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!
348 Episodes
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
Featured pic of Cody in one of the small group practice sessions in David's virtual Tuesday training group. Live Therapy with Cody, Part 1 of 2 I recently treated Cody, a young man wanting help with his fairly severe social anxiety since childhood, during one of our Tuesday evening Stanford training groups. My co-therapist for this session was Rhonda Barovsky, PsyD, the Feeling Good podcast co-host. The full session will be broadcasted in two parts, starting today and finishing next week. Part 1 T = Testing At the start of the session, Cody’s depression score was only 6 out of 20, indicating minimal to mild depression, but his score on the loss of self-esteem was “a lot.” His anxiety score was 11 out of 20, indicating moderate anxiety, and his anger score was only 2, minimal. However his score on the Happiness test was only 11 out of 20, which is only moderately happy, indicating a lot of room for improvement. If you like, you can review his Brief Mood Survey at this LINK. We’ll of course ask him to take this test at the end of today’s session so we can see what, if impact, we made on his feelings. E = Empathy Cody described his shyness like this: “I’ve been shy for as long as I can remember and feel introverted. It started in middle school. I felt like I never fit in or connected with people very deeply. In middle school, you really want to fit in. “I wanted my friends to like me, and one day they all started to torment me. Our seats in school were assigned, so I couldn’t get away from them. I cried at recess every day for months. Then, one day, they suddenly went back to being my friends again, and I never understood why. “When they were tormenting me was the most painful moment of my life. I felt like they were judging me. “I’ve worked on my own and I’ve gotten over 90% of my social anxiety. At first, I was afraid of answering the phone or even ordering a pizza, so I got a job where I was required to answer the phone and got over it. “Now I’d like to date, but this has been a problem for me. Also, when I’m treating someone, and this topic of social anxiety comes up, I get uncomfortable. I think if I could overcome the rest of my shyness, it would boost my confidence. “The podcast you and Rhonda did with Cai on Rejection Practice (LINK) inspired me tremendously, and I managed to do one Rejection Practice. By now I’m chickening out again. I go to the mall determined to do it, but I just keep putting it off. Asking women to reject me seems incredibly frightening, and I’m afraid people will judge me or see me as a predator. I love in a small town, and most people know each other. “When I was thinking about the session all day today, I felt nervous and my stomach tightened up. Cody brought a partially completed Daily Mood Log to the session, which you can review at this LINK. As you can see, the Upsetting Event was thoughts of approaching someone at the mall for Rejection Practice. His negative feelings included the entire anxiety cluster, shame, the entire inadequacy cluster, unwanted, humiliated, embarrassed, the entire hopelessness cluster, frustrated, annoyed, and anger with himself. These feelings ranged from a low of 35% for shame to a high of 100% for foolish and humiliated and 90% for the hopelessness cluster. And as you can see, many of his negative thoughts focused on the theme of being judged by others who might see him and think he was strange, or a disrespectful jerk, and so on. He was also convinced that women would be annoyed by him, and that the word would spread so that he’d lose the respect of people he cared about. A = Assessment of Resistance Cody’s goal for the session was to feel motivated to do the Rejection Practice he’d been avoiding, and to get rid of the negative thoughts that were holding him back. He said he’d be reluctant, though, to press the Magic Button and make all of his negative thoughts and feelings disappear, so we listed what his fears might actually say about him and his core values that was positive and awesome. Here’s the list we came up with: Positives My anxiety My anxiety shows that I care about peoples’ comfort. My anxiety protects me from rejection or doing something foolish. My fears of being seen as a predator show that I want to fit in with the social norms and not be weird or threatening to women. My fears show that I want to be respectful towards women. My fears of being judged show that I care about friends and family. My anxiety shows that I care about my reputation. My feelings of inadequacy show that I’m aware that I have things I want to work on. Those feelings also show that I’m humble. My feelings show that I really care about connecting with others, which is one of the most important things in life! My negative thoughts and feelings motivate me to work hard on changing. They also show that I have high standards. My hopelessness shows that I’ve tried to do Rejection Practice six times and have always chickened out. So I’m being realistic. My hopelessness also protects me from getting my hopes up and then being disappointed. My unhappiness gives me greater compassion for my clients. My anger energizes me and motivates to do something new. Tune in next week for the exciting conclusion of the live work with Cody! David and Rhonda
Curing YOUR Social Anxiety— The Ridiculously Cheap and Awesome Shame-Attacking Marathon Jacob Towery, MD Michael Luo Today, we are joined by Dr. Jacob Towery and Michael Luo to promote their  upcoming, two-day Social Anxiety Marathon. Jacob Towery, MD is an adolescent and adult psychiatrist and therapist in private practice in Palo Alto, California.  Michael Luo is a fourth year medical student at the Chicago Medical School. More on them at the end of the show notes, but here’s the scoop. Jacob and Michael will be offering a mind-blowing, two-day marathon for anyone who struggles with social anxiety, which includes shyness, public speaking anxiety, and performance anxiety. They will both be present, along with more than ten experts in TEAM-CBT, coaching participants in the latest tools for quickly overcoming all social anxiety. And here’s the amazing thing. You can come and attend, and transform your life, for only a $20 donation to one of their four listed amazing charities. For information / registration, click here How cool is that? Don’t pass this up. It will be an in-person, hands-on training experience designed to free you from the fears that narrow your life. You will learn and participate in cognitive therapy exercises, identifying and smashing the distorted thoughts that trigger social anxiety, as well as the Self-Defeating Beliefs that trigger social anxiety like the Spotlight and Brushfire Fallacies, the Approval Addiction, and more. They will also illustrate and lead you in a wide variety of Interpersonal Exposure Techniques, including Smile and Hello Practice, Self-Disclosure (which Michael demonstrates in real time on today’s show), Rejection Practice, Flirting Training, Shame Attacking Exercises, and more. David claims that Jacob is likely the world’s top expert in Shame Attacking Exercises, and we illustrate several on the podcast. Rhonda described a Shame Attacking Exercise that I challenged her with. It was incredibly terrifying, but turned out really well! David also described the impact of self-disclosure on a wealthy and powerful businessman he treated who was so insecure that he was even terrified to be around his wife and children. People who are socially anxious nearly always try hard to hide their negative feelings out of a sense of shame, so others, even friends and family and colleagues, typically aren’t aware of how they feel inside. Michael courageously discloses his own negative thoughts that triggered feelings of social anxiety at being around Jacob, his mentor. Maybe I’ll make a mistake. I might be wasting Jacob’s time. Then he might not want to mentor me. These thoughts caused feelings of loneliness and shame. I felt much closer to Michael when he disclose these feelings. Jacob added that he was totally unaware that Michael had been struggling with these thoughts and feelings. The treatment of social anxiety is profoundly serious, because we are involved in changing the lives of people who are suffering and lonely and inhibited, but the treatment can also be fun, hilarious and of course, enlightening. Michael wraps up the show by describing the transformation this training has had on his own life. If you wish to attend, act rapidly because space is limited and will be given out on a first-come, first-serve basis. I hope you can attend, and make sure you let Rhonda and David know about your experiences! Thanks for listening today! Rhonda, Jacob, Michael, and David
Secrets of Overcoming Romantic Rejection Part 2 of 2 In last week's podcast we interviewed Dr. Kyle Jones on the topic of how to overcome romantic rejection, and answered five of your questions. Today we publish Part 2 of that interview. Rhonda, Kyle and David will tell you how to stop obsessing about someone who has rejected you, and whether you can "heal completely,"and how you can get your confidence back, and more! 6. Do you have any tips for moving on and realizing that maybe your ex isn’t as great as you think they are? David 20 qualities I’m looking for in an ideal mate. Rhonda Time, patience, space away from each other. Make lists of qualities you liked about your ex and qualities you wish were different.  Fill out the form: “20 Qualities in An Ideal Mate” and review how many of these qualities your ex had. 7. Since cheating is something that happens so often in relationships, what would you recommend (techniques wise) for someone who’s been cheated on in trying to get their confidence back? David YOU CAN USE THE DAILY MOOD LOG, DOUBLE STANDARD, ETC. OVERCOME FEAR OF BEING ALONE. ETC. Examine the Evidence; Worst, Best, Average. Kyle Cheating can be really devastating if you and your significant other were in a monogamous relationship. What are the negative thoughts you have about yourself after you’ve been cheated on? Practice talking back to those. 8. How can we boost our confidence back up after a breakup in general even if we haven’t been cheated on? David SAME ANSWER. Rhonda Do things you love to do with people who love you:  go dancing, go to the beach, go hear music, read, etc. Daily Mood Log on the thoughts that lead to your lack of confidence. 9. Do you guys believe in the notion that you are capable of “healing completely from your ex (aka completely being over them and all the pain the breakup brought you)” or do you believe that it’s not possible. David I MEASURE THINGS. YOU CAN DO WAY BETTER AS YOU GROW. IS THERE A CLAIM THAT THERE IS NOW AN INVISIBLE BARRIER ON YOUR SCORE ON THE BMS. THIS IS SUCH, EXCUSE MY CRUDITY, HOGWASH! HOPEFULLY, YOU’LL NEVER AGAIN FIND SOMEONE JUST LIKE THE PERSON WHO REJECTED YOU! Rhonda You may never be exactly the same, why would you want to be?  Every experience in life gives you the opportunity to grow (as cliche and kind of yucky as that sounds). Maybe you need to acknowledge and examine your role in the breakup, come to a place of humility or maybe even compassion, but definitely understanding. Interpersonal Downward Arrow to look at the Roles and Rules in your past relationships.  Relationship Journal to see how you have contributed to the relationship problems.  Maybe do Reattribution to see what you contributed to the relationship problems and what they did. 10. What are some realistic expectations to have coming out of a breakup, recovery wise, and what are some unrealistic expectations? David I DON’T IMPOSE MY STANDARDS AND AGENDAS ON OTHERS! THAT’S LIKE MISSIONARY WORK, TRYING TO GET SOMEONE TO ADOPT YOUR STANDARDS. I TRY TO LISTEN (EMPATHY) AND THEN SET THE AGENDA WITH THE PATIENT, AND THE NEGOTIATION STEP IS SOMETIMES IMPORTANT. I ALSO USE STORY TELLING TO ILLUSTRATE A RADICALLY DIFFERENT REALITY FROM WHAT THE PATIENT “SEES.” Rhonda I can’t add anything to that, except, after examining your role in the relationship, you may see the expectations you want to eliminate and the ones you want to maintain. 11. Do you guys feel that you shouldn’t date for a while after getting your heart broken? David THIS CAN BE A GREAT IDEA. I ALWAYS INSIST, AS PART OF NEGOTIATION PHASE OF AGENDA SETTING, THAT THE PERSON OVERCOME THE FEAR OF BEING ALONE BEFORE DATING, WHETHER OR NOT A REJECTION HAPPENED. Rhonda This is a very personal decision.  Have you had time to heal before getting into a new relationship?  Have you had time to examine your role so you can make changes if you choose, so you won’t repeat the same mistakes in the next relationship? 12. Do you have to move on from your ex to go back out into the dating world again and to possibly be in a relationship again? Do you guys feel that “jumping” from relationship to relationship can be a bad thing? Why or why not? David THESE THINGS ARE ALWAYS ON AN INDIVIDUAL BASIS. I THINK IT CAN BE HEALTHY TO DATE A VARIETY OF PEOPLE AND NOT GLOM ONTO THE FIRST PERSON WHO EXPRESSES AN INTEREST IN YOU. THAT WAY, YOU CAN COMPARE A VARIETY OF RELATIONSHIPS AND IN ADDITION, YOUR DATING SKILLS WILL IMPROVE. THE “20 THINGS I’M LOOKING FOR IN AN IDEAL MATE” CAN BE VALUABLE. Rhonda “Jumping from relationship to relationship” sounds so judgmental.  Are you finding yourself in relationships where you have similar complaints from your last relationship, repeating patterns that you dislike?  Then I would pause and take time to heal and learn before starting another one. Kyle What does be “moved on” really mean here? Would you have to never have a thought about your ex again before dating? That might be impossible! I don’t think there’s anything wrong with dating multiple people or starting and stopping relationships with some frequency – especially if you’re looking for a good fit and it’s not working out with someone. 13. How do you overcome your trust issues when getting into another relationship after your heartbreak? David PATIENT WOULD HAVE TO GIVE ME A SPECIFIC EXAMPLE, AND NOT DEAL WITH THIS OR ANYTHING “ABSTRACTLY.” Rhonda Daily Mood Log work, starting with a specific event that led to the lack of trust. Let us know if you would like a third podcast on how to deal with romantic rejection at some point, since we have a number of remaining questions. Thanks! My book, Intimate Connections, will help you with dating and rejection issues! You can contact Dr. Kyle Jones at End of Part 2
Secrets of Overcoming Romantic Rejection Part 1 of 2 In today’s podcast we are proud to interview Dr. Kyle Jones from the Feeling Good Institute in Mountain View, California. Kyle Jones, PhD is a clinical psychology postdoctoral fellow affiliated with Feeling Good Institute in Mountain View, California where he provides individual psychotherapy in a private practice. He co-leads a monthly consultation group with Maggie Holtam, PhD where therapists can get help with exposure methods for anxiety. He has recently become an Adjunct Professor of Psychology at Palo Alto University - teaching Clinical Interviewing in the clinical psychology PhD program. Kyle wrote: “Here are some questions from patients of mine for our podcast today - we don't have to go through all of these bust just some talking points!" We will publish part of the questions in today's podcast, and several more next week. There are even more questions, so let us know if you would want a Part 3 on this topic at some time in the future. Below you will find the list of questions with some responses by David and Rhonda BEFORE the podcast. To get the true scoop, listen to the podcast, as most of the comments below were simply ideas that popped into our heads prior to the podcast. Although we focus on romantic rejection in these two podcasts, the idea really pertain to rejection in all segments of our lives. 1. Why do you think it’s so hard for us humans to handle rejection/why do you think we are so afraid of it? David THE LOVE ADDICTION SDB. LOOKING TO EXTERNAL SOURCES FOR FEELINGS OF SELF-WORTH AND HAPPINESS. THE CBA IS CRUCIAL, SINCE PEOPLE MAY NOT WANT TO STOP LINKING SELF WORTH WITH LOVE. Rhonda Plus, it hurts.  And our brain is wired to experience pain when rejected.  We are wired that way. Evolutionary psychologists believe it all started when we were hunter gatherers who lived in clans. Since we could not survive alone, being ostracized from our clan was basically a death sentence. As a result, we developed an early warning system to alert us when we were at risk of being rejected by our tribemates. People who experienced rejection as more painful were more likely to change their behavior, remain in the clan, and pass along their genes. Kyle Getting dumped sucks! We aren’t really taught how to handle rejection very well in our culture. 2. Are we capable of overcoming the fear of rejection and how do we accomplish that?  David You can face your fear with REJECTION PRACTICE. The FIRST SECTION OF INTIMATE CONNECTIONS IS ON OVERCOMING THE FEAR OF BEING ALONE. Rhonda Is part of the fear of rejection also a fear of being alone?  You can use the “What If” technique to uncover more about those fears.  Then put the thoughts in a Daily Mood Log, and challenge them with a variety of techniques you can select for a Recovery Circle. You can also face your fears with Rejection Practice and/or Exposure. 3. When it comes to getting dumped do you guys believe there is a good way to approach it communicating wise? David YOU CAN USE FIVE SECRETS TO FIND OUT WHY THE OTHER PERSON IS REJECTING YOU. OR, PERHAPS BETTER, YOU CAN TURN THE TABLES ON THE REJECTOR, SINCE IT IS PART OF A CHASE GAME. Rhonda If you want to know more about why you were “dumped,” will you trust the other person to be honest with you?  Will you believe them when they respond?  You might want to do a Cost Benefit Analysis to decide whether or not you even want to ask them to explain why you were “dumped.” Kyle It depends on the situation. If you have gone through a divorce and have children, you may still need to talk with you ex-partner. Generally, I don’t think it’s a good idea to stay in touch and keep chatting with an ex who dumped you! 4. If we are caught off guard with the breakup and don’t see it coming and all of a sudden one day our partner decides to end the relationship, how do we not let our emotions get the best of us in that moment in that very moment? David WHEN YOU SAY, “GET THE BEST OF US” IT SOUNDS LIKE YOU’RE NOT ACCEPTING YOUR FEELINGS. IS IT OKAY TO FEEL FEELINGS? THIS QUESTION SOUNDS LIKE EMOTOPHOBIA. Rhonda It’s perfectly reasonable to be sad, to cry, to be shocked and angry.  Why not have those feelings?  You also don’t have to expect to respond with a “perfect 5-Secrets.”  Maybe you need to take a break from each other, breathe, walk, calm down, and then meet again to talk talk, if that is what you want to do. Kyle If you get blindsided by a breakup it can really be shocking and overwhelming. It’s okay to feel how you feel in that moment I would think. 5. When it comes to recovery after being broken up with, how do you fight the urge to go back to your ex? David THIS URGE IS DUE TO THE BURNS RULE: WE ONLY WHAT WE CAN’T GET, AND NEVER WANT WHAT WE CAN GET. ALSO, CAN DO A CBA ON CHASING. Rhonda Also, look at the thoughts that are leading you to want to get back together.  What do they say about you that is awesome?  Then examine them for Cognitive Distortions, and talk back to them with Dbl Standard or Ext of Voices. Do a “Time Projection,” see yourself in 5 years, in 10 years, in 20 years.  Have a conversation with your future selves to talk about what you want, what kind of person you want to be with, how you want to be treated in the future. Practice “Distraction,” when you start thinking about your “ex” distract yourself by concentrating intensely on something else, music, work, friends, cooking, another hobby. Kyle Come back to reality and remember all the crummy ways an ex may have been treating you, instead of letting your mind ruminate on how great things were during the first few weeks of dating. Come up with all the good reasons to continue wishing/hoping you and your ex will get back together and talk back to those. My book, Intimate Connections, will help you with dating and rejection issues! Stay tuned for Part 2 next week.
How Skillful is your Shrink! Now you can find out! The Exciting Recovery Coefficient-- and the FEAR the grips the hearts of the therapists who are afraid to use it! People often wonder how skillful or effective their therapist is, but until now, there was no very valid or precise way to know. But now there is, and it has fantastic implications for psychotherapy. Today, we feature an interview with Kevin Cornelius, a therapist at the Feeling Good Institute in Mountain View, California.  Kevin Cornelius is a Licensed Marriage and Family Therapist in private practice at Feeling Good Institute, with in-person counseling for teens .Kevin is a Certified Level 4 Advanced TEAM-CBT Therapist and Trainer. I asked Kevin to write a brief description of his evolution from a career in acting to his career as a shrink. Here’s what he wrote: After many years of working as an actor I was ready for a change. After some painful personal events, I saw a therapist who was quite helpful to me. She helped me see that changing to a career as a therapist could be a great thing for me. I went to school and got my Master's in Marriage and Family Therapy. Just before I began applying for internships to complete licensure, I learned that the children's theatre group I had grown up in was looking for a new supervisor to lead the group following the death of its beloved founder and leader. This was a wonderful opportunity for me to use my theatre skills and my desire to help young people in their growth and development. I was very fortunate to be hired and worked as the director of the children's theatre group for 19 years. Towards the end of my years with the children's theatre, I was ready for a change and thought it might be time for me to finish getting my therapy license. It had been 15 years since I had worked with a patient in a therapy session, so I had a lot to learn! I was so lucky to discover David Burns and his amazing TEAM-CBT. The testing element of TEAM enabled me to see right away where I needed to improve so I could focus my efforts on improving specific skills. Being able to study with David in his Tuesday group at Stanford was a golden opportunity. Here was a framework designed to make therapy as effective as possible being taught (for free!) by one of the world's greatest therapists. I'm so happy I followed David's advice to get involved at Feeling Good Institute while I was still pre-licensed. Learning TEAM while I was completing the process to earn my license as a therapist enabled me to start my career in private practice with confidence and a stable foundation. Now, I get to continue learning from mentors at Feeling Good Institute, from the wonderful Feeling Good Podcast, and the valuable lessons I get from my patients. I'll sum up my good fortune with a theatre reference and quote the Gershwins: "Who could ask for anything more?" Kevin recently made the courageous decision to find out exactly how he was doing as a therapist. And the results surprised him tremendously. Background Information for today’s podcast Outcome studies with competing schools of psychotherapy in the treatment of depression have been disappointing. They all seem to come out about the same, slightly better than placebos, but not much. For example, in the British CoBalT study of 469 depressed patients treated with antidepressants vs antidepressants plus CBT, only 44% of the patients treated with antidepressants plus CBT experienced a 50% improvement in depression after six months of treatment, and the multi-year follow-up results weren’t any better. This was better than the patients treated with antidepressants alone, (only 22% experienced a 50% improvement), but still—to my way of thinking—very poor. We see more improvement than that in just one day in patients using the Feeling Good App. Here are just two of many online references to that landmark study: Because of the disappointing results of research on the so-called "schools" of psychotherapy, the focus is switching, to some extent, to the effects of individual therapists, since even within a school of therapy, there can be huge differences in therapists’ effectiveness. Some therapists seem to have the proverbial “green thumb,” with many patients improving rapidly, while others seem much less effective. Is there a way to measure this? Now there is! And do patients have a right to know how effective their shrinks are? That’s what I’m proposing! For at least twenty years or more, I’ve been trying to sell therapists on my Brief Mood Survey with every patient at every session. That’s because you can see exactly and immediately how depressed, anxious, or angry, etc. your patient was at the start and end of today’s session. This allows therapists to see, for the first time, exactly how much the patient improved in various dimensions within the session, as well as how much the patient relapsed or continued to improve between sessions. Here’s a simple example. To make things really clear, let’s imagine that your depression test goes from 0 (not at all depressed) to 100 (the worst depression imaginable, and your patient has an 80 at the start of today’s session. That would indicate a horrendously severe depression, similar to patients hospitalized with depression. And yet, your patient might be functioning effectively, and might appear reasonably happy. So, bonus #1, you can see exactly how your patient was feeling at the start of the session. You might think of the BMS as an “emotional X-ray machine.” Now, let’s assume you have an excellent session, and feel like you’re clicking with the patient, and the patient scores 40 on the end-of-session BMS. That would be a phenomenal 50% improvement. Of course, a score of 40 means that the patient is still moderately depressed, and has a way to go, still the goal is a score of 0 on the depression test and a huge boost in the patient’s score on the happiness test on the BMS. Keep in mind that in the dozens of psychotherapy outcome studies that have been published worldwide, the very highest levels of improvement in months and months of therapy are  never higher than this. So, I call this the Recovery Coefficient (RC), and it is a very precise measure of any therapist’s effectiveness in treating anything you can measure accurately. In an informal study of de-identified data of more than 10,000 therapy sessions at a local treatment center about two years ago. I discovered that the RC the first time therapists met with their patients predicted the improvement over the entire course of therapy. In addition, different therapists had vastly different initial RC scores, which can range from -100% in a single session (meaning a complete elimination of symptoms)  to +100% in a single session (meaning severe worsening.) Sadly, because all patient or therapist identifying information was removed to protect identities, I had no way of letting the therapists know their skill levels! But today, we are joined by a therapist who had the guts to calculate his RC in ten patients to see how he was doing. He was initial incredibly demoralize with his percent reductions (RC) of 45% for depression and 47% for anxiety in 50 minute sessions,  He reasoned that a 44% in a class would be a failing grade, but I pointed out that this isn’t the right comparison. After all, if you had a contract to build the Brooklyn Bridge, and could complete nearly half of it in 50 minutes, you’d be doing something incredibly amazing. Kevin's Depression and Anxiety Recovery Coefficient Calculations     Depression Anxiety Empathy 1 Before 6 14 20 After 3 1   % Change -50.00% -92.86%       Depression Anxiety Empathy 2 Before 5 6 20 After 1 3   % Change -80.00% -50.00%       Depression Anxiety Empathy 3 Before 12 10 20 After 9 9   % Change -25.00% -10.00%       Depression Anxiety Empathy 4 Before 10 5 20 After 5 3   % Change -50.00% -40.00%       Depression Anxiety Empathy 5 Before 5 9 18 After 3 5   % Change -40.00% -44.44%       Depression Anxiety Empathy 6 Before 18 15 20 After 10 9   % Change -44.44% -40.00%       Depression Anxiety Empathy 7 Before 14 12 20 After 10 6   % Change -28.57% -50.00%       Depression Anxiety Empathy 8 Before 2 9 18 After 4 5   % Change 50.00% -44.44%       Depression Anxiety Empathy 9 Before 2 1 20 After 0 1   % Change -100.00% 0.00%       Depression Anxiety Empathy 10 Before 6 5 20 After 1 0   % Change -83.33% -100.00%       Depression Anxiety Empathy Recovery Coefficient   -45.13% -47.17% 19.6                     And indeed, Kevin’s scores actually showed he was outperforming all the published outcome studies on depression by a factor of several hundred. Which was, I think, a well-deserved pleasant shock to his system! I’ve always had tremendous admiration and respect for Keven because of his obvious great skill and intelligence combined with world-class compassion and humility. In addition, patients complete the Evaluation of Therapy Session (ETS) immediately after the session, and rate the therapist on Empathy, Helpfulness, and other crucially important dimensions. Kevin’s Empathy score was 19.6 (96.5%), indicating near perfect empathy ratings from his patients. This is extremely impressive, since most therapists get failing Empathy scores from nearly all of their patients when they start using the ETS scales. However, what was really cool is that Kevin brought the Daily Mood Log he prepared prior to the podcast. As you can see if you check the link, recording his intense negative feelings and self-critical thoughts when he initially completed his calculation
Yikes! Do I REALLY have to share my feelings?  Last week, we featured Part 1 of a live therapy session with Keren Shemesh, PhD,  a licensed clinical psychologist who began having intense panic attacks when her mother and father visited from Israel.  Today, we feature the exciting conclusion of that session, with follow-up. If you are interested, you can listen to the follow-up with Keren and Jill who joined us st the end of today's podcast. They comment on the session as well as the details of what happened following the session. I (David) raised the question of why so many of us have trouble being honest and open with our feelings, especially anger. Jill suggested that it might be due to the false dichotomy people see, contrasting aggression with love. But you can be honest and loving at the same time, including when you express feelings of anger. Of course, we make the Five Secrets of Effective Communication sound easy, but these powerful tools actually require an enormous level of skill as well as commitment. Part 2 of the Keren session: M = Methods We began the Methods part of the session with a bit more Paradoxical Agenda Setting, and listed some really GOOD reasons NOT to open up more to her mother. I want to protect her because it may be hard and upsetting to her. I’m not used to being vulnerable with my parents. I don’t want to rock the boat or change the status quo. I’m not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won’t want to get “close.” Jill tried to finesse around this by suggesting Keren might aim for a more “honest” relationship instead of a “closer” relationship. There are things about me that they’ve rejected, like the fact that I don’t really want children. And I’m not so sure I want to make myself vulnerable and get rejected again! I’m afraid I’ll get swallowed up and enmeshed. We asked Keren what kinds of feelings she was hiding from her mother. My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach. I am scared for her future, since she is not in good health and she’s not taking care of herself. I have feelings of anger and resentment about the fact that I’m not the kind of daughter they wanted. I’m sad about her health and seeing her struggle. I feel hurt when I think how I have failed them and let them down. I sometimes feel like I don’t really belong. At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating. I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice. Then we did some Externalization of Voices with the thoughts on Keren’s Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique. You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session In addition, Keren and Jill will be with us to record the follow-up. T = End-of-Session Testing You can review Keren’s BMS and EOTS (Patient’s Evaluation of Therapy Session) at the end of the session at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she’s had the chance to share more of her feelings with her mom. Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she’s had the chance to do her “homework” following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while still leaving some room for improvement. On the EOTs, you will see that our Empathy and Helpfulness scores were perfect, along with our scores on the Satisfaction with Session, Commitment to homework, unexpressed Negative Feelings, and honesty scales. Here’s what she like “the least” about the session: “Nothing. This has been a powerful experience.” Here’s what she like “the best” about the session: “This has been empowering. The hidden emotion is like a blind spot. I know it is there, but I cannot see it. I loved when David pointed to my avoidance, and I am glad we focused on the hidden emotion. Jill and David were able to see the depth in situation and I feel seen and understood.” Follow-Up We exchanged a number of emails following the session, and will also talk to Keren and Jill live on the podcast so you can catch up on what happened. But here is an excerpt from one of Keren’s emails: Here is what has happened so far: On Friday morning, she made some comments about my gray hair and that the fridge gasket was not properly clean. I got really annoyed, but did not say anything. To be honest, I was too angry to use the 5 secrets and needed time to cool off. About after half an hour later, on our way to the acupuncturist, I told her that I love having her over and that it is special to me that we spend time together. She thanked me for everything that I am doing for her on this trip. Then I added: "this morning, when I came to check on you, you commented on my hair and then you told me to clean the fridge gasket..." I was going to follow up with 5 secrets, but before I was able to finish, she interrupted me and said "Gosh, I am so critical! I am sorry, I didn't mean it that way. I can see now why your sister gets upset with me. I can't believe myself." I told her that I love her honesty and while her criticism comes from a caring loving place the how and when she says things sets tone. This was a breakthrough because even though I did not finish using the 5 secrets I got through to her and felt heard. It was encouraging for me to feel that I could be understood and accepted by her.  I have clients who say that they love the 5 secrets, but like to call it the 3 secrets because they find it effective enough to use only 3. (I still encouraged them to use all 5). I can see now what they mean, I did not finish my 5 secrets spiel and got some good results. I believe that my conservation with my mother will further trickle during her stay. Perhaps because there is a lot to cover, or perhaps it's the way we communicate. In either case, I feel good about having the talks that I previously dreaded. I have not had any panic attacks since, but I don't think they have completely gone. I believe they will be there to remind me to address certain emotions that need addressing.. . . I will keep you posted and may even send this to the group. Just need to think about it a bit longer. Responses from the Tuesday Group who observed our work with Keren Here are just a few of the comments from the 35 therapists who observed the session. This is part of the feedback we get on the quality of our teaching at the end of every Tuesday training group. Please describe what you specifically disliked about the training/ Nothing. The live work was fascinating to watch. David and Jill were masterful as always! This was a truly moving and inspiring and helpful session. I can't think of anything I didn't like about it. Nothing I disliked. I think I would have liked to see Keren do more deliberate practice with the 5 secrets with grading and more roleplaying. Conceptualization was a bit hard to follow. Please describe what you specifically liked about the training. Thank you for such an authentic, moving, beautiful session. And tour-de-force demonstration of TEAM therapy. Observing David and Jill as co therapists in service of Keren was an amazing learning opportunity! The power between them was exponential and felt like they successfully addressed every angle. . .  I had not considered using EOV and loved how effective that was in crushing Keren's thoughts. I also loved how Jill finessed gently guiding her to address Hidden Emotion, having clear conviction that this was where the "action" was. I can understand what Keren said that she wants to be closer but does not want to be enmeshed. I think that it helped us in our work with immigrants and those who live away from where they were born. The discussion about the desire to be a parent or not, was another aspect of the work that I really respected. Excellent class tonight! Keren's gift to the class was priceless and David and Jill's masterful teaching was outstanding as always. Thank you!!! I got to feel closer to her and to several group members through their sharing. David touched me with the notion that opening up to one's parents is an important gift that many of them don't get to receive. Thanks for listening today! Rhonda, Keren, Jill, and David
When the Hidden Emotion isn't Hidden! Today’s podcast will feature a live therapy session on September 13, 2022 with Keren Shemesh, PhD,  a licensed clinical psychologist and certified TEAM-CBT therapist. The entire session was recorded and will be presented in two consecutive podcasts. The two co-therapists are Jill Levitt, PhD, a clinical psychologist, and Director of Clinical Training at the Part 1 of the Keren session I will summarize the work that Dr. Jill Levitt and I did with Keren according to the familiar sequence of a TEAM-CBT Session: T = Testing, E = Empathy, A = Assessment of Resistance (formerly Paradoxical Agenda Setting), and M = Methods, with a final round of T = end-of-session Testing. In today’s podcast, we will include the T, E, and A. In Part 2, we will include M = Methods and the final T = Testing. T = Testing Just before the start of the session, Keren completed the Brief Mood Survey (BMS) which you can review at this link: Keren's Pre-Session BMS As you can see, her depression score was only 3 out of 20, indicating minimal to mild depression. There were no suicidal thoughts, and her anxiety score was 10 out of 20, indicating moderate anxiety. She was also moderately angry (7 out of 20) and her happiness score was 10 out of 20, indicating very little happiness. Her relationship satisfaction level with her mother was 19 out of 30, indicating lots of room for improvement. However, she rated “degree of affection and caring” at 6 for “very satisfied,” which is the highest rating on this important item. We will ask her to take the BMS again at the end of the session, along with the Evaluation of Therapy Session, so we can see what the impact of the session was on her symptoms, as well as how empathic and helpful we were during the session. These ratings will be important, because the perceptions of therapists can be way off base, but the perceptions of our patients will nearly always be spot-on. Keren also brought a partially completed Daily Mood Log, which you can see at this link: Keren's Daily Mood Log (DML) at the start of the session As you can see, the upsetting event was her mother’s visit from Israel. She had moderately to severely elevated negative feelings in nine categories, along with 17 negative thoughts, along with her rather strong beliefs in all of them. Most of her thoughts were of a self-critical nature, with lots of Hidden Should Statements as well. E = Empathy At the start of our session, which took place in front of our Tuesday evening training group at Stanford, Keren described her struggles like this: On Wednesday I woke up at 3 AM with panic attacks, one after another, and no way of getting back to sleep. I get somatic symptoms, I felt weak, nauseated, with no strength, almost paralyzed, and emotionally unstable. This was four days after my mother arrived form Israel. In the last 20 years, she and my dad visited me only once, on my graduation. I always had to visit them in Israel every year and was frustrated they none came to visit me in the Bat Area. On my last visit in May, I expressed my frustration about them not visiting me. They took it to heart and made plans to come for the Jewish high Holidays. My mom arrived first a few days ago and It’s my first time alone with her. She’s a Jewish mom and she stresses me out. Of course, I was really excited when she first arrived, but after four days I feel overwhelmed. This is SO MUCH WORK! I feel sad. I’m afraid I won’t be able to function. I just cannot seem to enjoy my time with her. I feel fragile, but I’m hiding it. She’s 73, and the signs of aging are obvious now. She needs more care, and it’s tough to see her aging. Dad has always been super athletic, and he’s in great shape, but she doesn’t exercise or take care of herself. She’s frustrated about aging and is angry with us for not accepting her as she is. I don’t want to seem unhappy. I’m overwhelmed and just feel bad! David and Jill empathized, and Jill emphasized how much her parents must love her, coming from such a great distance to be with her, but also acknowledged how hard it must be for them and for Keren to be living at such a great distance. Jill pointed out that one of the issues Keren may be struggling with is the belief that their time together should be fun and conflict-free, since the time is so precious. Keren continued: My biggest problem is that I feel I cannot be me when I’m around them . . . . They want me to be a different version of myself. . . . They want me to be a mother, and they want grandchildren. But I’m in the 5% of women who don’t have any interest in having children. I’m 46 years old now, and I guess I could see myself adopting, but having a family is a big job, and I’ve never had the passion. So, I feel like I’m a disappointment to them. But we never talk about it. I sometimes feel invisible and unseen when I’m around them. They’d be so much prouder of me if I had children they could brag about. Keren also shared her frustration and anger with her mom for not taking better care of her health. Since her mom has been in town, Keren has arranged all kinds of fun activities for them to do together, but Keren’s joy is dampened by the many unspoken feelings she is constantly trying to hide, for fear of conflict and upsetting her parents. A = Assessment of Resistance Keren gave us an A+ in Empathy, so we went on to the Assessment of Resistance phase of the session, where we set the Agenda. Keren’s goal was to get over her panic attacks, and we discussed three possible treatment strategies with Keren: The Hidden Emotion Technique: This technique would be based on our hunch that Keren’s panic attacks are the direct result of the many feelings she is consciously, and subconscious trying to hide and sweep under the rug. Dealing with the self-critical thoughts on the Daily Mood Log she provided at the start of the session. LINK Using Forced Empathy to help her see the world through her mother’s eyes, as we did in a fairly recent podcast with Zeina, another member of our Tuesday training group who was in conflict with her mother. Keren expressed considerable enthusiasm for options 2 and 3. I (David) pointed out that she appeared to be ignoring / avoiding the first option, and raised the question of whether that meant it might be the most productive, but scariest, of the three options. Keren conceded that this rang true, and wanted to start out with learning to express her feelings more openly and directly, but in a respectful and loving way. In next week’s podcast, you’ll find out what happened! Part 2 of the Keren session: M = Methods We began the Methods part of the session with a bit more Paradoxical Agenda Setting, and listed some really GOOD reasons NOT to open up more to her mother. I want to protect her because it may be hard and upsetting to her. I’m not used to being vulnerable with my parents. I don’t want to rock the boat or change the status quo. I’m not sure I want a closer relationship with my mother. NOTE: David and Jill were thinking that we often resist intimacy because we have negative pictures in our mind of what real closeness is. For example, if you think it means something yucky and upsetting, you obviously won’t want to get “close.” Jill tried to finesse around this by suggesting Keren might aim for a more “honest” relationship instead of a “closer” relationship. There are things about me that they’ve rejected, like the fact that I don’t really want children. And I’m not so sure I want to make myself vulnerable and get rejected again! I’m afraid I’ll get swallowed up and enmeshed. We asked Keren what kinds of feelings she was hiding from her mother. My feelings of nervousness and intense anxiety, and the intense somatic symptoms, like the knot in my stomach. I am scared for her future, since she is not in good health and she’s not taking care of herself. I have feelings of anger and resentment about the fact that I’m not the kind of daughter they wanted. I’m sad about her health and seeing her struggle. I feel hurt when I think how I have failed them and let them down. I sometimes feel like I don’t really belong. At this point, I became so absorbed in the session that I stopped taking notes, so you will have to listen carefully to the recording of the session which was fascinating. I do recall, however, that we began working on communication, using the Five Secrets of Effective Communication (LINK), as well as tips on how to proceed, taking it one step at a time and not trying to do it all at once, and role playing practice. Then we did some Externalization of Voices with the thoughts on Keren’s Daily Mood Log, using several strategies: Self-Defense, the Acceptance Paradox, and the CAT, or Counter-Attack Technique. You can see the Daily Mood Log she completed after the session, based on the work we did in the session, at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session In addition, Keren and Jill will be with us to record the follow-up. T = End-of-Session Testing You can review Keren’s BMS and EOTS (Patient’s Evaluation of Therapy Session) at the end of the session at this LINK. Keren's end-or-session Brief Mood Survey and Evaluation of Therapy Session As you can see, her depression score fell to 1, indicating substantial improvement, while her suicidal thoughts and urges remained at 0. Her feelings of anxiety vanished, but her feelings of anger remained fairly elevated, falling from 7 to 4. We would not expect further improvement in this dimension until she’s had the chance to share more of her feelings with her mom. Her feelings of happiness only increased from 10 to 13, again any further improvement would not be expected until she’s had the chance to do her “homework” following the session. However, her satisfaction with her relationship with her mom increased from 19 to 26 out of 30, which is substantial, while stil
Ask David: Featuring Matt May, MD Can hypnosis be used for evil? Can you fall out of love? Why does cheerleading fail? In today’s podcast, we discuss three intriguing questions from listeners like you: Can hypnosis be used for evil? Matt says no, David mainly agrees, but isn’t entirely convinced. Is it possible to fall out of love? This can and will happen. What can we do about it? Empathy vs. Cheerleading: What’s the difference between cheerleading and genuine empathy with someone who’s upset? Can hypnosis be used for evil? David and Matt describe their experiences, both as kids and later as shrinks, with hypnosis. David and Matt both used hypnosis early in their careers, especially in David’s one-session treatment for smoking cessation, which Matt also used. But as their TEAM-CBT skills have grown, both of them use it much less frequently. It can be used for many purposes. In a recent podcast # (link) with Dr. Jeffrey Lazarus, we learned that it can be used for warts as well as a wide range of psychosomatic problems, like Irritable Bowel Syndrome and tics, as well as bedwetting, school phobia, performance anxiety, and more. Matt strongly believes that agenda setting (also called Assessment of Resistance) is just as important in hypnosis as in TEAM-CBT. You have to first bring the patient’s subconscious resistance to conscious awareness and melt it away using paradoxical techniques in order to optimize the chances of success with hypnosis. Matt pointed out that hypnotic states can be quite powerful, and can even be used for surgery, but emphasizes that people will never td what they genuinely don’t want to do when hypnotized. He says that hypnosis is really a form of willful collaboration between the hypnotist and the hypnotic subject. Although stage hypnotists seem to have some kind of “Svengali” power over the volunteers who come up to the stage to be hypnotized, these people are actually subconsciously volunteering to act silly and have fun in front of the audience. This doesn’t mean they are faking it, but it does put these shows into a slightly different perspective. David described many goofy things he did as a teenager after he purchased a book called “25 Ways to Hypnotize Your Friends” at a magic store in Phoenix for 25 cents, and found that the techniques actually worked with many of his friends. He sometimes had a lot of fun giving post-hypnotic suggestions, and that he and his friends found hypnosis to be incredibly exciting and fascinating. Once he hypnotized a friend named Jerry and told Jerry that after he woke up, every time he heard the word, “TV,” he would shout out “Boing” in a loud voice without realizing it. In addition, his subconscious mind would keep track of how many “TVs” he heard, and then he’d should Boing that exact number of times. David explains: Then we went to the local Dairy Queen a few blocks away all ordered at the window, one by one. When it was Jerry’s turn to order, and the lady asked him what he wanted, we all started saying “TV, TV, TV” as fast as we could, and Jerry would shout out “boing, boing, boing” in a loud, confident voice! She said, “I didn’t quite get what you want to order,” and when Jerry tried to order, we did it again. It seemed incredibly funny, and fun, but in retrospect I WAS using hypnosis to kind of take advantage of someone, so you might say it CAN be used for evil, perhaps. However, Jerry didn’t seem to mind, and we all thought it was a pretty exciting adventure. When I was a senior in high school, one of my teachers said that hypnosis was dangerous and told me to stop hypnotizing my friends, so I got scared and gave it up until I became a psychiatrist years later. Like anything, hypnosis is just a tool, and it can be helpful for suggestible individuals, but we have more than 100 techniques in TEAM-CBT, because no one tool has the answer for everybody and every problem. David and Matt both agree with anxiety, depression, and anger are very much like self-induced trances, since you are giving yourself and believing messages (hypnotic suggestions) that aren’t actually true. For example: The depression trance: “I’m no good. I’ll be depressed forever.” The anxiety trance: “Something awful is about to happen. I’m in incredible danger.” The anger trance: “You’re no good!” Psychotherapy can be seen as an attempt to get each patient to “wake up” from the trance that has trapped them. In David’s opinion, politicians sometimes put their followers in trance-like states, getting them to believe repeated suggestions that are blatantly untrue. We saw this in WWII, where Hitler essentially “hypnotized” an entire nation to believe some horrific lies and to spur them to unspeakably horrific actions. Of course, as Matt has pointed out, you have to WANT to be hypnotized, so possibly the German people wanted to see themselves as superior human beings who had been victimized unfairly by evil forces that needed to be eradicated. So, killing and the abuse of him beings became the focus and purpose of the nation. Is this possibly also happening today? And is that why narcissistic leaders want to control the media, so they can control the “hypnotic messages” that people get, and why they lash out in such a hostile way at anyone who dares to challenge or contradict them? Is it possible to fall out of love? A podcast listener says she often falls out of love with her husband, but after they talk things over, and resolve their differences, she falls in love again. She wants more on this topic, so Matt, Rhonda and David discuss the pitfalls of pursuing perfect, romantic love. David reminds us that some of the most successful marriages are in India, where the parents decide who you will marry. David said that when he was in private practice in Philadelphia, 60% of the patients he saw did not have a loving partner, and most were trying to find someone to love. That’s why this is one of his favorite topics. Then Matt, Rhonda and David contrast healthy vs unhealthy love, and Matt created the following table that contrasts them. Perfect Love By Matt with a little editing from David Unhealthy Love Healthy Love You rush to put the other person on a pedestal without knowing them. You fantasize that they are perfect and wonderful in every way. You take your time getting to know each other in a curious, vulnerable and respectful way, recognizing that neither of you is perfect. You believe that you need the other person and couldn’t be happy without them. You’re confident and content on your own but also enjoy the company of the other person. You selfishly focus on getting what you want from the other person. You focus on what you can give the other person, and what you can do, to improve the relationship. You imagine you will be in love forever. You accept that relationships require careful tending and nurturing, and realize that there will be moments of conflict, disappointment, and hurt feelings, which can sometimes be intense. You tell yourself that you’ll never and should never have any conflicts or disagreements. You see conflict as opportunities, in disguise, for greater understanding and closeness.   Cheerleading vs. Empathy Rhonda describes a recent traumatic experience which was profoundly disturbing to her. However, when she tried to tell a friend how upset she was, her friend did “cheerleading,” telling her that she shouldn’t be so upset, that she’d feel better again soon, and so forth. Rhonda said it was very annoying to be on the receiving end, and her friends efforts to cheer her up actually made her feel worse. Then, when two friends simply used the Five Secrets of Effective Communication to “listen,” it was a great relief. David recounted a similar experience when his beloved cat, Obie, disappeared in the middle of the night, and was likely killed by a predator animal in the woods behind his house. When David told his Tuesday group what had happened, one member of the group similarly tried to cheer him up, which triggered an angry rebuke from David, who told her NOT to try to take his grief away. He said, “My grief is my loving connection to Obie, who was my best friend in the whole world. I will grieve his loss for the rest of my life. And to this very day, I talk to Obie, as well as my good friend Marilyn Coffy who passed away recently, every time I go out slogging. This is not a problem that I need help with, but a gift of love.” We’ve touched on the codependent urge to cheerlead that so many people, including shrinks, have. For example, our podcast on “How to help, and how NOT to help,” covers this topic pretty thoroughly. However, we decided to focus on cheerleading again today, since it is such an important topic, and is a bit of an addiction that many people have. The following is a chart we discussed during the podcast, and you might find it helpful. Cheerleading vs. Empathy by David , Rhonda, and Matt Cheerleading Empathy You’re trying to cheer someone up to make them feel better. You are not trying to cheer them up. Instead, you acknowledge how they’re thinking and feeling, and you encourage them to vent and open up. You don’t acknowledge the validity of the person’s negative thoughts and emotions. In fact, when you try to cheer them up, you’re essentially telling that they’re wrong to feel upset. It’s a subtle put down, or even a micro-aggression. You find the grain of truth in what the person is saying, even if you think they’re exaggerating the negatives in their life.   Paradoxically, when you agree with them in a respectful way, they will typically feel some relief and support. The effect is irritating to almost everybody who’s upset, because you aren’t listening or showing any compassion or respect. You’re telling them that you don’t want to hear what they have to say. Cheerleading is condescending. Listening and acknowledging how they feel is a form of humility and an express
Horrific World Events: Can TEAM-CBT Help Us? Featuring Live work with Meina Last week, we presented Part 1 of the session with Meina, a young woman struggling enormously because of her feelings about the new Iranian revolution. Today, we present the exciting and unexpected conclusion and follow up of the incredible session with Meina. Part 2: The Conclusion When Meina returned, her mood scores were very similar to what they’d been at the start of the previous session. This indicated that empathy alone was not sufficient to trigger any meaningful changes in how she felt. She said that she’d had some fears about what listeners might think, since, as we mentioned, Meina rarely, if ever, opens up about how she’s feeling inside, so talking openly on the podcast definitely means facing her fears and venturing into some radically new territory. The ineffectiveness of Empathy alone is important, because she graded our Empathy as an A+. Many therapists wrongly believe that empathy is the most healing tool we have in therapy. This is idealistic, but wrong. Empathy is definitely important, but without the A and the M of TEAM-CBT, very little, if anything, will change. And, in most instances, patients appreciate good listening, that’s for sure, but they want more. They want tangible changes in how the feel and interact with others. Today, Meina showed more emotion. She mentioned that she’d been a Michael Jackson fan, and liked his song about how our (inner) voices don’t get out. She was feeling tearful, and angry, and said that in her work, her voice was not coming out, and this was a matter of great distress. She also mentioned that after she cried and expressed her rage about the young woman who was murdered by the morality police, an annoying “eye twitch” that she’d had for six months suddenly disappeared. Meina has also had many experiences in the past of experiencing health anxiety symptoms whenever she’s upset about something and hides or suppresses her negative feelings, like anger. She had participated in many of David’s Sunday hikes before the pandemic, and sometimes had weird somatic sensations, fearing she had some neurologic disorder, only to have her symptoms instantly vanish when she finally expressed her anger. Many of you will recognize this as David’s “Hidden Emotion Technique.” She also said she’s afraid she’ll be seen and stereotyped as an “angry woman” if she shows her anger, and said she may even have an Anger Phobia, thinking that anger shows that you’re a “violent person.” She said that she’s always been quick to get angry, and wanted to focus the session on anger. Her goal for the session had shifted in the two days since we did Part 1, and she now wanted to learn how to express her anger more effectively. M = Methods In the rest of the session, we used the TEAM interpersonal model to deal with an intense conflict Meina had recently when she was trying to get her colleagues to issue a statement on behalf of her institution supporting the women in Iran who were protesting, and had partially complete the Relationship Journal in preparation for today’s session. As you may recall, when you use the RJ, you will discover—and this can be quite shocking—that you are actually causing the very relationship problems that you are complaining about. And this came as a huge surprise to Meina. The remainder of the session was incredibly inspiring, and Mina did some magical work. I’ll let you listen to the rest of the session to see how the work unfolded. If you’d like to review Meina’s RJ, you can click this LINK. End of Session T = Testing If you’d like to see Meina’s end-of-session mood ratings, along with her Evaluation of Therapy Session, you can check this LINK. If you’d like to refresh yourself on the Five Secrets of Effective Communication, you can click this LINK. I was incredibly proud of the brilliant and inspiring work that Meina did during this session. She experienced the “Great Death” of her “self,” along with the “Great Rebirth,” or the “waking up” of the “non-self.” At the start of this podcast, we asked the question of whether TEAM-CBT could be of help when people are struggling because of events that are both real and horrific. Now perhaps you see my answer: a resounding and unexpected YES. However, there are a couple of disclaimers. First, the person has to be asking for help, and Meina definitely was. Having an agenda that makes sense to the patient is always, in fact, one of the most important keys to successful therapy. Second, the therapy will usually be totally unexpected, and the work we do with each person will be highly individual. We’re not in the business of creating simple formulas to deal with this or that problem. Instead, TEAM emphasizes a step-by-step process which will be unique and totally different for every person you work with. And finally, we have to thank our old friend, Epictetus, for once again reminding us that our feelings do not result from what’s happening, but rather from our thoughts about it. And the goal is NOT to blame you for the way you feel, but rather to give you the key to unlock the door and free yourself from the suffering you’ve endured. Meina, Rhonda, and I hope the incredible and brave work that Meina did in this session will be helpful for you, too!
Horrific World Events: Can TEAM-CBT Help Us? Featuring Live work with Meina Today, we see lots of horrific events, and violence and hatred seem to be on the upswing. There are the repeated and horrible mass shootings in the US, the horrific war in the Ukraine, and the extensive protests that are rocking Iran. Those problems are real, and terrible in reality. So, maybe the TEAM-CBT model, with its emphasis on our interpretations of reality, and our relationships with others, might seem like irrelevant and useless tools. Or are they? Let’s check it out. Sometimes, as you’ll see, things can a take sudden and unexpected change in direction in TEAM-CBT if you follow the energy. There is no “formula” for treating anything. We treat humans, not diagnoses or problems. But we do go through the T, E, A, M model in a systematic way so we can find out what, if anything, each patient wants help with, and then design an individualized plan to make that happen, if possible. Part 1 T = Testing Today’s guest, whom we’ll call Meina for protection, migrated to the United States from her mother country, Iran, as a young woman, and she’s definitely upset. In fact, her mood scores are among the most severe that I’ve seen recently. Her depression score of 15 out of 20 indicates severe depression, and her anxiety and anger scores of 19 and 20 out of 20 indicates extreme anxiety and anger. You can see Meina’s Daily Mood Log at the start of the session as well, with nine categories—depression, anxiety, guilt, loneliness, humiliation, hopelessness, frustration and hatred all estimated between 90 and 100 out of 100, again confirming the most extreme upset a human being can experience. As you might expect, her happiness score was 0 out of 20, indicating no happiness at all, and her Relationship Satisfaction Scale score, thinking of her husband, was only 19 out of 30, indicating considerable marital distress. What’s causing those feelings? Well, let’s take a look at her negative thoughts and how strongly she believes them: I’ll always suffer because of being born in Iran: 90% My heart will stop from feeling so much hatred. 80% There’s nothing I can do to help (the women who are protesting.) 100% It is pathetic that I can’t stop feeling so angry. 90% I’m going to get sick because of these feelings. 90% Many young women will be tortured and killed. 100% I’m going to lose all my friends because I’m so angry. 70% My marriage will also be negatively impacted. 100% E = Empathy In the empathy phase of the session, Rhonda and David simply listened, as Meina described terrifying memories of the being a child during the Iran Iraq war, and being left alone to care for her younger sister when her parents were away every day, and bombs were coming down all over the city. She said that on many occasions she was so scared that she wanted to commit suicide by jumping out of the window of their apartment in Iran. And now, all those terrifying memories have come flooding her mind again, triggered by the events in Iran, as well as her fears and run-ins with the “morality police” when she was a young woman. She expressed profound connection with the young women who are now fighting the intense suppression of human rights in Iran, all in the name of religion! Once their car was stopped, and a policeman put a gun to her mother’s head because she had not covered her hair properly. She also described the attempts always to separate the girls and the boys to prevent any type of dating or romantic behavior, and the constant fear of being imprisoned if you did the wrong thing. Meina tells us: I saw friends who were beaten up, and was humiliated for eating an apple. I was arrested for wanting to go to parties to listen to music. I lived in constant fear of being tortured and had panic attacks by night and by day. . . I left Iran when I was 22 and have never gone back, for fear of ending up in prison. . . Then, when I finally escaped to the United States, I never fit in. The young people were interested in the latest music, and did not seem interested in my story, in my experiences. I never felt like I fit in. I think I’ve felt lonely my entire life. Now I feel embarrassed, being from Iran, because it’s such a violent country. . . And I have panic attacks every night. I cope by imagining that I’m in Iran, visiting and counseling girls who have been imprisoned, and giving them tips on how to use the Five Secrets of Effective Communication so they won’t be tortured, raped, and murdered. Meina said she still feels alone, since few people, including her husband, are really interested in her story, including her horrific memories of growing up in Iran, or how she feels now. She said she also feels intensely guilty, since she still has friends and one relative in Iran who are facing desperate circumstances, while she enjoys comfort and safety here in California. She rated us as an A+ on empathy, so that brought us to A = Assessment of Resistance. She added that she always hides her emotions, something she learned to do for survival in Iran, and that she’s afraid to let them out, and continues to hold and hide them. As a result, she struggles with constant tension and anxiety of constantly hiding her anger. David commented on the paradox that she looks chipper and in control, and can be funny at times. But she feels incredible loneliness because other people rarely know or care about how she actually feels. She added: What if I’m just being selfish. Maybe I shouldn’t complain so much! A = Assessment of Resistance Meina said this about her goals for the session: I know I’m not in a position to change what’s happening in Iran, but what I do want help with is the fact that I’m so overwhelmed with negative feelings that I’m losing my effectiveness at work and I also don’t seem to be able to connect with my friends and colleagues. I don’t want to have such hatred and anger for the morality police. And I don’t want all those painful memories to keep coming back and ruining my life, like my uncle and grandmother who suffered from dementia and almost constant terror towards the ends of their lives. At this point, we ran out of time, and had to schedule the remainder of the session two days later. End of Part 1 Tune in next week for the fantastic and unexpected conclusion of the work with Meina!
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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