we used a variety of techniques, especially Externalization of Voices with the Acceptance Paradox, Self-Defense, and the CAT (Counterattack Technique.) We did quite a few role-reversals, which is typical, before Veena got to wins that were “huge.” There were lots of tears and laughter, and eventually Veena blew all of her negative thoughts out of the water. It was inspiring to observe this process, and to be a part of it. You can see her final Daily Mood Log if you click HERE. I think it is fair to say the Veena experienced a kind of enlightenment which was profound. Final T = Testing You can see Veena’s end-of-session Brief Mood Survey and Evaluation of Therapy Session if you click HERE. You can also see her final Daily Mood LOG if you click here. Our work with Veena was some of the most inspiring work that I can recall. It was tremendously mood-uplifting, and took on a spiritual quality. You will have to listen to the session to get a feel for how majestic it was. But in my opinion, Veena did not just recover, but she achieved enlightenment, which including discovering how to love herself and her extended family as well! The following is an email I sent Veena the next morning: Hi Veena, Thanks. You were totally awesome last night, thanks so much for your contribution. I am sure the podcast will reach huge numbers of people and make a big impact on peoples’ lives. I cannot remember a more exciting and loving session. We will see what the groups thinks in the feedback. I did not copy or read the chats during the session, but perhaps you or Jill did. . . We will invite you to join us on a podcast recording to get some follow-up information from you, as folks will be very interested, for the two-part podcast. Yes, I think we really were walking on holy ground last night! Thanks so much for making that happen! I am trying to recall (and will do more of this) the teaching points from last night, and a few seem important to me. They seem awfully basic and simple, but still of towering importance and have to be “seen” to be understood at a deep level. 1. In TEAM, even when a problem is “real,” it is still our thoughts that create our emotions. Our thoughts really DO create all of our feelings. 2. Those thoughts can be subtly distorted in all kinds of ways and seem determined to trick us into believing things that are not true. And even super smart people, like Veena, can be fooled. 3. We are not aiming for improvement, although that is obviously desirable, but a dramatic transformation of the human spirit and outlook. 4. Warmth, tenderness, and compassion—for others and for yourself--are important and powerful. 5. There is a strong mind-body connection, and healing your soul can often help to heal your body. 6. Good therapy can sometimes be much more than just “therapy.” Something almost magical can sometimes happen, and the change can sometimes happen rapidly. However, many people do not like hearing this, and some are even angered by this idea! This is especially true of people who have suffered and struggled for many years without success in changing the way they think and feel. 7. Recovery sometimes requires courage and trust. Just more babbling from the old guy! Apologies if it sounds ridiculous or “off.” If other teaching points come to mind, please let us know so I can add them to the list! I am betting that Jill and Veena can maybe add to this list! (and edit it as well) Warmly, david Below, you will find some excepts from the feedback that the participants provided after the session. Please describe what you specifically disliked about the training? What could have been improved? Were there some things you disagreed with or did not understand?  Nothing. It was beautiful. I wouldn't want to change anything about tonight's experience. It was so moving! Please describe what you specifically liked about the training? What was the most helpful? Were there some things you learned? I loved Veena's personal work and besides my admiration and pride of her and the gratefulness to David and Jill for sharing this wonderful work . . . I enjoy the empathy and validation as well as the trust in the process that was so beautifully demonstrated. Beautiful job by all concerned. Very impressed with Veena and how clearly she "got it" when she used the CAT (Counterattack Technique). I was very moved by Veena's story and her courage in sharing it with us. I felt as if we were witnessing a kind of history because, in the past, wives who couldn't bear children were often devalued and even rejected. Veena pushed back against that kind of thinking and instead chose to love herself. By working toward dispelling the distorted thoughts, she affirmed not only herself, but women with similar experiences now and throughout history. When she affirmed that her mother, mother-in-law, and husband would be empathetic and wouldn't actually reject her, I felt elated, thinking that the world is making progress and becoming a more compassionate place. I was also touched by the following ideas: feeling genuine sadness without distortions; locating the source of pain in distorted self-critical thoughts; painful experiences bringing loved ones closer together. The safe space that was created, the sensitivity with which the topic was handled and the respect accorded to the client. It’s incredible how the trainers (Dr. Burns & Jill), set aside their ailments, and were with Veena through her journey of anticipatory loss, and her fears and apprehensions, along with her inner battle of dealing with deeply entrenched social conditionings, that are hard to face and ward off. I loved the session. Enjoyed watching the whole team model unfold. I’m so grateful to Veena for sharing this previous part of her life with all of us. It was a huge honor. I am constantly surprised by Dr Burns’ and Jill’s mastery of TEAM and their deep empathy skills. This was moving and exhilarating…all at once. Observing two great therapists in action. I liked how Jill and David would make notes to the class about what step they were going on to next. Veena was so amazing and brave to share her experience. As a 23 year old woman with fears of fertility issues myself due to genetics, I found the experience extremely profound and impactful on a personal level. It was awesome to go from the NEWBIE group to this session whereby a lot of the skills we were learning individually were incorporated sequentially into the session. Thank you to everyone!! I liked seeing david and jill go through the entire team model. I liked the pointing out of the Emotional Reasoning distortion and even using the straight forward technique. Excellent! I really liked seeing an entire session completed in one sitting. A very beautiful night. I really felt for Veena and what she is going through, and it was great to see her recovery. David and Jill were empathic and so knowledgeable. The humor in dark moments. the tears from time to time It was exciting to see how as Veena shed the self-blame, simultaneously she was able to see the people in her life as the caring, kind people she knows them to be--and no longer to feel afraid that they would reject her. Accepting herself allowed her to see others as accepting, and not critical. What training could be better than watching David and Jill tag TEAM thru the model! Thanks to Veena's willingness to be vulnerable and her bravery doing this personal work and inviting us all into her world and her pain. It felt like we were all a web of love and support surrounding her and a privilege to get to know her. It was extraordinarily rich and illuminating. I loved everything: the incredible empathy Jill and David demonstrated and how things were turned around for Veena. I was amazed that this was
Live Therapy with Veena “It's all my fault!” The star of today’s 2-part podcast is Veena Mulchandani, a 28-year old certified Indian TEAM therapist who has just learned that her difficulties becoming pregnant result from an infection in one of her fallopian tubes. Veen feels devastated and fears that she might never be able to have a child. She also fears that her husband and extended family will judge and reject her, since there is so much pressure in Indian culture for women to have babies. And although she has many medical options, including IVF, she is intensely fearful that they might not be successful. My beloved colleague, Dr. Jill Levitt, will be my co-therapist for today’s session. Jill is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California ( Today you will hear part 1 (T = Testing and E = Empathy), and next week you will hear the exciting conclusion (A = Assessment of Resistance and M = Methods), along with some follow-up. Part 3 will be the Relapse Prevention Training we did one week after treating Veena. Jill and I treated Veena in our Tuesday evening training group at Stanford. We feel that personal work is an essential part of the training of any therapist. Veena with her two very beloved nephews who she considers being a mother to T = Testing and E = Empathy At the start of the session, we reviewed Veena's Brief Mood Survey just prior to the start of the session. You can review it if you click on it here. Veena was tearful and said that to make matters worse, her mother has been recently diagnosed with brain cancer, and although she is doing “okay,” she is not doing “great.” Veena explained that she has always dreamed of being a mother, and feels like she is lettin down the many people who love her and want to see her have a baby. She and her husband first talked about having children when Veena was 24, but they decided to defer that for a few years because of the intense demands of her graduate schooling. Now Veena is blaming herself, thinking she “should” have gotten pregnant when she was 24. I mentioned to Veena that my parents tried but were unable to create a pregnancy, so they finally adopted 3 children. Then I came along unexpectedly, after they had given up. I also said that I’ve treated many women who felt like they couldn’t become pregnant, who then became pregnant. You can listen to the dramatic podcasts featuring my session with Daisy and her husband, Zane (#79 and #80) as well as podcasts 268 and 269 featuring a session with Carly (Click here for list of podcasts with links). Both women became pregnant shortly after those sessions, and I hope we can do the same for Veena! However, the key is overcoming the tremendous despair, shame, anxiety, and disappointment that the woman feels, so that the body can heal and prepare for the pregnancy. You can see Veenas partially completed Daily Mood Log if you click here. As you can see, her negative feelings are extreme, and she is telling herself that I may never be a mother. I will ruin Sumit’s (her husband’s) life with her. My marriage may go “down the line” because of the absence of a kid. It’s all my fault for postponing the pregnancy when I was 24. My in-laws, who love me so much, may start ignoring me because I cannot give them an heir. I will always be looked down on and sidelined by my own people. My mother is ill, and I will not be a good daughter if I cannot give her a grandchild. There is no meaning to life without children. My own body cannot suffice for my baby. Her belief in these thoughts ranged from 60 to 80 or more, and she rated most at 100%. Veena with parents I asked Veena how she was feeling after opening up in front of so many colleagues in the Tuesday group. She said she felt sensitive and exposed, and was afraid they don’t understand and will also judge her for not starting earlier with attempts to become pregnant. Although we were still in the Empathy phase of the session, I suggested she might want to do an experiment to find out how they were feeling. Although this idea made her anxious, she asked quite a number of the Tuesday group members how they felt, and received an outpour of warmth, love, tenderness, and support. We asked Veena how we were doing in terms of Empathy. Did we understand how she was thinking? How she was feeling inside? And did she feel accepted. She gave us an A+, and so we were ready to move on to the A = Assessment of Resistance, which you will hear at the start of next week’s podcast. Thank you for listening today! Veena, Rhonda, Jill, and David
Making Space for Grief Featuring Thai-An Truong, LPC, LADC Today, we feature a popular podcast guest, Thai-An Truong who joins us from Oklahoma. Thai-An is a level 5 Certified TEAM therapist and trainer who specializes in post-partum problems as well as anxiety disorders, with a special focus on OCD. Today Thai-An describes a TEAM-CBT technique to help with grief. She believes that empathy is always crucial, and emphasizes that people who have lost a loved one need to be encouraged to express and accept their feelings and to make space for their grief. However, because empathy alone may not be enough, it is often helpful to go beyond empathy and offer specialized techniques to help the patient deal with feelings of grief and loss. In her work specializing in women struggling with post-partum depression, she has seen many women grieving over a loss—such as the loss of a pregnancy, or the loss of a parent when their child is young, or the loss of an infant at birth, or during the first couple months after delivery. She said that the entire TEAM model can be invaluable, including the initial Testing and Empathy, the Daily Mood Log to detect the grieving patient’s (often distorted) negative thoughts, as well as the Assessment of Resistance (the positive reframing step, and the Methods. Healthy grief is often complicated by feelings such as depression, guilt, anger, and more. These feelings can complicate and get in the way of healthy grieving. For example, Rhonda treated a woman who was struggling with guilt over the death of her son, who was in great pain because of advanced, metastatic cancer. At one point, she told him that it was okay to “let go,” and her son died shortly after that. But then, she felt guilty and blamed herself for his death, thinking he might have lived several more days if she had not said that. Thai-An said that losing a son or daughter is one of the greatest pains a parent can have. You may beat up on yourself with “I should have done X” or “I shouldn’t have said or done Y.” But these negative, self-critical thoughts and feelings will nearly always be expressions of your core values as a human being, and your love for the child you lost. This can sometimes be eye-opening, and a relief for the person who is grieving. Thai-An has struggled with grief. She told us about the loss of one of her best friends 16 years ago. He was like a brother, a young man with bipolar manic-depressive illness. At times during manic episodes, he would get high and go out “teaching” on the streets. During one of these episodes something tragic happened—Thai-An was unable to find out what—but her friend was found dead in an alley. Thai-An felt a profound sadness and regret, and to compound the problem, her friend’s mother cut ties with Thai-An, who didn’t even know if a funeral was held or was able to ask any questions about what happened to him.. Thai-An felt understandably hurt and angry,. She recently found out he was buried near a Buddhist Temple in Houston, Texas. She emphasized the value of maintaining a ritual with the person who has died so as to continue the relationship. For example, a woman had a beautiful baby boy who died of an overwhelming infection shortly after he was born. This woman loves nature, and thinks of her son whenever she gardens. For example, when she sees a little bird, she thinks, “that little bird looks just like him!” Thai-An feels that a wide variety of rituals can nurture the bond with the person who died. You might light a candle, or even bake a cake for the baby or person you have lost. The goal is not to achieve some kind of “closure” that is so often emphasized in the media, but rather to continue a positive and meaningful relationship with the person you have lost. Thai-An illustrated a therapeutic technique she calls the Grief Method that involves doing a role-play with the person who has died. The therapist first gathers messages that the grieving patient would like to share with their deceased loved one. The therapist then takes on the role of the patient as the patient takes on the role of the person who has diedThis gives the patient the chance to have a conversation with the love one they have lost. In the following role play, Rhonda played the role of Sam, the young man who died of overwhelming cancer, and Thai-An played the role of his mother, who was grieving and feeling guilty about her son’s tragic death. Thai-An (as Mother): Hi Sam, I really miss you every single day. Rhonda (as Sam): Hi Mom, you’re the person I miss the most. Thai-An (as Mother): I’m sorry we had an argument shortly before you died. Rhonda (as Sam): It’s no big deal. . . We got into little fights pretty often. . . but we always got over it. Thai-An (as Mother): I regret that I left when the doctor told me to leave the room. I should have stayed, so I could be with you when you died. Rhonda (as Sam): I understood that they pushed you to leave the room, and I know that you would have stayed if they’d let you. . . I was in a lot of pain, and I was ready to leave. You gave me a lot of reassurance. Now I’m with grandma. Thai-An (as Mother): I would have done everything for you. Rhonda and Thai-An processed the experience together, and they both cried, even though it was only a role play. Thai-An emphasized the importance of letting your negative feelings flow, and continuing your bond with the person or beloved pet you have lost. For parents who have suffered the loss of a child, Thai-An recommends the book Shattered: Surviving the Loss of a Child by Gary Roe. To access her free grief training for therapists, you can visit This summer, Thai-An will be offering a special 14-week training course (2 hours / week) which will focus on treating individuals and couples with relationship problems using TEAM. For more information on this and other TEAM training courses, go to . Thank you for tuning in today! Rhonda, Thai-An, and David
The Invitation Step in Family Life: "Dad! Don't give me that psychology crap!" Today we are joined by our beloved Mike Christensen and his wonderful daughter, Caelyn, for a discussion of one of the humblest but most important and challenging tools in TEAM-CBT, the Invitation Step. We will focus on how this can be important in family life as well. Caelyn will be entering college in the fall, and plans to major in psychology, but she has already picked up a lot of TEAM-CBT from her dad. We’ll tell you more about her at the end of the show notes. The invitation step is the bridge from the E = Empathy phase of TEAM-CBT to the A = Assessment of Resistance, but you don’t issue an invitation until you get an “A” in Empathy from your patient. This generally takes about 25 minutes or so with a new patient if you empathize skillfully using the Five Secrets of Effective Communication. There are two types of Invitations: the Straightforward and the Paradoxical. The Straightforward Invitation is for reasonably cooperative and motivated individuals who are struggling with individual mood problems, like depression and anxiety, and it’s fairly simple. You simply say something along these lines: Jim (or whatever the patient’s name is), you’ve told me some pretty heartbreaking and painful problems you’re confronting, including X, Y, and Z, and I’d love to help you change the way you’ve been thinking and feeling. I’m wondering if this might be a good time to roll up our sleeves and get to work, or if you need more time to talk and vent, because that’s important and I don’t want to jump in before you’re ready. Typically, the person will say “I’m ready,” and you’re all set to set the agenda for the session and reduce the patient’s resistance to change using the many familiar TEAM-CBT techniques, like Miracle Cure Question, Magic Button, Positive Reframing, Magic Dial, and more. The Paradoxical Invitation is for patients who seem unmotivated or even oppositional, and is intended for patients who are struggling with Relationship Problems or Habits and Addictions. Unlike the Straightforward Invitation, your assumption is that the patient probably is NOT asking for help, but just wants to vent, so you might say something along these lines: Sarah (or whatever the patient’s name is), you’ve told me some pretty upsetting things about your conflict with your sister ever since you were young. You say she constantly criticizes you and says things that aren’t really true, and that you’ve tried everything, but nothing works. For example, she insists that you look down on her because you have a PhD, and she didn’t graduate from college, and when you tell her that’s not true she just gets enraged. I can understand how frustrating that must be for you. I’ve got some really cool tools that might help you turn things around and develop a more loving relationship with her, and I think you’d really learn these tools quickly because you’re clearly very smart, but I’m not hearing that you’re asking for that. I’m thinking that you mainly wanted to let me know how difficult and impossible she is. Am I reading you right? I’d love to work with you on your relationship, but would totally understand if that isn’t what you’re looking for. So, in the Paradoxical Invitation, you’re asking the patient to put their cards on the table and acknowledge that they’re NOT looking for help. This prevents a power struggle and you can ask them if there’s something they DO want help with. At the start of today’s podcast, Mike pointed out that the Invitation Step is not only important in therapy, but in family life as well. For example, a lot of parents ask him, “How do I help my teen?” Well, the first answer is to stop trying to help and use the Five Secrets of Effective Communication to listen and understand where your teen is coming from. This is actually hard to do, because so many parents struggle with the compulsion to throw “help” at their kids, and this usually just creates a lot of tension. At the same time, Mike emphasizes that many parents ask, “Well, what do I do when I’m doing empathizing?” Mike says, “That’s the time to issue your invitation. If I don’t do that, Caelyn gets irritated and says, “Don’t’ give me that psychology crap!” If I jump in and try to help or give advice (which is what all parents do almost all of the time) it just ends up in a power struggle. Mike sometimes asks this question: “Did you just want to get that off your chest? What do you want going forward?” Mike and Caelyn did some role-playing to illustrate how this is done, including bad parent technique and excellent parent technique. Caelyn described a disturbing interaction with an angry customer where she works, and Mike first played the “bad dad” and then the “good dad”. Caelyn was delightfully wise and skillful and is heading for a great career in counseling or psychology. For more on this topic, you might want to listen to the podcast #164 on “How to help and how NOT to help!” LINK: How to HELP, and how NOT to Help! Rhonda and I love Mike, and Caelyn as well, and were touched by getting to take a look inside of a real and beautiful father-daughter relationship! Caelyn Bio Sketch Caelyn is a keen student of psychology and is starting her university career in the fall of 2023 She loves animals (her Cat Evie and horse Tulio top the list) and has studied positive reinforcement focused training with horses, under Adele Shaw, at The Willing Equine in Texas. She has read a number of Doctor Burns's books and  implements his CBT principles into her writing. Currently she works full time in customer service at a beauty salon and part time at a garden center where she gets regular opportunities to practice  her 5 secrets skills.  She is a big fan of Taylor Swift. Thank you, Mike and Caelyn, for an awesome interview today! Warmly, Rhonda and David
The Outer Bully Featuring Matthew May, MD Today we are proud to be joined again by our old pal, Matthew May, MD. This is a special two-part edition of Ask David, focusing on two of the most important problems that trigger emotional and interpersonal suffering. Last week, Matt led our discussion of the Inner Bully that causes the lion’s share of internal suffering in the world. Feelings of depression and anxiety always result from the harsh distorted messages we give ourselves, telling ourselves we’re “less than,” or “defective,” or “unlovable,” and so forth. However, the world is also filled with Outer Bullies who can be threatening, even violent. Today we describe how you can often deal with the Outer bully with the Five Secrets of Effective Communication (LINK). Today’s podcast was inspired by a question submitted by Guillermo, one of our podcast fans: Hello, Dr Burns I’ve seen some cases of bullying lately in schools. Would the 5 secrets help a kid who is being bullied in school? (Not physical bullying). I have a son who will be going to middle school next year and wonder about this. David’s Reply Hi Guillermo, Thanks, I might read question on podcast and address it. Might have two consecutive shows on the "inner bully" and then the "outer bully." I know one thing for sure, although I am not an expert in this area, and haven't worked much with kids. But ultimately, only your thoughts can upset you. The words and criticisms of others will never upset you, unless you buy into them. So, the good old Daily Mood Log is always the first step. Once you no longer find bullying threatening, it becomes much easier to deal with it. The bully relies on getting you all scared and terrified and hurt and so forth. Warmly, david Matt began today’s podcast with a real case description working with a violent, involuntarily hospitalized, 6’6” patient weighing 300 pounds snuck into his office while Matt was dictating his notes, locked the door, and announced that he was going to kill Matt because the involuntary hospitalization was “illegal.” The man had been brought to the hospital by the police in a psychotic manic state because of bizarre behavior at his home that troubled the neighbors. Matt was terrified and said, “That was just one occasion when the Five Secrets of Effective Communication saved my life!” Link to Five Secrets Here's what Matt said to the man. I will indicate the communication technique(s) in each sentence in parentheses at the end of each sentence: “You’re right! (Disarming Technique) You served your country and fought for our freedom (Stroking) and now we’re taking away your freedom. (Disarming Technique) I feel the same way you do, (I Feel Statement). Can you tell me more about what you’ve been going through?  (Inquiry)” The man was taken aback and immediately sat down and began to open up. Matt continued to empathize, using the Five Secrets, and after a few minutes the patient fell asleep in his chair. He was then transferred to a higher security hospital ward. Essentially, Matt sided with him, rather than getting defensive or arguing, and saw the truth in what the man was saying, in spite of the fact that he was floridly psychotic, and treated the man with respect. David summarized the case of a colleague of his who was kidnapped by a violent serial rapist. She also used the Five Secrets, which transformed the entire nature of the interaction, and the rapist gave himself up to the police. He also described being bullied by two violent teenagers in a gigantic jeep when he was driving home from the drugstore, where he’d rented an enormous carpet cleaner. David’s use of the Five Secrets in response to violent threats prevented violence, but also turned a potentially hostile and abusive interaction into a joyous and warm one. We concluded with Bullying Practice, saying the worst imaginable things to each other, like “David, you’re a terrible person,” or “Matt, you’re a bad therapist,” or “Rhonda, you’re an insignificant person,” and then responding with the Five Secrets. It was an unexpectedly fun exercise, and the Five Secrets triumphed big time every time! The Outer Bully had no chance at all! However, this level of skill requires that you’ve mastered your own inner Bully, so you’re not buying into what the bully says to you. This gives you a sense of peace and confidence that makes the Five Secrets a piece of cake, so to speak! David, Rhonda, and Matt want to emphasize that we make the Five Secrets look really easy and almost magical. Nothing can be further from the truth. We do hope to inspire you with examples of what’s possible, but mastering these powerful tools takes an enormous amount of dedication, determination, and practice. If you’d like to learn more, I would strongly recommend reading David’s book, Feeling Good Together, and doing the written exercises while reading. This would be an excellent first step! (Include book cover with link to Amazon.) Here, by the way, is an interesting link to a Ted Talk on bullying that you might enjoy. One of our colleagues, Dr. Daniele Leavy, found it and shared the link with our Tuesday group. Link to Ted Talk on Bullying Daniele explains: The speaker does a good job of differentiating what is commonly referred to as bullying from assault or criminal behavior, and demonstrates how to playfully use Disarming and Stroking to deflect the bullying. Thanks for joining us today! Matt, Rhonda, and David
Featuring Matthew May, MD Today, Part 1. The Inner Bully Next week, Part 2. The Outer Bully There are two types of dialogues that can get us in trouble. The first is your “Inner Dialogue.” Your Inner Dialogue sometimes consists of negative thoughts and perceptions of yourself and the world, which are often dominated by the familiar cognitive distortions that trigger internal mood problems, like depression, anxiety, guilt, shame, inadequacy, loneliness, hopelessness, and more. Examples would be “I’m a failure because . . . “ or “I should be better than I am,” or “I’m really going to blow it when I give my talk, and a myriad of variations on these themes. Your Inner Dialogue often consists of mean-spirited things you say to yourself, much like the schoolyard bully who intimidates younger, weaker children. The only difference is that you are doing this to yourself, often without noticing or realizing  what that voice inside your brain is up to. When you challenge and crush these distorted perceptions, you can CHANGE the way you FEEL. Your Outer Dialogue consists of the things you say when you have with interactions with other people, and this can be especially important when you’re dealing with others who are critical of you, or even threatening you with violence.  The strategies are quite different from the strategies you might use to challenge and defeat your Inner bully. Today, Rhonda, Matt and I will demonstrate various strategies for defeating the Inner Bully. Next week, in Part 2, we will demonstrate strategies for defeating the Outer Bully! Those strategies, in extreme cases, might even save your life one day, as you’ll see next week. Rhonda starts the podcast by reading an awesome comment by certified TEAM-CBT therapist Dan Prine, who commented in a kindly way on podcast 334, where we interviewed Michael Yapko on hypnosis. Then we focus on multiple techniques to challenge two negative thoughts with a variety of strategies. The first negative thought is one we’ve seen on a number of occasions from women who had abortions as teenagers, and then experienced extreme depression and guilt later in life because of their thought, “I’m a bad person because I murdered my baby.” Using role-playing, we illustrated E = Empathy, using the Five Secrets of Effective Communication, followed by A = the Assessment of Resistance, using the Magic Button, Positive Reframing, and Magic Dial, followed by M = Methods. Methods included Examine the Evidence, the Double Standard Technique, the Externalization of Voices (with Self-Defense, the Acceptance Paradox, and the CAT, or Counter-/Attack Technique, along with the Socratic Technique, and more. Then we focused on a thought familiar to Rhonda during moments of insecurity and self-doubt: “I don’t matter!” This thought has plagued Rhonda since she was a child. She recalled her father often saying, “c"Who are you? You don't matter!" She told herself, “he’s saying that because I don’t matter.” Even the memory causes great pain and agitation. Of course, on some level, her father’s comments never had any effect on her. Only your thoughts can cause you to feel one way or another. But this was devastating to Rhonda because she believed what her father said, which is understandable, and those thoughts caused the pain. We again illustrated many approaches to challenging this thought, but one of the techniques that was most helpful was the CAT. During the Externalization of Voices, the Positive Rhonda said this to her Inner Bully: “I’m not going to listen to you anymore! I’ve had enough of your BS!” Thank you for listening today. Remember to tune in to the Outer Bully next week! Rhonda, Matt, and David
Sexual Abuse / Emotional Eating Personal Work with Orly, Part 2 of 2 Last week, you heard the first half of our live session on Emotional Eating, featuring Orly. Today, you will hear the second half and exciting conclusion and follow-up on that therapy session. A = Assessment of Resistance (previously called Paradoxical Agenda Setting) Orly did want help, but there were a number of directions / conceptualizations we could have pursued, including: Working on the distorted negative thoughts that were triggering intense negative feelings and robbing Orly of self-esteem. This would involve the use of the Daily Mood Log. Working on relationship conflicts with the Relationship Journal. Working on the addiction to binging, using the Habit and Addiction Log and the Triple Paradox if you click HERE. Exposure work to help Orly overcome her Emotophobia. That’s a term I coined that means “fear of strong emotions.” Orly shared a number of additional negative thoughts: I need to take care of myself because in truth I really am unlovable. I’m not entitled to feel traumatized because he did not hurt me. If I get excited or upset, and I don’t eat, I might go crazy. If I feel strong emotions, I’ll end up rejected and alone. Orly said she already had the tools for working on her negative thoughts and her relationship problems, but really wanted help with #3 and #4. So we first worked with her Triple Paradox that she brought to the session. This is a key tool in working with any habit or addiction, and Orly did an amazing job with it. You’ will enjoy that portion of the session and learn a great deal if you pay close attention. M = Methods We did a little work with Orly’s tempting thoughts from her Habit and Addiction log (click here to review.) Orly was extremely effective in challenging the tempting thoughts. Thanks to Jill’s brilliant guidance, we next decided to focus on cognitive flooding (exposure,) and gave Orly the assignment of scheduling one hour every evening for the next three weeks experiencing negative feelings and simply tolerating them, refusing to give in to the urge to binge.’ We also made her accountable, asking her to record her moods during each flooding session and to send a report the Tuesday group  the following morning. Either “Mission Accomplished” or “I stubbornly refused.” T = End of Session Testing You can click to see Orly’s Brief Mood Survey and Evaluation of Therapy Session at the end of the session. As you can see, she reported significant improvements in all of her feelings, and gave Jill and David perfect scores on the Empathy and Helpfulness Scales, as well as the other therapy process scales. Group Q and A After live work, we spent 30 minutes responding to questions and comments from the group participants. If you like, you can review just a few of the many comments in the feedback from the training group. Absolutely superb training! Thank you, Orly for the gift of your amazing personal work. And, thank you David and Jill for another magnificent teaching and healing session. I love the interplay between David and Jill. I loved Jill's empathy. I was so happy to get to know Orly better, and felt so close to her after the session. I was touched by her candor and disclosing about her abuse and life experiences. Unbelievable session, more like a miracle. A lifelong deep emotional issue to flow towards resolution in a couple of hours happens only in TEAM therapy. This was so very real; Orly was so open and insightful and vulnerable. Jill's identification of the choice point as to what to work on, and specifically, the option to focus on emotophobia--the anxiety around feeling intense emotions--and hence, exposure/flooding as treatment, struck me as so great, so much deeper than I'd initially expected. Jill's explanation that she focusses on the thoughts that drive the behavior in the HAL encapsulates it well. I loved the focus on feeling more. Recently, I read an article that stated CBT encourages clients to feel less and I didn't agree that was true at all. Tonight's session supported the sense of doubt I had. I thought the flooding concept was extremely helpful. Follow-Up Today, we recorded a live follow-up with Orly and Jill. Orly is doing great, and was very inspired. Jill made some (as usual) brilliant teaching points as well. If you like, you can also review one of her evening Emotional Eating Flooding sessions. Thanks again for listening! See you all next week. Warmly, Rhonda, Jill, Orly, and David
Sexual Abuse / Emotional Eating Personal Work with Orly, Part 1 of 2 In today’s podcast, you will hear the first of a two part series on Emotional Eating, featuring Orly, an Israeli psychologist who experienced sexual abuse at age 6 when she was a “skinny little girl.” After that, she began devouring her grandmother’s delicious cookies, and suddenly gained a great deal of weight. She continued binging for more than 50 years whenever she was excited or upset. This led to a pattern of dramatic swings in weight of 100 pounds or more over and over again. And now, Orly has decided she wants to end this pattern. My dear colleague, Dr. Jill Levitt, will be my co-therapist in this single, 2 hour-session that was conducted in front of my TEAM-CBT Tuesday training group at Stanford. Part of therapist training involves doing your own personal work, although this is not a requirement, it is recommended. That’s because the patient experience gives you a much deeper appreciation for how the therapy works. Rhonda, Jill and I want to thank Orly for permission to publish her highly personal work, and hope you find it immensely educational—so you can see exactly how TEAM-CBT works in real time with real people—and inspirational as well. Nearly all of us are pretty flawed in one way or another or many, and learning how to accept our flawed selves and celebrate is one of the deeper goals of the therapy. Today, we will cover the T = Testing and E = Empathy phases of the treatment. Next week, you will hear the exciting conclusion of our work with Orly, as well as the follow-up. Will she really be able to resolve a severe problem that has defied a solution for more than 50 years in a single TEAM therapy session? Let’s check it out! Part 1 of the personal work with Orly T = Testing At the start of the session, we reviewed Orly’s scores on the Brief Mood Survey that she completed just prior to her session. She scored only 3 out of 20 on the depression test (minimal), zero on suicidal thoughts and urges, 5 out of 20 on anxiety (mild), and 2 out of 20 on anger (minimal.) Her happiness score was 16 out of 20 (very happy with a little room for improvement), and her relationship score with her daughter was 18 out of 30, indicating lots of room for improvement. She indicated she'd done a great deal of homework in preparation for the session. You can also see her scores on nine mood dimensions if you take a look at her molestation Daily Mood Log. As you can see, her scores were quite high, and you can also review many of her negative thoughts when she was growing up. For example, at age 8 she told herself, “I am the fattest kid here. I will never be beautiful or desirable.” You can also see her Habit and Addiction Log (HAL) just prior to binging after a backpacking trip if you look HERE. Once again, you can see that all of her negative feelings were intense, and rated in the range of 90 to 100. You can also see her tempting thoughts, like “I can afford it since I spent so many calories during the hike.” E = Empathy David and Jill empathized while Orly told her graphic story of sexual abuse from a young man while growing up on a farm in Israel around the time of the “Six Day War” in 1967. She explained that he had been like an “older brother,” and she didn’t quite understand what had happened, since there was no Hebrew word for sexual abuse, and the subject was never discussed in public or with children. As she grew up, she learned to be independent, and felt like she was “different” and never really fit in. She developed a strong connection with nature and with spiritual values, and served as a park ranger during her military service in Israel. After her military service and an undergraduate degree from the Hebrew University, she set out to backpack in South America for a year and then settled in Los Angeles. She was married, and had a daughter who she considers her most important relationship, However, it was a troubled marriage and Orly and her husband were divorced when her daughter was 6. For quite a while, her daughter “blamed me for the divorce and for many  other things.” Eventually, she settled down in the United States and decided to become a psychologist after going to therapy, which was “the only diet I had never tried.” In 2020 she got some medical help from her doctor and started hiking extreme distances and heights, and lost a tremendous amount of weight. Nonetheless, she still finds herself “eating her feelings” and engaged in binge eating every once in a while. She also joined our Tuesday training group at Stanford, and said that it made an enormous impact on her life and on her clinical practice, and began at times to think, “Maybe there’s NOT something wrong with me.” She said the group made her an effective therapist and “I got to liking myself just a little bit!” She said the group also helped her tremendously with relationships. I believe she was referring to the five Secrets of Effective Communication that we have demonstrated so often in our podcasts as well as other tools such as the Relationship Journal She shared she was feeling terrified and had a number of negative thoughts during our session, since she was really hopeful that she could finally end her Emotional Eating. Her thoughts included: I don’t belong. 70% Something is wrong with me. 70% What I do is not good enough. 60% Now that I’m more than 60 years old, most of my life is over. 60% If I don’t get over my emotional eating, I’ll never feel normal. If I fail to solve my addiction, I’ll fail in my most important existential tasks. That would mean I’m a failure. That would mean that didn’t make a positive impact on the world. Jill empathized, using Thought Empathy, Feeling Empathy, and warmth, and then we asked, “What’s our grade? How good a job have we done in understanding how you think, how you’re feeling, and accepting you?” She gave us an A, meaning it was time to get on to the next phase of the session. Orly also shared that she never told her parents about the abuse, and never felt really close to her mother, who had her and two boys, all within 19 months. She said, “I was a problem for her, and always challenged her. Orly told friends about the abuse, but not her folks because she was desperately afraid they might not empathize or support her. She added, “Deep down, I fear that I am not really lovable, and that it might be too late for me.” I would add that feelings of hopelessness are so common in all of our patients, and this is what makes our work so challenging for us and painful for our patients—and also so rewarding when we can provide genuine, rapid, and profound relief. But will that really be possible for Orly? Next week we will set the agenda for the session and select some methods that might be helpful for Orly. End of Part 1 Thanks again for listening! Warmly, Rhonda, Jill, Orly, and David
Good Grief—Featuring Mike Christensen     Mikes' beloved friend, Kris Yip, word-ranked bicyclist who suddenly and tragically died. Mikes' beloved dog and best friend, Josie, who died the day before the podcast was recorded In today’s podcast we feature one of our favorite people, Mike Christensen. Mike is a Certified Level 5 Master TEAM CBT Therapist and Trainer, and is the Director Feeling Good Institute, Canada. Mike is a Registered Clinical Counsellor with the British Columbia Association of Clinical Counsellors and holds a Master of Arts in Counselling Psychology degree. His diverse background in business, community organizations, and family support roles has provided Mike with a wide array of experience in leadership, administration, parenting training, and team building. He provides advanced level online training with the Feeling Good Institute for therapists around the world and is currently co-authoring a book with Maor Katz on Deliberate Practice of TEAM-CBT. Mike specializes in treating depression and anxiety, with experience and training in addictions, PTSD, and relationship challenges. Today, Mike comes to us today with a personal issue, grief and loss. The day before the recording Mike’s beloved dog, Josie, died, and this came on the heels of the death of one his best friends, Kris Yip, a month earlier. Kris had died suddenly and unexpectedly at the age of 47. Kris was 7 or 8 years younger than Mike, and appeared to be the perfect example of health and fitness, so his loss was an unexpected and devastating punch in the gut. Mike explained that Kris was a celebrity in the bicycling community. He was the Canadian national champion and war ranked 59th in the world. However, he was humble and never promoted himself. Instead, he always focused on others, encouraging even those who were just beginners. Mike has also been a competitive bicyclist, and Kris had invited Mike to join an online racing team consisting of four friends who got together daily on stationary bikes linked by videos on the internet so they could talk while biking. In January of 2023, while riding, Kris’s heart suddenly stopped. A friend of Kris called Mike to say, “Kris is gone!” This was devastating to Mike, who said: “He was the fittest of our group. The impact was profound.” He had trouble sleeping and was in disbelief. He said, “It felt surreal. It felt like something is wrong. He told himself, “I should be able to keep it together without falling apart.” Mike also told himself that Kris, was too young to go, and missed him tremendously. Mike thought of Kris’s mom, and how much she was suffering, so he spent a week with Kris’ family and friends in Prince George. Which was where Mike was born, and his brother and his other biking buddies live.  He said, “We cried together and were together.” He explained, “Whenever I got on my bike to ride, Kris was always there. He’d always say, ‘Let’s ride.’ I miss his voice.” He also said that during his rides, you could see Kris’ face on the video feed, and he was always struggling, digging deep, suffering, but loving it! Mike said that all of his losses, including his sister, his son, and Kris,  were actually double losses, because “I lost not only what had been, but what was to come in the future, and didn’t.” Mike said, “Kris was so humble, so I want to brag for him. He always cared and made all of us feel so encourage and inspired!” Mike mentioned some of the positives he saw in the pain of grief: It honors the depth of the love and the depth of our relationship with Kris. Our grief has motivated us to cherish our riding group and to cling together even more closely. Tears can be the purest form of love. Tears allow us to keep the other person alive in our hearts and minds. I mentioned how I talk to three people I’ve lost every day when I do my “slogging:” my beloved cat Obie, and two dear colleagues I’ve lost, Ann Hantz in Philadelphia and Marilyn Coffy from Oakland. Mike described how touched he was when visiting Kris’ family, and how his mom had arranged all of Kris’ bicycles in the garage, ready to be ridden, with all of his racing jerseys on display. Mike confessed that also felt angry and often thought: “You bugger. It  should have been someone else!” Mike has endured many tragic losses in his life, including the devastating death of his older sister when he was just 15, and the tragic loss of his son, Graeme Michael, who died shortly before birth. Mike reminded us about the various conceptualizations we use in TEAM-CBT, which can include individual mood problems (like depression or anxiety), personal relationship problems, habits and addictions, and “non-problems.” A non-problem refers to people who do not have distorted negative thoughts or problems that need to be solved—they just have strong and appropriate negative feelings, and the job of the therapist is simple: resist trying to “help,” and instead use the Five Secrets of Effective Communication to listen and give the grieving person the chance to vent and expression their feelings. With this in mind, Mike described the support he received from colleagues at the Feeling Good Institute, including one who told him to make sure he was feeling sad! He greatly appreciated this! In my clinical experience, “non-problems” were actually rare, but there were several patients who only needed to vent and receive support. one of my favorite chapters In my first book, Feeling Good, was Chapter 3. entitled Sadness is not Depression. I described my experience as a medical student with a terminally ill elderly man in the Stanford Hospital who reminded me of my grandfather. His extended family had gathered around the bedside as he was slipping into a coma from liver failure due to metastatic kidney cancer, and asked “Would it be okay for you to remove his catheter? It was a bit uncomfortable for him, and we’re not sure if he still needs it.” I was very inexperienced and asked at the nursing station if it would be okay to remove it, and if so, how would I do it. They said he was, in fact, dying, and would not last much longer, and explained how to remove the catheter. I pulled the curtain around his bed, and did that and told the family, with tears in my eyes, “He can still hear you, but not for much longer, so it’s time to tell him how much you love him and say goodbye.” Tears were flowing down my cheeks and they began to cry as well, and began saying good bye. I went to the room where the medical students and resident make their notes, and wept. The family later told the department chairman how much they appreciated what I did for them. I was a pretty terrible medical student, and for the most part had a bad attitude, but that was on moment I still feel very proud of. There are several differences between sadness and depression. First, the thoughts that trigger depression, like “I’m defective. There must be something wrong with me,” are distorted. Depression, as I’ve often said, is the world’s oldest con. In contrast, Mike’s thoughts, like the thoughts that trigger healthy grief, are not distorted, like “I miss Kris. I admired him and loved him, and he made a tremendous difference in my life, and the lives of all who knew him.” Second, depression can go on and on endlessly. I’ve had patients who told me that they’d never had even one happy moment in their entire lives. Healthy grief, in contrast, only needs to be accepted and expressed, and runs its course naturally, If grief is extended, or impairing the person’s life, then it’s a certainty that distorted thoughts are present and preventing the person from healthy grieving. In this case, treatment can be enormously helpful. Finally, depression robs us of joy, hope, and productivity. Life often seems meaningless and worthless. Grief, in contrast, though painful, enriches us and provides us with a deeper level of meaning and gratitude for life. Rhonda and I are very sad for Mike’s many losses, now and in the past as well. But we are both grateful to have him as a friend, and cherish him tremendously. Thank you, Mike, for letting us in today! Warmly, Mike, Rhonda and David Following the session, I emailed Mike to ask a couple questions about peoples’ names, and also find out if we might have perhaps let him down during the podcast, not given him enough space to grieve, and so forth. When I get worried about things like that, I have found that checking it out usually beats “Mind-Reading” by a pretty huge margin. Here’s the wonderful email that Mike sent. It will give you a deeper view of his inner warmth and depth. Hi David, Thank you for your kind words. I experienced our time together as deeply moving and came out of it with a renewed sense of purpose in the sadness. I guess my hope was that we might be able to illustrate and share the value in empathy and the positive reframe in our grief work. That was enhanced to a new level for me with the way you guided me to explore some aspects I had missed. I wouldn't change a thing about it. It also opened up the way in which your stories and the journey we go on with clients can provide healing for others. I am so grateful that you were willing to take that time to revisit them. Our son's name was Graeme Michael. He was in between our oldest (Thomas now 25) and our middle daughter (Janae now 22). We (my wife Janna and I) never had the opportunity to hear his voice or see him smile. We were informed that it was a chord accident. Janna knew something was wrong and an ultrasound confirmed that she would have to deliver him knowing he was already gone. The first time we held him was also the last. Whenever people ask me how many children I have I say 3 (Thomas, Janae & Caelyn -19  & you will meet soon)  but in my mind it is always 4. Thank you for asking. My wife Janna is a nurse and the director of a pregnancy outreach program. She has been blessed with the opportunity to work with at-risk pregnant moms and young families for 17 years and ou
Amy and her "fab fiancé," Randy Kolin! Secrets of Flirting, Sex Appeal and True Love! Today Rhonda and David interview Amy Berner, who has fallen in love and has quite a story to tell! Today is Valentine’s Day (we recorded this on February 14, 2023), so we thought a love story would be a ray of joy for all of you, whether you are in a loving relationship or still looking for one! But first, Rhonda and David briefly interview Jeremy Karmel, the co-CEO of David’s Feeling Good App. Jeremy tells his dramatic personal story that led to the creation of the app, and solicits for people who might want to join us for beta testing, which has gotten very busy of late. David also present some amazing data from a small, four-week beta test in December involving around 45 beta testers. The findings appeared to indicate that beta users experience far greater warmth and understanding from the app than from the people in their lives, which is on the sad side, since at the time users applied for the app, they only estimated 55% (on a scale from 0 to 100) warmth and understanding from the people in their lives, and roughly 85% from the digital “David” they interacted with in the app. We’ll see if those amazing findings hold up in two larger replication studies now in progress. If you think you might be interested in being a beta tester, please sign up at Rhonda also gave an endorsement for the upcoming second World Congress on TEAM-CBT in Warsaw, Poland this year, March 30-April 2, 2023. It sounds exciting. I will be there is a variety of capacities including conducting a personal session with Jill Levitt, PhD. Please check it out! And, as usual, she read a compelling comment from one of our regulars, Irish Brain, who wrote: “Another amazing podcast for the collection!” Amy Berner is a licensed marriage and family therapist who works with adults and teens online in California. She loves helping her clients heal from heartache, depression, and anxiety. You can find her at the Amy’s love story started at a women’s group that Rhonda was also in more than a year ago. It turns out that Rhonda is quite the match-maker, and has arranged dates for large numbers of her friends and colleagues, including Amy. However, Amy was feeling insecure, as so many of us might, before this date. To help her, Rhonda suggested the Feared Fantasy Exercise, and asked Amy to list some of the things she was afraid her blind date might be thinking, but not saying, when they met. When you do the FF, one person plays the role of the “Date from Hell” who not only thinks these awful things about you, but gets right up in your face and says them. This list of awful things the Date from Hell might say included: “I’m just doing Rhonda a favor in dating you.” “You look a lot older than your picture!” “I haven’t gotten over my last relationship yet.” “You’re not smart enough.” “You’re just not very interesting.” We demonstrated the FF on the podcast, and Amy knocked them out of the park, using humor plus the Acceptance Paradox. She said that when they’d done that at the women’s group, in greatly reduced Amy’s fear and trepidation prior to their first date. Amy said she was also greatly helped by being in my small practice group the following Tuesday at our weekly psychotherapy training group. We were working on the “Interpersonal Downward Arrow,” a technique I developed that quickly illuminates the roles people play in problematic relationships. Amy discovered that she was playing the role of the inadequate, inferior, insecure person, and this was illuminating. One bad thing about this role is that it quickly becomes a self-fulfilling prophecy because if you see yourself as inferior, you will chase, and come across as insecure, and that will cause the other person, in most cases, to reject you. David suggested a technique he described in his book, Intimate Connections (which you can see below). called the Queen Bee Phenomenon. Instead of playing the insecure role, you give yourself all kinds of positive messages about how sexy and awesome and desirable you are. Once you get into that mind-set, this mind-set can also act as a self-fulfilling prophecy. That’s because of the Burns Rule, which states that in any relationship, especially at the start, one person will be the pursued, and the other person will be the pursuer. The pursued person has all the power, and the pursuer is usually rejected. So why not utilize the Queen Bee Phenomenon and let the guys chase you? This idea was transformative for our wonderful Amy, who is now happily, giddily, engaged, and she tell her story today with her typical wit, humor, and charm. She emphasized another important concept from Intimate Connections. Self-love has to come first. Once you chose to love and like yourself, your fear of being alone disappears, and you discover that you can be incredibly happy when you’re alone. Then, you will no longer “need” men; and as a result, men will need and chase you. That’s another expression of the Burns Rule which states: Men (all people actually) ONLY want what they CAN’T get, and NEVER want what they CAN get. So, if you don’t “need” other people, they will have to chase you! And that’s what happened! Rhonda, Amy, and David also reviewed the principles of effective flirting. 1, Be playful, and not heavy or serious. 2. Have fun. 3. Give playful, specific compliments. Amy has developed a game called “Flirty Dice” which helped her and many others. It is suitable for anyone 14 years or older and can be obtained at the Feeling Great Therapy Center. At the same time that her love life zoomed into orbit, her clinical practice did the same. This is common—when you become a source of joy, others just naturally are attracted to you. Kind of like human magnetism. Amy sees people virtually from all over California. She practices TEAM-CBT and specializes in the treatment of depression and anxiety, and of course, dating and relationship issues. So, if you want to give your love-life a kick-start, or recovery from rejection, contact her at Thanks for listening today! Last month, (January 2023), we broke our one month download record (>182,000 downloads), so thank you for that. We will surpass 6 million downloads shortly. Rhonda, Amy, and David
Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 2 Mariusz and his wondaful family. Last week, you heard Part 1 of the personal work that Rhonda and I did with Dr. Mariusz Wirga, which included initial T = Testing and E = Empathy. Today, you'll hear the conclusion of our work, including the Assessment of Resistance, Methods, final Testing and follow-up. I am repeating this darling photo Mariusz's beloved cat, with his tail strait up, showing pride and love for Mariusz! Orangina at her favorite scratching post, with tail straight in the air to show pride and love for Mariusz!  A = Assessment of Resistance Once we empathized, we issued a Straightforward Invitation, asking Mariusz if he needed more time to talk and have us listen, or was ready to focus on the problem and see what we might do to help. Mariusz wanted to get to work, and said his goal for the session was to reduce his perfectionism, but when I asked the Magic Button question, he said he would not press it, even if the Magic Button would bring about a sudden and dramatic elimination of all of his negative thoughts and feelings. So, together, we listed the many positives and advantages of his negative thoughts and feelings, including: My anxiety keeps me on my toes. My feelings of inadequacy keep me humble. My hopelessness protects me from disappointment in the session with Rhonda and David isn’t effective. My hopelessness and loneliness show how much I care. My hopelessness shows how helpless I feel to free myself from the many pressures and heavy weights I have been carrying for many years. My negative thoughts and feelings show how much I care for others, including my wife and kids. My suffering with depression and anxiety increases my compassion and understanding of my patients who are suffering and frightened. My anxiety protects me from danger. My anxiety is motivating. My self-criticisms show that I have high standards. My loneliness shows that I welcome intimacy and close relationships. My sadness shows that I am realistic and willing to look at the dark side of life. As you likely know, this process is called Positive Reframing, which is looking at the positive side of things that appear to be negative. Effective Positive Reframing isn’t just listing positives from a list or book, like Feeling Great,  It’s suddenly “seeing” something that you hadn’t previously realized, and having an “ah-ha” moment. So, I asked Mariusz if he could see any additional positives in his fairly intense feelings of sadness and depression. To help him, I primed the pump a little bit by pointing out that sadness and depression are the feelings you have when you’ve lost something or someone your really cared about, or when you notice that something incredibly important is missing from you life. At this point, Mariusz became tearful and said he’d been very lonely as a child. Saying this gave him a “choking pain.” But he said he always turned away from his pain, and distracted himself, with work and activities. He said “I was an obedient child, and I was an only child. Both of my parents worked. “You say something is missing. I think what is missing is life I’m too busy. I’m always distracting myself. But I’m afraid that if I slow down, I won’t be able to pay my bills. I believe that 95%. Then I’ll be a burden. I’ll lose the respect of my family.” At the end of the Positive Reframing, he set his goals for the session, which you can see if you click on his Daily Mood Log again. As you can see, he did not seem to want to reduce his feelings to super low levels, which was surprising to me. M = Methods Rhonda suggested we could do a Feared Fantasy and asked what he thoughts others would think about him, but never dare to say, if he did slow down and they judged him. They’d think: You’re unreliable. We won’t include you anymore. We hate you. We reject you. We’ll tell the world about you. And his worst core fear was ending up in a homeless camp. We did role reversals using the Feared Fantasy Technique until he hit the ball out of the park, and did the same using the Externalization of Voices to defeat the negative thoughts on his Daily Mood Log. When you listen to the session, you’ll see that there was a lot of tenderness at this point, and we discussed our love for cats, and what we can learn from them—the joys of being average and loved and loving your life. We gave Mariusz several homework assignments: Finish your Daily Mood Log in writing, completing the Positive Thoughts and make sure you’ve crushed all of you negative thoughts. Experiment with being open and vulnerable with loved ones (wife and family) as well as colleagues. Practice saying no to colleagues who make requests on your time, and cut down on activities that are not cost-effective. T = End of Session Testing You can find Mariusz final Daily Mood Log if you click HERE, and his end of Session Brief Mood Survey if you click HERE, and his Patient’s Report of Therapy Session if you click HERE. David, add three links when you get documents. Rhonda and I wish to thank you, Mariusz, for a brave and touching session! You gave me the chance to process some of my own perfectionism, and to express my gratitude once again for the stray cats that my wife and I have adopted who have taught me so much about love, acceptance, and the simple things in life! Follow-Up I emailed Mariusz to find out what happened when he decided to become more open and vulnerable with wife, patients, and colleagues. He wrote back: Right before the Eureka moment, there is this state of dense confusion. So I was hesitant about where to go, but there was no visible path to choose yet. It feels like your brain is not getting it. It feels dense, also in an intellectual way. Like your brain stops working. It is quite dark and heavy. And then suddenly, the tears come and things become clear and light (in the sense of brightness and lifted weight). And that you all for listening today! Last month, January, was our biggest month so far, with more than 182 thousand downloads of Feeling Good Podcasts, and this is due, in large part, to your support of our efforts and sharing the show with friends and colleagues who might benefit from it! Thanks again, Mariusz! You are shooting into orbit! I'm SO proud of you and happy for you, and grateful to have had the chance to get to know you on a deeper and more human level, and to share a little of myself with you, too! Several days later, he sent me three addition al Negative Thoughts for his Daily Mood Log. They are touching, take a look at how he challenged and smashed them! Warmly, Rhonda, Mariusz, and David
Mariusz and his wife, Aleksandra, who is also a psychiatrist. Personal Work with Mariusz, Part 1 Mariusz and his wondaful family. In today’s episode, Rhonda and I do live TEAM-CBT with Psychiatrist Mariusz Wirga, MD, who has struggled with perfectionism his entire life. Our training philosophy for TEAM-CBT involves doing your own personal work for a variety of reasons, including: 1. When you sit in the patient’s seat, you develop a radically different perception of the value of the various components of TEAM, including T = Testing, E = Empathy, A = Assessment of Resistance, and M = Methods. 2. When you experience your own recovery, or “enlightenment,” you have a crystal clear vision of what’s actually involved in rapid, effective treatment. 3. You will be able to tell your patients, “I understand how you feel because I’ve been there myself, and it will be my pleasure to show you the path out of the woods.” This message makes a highly beneficial impact on most patients. Bio sketch, by Rhonda Among his many other accomplishments, Mariusz organized the highly successful first world congress for TEAM-CBT in Warsaw, Poland in 2022. He is planning a second four-day TEAM-CBT intensive in Warsaw from March 30 to April 2, 2023. If you are interested in attending, you can learn more at or Mariusz says, " "For the first time ever we will teach a parallel track for business and corporate applications of TEAM CBT at the 4-Day Warsaw Intensive ( & It will be taught by our singular Dr. Leigh Harrington, with Polish psychologist and TEAM CBT therapist Patrycja Sawicka-Sikora. In 2023, there will also be major TEAM-CBT conferences in Bristol, UK (August 14-17, 2023, ) and Mexico City (November 6-9, 2023, )" In today's podcast we will listen to the Testing and Empathy portions of his session. Next week, you will hear the Assessment of Resistance and Methods and exciting conclusion of his session. T = Testing We began by reviewing Mariusz’s scores on the pre-session Brief Mood Survey, which you can review. We will, of course, ask him to take this test at the end of the session, so we can see how effective or ineffective we were in helping him change the way he’s thinking and feeling. Mariusz's beloved cat, Orangina, played a featured role in his session with Rhonda and David! E = Empathy We discussed his anxiety which had spiked in apprehension of today’s live session. He had several negative thoughts that we elicited with a brief Downward Arrow Technique. The percents indicate how strongly he believed each one. I will be talking about private issues, and people will think less of me. 70% Then people will be less likely to want to see me for therapy. 50% My patients might be disappointed in me. 50% This could affect me financially, and I won’t be able to pay the bills, and my daughter’s wedding is coming up. 50% (Mariusz, my estimate on % belief.) If that happens, my wife and kids will turn against me. (Need % belief that you had at the time, Mariusz.) My also reviewed the Daily Mood Log that Mariusz prepared prior to today’s session. Feel free to review it. As you can see, he woke up in the middle of the night and remembered that he’d forgotten to send a form he promised to send to a patient whom he’d seen two days earlier. You can also see that his negative feelings were very elevated, ranging from 60% to 85% for loneliness, embarrassment, sadness, inadequacy, frustration and anger,  to 100% for guilt, shame, and anxiety. If you review his DML, you will also see that he’d recorded 10 self-critical thoughts, and many of them were Should and Shouldn’t Statements. For example, “I should have sent her the homework. I shouldn’t have made such a basic therapy error.” He also identified the many distortions in each thought. All-or-Nothing Thinking, which is the mother of perfectionism, was present in most of them. Other common distortions included Should Statements, Overgeneralization, Magnification, and Self-Blame, to name just a few. Mariusz’s belief in all of his negative thoughts was high. You may recall the two requirements for feeling upset: 1. Your mind has to be filled with negative thoughts. 2. You have to believe those thoughts. Mariusz also described his extremely busy and demanding schedule, including the groups he runs in the hospital for cancer patients, his clinical practice, research, teaching, organizing large international TEAM-CBT conferences, and more. His hectic schedule means he always has to be moving fast, so mistakes and slip ups are fairly common. That’s when he beats up o himself, gets anxious, and has trouble sleeping, which compounds everything. He also beats up on himself and feels guilty for falling behind in some of his commitments. Rhonda and I empathized, using the Five Secrets of Effective Communication, and then Rhonda asked him to grade our empathy. He gave us an A+. Orangina at her favorite scratching post, the one that Mariusz got for her, with her tail straight in the air to show pride and love for Mariusz! This ends Part 1 of the work with Mariusz. Next week, you'll hear the exciting conclusion of his session. Warmly, Rhonda, Mariusz, and David
What IS Hypnosis? Transcending Old Myths Today, Rhonda and I interview Dr. Michael Yapko, a clinical psychologist and expert in clinical applications of hypnosis. Michael D. Yapko, Ph.D. is a clinical psychologist residing near San Diego, California. He is internationally recognized for his groundbreaking work in applying clinical hypnosis, especially in the active treatment of depression. He has taught in more than 30 countries across six continents, and all over the United States. He has been a vocal critic of the medical model of depression and instead advocates for a social perspective, suggesting the problem is less in your biochemistry and more in your circumstances and perspectives. His YouTube lecture on “How to Recover from Depression” has now been viewed nearly 5 million times. Dr. Yapko is the author of 16 books, including his newest book for professionals called Process-Oriented Hypnosis, and his classic hypnosis text, Trancework (5th edition). His popular general audience books  include Depression is Contagious and Breaking the Patterns of Depression. His works have been translated into 10 languages. He is also the Chief Content Advisor for MindsetHealth, a digital hypnotherapy mental health app. More information about Dr. Yapko’s work is available on his website: On the personal side, Dr. Yapko is happily married to his wife, Diane, a pediatric speech-language pathologist. Together, they enjoy hiking in the Great Outdoors in their spare time. Michael’s first experience with hypnosis was as an undergraduate psychology student at the University of Michigan. He went to a clinical course on the topic of hypnosis which featured a live hypnosis demonstration. The demonstration subject was a woman who was suffering with intense chronic leg pain following a traumatic auto accident three years earlier. The relentless pain had disabled her and greatly impacted her life on many levels. Michael said he listened to her sad story in skeptical awe, unable to imagine what the hypnotist could possibly say to someone suffering so much that would be helpful to her. He was deeply absorbed in observing every nuance of the interaction wondering what help hypnosis might offer in such dramatic circumstances. The initial phase of the interaction was simply a series of suggestions for relaxing and focusing her attention. He gradually offered suggestions to visualize the pain as a dark, viscous liquid that could flow down her leg, out of her foot, into her shoe, and then spill out onto the floor as a “harmless puddle of pain.” And it was gooey! After re-alerting her from hypnosis, she became tearful and reported that she was pain-free for the first time in almost three years! The change in her appearance was both obvious and deeply impressive. Observing this dramatic demonstration of hypnosis for reducing chronic pain was a transformative experience for Dr. Yapko. He literally thought in that moment that hypnosis had remarkable potentials and that he would dedicate himself to learning all he could about the intricacies of hypnosis and its merits in a wide array of clinical interventions. The demonstration blew Dr. Yapko’s young mind and led to a 50-year career practicing, studying, writing about, and teaching clinical hypnosis to health care professionals worldwide. Although he has recently retired from active clinical practice, he continues to offer trainings and says his fascination with hypnosis is just as strong as ever today. There are a number of striking areas of overlap between Michael’s use of methods of clinical hypnosis and traditional Cognitive Therapy. For example, he routinely uses the Experimental Technique, and gives experiential homework assignments to help patients “see” or discover something that they have not previously seen or realized that would be helpful to them. This can be important when treating patients who hold rigid beliefs that can become the basis for emotional distress. However, the types of experiential experiments Michael suggests are sometimes more ambiguous in their purpose, and are sometimes more paradoxical, but all are designed to lead the patients to a shift in their mindset. In one example, Michael described a severely depressed woman who felt like a victim and constantly compared herself to others she actually knew very little, if anything, about. Then she felt terrible about herself because she was convinced that everyone else was happy and had beautiful, problem-free, ideal lives and she didn’t. She had developed unrealistic perceptions of other people on the basis of little or no actual data. These thoughts made her miserable and she was convinced she was the only one who had been singled out for misery. Of course, we can see many of the familiar cognitive distortions, including Mind-Reading, which is assuming, without evidence, that we know how other people are thinking and feeling or how their lives are going. For most people, this process is so reflexive and unconscious they don’t realize what they’re doing. As Michael said, “too often people think things and then make the mistake of believing themselves.” To her detriment, this woman had never tested her assumptions about others. Michael’s view was similar to that of cognitive therapists, that there would need to be a change in her way of reaching unfounded conclusions if she was going to feel better about herself and her life. But what kind of experiment, or exercise, could he assign to help her discover that her thinking WASN’T always correct ? Telling her to “stop doing that!” would not likely help her. Instead, Michael did a hypnosis session with her and oriented her to the idea that forming interpretations or conclusions without evidence is a reliable path to making mistakes that can be costly. Then Michael gave her an easy assignment that had the potential to make obvious how readily she formed conclusions without any evidence. He encouraged her to go on a hike in a state park near San Diego. The trail he wanted her to go on is called the Azalea Springs Trail, an easy three mile walk. The trail’s name suggests a beautiful trail with flowers and flowing springs and sounds like an awesome, inspiring experience. But in reality, the hiking trail goes through barren desert brush, eventually leading to a clearing. In the center of the clearing, there’s a rusty pipe sticking up out of the soil with a small amount of water dripping out. A sign attached to the pipe reads, “Azalea Springs.” All the expectations of an abundance of beautiful azaleas and a lovely flowing spring naturally exploded in only a moment! When she read the sign and realized how far off her expectations were from the reality, she suddenly “got it” and burst out laughing. She learned in a powerfully memorable way that our expectations are not always the way things are. Subsequently, having absorbed that powerful learning, she regularly caught herself making assumptions about others and using them to build them up and tear herself down. This hurtful pattern changed dramatically, giving rise to a much happier and more satisfying life. Michael also uses the Survey Technique, which is common in TEAM therapy. He described a shy man who desperately wanted to be married and fantasized living in domestic bliss in a house with a picket fence. But he was convinced that no woman would ever be interested in him because he’d been hospitalized for two weeks for depression 15 years earlier. Again, he was rigidly fixated on this unfortunate idea, which he believed to be absolutely true. Michael first conducted a hypnosis session that introduced the idea that “someone can be very sure…and very wrong.” Hypnosis often makes it possible to loosen the hold of unhelpful ideas and shift to a more useful perspective. This is because people in hypnosis process information differently than when in their usual frame of awareness. Having a rational conversation with someone is quite different than guiding someone through a hypnotic experience which can create possibilities that rational conversation alone simply can’t. Hypnosis is all about focus and Michael describes how people’s problems are often problems of focus: they focus on what’s wrong and miss what’s right, or they focus on the unchangeable past and miss positive future possibilities. Those of you who are familiar with CBT or TEAM may recognize these distortions as Mental Filtering and Discounting the Positive. It’s important to appreciate that hypnosis is NOT the therapy. Rather, it’s a vehicle for delivering therapeutic ideas and perspectives at a deeper level that can give rise to more adaptive automatic responses. Following hypnosis Michael gave his patient the assignment to generate a series of general questions that he’d be interested in hearing women answer. Michael included the following question as number 7 on his 10 question survey: “Would you consider dating, getting involved with, and even marrying a man if you knew he’d been hospitalized for two weeks for depression 15 years ago?”  Michael then convinced him to go to the local mall and randomly stop women and ask them to respond to some survey questions he was researching. He could tell a number of women that he was conducting a brief survey and would appreciate getting their opinions. Although he got many varying opinions, he was shocked to discover that the vast majority of women said it would NOT be an issue. He had built his misery around a belief that had no bearing on how women actually felt. Once again, although Michael emphasizes the value of hypnosis, his  therapy techniques have some overlap with Cognitive Therapy. He promotes the idea that the shifts in both physiology and cognition that take place during hypnosis can provide a multi-dimensional foundation for amplifying the effects of virtually any type of psychotherapy. In fact, in his classic text on hypnosis, Trancework (5th edition), Michael cites numerous studies that show that
Ask David: Featuring Matt May, MD What causes anxiety? Is recovery permanent? What if the cognitive distortions aren't helpful? Do hormones cause anxiety and depression? What's the role of vitamins and nutrition? How do Exposure and Response Prevention work? And many more answers to your questions! In today’s podcast, three shrinks discuss many intriguing questions about anxiety from individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Several of the questions were answered on the podcast, and a great many more are answered in the show notes below. But first, Rhonda opened the podcast by reading an endorsement from a listener named Rob, with a link. Here it is! Hi Dr. Burns: I'm a long-time listener/reader, first-time caller. I stumbled upon this endorsement for Feeling Good today, and I thought it was worth sharing with you. I can't think of a better endorsement for a book. I hope you enjoy it! "I’ve replaced my copy close to ten times, as I keep lending it to friends who never give it back." Have a great day! Rob Thanks, Rob! And now, for the many excellent questions submitted by listeners like you! Many were answered in depth on the podcast, but you'll see that all questions have written answers as well. When you talk about someone recovering, is that free of panic attacks and anxiety forever, or a great decrease in symptoms but you will always be an anxious person to a certain extent? Especially for someone who has fundamentally been anxious since they were young so not episodic but continuous. David's Answer. Some people are anxiety-prone, and that is likely due to a genetic cause. I am like that, for example. Once you are 100% free of any form of anxiety, like my public speaking anxiety, you need to continue with exposure, or the old anxiety will try to come creeping back in. So, I do public speaking all the time! What if your client/patient understands the Cognitive Distortions but doesn’t believe them to be true? David's Answer. It is hard for me to comprehend what you mean. But I will say this. Anxiety and depression and other negative feelings result 100% from distorted negative thoughts. And the exact moment when you stop believing the thought that’s triggering your anxiety or depression, you will almost instantly feel relief. And here’s the precise answer to your question. When someone says, “I understand the distortions but it doesn’t help,” they still believe their negative thoughts. Resistance, too, is an issue. Nearly 100% of therapeutic failure results from jumping in and trying to help the patient without first comprehending the many reasons why the patient will fight against the therapist’s efforts to “help.” Has research been done on the possible relationship in hormone levels in women and anxiety or depression? Especially during pregnancy, post pregnancy, and those going through menopause? Also, can negative thoughts also depend on the person’s nutrition? Could it be that vitamins that are lacking? David's Answer.  First, I am not aware of any convincing evidence linking hormone levels with depression, anxiety, irritability, or any other negative feelings. However, we can say with certainty that whatever the cause, which is unknown, distorted thoughts will always be present and will be the trigger for the negative feelings. In or near the first chapter of my most recent book, Feeling Great, I describe case of post pregnancy depression, and you can take a look and see the mother’s negative thoughts clearly. And you will also see that the moment she crushed those thoughts, her depression disappeared! People want to “biologize” emotional problems, and I started out as a “biological psychiatrist” and researcher, but found the biological explanations to be erroneous and unhelpful. Could you please give a brief overview about Exposure with Response Prevention for OCD treatment.  Thank you! David's Answer. Sure, these are tools that can be helpful, along with many other kinds of tools, in the treatment of anxiety, including OCD. They are not, for the most part, treatments. I use four models in the treatment of every anxious patient: the Motivational, Cognitive, Exposure, and Hidden Emotion Models. Exposure is facing your fears and enduring the anxiety until the anxiety subsides and disappears. Response Prevention is refusing to give in to the superstitious rituals OCD users when anxious, like counting, arranging things in a certain way, and so forth. END OF QUESTIONS DISCUSSED LIVE ON THE PODCAST The answers to the questions below were written by Dr. Burns but not discussed on the Podcast. Questions can I ask to overcome the Cognitive Distortion “jumping to conclusions”? That is the toughest for me. David’s Answer. I would need a specific example. Jumping to Conclusions includes a vast array of topics and negative thoughts. Fortune Telling and Mind Reading are the most common forms of Jumping to Conclusions. Feelings of hopelessness always result from Fortune Telling. All forms of anxiety always result from Fortune Telling as well. Social Anxiety typically includes Mind-Reading, and Mind-Reading is almost universal in relationship conflicts. In addition, I never treat a distortion, an emotion, a diagnosis, or a problem. I treat human beings systematically, using the T E A M algorithm. Matt’s Answer. There are many methods in TEAM that can be applied in the form of a question. These methods and how they are carried out, depends on the circumstances and the specific thoughts a person is having. Below are some examples of negative thoughts (NT’s) and the types of questions that might help overcome them. (NT): ‘Something really bad is going to happen’  (Be Specific Technique): ‘Like what? What’s going to happen?’  NT: ‘I’ll fail my biology test’  What-If Technique: ‘What if I failed my biology test, why would I be worried about that? (write down any new thoughts) What if those things happened, too, what then? (write down any new thoughts) What’s the absolute worst thing that could happen? (write this down).  Measurement: How certain am I, that these things will happen? On a scale from 0 – 100%, how likely are each of these predictions, in the form of negative thoughts, to occur?  Socratic Outcome Resistance: What do each of these negative thoughts say about my values that I can feel proud of? (write these down) What is appropriate about how I’m feeling and thinking? (write these down) What are the advantages of having these thoughts? (write these down). What would I be afraid of, if I didn’t have this thought? (write these down)  Pivot Question: Given the many positive values related to worrying, the advantages of doing so, the disadvantages of a carefree existence and the many reasons why my worry is appropriate, why would I change this?  Forgetful Clone (Double-Standard Amnestic Technique for Outcome Resistance): What would you say, to a dear friend, in an identical situation, when they asked these questions: ‘I’m really worried about failing my biology test, would you be willing to help me? (if ‘yes’, then continue) … Don’t I need to keep worrying? Won’t that protect me from failing? Don’t I need to worry, so that I’m highly motivated to succeed? Don’t I need to worry, so I avoid making mistakes? Don’t I need to worry, to maximize my rate of learning new material? Won’t I get lured into a false sense of security, if I stop worrying? Won’t I jinx it, if I get too confident? What would you recommend to me? How much do you think I should worry? I am prepared to do so … would it be helpful for me to go into a sustained panic, at this time?’  Cost-Benefit Analysis: Is worrying about failure worth the price? How would you weigh the advantages of worrying about failure against the disadvantages? What are the pro’s and con’s? How would you divide 100 points, to reflect the power of these two arguments?  Examine the Evidence, Motivational: What evidence is there that worrying improves academic performance, concentration and learning? What evidence is there that worrying worsens academic performance, concentration and learning? Magic Dial Question: ‘‘Should I remain maximally worried, at all times, forever? (If not, keep going) ’What amount of worry is best, for me, in this moment?’, ‘How about future moments? How frequently do I need to worry and for how long?’  Process Resistance for Activity Scheduling, Worry Breaks/Cognitive Flooding, Self-Monitoring/Response Prevention: ‘Would it be alright to ignore my worry most of the time and only focus on it during scheduled times? Let’s say I could learn how to be extremely calm and focused most of the day, without worry … would I be willing to worry as intensely as possible, for ten minutes, three times per day, to achieve this? When my worry comes up at other times, would I be willing to observe and record that event, then return to the task on my schedule?  Socratic Questioning: Am I absolutely certain that this thought is true, that I will fail? How do I know that I will fail? What specific questions will be on the Biology test that I will get wrong? What number grade will I get? A 60? 58? 39?’, ‘Would I bet money on my getting precisely that grade? Why not?’.  Examine the Evidence (cognitive): ‘What evidence is there that I will fail? What evidence is there that I will pass?  Reattribution: Let’s say that I fail. Would that be entirely my fault? Are there any other factors, outside my control, that might have contributed to this outcome? My genetics, for example? Or the nature of the world, into which I was born? Did I choose my genetics? Did I choose the world into which I was born, when I was born, my parents, teachers, etc.? Could any of these factors have played any role in the outcomes in my life?  Other examples of Inquiry-based methods, using different NT’s:  Negative Thought: ‘People will be angry and judge me, if I fail’  Interper
Ask David: Featuring Matt May, MD How can I help my son? Is rapid recovery just "First Aid?" Do early "attachment wounds" cause anxiety? What's the Hidden Emotion Model? Are anxious people overly "nice?" And more! In today’s podcast, three shrinks discuss many intriguing questions about anxiety from listeners like you, and begin with a question from a man who is worried about his relationship with his 11 year old son, who is just starting to get cranky and a bit rebellious. Then we field questions posed by thousands of individuals who attended one of Dr. Burns' free workshops on anxiety sponsored by PESI more than a year ago. Most of the answers included in the show notes below were written prior to the podcast, so the live podcast will contain more information than the answers presented below. Guillermo asks: How can I get close to my 11 year old son? Hi, Dr Burns Thank you for all the knowledge you share through your books and your podcasts. “the way you think creates the way you feel” has changed the way i view life. I wanted to share an exchange I had with my 11 yo son 2 days ago. I was asking him to move some stuff around to clean his room and he was not loving it so his attitude reflected that, then i asked him about a particular lovely drawing of his that i found (from kindergarten) and he was dismissive and said “just throw it away” and i raised my voice and said “I CAN ALSO HAVE A BAD ATTITUDE, WOULD YOU LIKE FOR ME TO TALK TO YOU LIKE THIS?” (I was rude and loud) To which, he got startled and teary eyed and said “no”. And i immediately felt bad, noting that i pushed him away when i wanted to get closer to him. I later came to his room and apologized for my behavior and gave him a hug. I said “im sorry i raised my voice, im sure that hurt you and that hurts me bc you're the most important person in the world to me” and i gave him a hug. That same night I heard podcast 278 or 279 and you said “the road to enlightenment is a lonely one, my friend” when responding to someone asking about the other person in a relationship. I thought, damn that’s true hahaha. I was going to say sorry but was thinking about what happened, this just reinforced it so much! After this I went over to his room to apologize. I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this? Thank you again for all you do, Guillermo David’s answer: I can't tell you what to do, but I loved your last sentence, " I seem to be struggling to stay close to him as he goes into his teenage years, any advice/thoughts that could help me improve my role in this?" In my book, Feeling Great, my dear colleague, Dr. Jill Levitt did this exact thing with her son with fantastic results. Said almost that exact thing! Warmly, david ANSWERS TO DAVID'S PESI ANXIETY LECTURE QUESTIONS Is this rapid response merely first-aid. Am I right in assuming the sustained work (psychodynamic, therapy, body work etc.) is still required? David's answer. Nope! But of course, all humans are unique, and some will require a longer course of treatment than others, but this is not due to any “first aid” problem! Matt’s Answer: I agree with a lot of this.  While we are frequently seeing rapid and complete elimination of negative feelings, like depression and anxiety, while using the TEAM model, we expect 100% of people to ‘relapse’, at some point in the future.  Educating people about this is important and part of ‘Relapse Prevention’.  Part of Relapse Prevention involves accepting the impermanence of things, including our euphoric, enlightened experiences.  As the Buddhists say, ‘we all drift in and out of enlightenment’.  Relapses, the ‘drifting in-and-out’ is a sign of a healthy brain.  Recovery is a bit like learning a new language, including how to talk-back to your negative thoughts.  While you can learn a new language, your healthy brain will not permanently forget your native tongue, so you’ll occasionally go back to old habits in thinking.  So, achieving optimal mental health requires an ongoing practice with the methodology.  Rather than some new methodology, however, the one that is effective will be the one that helped you recover, in the first place.  If it was Exposure, you’ll have to keep on doing that.  If it was talking back to your negative thoughts, then you’ll have to do that, occasionally, etc.  This can be a bit disappointing or disheartening to hear, if you were expecting permanence or perfection.  Paradoxically, accepting the imperfect and impermanent nature of our reality is what leads to relief and recovery.  That is to say, ‘Enlightenment’ is not a ‘perfect’ mental state but an acceptance of an imperfect one.  If this seems distasteful, Enlightenment may not be what you’re after!  For those of you willing to embrace and appreciate your average, imperfect and impermanent experiences in life, you are very likely to recovery.  You’ll still need Relapse Prevention, including a commitment to continue to practice on an ongoing basis.  This leads to a higher level of recovery, in which you become your own ‘best therapist’.  Another place where I agree with you is that one might achieve (imperfect) recovery from anxiety and depression, and even take on the responsibility of maintaining these results, and yet still not be satisfied with some other aspects of life.  It’s possible (in fact likely) for any given person to suffer, not only from mood problems, like anxiety and depression, but from other types of problems, like unwanted habits or addictions, or relationship problems.  TEAM contains methodologies that address these concerns as well.  ‘Recovery’ from these conditions is the same as for mood problems, in that recovery will be imperfect and impermanent and require practice to sustain.  What type of practice that might be depends on the individual and we can’t predict, in advance, what types of exercises will be effective, for a particular person.  In fact, there’s a danger in assuming we know what will be effective and closing our minds to alternative approaches.  It’s a common error, for therapists, to pick up one tool and use that, regardless of results, rather than trying new approaches.  This is kind of like having a hammer in your hand, and seeing all your patients as nails!  I like how David says it: ‘Treat people, not conditions’.  So, I think I agree with what you’re saying, in that it requires trial-and-error with multiple methodologies to achieve initial recoveries, as well as ongoing practice to achieve optimal results.  I also feel compelled to observe the tendency for certain dangerous and wrong ideas to persist in our culture, kind of like ‘Urban Legends’ or ‘Mythology’.  One example is the revolution that occurred in medicine when people realized that pathogens, like viruses and bacteria, cause disease.  It had previously been thought that disease states were caused by an imbalance of the ‘Four Humours’, blood, bile, phelgm and calor (heat).  The treatment, for pretty much anything that ailed you, back then, was leeches and blood-letting, in hopes of restoring the balance of these ‘humours’.  A revolution in our understanding of disease occurred with the invention of the microscope.  It was now possible to visualize microscopic organisms, like bacteria, that we now know, after many experiments, are responsible for disease states. This allowed us to develop medications, like Penicillin, that kill bacteria and lead to rapid recoveries from infections, like pneumonia and immunizations that prevent infection.  Despite undeniable scientific evidence, people are prone to believing the old mythology, keeping the wrong and outdated model alive.  For example, many people are afraid, on a cold day, because they think that exposure to cold temperatures will lead to having a disease, which is even called a ‘cold’.  Meanwhile, we know, scientifically, that it’s not cold temperatures or an imbalance of any ‘humour’, that is causing colds, flus, and pneumonia.  It is microorganisms, like viruses and bacteria.  If you don’t want to get a cold, it’s better to sanitize your hands and wear a mask, than to bundle up on a cold day.  Instead of bloodletting and leeches, try vaccines and antibiotics.  Of course, people also make up new mythologies, around these, much to their detriment and at great cost to society.  My advice would be to listen to develop a skeptical mind and read the scientific literature.  Or, try to understand Neil DeGrasse Tyson, when he says, ‘Science is True, whether you believe it, or not’.  A similar revolution in our understanding has occurred in the field of Mental Health.  Like seeing bacteria, for the first time, after the invention of the microscope, we are returning to the understanding (which ancient Greek and Buddhist philosophers noted, as well) that it is our negative thinking that causes our suffering, more than our circumstances.  We know, now, that psychoanalysis is not required, to optimize mental health, any more than bloodletting or leeches is required to treat Pneumonia.  Thanks to Dr. David Burns, there is now a rapid, highly effective and medication-free treatment for depression and anxiety, called TEAM. Is the Hidden Emotion Model suitable for anxiety caused by early attachment wounds? David's answer. These big words are out of my pay scale, although they certainly sound erudite! In fact, the cause of anxiety is totally unknown, so when you say “caused by” we are in different universes! But the simple answer is yes, in 75% of cases, anxiety is helped greatly by the Hidden Emotion Model. Thanks! Matt’s Answer:  The Hidden Emotion model would always be on my list of methods to try, for an individual who wanted help reducing their anxiety.  That said, it’s better to select methods based on an individual’s specific negative thoughts rather than the presence or absence of trauma in childhood.  In fact, the assumption that we know the cause
What's the Antidepressant Myth? Have We Been Scammed?     Today, Rhonda and I interview one of our heroes, Dr. Irving Kirsch, who is a giant in depression research and a fun, down-to-earth human being at the same time! Dr. Kirsch is Associate Director of the Program in Placebo Studies and the Therapeutic Relationship, and a lecturer on medicine at the Harvard Medical School (Beth Israel Deaconess Medical Center). He is also Emeritus Professor of Psychology at the University of Hull (UK) and the University of Connecticut (USA). Dr. Kirsch has published 10 books, more than 250 scientific journal articles and 40 book chapters on placebo effects, antidepressant medication, hypnosis, and suggestion. He originated the concept of response expectancy. This is the expectation that people have that a given treatment or intervention will be helpful. Kirsch’s 2002 meta-analysis on the efficacy of antidepressants influenced official guidelines for the treatment of depression in the United Kingdom. His 2008 meta-analysis was covered extensively in the international media and listed by the British Psychological Society as one of the “10 most controversial psychology studies ever published.” His book, The Emperor’s New Drugs: Exploding the Antidepressant Myth, has been published in English, French, Italian, Japanese, Turkish, and Polish, and was shortlisted for the prestigious “Mind Book of the Year” award. It was also the topic of a 60 Minutes segment on CBS and a 5-page cover story in Newsweek. In 2015, the University of Basel (Switzerland) awarded Irving Kirsch an Honorary Doctorate in Psychology. In 2019, the Society for Clinical and Experimental Hypnosis honored him with their “Living Human Treasure Award.” In today’s podcast, we cover a wide range of topics, including a patient-level reanalysis of all of the data on the effects of antidepressant medications versus placebos submitted to the FDA. This analysis included more than 70,000 depressed individuals and indicated something troubling and surprising. The difference in improvement between individuals treated with antidepressants and individuals receiving antidepressant medications was only 1.8 points on the Hamilton Rating Scale for Depression. This test can range from 0 to 50, and a difference of 1.8 points is not clinically significant. In addition, the beneficial antidepressant effects observed in both the placebo and “antidepressant” groups are large, with reductions of around 10 points or so on the Hamilton Scale. These were the shocking discoveries that led to his popular book, The Emperor’s New Drugs (LINK), and to his appearance on the Sunday evening 60 Minutes TV show. In addition, Dr. Kirsch agreed that tiny difference between the “effects” of antidepressants vs placebos could be the result of problems in the experimental design used by drug companies. Because they give patients in the placebo groups pills with inactive ingredients, there are no side effects in the placebo groups. This makes it fairly easy for individuals to guess what group they were assigned to—the “real” antidepressant group or the placebo group. This might account for the differences in the groups, since many individuals in the medication groups may think, “Hey, I’m getting some side effects. I must be in the antidepressant group. That’s terrific!” This thought would be expected to trigger some mood elevation, but it’s the thought, and not the pill, that causes this. In contrast, some individual in the placebo groups may have the thought, “Hey, I’m not getting any of the side effects they described. I must be in the placebo group!” And this thought may trigger disappointment, and a worsening of depression. This would contribute to differences between the drug and placebo groups in drug company outcome studies with new chemicals that they hope to get approved as “antidepressants.” This problem could easily be corrected by the use of active placebos, like atropine, which produces dry mouth, a side effect of many antidepressants and has been used as an active placebo in a small number of trials. Most of the studies using active placebos have failed to show any significant effect of the antidepressant over the active placebo. Drug companies have been reluctant to implement this change in their research designs, perhaps due to the fear that it will “erase” the tiny differences that they have been reporting. This would be of potential concern since billions of dollars are at stake if the FDA gives you permission to call your new chemical an “antidepressant.” We also discussed Dr. Kirsch’s unlikely journey to Harvard. When he was in England, planning to return to the United States, he asked a colleague at Harvard if it would be possible for him to get a library card so he’d have access to articles in research journals. His colleague told him that it was difficult to obtain a library card for people not affiliated with Harvard. However, they were willing to offer him a position as Instructor on Medicine, given that he was the Associate Director of the  Program in Placebo Studies and the Therapeutic Relationship, which was hosted at one of the Harvard teaching hospitals. That’s a wow! But certainly deserved, and a most fortunate affiliation with unanticipated and highly positive consequences that have led to many important discoveries on how the placebo effect actually works. The placebo effect is not a bad thing, and has been one of the doctor’s best “medicines” for hundreds if not thousands of years. On the podcast, we also discussed the confusion—for patients, doctors, and researchers alike—caused by the placebo effect. For example, many people who receive antidepressants do improve, and some recover completely. They will SWEAR by antidepressants, and may feel hurt or disappointed by the results of Dr. Kirsch’s research. But in fact, there is no discernable difference between the effects of placebos and so-called “real” effects. And one of the downsides of the confusion about placebos is that people who take antidepressants and improve have improved because of changes in their thinking, and not from the antidepressant. But they wrongly give credit to the pills they took, whereas they deserve the real credit for overcoming their feelings of depression. We discussed many other topics, including pushback he has received from the psychiatric community and some in the general public as well who have not taken kindly to his findings. I, too, have experienced that when I have summarized the data in the Food and Drug Administration, and have had to be very careful in how I present this information, because none of us want to discourage anyone who is depressed. We have also invited Dr. Kirsch to consult with us on the research design we use in our beta testing of the Feeling Good App, and have developed tests of “expectations” (the so-called placebo effect) that we will use in our latest beta test as well. We want to “walk the walk” and not just “talk the talk” and find out how much the improvement we see in beta testers might be due to a placebo, or “mega-placebo” effect. Rhonda and I were honored and thrilled to have this chance to interview Dr. Irving Kirsch, a friend and research giant for sure! Thanks so much for listening to today’s podcast! Irving, Rhonda, and David
Integrating TEAM-CBT with Martial Arts Training! Podcast Episode 330, Featuring Dor Star Our guest today is Dor Star. Dor is an educational counselor (MA) and a level 2 TEAM practitioner who works with children in Israel who have emotional and interpersonal problem. He works with children as young as four years old, but most of his work is with children ages seven to twelve years old. The children he works with experience various challenges and difficulties such as: Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), learning disabilities, tantrums, outbursts of anger, all kinds of anxieties, social difficulty, bullying and much more. His work is unique because he works mainly in small groups (4-6 participants) using martial arts and sports as therapeutic tools. In his work Dor uses the TEAM model with some adaptation, because of the children’s ages and sports methods, with great success! In fact, one can say that he discovered for himself, and for his patients, a new way to use the TEAM model. He also teaches sports and martial arts trainers who are interested in entering the field of child therapy. Dor describes his first encounter with TEAM-CBT, which blew him away, but he was initially frustrated because he was thinking of his conventional ways of dealing with kids VS TEAM. But after a few weeks he discovered that he could use the TEAM structure to improve his approach, and wow, did he ever start to shine, as did his results with TEAM. Today’s podcast was really a breath of fresh air! Dor began with T = Testing, and describes how he developed simple assessment tools to rate how his children (aged 4 to 11) were feeling at the start and end of his classes, but also how they felt about him. He uses simple questions like “Did I understand you today? How well did I listen?” He also asks them, “How much fun was the session,” and “How did you grade yourself?” Then they grade him on a scale from 0 (the worst) to 10 (the best.) So, it’s quick, easy, and . . . shocking. Dor says: “I found out that I wasn’t nearly as effective as I thought. Sometimes the kids thought the class was fun, but I got really low grades on Empathy, as well as how depressed, anxious and angry they were feeling at the start and end of each group session. Essentially, I discovered that I wasn’t achieving almost any of my goals for my kids. This was disturbing at first, and I had to let my ego die. But I decided to try to view it as valuable information that I might be able to use to learn and grow.” For example, I had one of the most amazing sessions with an 11 year who was smiling the entire time. I was absolutely certain it was one of my best sessions ever. But when I asked him for my grade, he gave me a 3 out of 10! When I asked why, he explained that at the start I didn’t introduce myself or ask him about himself! So, in this simple but compelling way, Dor has used the T = Testing to transform the entire way he works with kids! I believe he’s had the same experiences I’ve had with the T = Testing component of TEAM. Dor has made his patients his teachers, and this has led to some amazing and revolutionary developments in his approach. Dor emphasizes the importance of E = Empathy, and says that “the Five Secrets of Effective Communication” are incredible! For example, if they’re having a rage attack, or a temper tantrum, you can tell them they are absolutely right in the way they’re thinking and feeling.” He also uses what he calls the Five Ways of Love. Verbally expressing respect and liking Giving service: tying a child’s shoes, giving them some water during the training. These small acts can create feelings of trust and connection. Spending time with them, paying attention to them. This is especially important because so many are angry and try to push others away. They are good at getting other people to reject them and not want to spend time with them. Giving gifts, something they can take home and show to their parents. Making physical contact with them during the martial arts training, playing with them, having fun. I (David) would note that physical contact might be something to be careful with. Of course, when you are teaching martial arts, it may be perfectly justified and desirable. I came from the psychotherapy perspective, and I have been trained that ANY touching of a patient other than shaking hands at the initial and final sessions is grounds for a malpractice suit as well as an ethics charge. Dor also made some really illuminating comments on the A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) At the initial evaluation, he talks to the teachers, parents, and students. The agendas from teachers and parents are things like “he has an anger problem” or a problem paying attention in class, or whatever. However, 90% of the time, the children frequently are unaware of those agendas, or have no interest in the goals of the teachers and parents. Instead, he finds out what the children want to work on, and finds this to be the most and only effective way to approach the treatment. He says that it is fairly easy to set goals with children of any age, even as young as 4 years old, but those in the 8 to 11 years of age are the most difficult. He said that the children’s goals may be to learn how to hit back when they are being bullied in school, or to have fun and make friends with other kids. I was delighted to hear about Dor’s methods of setting goals with his kids and have felt strongly along these lines for many years! I say, Kudos, Dor! He also described doing a Cost-Benefit Analysis of crying when being bullied, and also helps his children see the positives in their symptoms using Positive Reframing. Dor explains: For example, I worked with a child who was bullied at school. In order for the work to be effective, I asked that the boy who bullied him be included in the group as well. After seeing the bullying happening in real time, I had two private five minute sessions with each child while the other kids played. In these sessions I used empathy techniques and received a score of 10 I started fooling around with the TEAM-CBT Agenda-Setting techniques. The goal was for the child who suffers from bullying to choose to behave in a different way. The child said he was willing to do it to prove to me that he is strong and to get back at the kids who beat him. I then talked to the bully boy and asked him if he was willing to help me work with that boy. He was happy to do it because he wanted him to stop crying all the time and get punished for it. After that the M = Methods part was really easy and fun. I hade the bully train the kid =whom he’d bulled. Two meetings after that they were best friends. In my experience (and I have done this process several times) the bully is the best therapist for a child who suffers from bullying! After Dor described his approach to helping kids who are being bullied, he said that if the parents or authorities step in to help it can make things worse because they child is placed in the role of being a baby, which may intensify the bullying. David asks: Dor, is a safety plan for the child important? Can the child always learn to deal with the bullying on their own? Any details or examples would be great! This was Dor’s answer: I didn't address it enough, but you can't provide good therapy without providing good education. That's why I like working in schools because I can easily talk to the teachers. It is clear that we as adults need to talk about values and set boundaries, and in severe cases we may need to intervene and provide a safety net for the therapeutic process. But I feel that it is my job as a therapist to give my patient the tools to deal with their problems on their own. And bullying, like any problem in a relationship, is about guilt. And as soon as I stop blaming the other and start trying to improve myself and treat the other and his wishes with respect the change begins to happen. David: I agree strongly with what you just said! My research when I was in Philadelphia years back strongly supported the notion that blame is one of the main causes of relationship conflicts. Dor continues: In another case of mine, I worked with a child who complained that whoever was sitting on him was yelling at him and throwing things at him. I wasn't sure what could be done and gave him all kinds of bad suggestions At this point a 10-year-old boy with autism stopped me () and asked him what he asked the boy who was bothering him. He said that the he was criticized for the exact same thing--he was making noises that disturbed the boy next to him. From there we continued with homework to find out what is bothering that child, to tell him that he is right, and to ask him if he is ready to stop hitting and yelling at the second patient and his behavior will change. It was a huge success. Dor continues to talk about the idea of specificity which is so central to TEAM-CBT: I discovered that the techniques we teach children should be direct and simple. In the past we believed in all kinds of indirect techniques that were supposed to somehow help the child. The idea is to stop using general definitions like "self-confidence" "concentration abilities" and "social problems." Instead, we can start being specific in our goals and techniques. Rhonda and I were thrilled to learn about Dor’s terrific work adapting TEAM to working with very young people. I encouraged Dor to consider a book on TEAM for TOTS (or some other title) so other therapists can learn how to adapt TEAM to work with children with specific problems such as intense shyness, autism spectrum problem, ADHD, anger issues, and more. Several days after the recording session, Dor was already working on his book. Awesome! Thanks so much for listening today! Rhonda, Dor, and David If you wish to contact Dor, you can email him at:
329: Narcissism!

329: Narcissism!


Ask David: Featuring Matt May, MD 329: How can you deal with a “narcissist?” In today’s Ask David, we respond to a listener who requested a podcast on the topic of narcissism, including how to deal with them, so we will focus on these topics. The following show notes were prepared prior to the actual podcast to provide a structure. For more great information, listen to the podcast, as much more was covered! David What is the definition of “narcissistic personality disorder”? Narcissism involves: Grandiose fantasies and feelings, thinking that you are superior to others Lack of empathy for others Extreme self-centeredness Intolerance to criticism or disapproval Urges for revenge on anyone who crosses you. We do not know whether these are just extremes of personality characteristics that everyone has in varying degrees, or whether it actually consists of a “disorder” that is qualitatively different and distinct. But it is definitely true that all of the characteristics I have bulleted above do exist to some degree in most, if not all, human beings. How do you treat narcissistic patient? I do not treat diagnoses, just human beings. This is a radical departure from the way many mental health professionals approach their work. No matter who I’m treating, I always start with the T and E of TEAM (Test and Empathy) and then move on to A = Assessment of Resistance (formerly called Paradoxical Agenda Setting.) The main idea is to find out what, if anything, the patient wants help with. It would be rare for someone with narcissistic qualities to want help with their narcissism. Generally, they want help with a troubled relationship or with feelings of depression, anxiety, or anger. Then I would ask them to zero in on one specific moment when they were upset and wanting help, and deal with Outcome and Process Resistance. If the patient can convince me that she or he does want help, then I move on to M = Methods, and the methods would have to do with the nature of the problem they want help with. I once presented a case illustrating rather dramatic and rapid recovery in a patient I was treating for depression and anxiety. To my way of thinking, it was a great outcome. However, during the Q and A I got an angry rebuke from a therapist in the audience who pointed out that I hadn’t treated the patient’s “obvious narcissism.” This is the “great divide.” I don’t feel like it’s my calling to evangelize for any model of “ideal mental health.” For the most part, and there are always exceptions to every rule, I do not impose my agenda on the patients, but try to work with what they want to change. I might suggest possible ways we could work together, but in the final analysis it is up to the patient. I liken my role to that of a plumber. If you’ve got a broken toilet, give me a call and I’ll fix it. But I don’t go from door to door promoting copper pipes! How can you deal with narcissistic individuals in the real world? Once again, it depends on the specific moment that you want help with. However, I always like to emphasize the value of the Disarming Technique and Stroking when interacting with someone with strong narcissistic tendencies. The goal, in my opinion, might be on “dealing with them skillfully” as opposed to “changing” them or “winning.” For example, (David can give example of Erik’s friend when growing up.) What are the causes of narcissism?  Scientists do not know, for the most part, what causes most of the so-called “mental disorders” listed in the Diagnostic and Statistical Manual of the American Psychiatric Association, but it seems possible, even likely, that there could be genetic and environmental causes, and the environmental causes could have to do with the past (childhood influences) and present. For example, when people begin to experience significant success, in academics, sports, or some other field, others begin to admire them and want to be with them. This can fire up our egos, and can feel good. And as they level of fame and status increases, the attraction of others intensifies, and eventually people fear saying no or contradicting the narcissistic person who has such power. So, the narcissistic person is constantly reinforced, even for bad behavior or irrational beliefs, with little or no negative feedback to correct his or her course of actions and thinking. Some experts also point to profound feelings of shame and insecurity under the surface, which might also be genetic, at least in part, or triggered by adverse childhood experiences. What you have to let go of to relate to someone who is narcissistic? To my way of thinking, you have to give up the idea that the narcissistic person is going to take you seriously or care about you, You may also have to give up the notion that you are going to “change” or “help” them. You may have to use a more manipulative approach, using lots of Disarming and Stroking, instead of being so sincere and serious. This involves “letting go,” and moving forward with your life. What is “Malignant Narcissism?” This is a severe form of narcissism where the person will resort to extreme tactics to get their way, including murder. You see this in politics and cults. Names like Jim Jones, Adolph Hitler, and even some politicians today around the world, and many despots throughout human history. What does it mean when someone is “manipulative?” David explain that he’s heard that term for years, decades really, but did not understand what it meant until a few weeks ago, based on a personal experience. The group contrasts a relationship based on using people, and seeing them as objects, vs a relationship based on warmth, vulnerability, trust, respect, and openness. Thanks for listening today! Matt, Rhonda, and David
"Overcoming Toxic Shame" Join Dr. Jill Levitt and me  at our fabulous new workshop Sunday, February 5th, 2023 8:30am - 4:30pm PST - 7 CE units Click here for information and registration In today's podcast, David and Jill describe their new workshop on Overcoming Toxic Shame. This workshop will feature video snippets from a fantastic session with a beloved colleague named Melanie who struggled with intense feelings of anxiety and shame for more than 8 years. You will see her transformation from utter despair to joy in a single therapy session lasting roughly two hours, and you will get the chance to learn and practice the techniques that were so transformative for her. Most mental health professionals also struggle with feelings of shame because of their belief that they aren't "good enough" and from fears of being found out. You will have the chance to heal yourself while you master cool new techniques to transform the lives of your patients! In today's podcast, David and Jill do a live demonstration of a couple of the many techniques they will illustrate on February, which will include the Paradoxical Double Standardl Technique, Externalization of Voices, and the Feared Fantasy. You will not only witness a remarkable change in Melanie, as well as a sudden, severe and unexpected relapse half way through the session. David ang Jill will ask, "If you were the therapist, what would you do right now?" What follows is AMAZING! Jill practices and serves as the Director of Training at the Feeling Good Institute in Mountain View California. She is also co-leader of my Tuesday evening weekly training group at Stanford (now entirely virtual). This group is totally free and is available to mental health professional in the Bay Area and around the world. You can reach Dr. Burns at
Live Therapy with Cody, Part 2 of 2 Last week we presented the first of our session with Cody, a young man wanting help with his fairly severe social anxiety since childhood. My co-therapist for this session was Dr. Rhonda Barovsky, the Feeling Good Podcast co-host, and Director, Feeling Great Therapy Center. Today, you will hear the exciting conclusion of his session, and the follow-up as well! Part 2 M = Methods We focused on cognitive work and interpersonal exposure techniques as well. I will leave it to you to listen to the podcast, as I became so engrossed in what we were doing that I stopped taking notes. However, we used a number of tools within the group, including: Identify the Distortions in his thoughts Examine the Evidence Externalization of Voices Self-Disclosure Rejection Practice The Experimental Technique The Feared Fantasy And more. Cody received an abundant outpouring of love, respect, and encouragement from those in attendance (LINK). We also gave Cody two “homework” assignments to complete following the group. Do at least three Rejection Practices in the mall and notify the training group members via email within 24 hours that he had completed this assignment. Complete the Positive Thoughts column of your Daily Mood Log. If you'd like to see Cody's complet4ed Daily Mood Log, you can check this LINK. If you'd like to see Cody's intimal and final Brief Mood Survey plus Evaluation of Therapy session, check this LINK. As you can see, there were dramatic changes in all of his negative feelings. However, he wanted to retain some anger toward his childhood friends who made fun of him. Here’s the email we received from Cody about his homework assignment. Hello groupers, I can proudly say mission accomplished! Although it took me around 7 hours to do it, I did it. A lot of emotions came up as I kept trying and chickening out. I really feel like something has changed in me, by the last person I felt almost no anxiety and now I keep asking myself why I was ever afraid of this (I hope it sticks. I know I'll need to keep up this momentum I'm sure). Having to do this email and being held accountable to you all was what drove me to the finish line. Thanks again, see you all next week! Thanks to you, Cody. You were incredibly inspiring in group and after and the work you did will touch the hearts of many people, just as you have already touched the hearts of all the people in our group! And thank you all for listening! Cody, Rhonda, and David
Comments (20)

Afreen C

Interesting podcast. I think there should be a disclaimer for this podcast as some comments that the guest made are not consistent with long-term empirical research about how trauma impacts the brain.

Sep 21st


Amazing results!

Mar 5th

Sasan Parvini

What's with the skips in the beginnings?!

Feb 22nd

Milad Sasha

Fuck this for the annoying sound of chain or something

Apr 2nd


I have tremendous respect for David and his work. However, at various points in this episode, he calls new research "stupid," refers to distressed people as "whiners," dismisses whole studies with personal anecdotes, and uses a derisive mimicking voice. I understand that expertise creates ego, but the sheer lack of empathy here is surprising. It seems to contradict the methods from the early episodes.

Mar 9th


I never knew there was a name for reading OCD. I hope you do a full episode on it!

Feb 23rd

Dj Lady K

Women therapists cant take negative feedback. So many are extremely narcissistic. They need more hard-core therapy than their patients.

Jan 3rd
Reply (1)

Dj Lady K

This world needs better therapists that actually do their jobs, don't abuse their patients, try to understand their patients, and care. Half ass therapy doesn't work. So many just want a paycheck. So many cross boundaries and break the confidential laws and get away with it. So many re-traumatize patients. So many false diagnoses and not knowing what they are doing. I wish more people were like Dr. Burns.

Jan 3rd

Mohamad Hadi Sarafrazi


Nov 4th
Reply (1)

Mohamad Hadi Sarafrazi


Nov 2nd

Clellie Merchant

T does not stand for transsexual. This is basic 2019 knowledge.

Aug 9th


I really like these podcasts, but I didn't think that David answered the question in this one. It seemed the listener had already dissolved her distorted beliefs and asked about how to prevent relapse when surrounded by circumstances that support the distortions. Fabrice's example of the alcaholic seemed apt, but the other examples and answers didn't address external circumstances.

Jul 27th



Jul 25th
Reply (1)

Marty Schwebel

I'm truly thankful for this podcast!

Jul 17th
Reply (1)

Djamel Eddine

I'm grateful that I've come cross this Podcast!

Oct 10th

Avi Ehrman

That was really enjoyable, and rich with valuable teachings. One concern I have with the feared fantasy technique in this particular setting, Since it's being done in such a friendly and supportive environment it doesn't reflect in a meaningful way a real life fear, does that not minimise it's effectiveness? Thanks, Avi

May 16th
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