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

Ask David: What's Self-Esteem? What's Self-Acceptance? In today's podcast we address six common questions about self-esteem, including: What is Self-Esteem? How does it differ from self-confidence? How does it differ from self-acceptance? What's the difference between conditional and unconditional self-esteem? What's the best way to develop self-esteem? What do you mean when you say that once you develop unconditional self-esteem, you should get rid of it as fast as possible? Please keep the questions coming. We enjoy the exchange of ideas with all of you. Thanks! Brandon Vance and Heather Clague begin today's show with a pitch for their upcoming Feeling Great App Group, an 8 week experience that will begin in September. If you use the Feeling Great App, or plan to get it, this group would be an inexpensive and incredible enhancement, so you can meet with like-minded people once a week to schmooze, practice the techniques in the app, and get your questions answered by compassionate and personable experts. For more information go to www.FeelingGreatTherapyCenter.com/appgroup. Feeling Great App Group Sept-Nov 2024 Led by Brandon Vance MD and Heather Clague MD, meets online for 80 minutes for 8 weeks, offered Mondays 4-5:20pm Pacific Time, September 23rd - November 11th. Cost is $12 per session ($96 total) plus the cost of the app ($99 per year after 7 day free trial). Sliding scale for both the group and the app are available. No one turned away for lack of funds. Feeling Down? Try the Feeling Great App for Free! It's now in the IOS and Android app stores, and you can check it out for free. It's works super fast. Let us know what you think! Thanks! Rhonda, Matt, and David appreciate your support. Keep your questions and testimonials coming. They mean a lot to us!

Feeling Down? Try the Feeling Great App for Free! The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it out at FeelingGreat.com! What's the Meaning of Life? Before we start today, I have a special shoutout to Max Kosma, our new colleague, friend and brilliant technical guru who helped make our new video studio possible! Next week, we'll see if we can pipe him in to say hello to all of you. His spirit is joyous, infectious, incredibly generous and supportive. Thanks, Max! Rhonda opened today's podcast with a vibrant and inspiring endorsement from Jeff, a podcast fan who was raving about the Feeling Great App. Thank you Jeff, and please check out our new app at FeelingGreat.com. Important Announcement Rhonda, along with a group of dedicated TEAM Therapists, including Amy Berner, Brandon Vance, Leigh Harrington, Mariusz Wirga, and Mark Noble, has just created a new non-profit organization called TEAMCBT International (TCI). TCI will provide seed money in the form of no-or-low-interest loans for groups around the world who want to offer TEAM-CBT intensives for therapists in your country. Rhonda has been instrumental in the organization of successful intensive workshops in India, Poland, Mexico, England and Ireland. They have been well received, but can be somewhat costly to produce, so Rhonda's new group is ready to provide a helping hand. I've had the honor of presenting keynote addresses, live therapy demos, and Q and A sessions in many of those programs, and have totally enjoyed them. A big hug and THANKS to Rhonda once again! To learn more, just go to TEAMCBT.International. Today, Matt joins us for a discussion of the meaning of life, something young people often worry about, but people of any age can be concerned. So, today, you may finally find the answer to that lofty question! But first, I (David) mentioned a little about one of last week's questions, "Is the universe real?" I provided the type of answer the famed philosopher, Ludwig Wittgenstein, might have provided. Namely, that the question is nonsensical, it is language "out of gear." So, we can dismiss the question, as opposed to trying to answer it. HOWEVER, the question DOES make a ton of sense when we ask if human beings are "real." And I am not referring to some metaphysical nonsense, but rather the tendency of many people to present a happy or confident false front, all the while feeling empty, lonely, anxious and ashamed inside. Two of the now more-than-140 TEAM techniques include Self-Disclosure and the Survey Technique, where you take the chance of opening up about some of the secrets you've been hiding, and ask others what they think about you. Although this takes tremendous courage, it often results in tremendous warmth and connection to others. I provide a description of a young man who disclosed a tremendous amount he'd been hiding in our recent Tuesday group at Stanford, and he was convinced the group would judge him and look down on him. But just the opposite happened. He encountered a flood of warmth, admiration, and respect from the people in our group. A small miracle, perhaps, but a real and meaningful miracle at the moment when his universe suddenly became "real" and radically different from the dangerous and critical world he'd feared and imagined. Then we tackled today's philosophical question: "What's the Meaning of Life?" As usual, our brilliant and beloved Matt May began with a description of an extraordinarily depressed patient he once treated who'd been hospitalized for 180 days with no improvement, including a very dangerous suicide attempt. Matt was worried for the patient's safety, so told the referring doctor that he'd been willing to talk with the patient while the patient was still in the safe environment of the hospital. The patient called Matt and, after some listening and empathy Matt said he would like to help and that there would be committed to helping the man and thought he could help him make a complete recovery, work with this man, and thought there was an excellent chance for significant progress, perhaps even complete recovery, but the patient probably wouldn't want to work with him.as long as he'd be willing to give Matt what he needed in order to work together effectively. Matt suggested the patient give him a call. On the call, Matt told him he might not be able to afford treatment, since part of the "cost" of therapy was that the patient had to make a commitment to life, and that he must agree never to attempt suicide no matter what, for the rest of his life. After a couple days of reflection, the man convinced Matt that he WOULD make that commitment. Then Matt described the man's problem. Both of his parents were world famous, successful scientists, and during his upbringing, his parents emphasized how fantastic and rewarding a career as a scientist could be, and he was convinced that his par

Feeling Down? Try the Feeling Great App for Free! The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it out at FeelingGreat.com! Is the Universe One? Is the Universe Real? Is the Universe Real? These two philosophical problems used to seem nonsensical to me, and certainly not relevant to much of anything in my life—or anyone's! But now the picture has changed a bit! When I was a student at Amherst College, I majored in the philosophy of science. On this show, I've often talked about my hero, Ludwig Wittgenstein, who attempted (successfully in my opinion) to "solve" all the problems of philosophy. He wanted to help those of us who were "afflicted" by an attraction to philosophical problems to see through them and understand precisely how and why they were nonsensical. He hoped to provide a "treatment" for philosophers so we could give up the need to obsess about nonsensical philosophical problems. Once you see through the these problems, they become kind of like a joke, and you can use jokes to help other people see through them. For example, here's a kind of lame joke about the question of whether or not the universe is "real." Wittgenstein said that before we try to answer questions like that, we might want to ask ourselves if these questions even makes sense! And if it a philosophical problem doesn't make sense, it isn't a real question, so we won't need to deal with it. In other words, questions that don't make sense don't need to be answered because they're not real questions. Take the question, "Is the universe real?" You could ask, "Well, what would it be like if the universe weren't real? What would that look like? How would things be different?" If you can't answer that question, the question might not make sense. To most of us, philosophical questions wound nonsensical because we are taking words, like "real," out of the contexts in which it DOES make sense. For example, we can ask : "Is this painting real? Or is it a fake?" That question does make sense. It has an obvious meaning, since many valuable paintings are copied and are fakes, and they try to pass them off as the "real" thing. But what would a "real" or "fake" universe look like? How would it differ from our universe? Now let's think about another example that is mildly humorous. Let's imagine you're driving through Iowa in the summer, and you spot a farmer working in his corn field. You're interested in speaking to him because you are writing a story about your travels in Iowa, and want to talk about the lives of farmers. So, you pull your car over to the side of the road and shout, "Howdy! What are you doing in the field?" The farmer seems pleased and grabs a gorgeous stalk of corn and holds it up and proudly shouts, "I'm growing corn, and it is real!" Well, that's great that he's happily growing corn, but what does the tag-on, "and it is real" mean? It doesn't actually mean anything, because farmers don't grow "unreal corn." So, in this context, the word has no meaning. Now, if you were on a movie set, they might actually be using artificial corn as a prop, so now the contrast between real and unreal corn becomes meaningful. This is a very humble point, but it's the very heart of what Wittgenstein was trying to make us aware of. Philosophical problems kind of sound meaningful and puzzling, but most of the time, they are simply a kind of nonsensical use of language. Now, in personal relationships, we might also have a notion of when people are being "real" or fake. And we often act fake because we don't think we're good enough just the way we really are. So, for example, you may hide your shyness in social situations because you're ashamed, and telling yourself that your shyness is incredibly weird and abnormal, and makes you "less than" other people. One method of helping people overcome shyness is simply to disclose it to others. This TEAM-CBT technique is called "Self-Disclosure." Instead of hiding your shyness and feeling awkward and ashamed in social situations, you share your feelings openly. Shame depends on hiding, so when you open up, the feelings of shame will often disappear. For example, in a recent podcast of a dramatic, live therapy session, a man named Chris revealed many troubling things about his teenage years that he'd been hiding for years. When he opened up, he began sobbing intensely, thinking he'd let his father down with his wild behavior when he was a high school student. His grief, he was incredibly compelling, and his courageous self-disclosure was appealing to most of us who were privileged to witness that session. Showing us his "real" self became his path to enlightenment, joy, and deeply meaningful relationships with himself and with all of us who witnessed that amazing session. So, although the question, "is the universe real" is silly and nonsensical, the question, "are we being real with each ot

Special Announcement #1 The Legendary Summer Intensive Starts on Thursday of this week! Featuring Drs. David Burns and Jill Levitt August 8 - 11, 2024 Click for registration / more information! This workshop is a training program which will be limited to therapists and mental health professionals and graduate students in a mental health field Apologies, but therapists have complained when non-therapists have attended our continuing education training programs. This is partly because of the intimate nature of the small group exercises and the personal work the therapists may do during the workshop. Certified coaches and counselors are welcome to attend. Special Announcement #2 Here's some GREAT news! The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it Today's Podcast #408-- Does God exist? We started today's podcast with a beautiful testimonial and a shout out for the intensive from August 8 to 11, 2024 at the South San Francisco Intensive in person or virtually if you prefer. To learn more, contact www.CBTintensive.com. Act fast because the intensive is on Thursday of this week when today's podcast will be published. Today, we tackle another popular and intensely debated philosophical / religious puzzle: Does God exist? People have very heated views, one way or the other. I (David) will start with a brief explanation of a Wittgenstein answer to this question, and then for the most part, we will focus instead on the question of how we all incorporate spirituality into TEAM-CBT. Wittgenstein emphasized that philosophical problem exist when we debate about the meanings of words or terms that are vague, or poorly defined. Traditionally, we think there are three positions one could take: Theism: You believe that God exists. Atheism: You do not believe in God. Agnosticism: You say that you do no know whether or not God exists. My own thinking, which is strongly influenced by Wittgenstein, would be that I don't understand any of those three stances because I have no idea what you mean by your use of the word, "God." What is it, exactly, that I'm supposed to believe in, or not believe in? To me, the question, "Do you believe in God," is nonsensical, so I simply do not deal with it. All of the three positions listed above are based on the idea that the word, "God," has some kind of clear meaning that we can all agree upon. But it clearly does not. You might define "God" as the "creator of the universe." Well, there is certainly something magical and mysterious about the existence and creation of the universe (assuming it did begin with some kind of "big bang.") Some questions might include "Where did all the energy come from all of a sudden?" Or "Are there many universes?" These are valid questions, and physicists are pursuing the answers, which is very exciting and fantastic. But they are generally not invoking the concept of a "God," although some undoubtedly would say that they do "believe in Gad." Regardless, I cheer them on and find every new discovery about the nature of the universe, and how the universe works, endlessly fascinating! For today, we will ask a much simpler question of whether and how we include some kind of spiritual dimension into our work as shrinks. This is a topic that is equally exciting, and definitely meaningful. Rhonda got us started by explain that she sees the belief in God as a matter of faith, and is not something that can be tested empirically, which is certainly true. She says she does believe in God, or some "higher power," but does not believe in a God who "rules over things." She was raised in the Jewish religion, and says that many Jews believe that God exists in everyone . This sounds a little like Hinduism, which traces back at least 2500 years ago, and possibly as early as 5000 years ago. I believe that the Hindus believe that God exists in everything. The practical impact of the belief that God exists in all of us, is that we will treat each other with love and respect, since we are all an expression of God. She also said that we can "create God among us as a community." Matt said that he was raised as a Christian and that when he was growing up he had heard about miracles, like Jesus raising Lazarus from the dead in the New Testament on the Gospel according to John. He said that he views our work with individuals who are severely depressed as a kind of spiritual healing, even though we are working with purely secular methods. This is especially true when we are working with individuals who appear to be paralyzed by depression, claiming they are unable even to get out of bed, people who bombard themselves with harsh criticisms, and feel hopeless and ashamed. Matt said that self-acceptance (accepting ourselves exactly as we are) is one of the many tools we use, and that he (Matt) loves to think about the ripple effects of our work, which not only transforms the l

Special Announcement #1 Attend the Legendary Summer Intensive Featuring Drs. David Burns and Jill Levitt August 8 - 11. 2024 Learn Advanced TEAM-CBT skills Heal yourself, heal your patients First Intensive in 5 years! It will knock your socks off! Limited Seating--Act Fast Click for registration / more information! Sadly, this workshop is a training program which will be limited to therapists and mental health professionals and graduate students in a mental health field Apologies, but therapists have complained when non-therapists have attended our continuing education training programs. This is partly because of the intimate nature of the small group exercises and the personal work the therapists may do during the workshop. Certified coaches and counselors are welcome to attend. Special Announcement #2 Here's some GREAT news! The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it Today's Podcast Practical Philosophy Month Part 2, Do Humans have "Selves"? This is our second podcast in our Practical Philosophy Month. Last week, in our first episode, we focused on the "free will" question. As humans, we all feel like we have "free will," but is it just an illusion, especially if all our actions are the result of the physical processes in our brains and the laws of the universe? The Bible certainly dealt with this in the book of Genesis, where we learn that the first humans, Adam and Eve, were given a wonderful Garden of Eden to live in, but they had to choose whether or not to obey God's rule NOT to eat the forbidden fruit from the tree of knowledge of good and evil. They chose to eat the fruit, implying that humans have free choice. But the philosophical arguments rage on. In today's podcast, we are joined by two beloved and brilliant colleagues, Drs. Matthew May and Fabrice Nye, as we explore the question of whether or not the "self" exists. We all feel like we have a "self," but is this real or just an illusion? When you try to define your "self," you may run into problems. For example, you might think that the "self" has to be the part of us that does not change from moment to moment, and is always 'the same." For example, I might think back on my childhood and feel convinced that I was the "same David Burns" then that I am now. And, if you are religious, you might also be comforted by the idea that your "self" is the same as your "soul," and that you will therefore live on after you die. This concept of a "soul" is a core belief in many religions. But are we fooling ourselves? And what was the Buddha thinking about 2,500 years ago when we talked about enlightenment as resulting from the "Great Death" of the "self." He seemed to be hinting that something wonderful can happen when you give up the idea that you have a "self." In the original draft of my book, Feeling Great, I had a chapter on entitled, "Do you need a "self?" Join the Grateful Dead." I tried to persuade readers that the existence of a "self" is nonsense, based on the philosophy of Ludwig Wittgenstein in his famous book, Philosophical Investigations. But readers found the chapter so upsetting that I decided, on their urging, to delete it from the manuscript, which I did. My goal is not to disturb people, but to provide a path to joy and to loving connections with others. But to this day, I still get emails from people asking me to offer that chapter, or to deal more deeply with this concept of the "self" vs "no self" in a podcast. So, here is my attempt today. I will start with my own take, and then summarize some of the views about the self that were expressed by Fabrice, Matt, and Rhonda during the show. Here's my thinking. There are many key questions you could ask about the concept of the "self?" including: Do we have a "self?" And if so, what is it? Does the first question even make sense? I'm sure you would agree that if a question doesn't make sense, then it isn't a "real" question, and there really isn't anything to talk about. Then we can just stop feeling frustrated and perplexed, and move on with our lives. That is the precise position that the late Wittgenstein would probably have taken. He stated that words have no ultimate or "true" meaning outside of the various contexts in which we use them in daily life. Most words have many meanings, because they are used in different ways, and you can find most of the meanings in any dictionary. So, if you think of the word, "game," you will quickly realize that it does not have one "true" or essential meaning. It can mean a sports competition, with two teams competing against each, like soccer. But you can have two teams competing in some way other than a sport. And you don't even need two teams to have a "game." For example, some games are played by one individual, like solitaire with a deck of cards. Or you can think about the "dating game," or refer to "game birds," or a "game b

Special Announcement #1 Attend the Legendary Summer Intensive Featuring Drs. David Burns and Jill Levitt August 8 - 11. 2024 Learn Advanced TEAM-CBT skills Heal yourself, heal your patients First Intensive in 5 years! It will knock your socks off! Limited Seating--Act Fast Click for registration / more information! Sadly, this workshop is a training program which will be limited to therapists and mental health professionals and graduate students in a mental health field Apologies, but therapists have complained when non-therapists have attended our continuing education training programs. This is partly because of the intimate nature of the small group exercises and the personal work the therapists may do during the workshop. Certified coaches and counselors are welcome to attend. Special Announcement #2 Here's some GREAT news! The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it Today's Podcast Practical Philosophy Month Part 1, The Free Will Problem Welcome to Practical Philosophy month. For the next five weeks, we will discuss some of the most popular and challenging problems in philosophy, such as these: Do human beings have free will? Or is free will just an illusion? Do human beings have a "self?" Or is the "self" just another illusion? Is it possible to be more or less "worthwhile?" Are some humans "better" or "worse" than others? Does God exist? Is the universe "real" or "one"? What's the meaning of life? What is "self-esteem"? How does it differ from self-confidence? What's the difference between conditional and unconditional self-esteem? What's the difference between self-esteem and self-acceptance? What do you have to do to experience joy and feelings of worthwhileness? We will try to complete the list in five weeks, so some weeks we may include more than one topic, since many of these topics are related to one another. Rhonda and David will be joined by our beloved Dr. Matt May, a regular on our Ask David episodes, and for the first and second sessions we will be joined by our beloved Dr. Fabrice Nye, who created and hosted the Feeling Good Podcasts several years ago. Each week, you will also hear about the linkage between these philosophical dilemmas, and emotional problems, like depression, anxiety, and relationship conflicts. For example, nearly all depressed individuals believe that they aren't sufficiently "worthwhile." I see my goal as a psychiatrist not as helping people feel "more worthwhile," but rather showing people, if interested, how to give up this notion entirely and become free of certain kinds of damaging judgments of the "self" and others. You will also learn how these types of philosophical problems continue to play a large role in psychiatry and psychology, including the DSM5 diagnostic system. For example, is the diagnosis of "Generalized Anxiety Disorder" a true "mental disorder" that you could "have" or "not have?" And might some or most of the so-called "mental disorders" listed in the DSM be based on faulty philosophical / logical thinking? And if many or most of the "mental disorders" are based on goofy, faulty thinking, is there a more productive and effective way to think about most emotional problems? And how did we get into this mess in the first place? Worrying certainly exists, and we all worry at times. But how much or how often do you have to worry before you develop or have a "mental disorder" called "Generalized Anxiety Disorder" that can be diagnosed like any medical illness and treated with drugs? Or is "Generalized Anxiety Disorder" (and hundreds of other "mental disorders in the DSM" based on a certain kind of nonsensical thinking? And if so, why? What is the goofy, faulty thinking in the DSM? And are there some "mental disorders" that are valid and real? We HAVE touched on all of these themes in previous podcasts, but I thought it would be nice to put them all in one place and bring in a variety of "solutions," controversies, and experts. I David, will often represent (hopefully, and to the best of my ability) the thinking of Ludwig Wittgenstein, as expressed in his famous book, Philosophical Investigation, published in 1950 following his death. That book consists of a series of numbered brief essays (a few paragraphs each) that were based on notes found in a metal box under his dormitory room at Cambridge University. He'd written these in preparation for his weekly seminars in his dormitory room. Wittgenstein, although now widely regarded as one of the greatest philosophers of all time, did not think he knew enough to teach in a classroom. In fact, because of his feelings of depression and self-doubt, he sadly never tried to publish anything when he was alive. Wittgenstein's philosophy also played an indirect but significant role in the evolution of several modern psychotherapies. His philosophy created new ways of thinking that gave rise to the

Special Announcement #1 Attend the Legendary Summer Intensive Featuring Drs. David Burns and Jill Levitt August 8 - 11. 2024 Learn Advanced TEAM-CBT skills Heal yourself, heal your patients First Intensive in 5 years! It will knock your socks off! Limited Seating--Act Fast Click for registration / more information! Sadly, this workshop is a training program which will be limited to therapists and mental health professionals and graduate students in a mental health field Apologies, but therapists have complained when non-therapists have attended our continuing education training programs. This is partly because of the intimate nature of the small group exercises and the personal work the therapists may do during the workshop. Certified coaches and counselors are welcome to attend. Special Announcement #2 Here's some GREAT news! The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it Today's Ask David Podcast We have lots of great questions today. The answers in the show notes were written prior to the podcast, and the answers in the live podcast as we discussed these questions may differ somewhat or amplify the written materials in these show notes. We love your questions. Remember to send them to [email protected]. Ask David Questions for Today Bosley asks: My father can be very critical of my plans for the future. What's the best way to respond to him? Willie asks: I have a dating questions. Why do women keep ghosting me? Should they be more willing to work out differences with the Five Secrets of Communication? 1. Bosley asks: My father can be very critical of my plans for the future. What's the best way to respond to him? "To explain somewhat concisely, I just want to move to the nearest major city (Seattle) since I feel really really happy there. I also love volunteering for a specific organization and have some community there that I care about, and I feel very isolated having been away from for months. I'm willing to carry the load of all the work I would need to do to make it happen, and do a business training my dad wants me to complete. He has other thoughts. He looks down on volunteering and his thoughts on friends are simply that I can make new ones anyway. He is very aggressive and intimidating in his arguments, full of insults and many factually incorrect statements that are difficult to disarm on the fly. He shoots down the idea upon mention, so it's difficult to collaborate to find mutually beneficial solutions. He is a successful businessman, despite recent financial issues, and has a sort of strict plan for me that he has wanted me to follow, although I really don't feel this conflicts with his goals to have me run things in the future. I'm just worried since he has a long past of being emotionally abusive and of going back on his word. Plus, I just want some autonomy. In the end, it's his way or the highway. He says "You keep scheming and going down a twisted path instead of doing what I tell you." David's reply I suggested he might complete the first four steps of the Relationship Journal so we could see how he's communicating with his dad. Here is Bosley's partially partially completed Relationship Journal (showing steps 1 to 4, but not 5.) Step 1 – S/he said: Write down exactly what the other person said. Be brief: You keep scheming and going down a twisted path instead of doing what I tell you! Step 2 – I said: Write down exactly what you said next. Be brief: What? Circle or bold the emotions S/HE might have been feeling Circle or bold the emotions YOU were feeling Sad, blue, depressed, down, unhappy Sad, blue, depressed, down, unhappy Anxious, worried, panicky, nervous, frightened Anxious, worried, panicky, nervous, frightened Guilty, remorseful, bad, ashamed Guilty, remorseful, bad, ashamed Inferior, worthless, inadequate, defective, incompetent Inferior, worthless, inadequate, defective, incompetent Lonely, unloved, unwanted, rejected, alone, abandoned Lonely, unloved, unwanted, rejected, alone, abandoned Embarrassed, foolish, humiliated, self-conscious Embarrassed, foolish, humiliated, self-conscious Hopeless, discouraged, pessimistic, despairing Hopeless, discouraged, pessimistic, despairing Frustrated, stuck, thwarted, defeated Frustrated, stuck, thwarted, defeated Angry, mad, resentful, annoyed, irritated, upset, furious Angry, mad, resentful, annoyed, irritated, upset, furious Other (specify) Other (specify) Step 3 – Good Vs. Bad Communication: Was your response an example of good or bad communication? Use the EAR Checklist to analyze what you wrote down in Step 2 Step 4 – Consequences: Did your response in Step 2 make the problem better or worse? Why? It probably made things worse. I came off dismissive, which probably confirmed for him that I automatically ignored any advice or direction that he gave me. I wasn't assertive in fear of escalating anger or just being

A Riveting Story of Raw Emotion. . . "Dad, I let you down!" Part 2 of 2 Special Announcement The long awaited Feeling Great App is now available in app stores. IOS and android! Check it out. Take a free ride! And now, on with the exciting conclusion of the personal work Dr. Jill Levitt and I did with Chris, along with a fabulous followup interview you will hear at the end of the session. I hope you enjoyed the session with Chis, and hope you found it inspiring. His message of hope and joy could be helpful and inspiring to any of you who may be struggling, and feeling, as he was, that you're just "not good enough." His work is, of course, important from a psychological perspective, because it illustrates the powerful steps of TEAM in a sequence that brought Chris from the depths of despair to the peaks of enlightenment. However, as you will hear in the postscript dialogue, the work for sure takes on a spiritual and mystical quality for sure! When you hear Chris live during the follow-up interview at the end of Part 2 of this two-part podcast, you will not be disappointed! Postscript As I mentioned earlier, I was overjoyed when I learned that Chris had unexpectedly changed his mind and offered us the chance to publish his personal work and provide a follow-up recording of how he's doing now. Here's my email to him just prior to the follow-up recording. Hi Chris, I'm assuming that Rhonda will coordinate this and she has us scheduled for this Friday, I believe. When it is 4 PM in your time zone, what time is it in our time zone? Are you two hours later? I just reviewed my chart notes from a year or so ago, and it will be terrific to reconnect with you. I deeply appreciate the chance to share your session with our many listeners, as it is full of raw emotion and is riveting. You are making a super strong statement to the world, to my way of thinking, and it takes incredible courage to say, "This is me! I am very real, and sometimes very raw!" I think many people suffer due to thinking that everyone else is somehow "better" than they are, and that they are somehow "not good enough." That is perhaps the main theme I hear when doing clinical work, and that includes my work with mental health professionals who are equally vulnerable to this kind of thinking. What triggered your decision to go public, so to speak. And how might this impact your students, and their parents, and so forth? Hopefully, we can chat this Friday about those and any other questions or topics that touch or interest you. It will be great to get caught up on your past year! If Jill or Rhonda want to add your thoughts, please do! To me, this is a very significant occasion to have the chance to connect with you, Chris, again! The work you did is among the most powerful and impactful ever in my memory, although every time we do live work it is pretty incredible to my way of thinking, especially when people become "real," whatever that means! Humans have a dark side, to be sure to my way of thinking, but something incredibly beautiful and amazing can emerge. I am babbling so will stop. But I am so excited to talk to you again, Chris! Warmly, david Thank you for listening, and please let us know what you think. if you are a therapist, and want to learn how to do this, consider attending the summer intensive from August 8 to 11, on line, or in person at the South San Francisco Conference Center (ten minutes from the SF airport.) See the details and a link below, or go to www.cbtintensive.com. Chris, Rhonda, Jill, and David Click for registration / more information!

A Riveting Story of Raw Emotion. . . "Dad, I let you down!" Special Announcement The long awaited Feeling Great App is now available in app stores. IOS and android! Check it out. Take a free ride! And now, on with today's podcast! Part 1 of 2 Our work with Chris started with this email: Hi David and Jill, I am 40 years old and have never been in a relationship. I've only had a handful of sexual experiences. I used to carry a lot of shame around this, but have done some work on myself, have more or less come to terms with where I'm at, and actually really enjoy my life and am pretty happy most of the time. However, I recently developed some strong feelings towards a coworker, and this led me to re-evaluate my stance on being single. The DML (LINK) details an incident from last week concerning this coworker. I haven't had extensive interactions with her and she works at a different site. Our clinical team meets twice monthly for online zoom meetings. She recommended a book to the team a few months ago, I read the book and enjoyed it, and was hoping to meet up with her and talk about it sometime. I was feeling a little terrified and didn't know if it was the right thing to do, but ultimately sent her an email asking if she'd like to speak with me about the book sometime. She politely declined the invitation. The daily mood log documents the hour or two immediately after I sent the email, as well as some of the thoughts that happened after I received her reply. There were a lot of negative thoughts, so I only included a few. There were also a number of hidden thoughts/beliefs that occurred to me over the last few days, which I have not included. It seems worth noting that for 2-3 hours after I sent the email, I experienced a lot of emotional turmoil. However, at 4pm when I got off work, from the long drive home until I went to bed, I was in a euphoric state. I was happy about what I did, how I responded to the rejection, and was optimistic about my future. I was working out at the gym and had a hard time keeping a smile off my face. I went to bed feeling great, but woke up in the middle of the night and felt terrible again, the painful sting of rejection kept me from sleeping. Since then, I've mostly felt just fine about it, only a few brief moments of really feeling that sting and they don't last long. My goal isn't to necessarily get into a relationship or have more sex; it's to feel more confident in my interactions with women. After being rejected, I think 15 seconds of agony is enough, no need for more than that. In the past, when I've developed strong feelings towards a woman, I notice that I am prone to both negative and positive distortions, some version of: "It's the end of the world if she isn't attracted to me," or "She's perfect for me; there is no one else like her," or "Sex with a beautiful woman will complete my life, or completely fulfill me". I think I'd be better off without these distortions, but find the positive distortions to be somewhat addictive. They also make it hard for me to let go and move on. I still feel somewhat attached to this woman and haven't been able to let go and move on. Also, I want to note that there are a few experiences from high school that really impacted my sexuality, relationship with women, and probably inform some core beliefs on these subjects that have recently come to surface. I'm not sure how much to share about this or whether it's even necessary to, but I suppose that could be addressed in the empathy phase on Tuesday. One other thing that I didn't include in the DML, is when I'm in that negative state, sometimes I have intense thoughts directed at me that come in the form of the second person, like You're a piece of shit. I fucking hate you. Cut your throat You don't deserve to be alive. I'll fucking kill you. I don't really believe these thoughts, but they do make me sad. Hope this all makes sense, let me know if you have questions or if I'm missing something. Looking forward to working with you. Thanks, Chris This email led to personal work with Chris in our Tuesday TEAM-CBT training group, roughly one year ago. Dr. Jill Levitt, the Director of Training at the Feeling Good Institute in Mountain View, California, was my co-therapist. It was one of the rawest and most riveting sessions that I can recall. Here is the Daily Mood Log he sent, along with his Daily Mood Log: Daily Mood Log Due to the intensely personal, explosive revelations Chris shared with us during his session, he decided he did not want us to publicize his work as a podcast, which was totally understandable. Our highest priority is always the peace, safety, confidentiality, and well-being of the people we work with. However, roughly a year later, Chris contacted us and said he'd changed his mind, which was fantastic news. He said he'd changed his mind because he had a relapse, and decided to listen to the recording of the work you're about to hear. He said it was extremely helpful, and so

Ask David Unfairness Worthwhileness Erasing Depression with Lasers TEAM in the UK What's the Most Powerful Technique? We have lots of great questions today. The answers in the show notes were written prior to the podcast, and the answers in the live podcast as we discussed these questions may differ somewhat or amplify the written materials in these show notes. We love your questions. Remember to send them to [email protected]. Special Announcement Attend the Legendary Summer Intensive Featuring Drs. David Burns and Jill Levitt August 8 - 11. 2024 Learn Advanced TEAM-CBT skills Heal yourself, heal your patients First Intensive in 5 years! It will knock your socks off! Limited Seating--Act Fast Click for registration / more information! Sadly, this workshop is a training program which will be limited to therapists and mental health professionals and graduate students in a mental health field Apologies, but therapists have complained when non-therapists have attended our continuing education training programs. This is partly because of the intimate nature of the small group exercises and the personal work the therapists may do during the workshop. Certified coaches and counselors are welcome to attend. But there's some good news, too! The Feeling Great App is now available in both app stores (IOS and Android) and is for therapists and the general public, and you can take a ride for free! Check it out! Today's Questions Kiernan asks about "unfairness" and the connection between worthwhileness and achievement. Brittany asks: Can you "erase" feelings of sadness and depression by shining lasers in the patient's eyes? James asks about the use of TEAM methods in the NHS in the UK Brian asks: Is positive reframing the most successful technique you have used with your patients? 1. Kieran asks (slightly edited for clarity): How would you talk back to negative thoughts like this one: "It's not fair that I can't afford quality food when there are millionaires that will have access to better food and a healthier lifestyle which has an effect on overall health and longevity'"? Or what if you feel like it's unfair that you should have to pay a lot of money for an expensive dental treatment that you can't afford? Kieran also asks (slightly edited by david): What if worthwhileness is not based on achievement but there are still things you would like to have and enjoy? They would buy and own things that they happen to like and not to impress others. Hi David and Ronda, and if Matt is on I have been listening to your wonderful podcast for about the last 3 years as I drive to work. It has really opened my eyes about how your thoughts create your interpersonal reality. Loved the podcasts on jealousy addiction, perfectionism, achievement addiction and many more. My questions would be: What about if someone wants to achieve more but it isn't based on worthwhileness? They would buy and own things that they happen to like and not to impress others. Let's say they wanted to be able to afford a nice house, healthier higher quality food and water. As the quality does have an effect on health especially in the US as the regulations are not the greatest. However, the fact that they couldn't afford to buy these upsets them? Thoughts: 'It's not fair that I can't afford quality food but there are millionaires that will have access to better food, lifestyle which has an effect on overall health and longevity' Or if someone has to pay for unexpected expensive dental treatment. Thoughts: 'It's not fair that I have to pay £14,000 for this treatment'. 'It should be more affordable to lower income households, as it is essential to have functional teeth' I hope I have explained this well, I would love to hear your thoughts. Keep doing what you are doing and all the best. Kieran David's response Sure Kieran, if you like I will make this an Ask David question for a podcast. LMK if that's okay, and if it is okay to use your first name. Great question, and has to do with the theme of acceptance: should I or shouldn't I? Here are the quick versions, but we can discuss in more detail on the live podcast. First, I do not find it useful to base my worthwhileness on my achievements or on my failures. I do work hard and like creating things that are helpful to people, and I enjoy earning money to support my family. I can be motivated to work hard to get things we want or need, but I don't base anyone's worthwhileness on how much money they have, or anything, to be honest. In fact, I could also easily accept wanting to buy something really cool, not just because I like it, but because it might impress others, or because they might find it fascinating, too! I don't try to regulate my life with a lot of shoulds and shouldn'ts, and find that I am happier and more peaceful without lots of shoulds. In the Feeling Great App I have created a class called "Your PhD in Shoulds." You might enjoy it! Second, you can say that it is unfair that some people have more

Ask David Bipolar, the Dark Side, Changing Behavior We have lots of great questions today. The answers in the show notes were written prior to the podcast, and the answers in the live podcast as we discussed these questions may differ somewhat or amplify the written materials in these show notes. We love your questions. Remember to send them to [email protected]. Announcement: Our awesome summer intensive is returning after a long, five years due to the pandemic. It is typically the most outstanding and rewarding TEAM-CBT training of the year, and it will take place again and the wonderful South San Francisco Conference Center from August 8 – 11, 2025. You can attend in person if you register soon, since in-person seating will be strictly limited and only a small number are still available. You can also attend the online, live-streamed version of this program at a substantial discount. The online experience and small group exercises will be similar for the in-person and online participants. Check out the details, including early-bird discounts, at www.cbtintensive.com www.cbtintensive.com Hope to see you there! Warmly, david Today's Questions Alison asks: I have bipolar Disorder and I have had trouble challenging my negative thoughts. I'm suffering. What can I do NAME WITHHELD asks: Can or should a person really and truly accept their dark side? Trainor asks: In TEAM there is a strong emphasis on changing the way you think. But is it sometimes also important to change your behavior, or to make real changes in your life, or to help others who need help changing their circumstances==for example, people who are struggling in poverty. 1. Alison asks: I have bipolar Disorder and I have had trouble challenging my negative thoughts. I'm suffering. What can I do? Hi David, Many years ago I used your book to beat depressive thinking… in the last three years I've been diagnosed with Bipolar Disorder and have found my depressive thinking too difficult to budge with your book. I'm really suffering; any ideas about what I could do? Thank you for your service to humanity. I always recommend your book. David's response Hi Alison, A therapist could help. The new Feeling Great App could help. And tons of free resources at www.feelinggood.com. In addition, can you please give me an example of the negative thoughts you can't budge. Then we can point things out in the podcast and try to figure out why you're getting stuck! I have found that doing cognitive therapy / TEAM-CBT with individuals with Bipolar Disorder is exceptionally helpful during the depressed (not manic) phase, and works pretty much the same way as with anyone who's feeling down. Best, david 2. NAME WITHHELD asks: Can or should a person really and truly accept their dark side? Hello David, My name is NAME WITHHELD and I am doing my PhD degree in Neuroimmunology in LOCATION WITHHELD. I had come across your book feeling good and your podcasts by one of my therapists - they have had an immense impact on my way of thinking. I really love disarming and using "I feel" statements to connect! I had also realized that by finding some genuine truth in a person's belief even if it sounds ridiculous, I would automatically develop certain level of respect for that person! I really love that! I feel really happy that I can respect a person even without accepting his/her beliefs!! I am now working on my distortions. I really love working on my mind that way. Anyway, I have wanted to ask you if a person CAN accept his/her dark side? I seemed to have loathed myself for quite a long time and couldn't stand living alone without a partner or a person around. I hated myself for disrespecting my mother whilst growing up. But, sometime during Dec last year, I had had an epiphany of why things happened the way they did and somehow, I learnt that the reason why I had disrespected my mother was because my father, after their separation, kept filling my mind about how wrong my mother was for breaking up the family and I believed him because I had a good rapport with him, than I had with my mother. Also, my mother was very awkward in building a relationship with me and I had misconstrued that with her indifference towards me. After that, I stopped hurting myself over it because I had learnt to empathize with myself then. I sobbed profusely that day. Is it really possible to truly accept yourself? I feel at ease a lot more these days than I used to before. But I also have to battle my distortions too on a regular basis! Please help me out here! Thank you so much for everything that you have done!! I really love your work!! Regards, NAME WITHHELD David's reply Thanks so much. I hid your name and location, and hope that's okay, and we WILL include your excellent question on our upcoming podcast. My brief reply is that all human beings have a "dark side," and that we are far better off accepting it, as opposed to denying it and seeing ourselves as "totally good," because then we might see

#400! Yippee! Today, Rhonda has prepared a special celebration for our 400th podcast, and still going strong! She has invited a number of our favorite people and podcast guests to celebrate with us, starting with our beloved friend and frequent Ask David contributor, Matt May, MD, who officially joined us in early 2000. Matt's presence on the show had meant a great deal, personally and professionally, because I supervised Matt when he was a Stanford psychiatric resident, and had been missing our weekly chats! Our reunion via the Feeling Good Podcast has been special for that reason, but also because of Matt's kindly but scholarly answers to the many questions all of you submit. Keep them coming, and send them directly to Rhonda or David. We love reading and answering them! Next, we were joined by two more extraordinary psychiatrists and human beings, Drs. Heather Clague and Brandon Vance, who song their rendition (with guitar accompaniment) of "Help Dr. Burns!" (Based on Beetles' Help, I need somebody!" With their kind permission, here are the brilliant lyrics! Help! I need a podcast! Help! Not just any podcast! Help! Pushing the Magic Button for .... Help! When I was younger, 8 years younger than today I thought I could help everybody; help them in every way. I got so grandiose; I was so self-assured. I'd push my brilliant techniques, but my patients were never cured. So, Help me not to Help oh Dr. Burns Will they like me if they have to do the work? If I set an ultimatum, am I a jerk?! Won't you please, please stop me?! So many times, I tried to help, but then got stuck I didn't know but my patients were also thinking what the #?@! Your podcast said to test at the start and after every session. And then my eyes they opened wide Boy, was that a lesson! Oh Help me not to help, oh Dr. Burns! Help me unlearn the bad habits I have learned I'll do homework when my urge to help returns Won't you please, please help me?! Now I explore my patients' reasons not to change. I learned to sit with open hands if they choose to stay the same. Only when they fight for change and want to do the work, That's when I offer tools, and know the changes will endure. You've helped me not to help, oh Dr. Burns 'Til my patients show me that they really yearn To do the work and ask me really firmly Won't you please, please help me? Your podcasts helped ME! Oooooooh! Much warmth to each of you! Heather and Brendan Our next guest was the brilliant and beloved Dr. Jill Levitt who joined my weekly Stanford training group when she and her husband, Brian, and two boys moved to the Bay Area from New York in 2007. Jill has moved up in the ranks and now co-leads the Tuesday group with me, and also joins me as co-therapists in a great many live sessions we have published as two consecutive podcasts. The idea is to document exactly how TEAM-CBT works, and how we can nearly always get such blow-away results in a single, extended session. That was my dream as a young man, since the methods I was taught as a psychiatric resident almost never got rapid results, or even any noticeable changes in my patients. Now that dream has become a reality, and a great many people in our TEAM-CBT community have contributed to that evolution. Next we were joined by our beloved Dr. Amy Huberman. Her riveting personal work on perfectionism was published recently on two consecutive Feeling Good Podcasts. Amy was glowing and filled with joy, which gave us great feelings of joy as well! And then we were graced by a visit from Mina, who has starred in many Feeling Good Podcasts on a number of personal issues. I will be seeing Mina and her beloved husband in a few minutes for our Sunday morning hike and dim sum feast afterwards. It is always a highlight of my week! Next was another Amy Berner who reported on her recent and wildly successful Intimate Connections Book Club with yet another psychiatrist, Dr. Leigh Harrington. Amy did some personal work with me on dating and sex appeal three years ago, when we discussed the Queen Bee phenomenon. Apparently, it was successful, because she brought her fantastic husband, Randy Kolin, as proof of the effectiveness of the many dating strategies and tips in that book. Randy is also a mental health professional who works with stressed-out scientists working on nuclear fusion at the Lawrence Livermore Laboratories. We wish him all the best since the work of those scientists is well on the road to creating commercially viable nuclear fusion, which will transform life as we know it on the surface of the earth by supplying unlimited, clean, low-cost energy. Their visit was followed by Zane Pierce, whom I hadn't had the chance to chat with much for a number of years. He led a recent "delight" and "gratitude" hike that we published on podcast # 361entitled "Finding Joy in Everyday Life," with Dr. Angela Krumm from the Feeling Good Institute in Mountain View, California. We have done previous podcasts with Zane, and his lovely wife, Dai

FROZEN: Part 2 of 2 Featuring Personal Work with Cody Today, you will hear the exciting conclusion of the work that Jill and David did with Cody, a young man who sometimes freezes in social situations due to feelings of anxiety. He actually froze up when Jill and David were working with him in part 1 last week. What will they do? Tune in today and you'll find out! Before I describe Cody's session, I want to remind you that I am bringing back my annual, four-day summer intensive at the South San Francisco Conference Center this year, for the first time in five years. We had to abandon it due to the pandemic, and this year we are bringing it back to life on August 8 to 11. It will cover TEAM-CBT for depression and anxiety, but with a few changes, hopefully innovations and further improvements. For one thing, you can attend in person or online this year, and Dr. Levitt will be teaching with me. This will make the experience even better, since Jill is a brilliant psychotherapy teacher, certainly among the top in the world! The in-person seating will be strictly limited to 100, so register early if you are interested, at Intensive Information / Registration The online version will be identical, with many skilled experts to guide you in the many interactive exercises, making both the in person and online versions identical. However, the online will be roughly half the cost, so that could be an appealing option if you are cost-conscious or if you live far away. No travel needed this year! But perhaps most important, this annual intensive always proves to be the best training experience of the year, with chances to learn sophisticated and magnificent TEAM techniques to use with your patients. But you will also have the chance to do your own personal work. Many, many people have said that the intensives are absolutely magical, and I totally agree! In fact, the summer intensive might be the training you always dreamed about, but never really received, in graduate school!. Sadly, this workshop is a training program which will be limited to therapists and mental health professionals and graduate students in a mental health field Apologies, but therapists have complained when non-therapists have attended our continuing education training programs. This is partly because of the intimate nature of the small group exercises and the personal work the therapists may do during the workshop. Certified coaches and counselors are welcome to attend. Beginning of Part 2 with Cody You will hear some of the tools that seemed especially helpful, including Self-Disclosure Positive Reframing, not only for his negative feelings but also for his freezing Identify and Explain the Distortions Externalization of Voices with Acceptance Paradox the Feared Fantasy the Experimental Technique And more. Whether you are a shrink or general citizen, I think there might be a lot for you to learn from Cody, not only about techniques to treat social anxiety and feelings of inadequacy, but also about enlightenment as well. ' That's because the goals of a TEAM-CBT session are not just the reduction of negative feelings, but the complete obliteration of negative feelings, along with jumping on a psychic trampoline that catapults you into a state of profound self-acceptance and enlightenment. At least, that's my take on it! Did it really happen? Here's how Cody was feeling at the start of the session, along with his goals for each feeling at the end of Positive Reframing, and his feelings at the end of the session. As you can see, all of his negative feelings went to zero. Emotions % Before % Goal % After Sad, blue, depressed, down, unhappy 40 10 0 Anxious, worried, panicky, nervous, frightened 95 15 0 Guilty, remorseful, bad, ashamed 20 5 0 Inferior, worthless, inadequate, defective, incompetent 40 10 0 Lonely, unloved, unwanted, rejected, alone, abandoned 50 10 0 Embarrassed, foolish, humiliated, self-conscious 100 30 0 Hopeless, discouraged, pessimistic, despairing 50 15 0 Frustrated, stuck, thwarted, defeated 50 15 0 Angry, mad, resentful, annoyed, irritated, upset, furious 30 5 0 Confused 60 10 0 What explains these seemingly impossible changes in a single therapy session? And are they real, or is this all just a bunch of hype? Stay tuned and let us know what you think at the end! Early, I had a challenging exercise to do on Cody's SDBa. Here's the solution. To my way of thinking, Cody's Downward Arrow chain of thoughts suggest a number of related Self-Defeating Beliefs, including: Perfectionism: I should always try to be perfect. Perceived Perfectionism: Others will not love and accept me if they see that I'm flawed or if I screw up. I must earn the respect of others. Approval Addiction: I need everyone's approval to be worthwhile. Achievement Addiction: My worthwhileness and capacity for happiness are based on my intelligence, achievements, and productivity. Fear of Rejection. Being rejected and alone would be devastating. Worthlessness Schema (pos

FROZEN: Part 1 of 2 Featuring Personal Work with Cody In today's, and next week's, podcasts. we present the next episode of live work with Cody. The first, which featured Rejection Practice for social anxiety, was published as Podcast #326 on January 9, 2023 at this LINK. My co-therapist for this session was the wonderful Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mt. View, California (LINK.). Before I describe Cody's session, I want to remind you that I am bringing back my annual, four-day summer intensive at the South San Francisco Conference Center this year, for the first time in five years. We had to abandon it due to the pandemic, and this year we are bringing it back to life on August 8 to 11. It will cover TEAM-CBT for depression and anxiety, but with a few changes, hopefully innovations and further improvements. For one thing, you can attend in person or online this year, and Dr. Levitt will be teaching with me. This will make the experience even better, since Jill is a brilliant psychotherapy teacher, certainly among the top in the world! The in-person seating will be strictly limited to 100, so register early if you are interested, at Intensive Information / Registration The online version will be identical, with many skilled experts to guide you in the many interactive exercises, making both the in person and online versions identical. However, the online will be roughly half the cost, so that could be an appealing option if you are cost-conscious or if you live far away. No travel needed this year! But perhaps most important, this annual intensive always proves to be the best training experience of the year, with chances to learn sophisticated and magnificent TEAM techniques to use with your patients. But you will also have the chance to do your own personal work. Many, many people have said that the intensives are absolutely magical, and I totally agree! In fact, the summer intensive might be the training you always dreamed about, but never really received, in graduate school!. Sadly, this workshop is a training program which will be limited to therapists and mental health professionals and graduate students in a mental health field Apologies, but therapists have complained when non-therapists have attended our continuing education training programs. This is partly because of the intimate nature of the small group exercises and the personal work the therapists may do during the workshop. Certified coaches and counselors are welcome to attend. Now, back to the podcast, in which you'll hear some additional TEAM-CBT magic. Cody asked for help with a problem that's been bugging him for some time. He sometimes freezes up when asked to do a role play or answer a question during psychotherapy training sessions. This typically leads to an awkward silence, and feelings of intense anxiety, inadequacy, frustration, embarrassment and more. Here's how he described it: Upsetting event: I was doing a suicide screening role-play with our clinical supervisor and other therapists. After working through the first step of the role-play, I froze and did not say a word! Here's how Cody was feeling. Emotions % Before % Goal % After Sad, blue, depressed, down, unhappy 40 Anxious, worried, panicky, nervous, frightened 95 Guilty, remorseful, bad, ashamed 20 Inferior, worthless, inadequate, defective, incompetent 40 Lonely, unloved, unwanted, rejected, alone, abandoned 50 Embarrassed, foolish, humiliated, self-conscious 100 Hopeless, discouraged, pessimistic, despairing 50 Frustrated, stuck, thwarted, defeated 50 Angry, mad, resentful, annoyed, irritated, upset, furious 30 Confused 60 As you can see and might imagine, the most intense feelings were anxiety and embarrassment, but several other feelings were fairly intense as well: such as feeling alone, discouraged, frustrated, and confused. These were some of his negative thoughts on the Dailly Mood Log that he brought to the session, and the percent he believed each one. Thought 5a, b, and c are an Individual Downward Arrow series, designed to get at the Self-Defeating Beliefs underneath the Negative Thoughts. What do you think Cody's SDBs are? Take a guess, and then you can look up the answers, or at least my own thinking, at the end of the show notes. Negative Thoughts % Belief 1. I shouldn't have screwed up. 80 2. I'm not good enough. 80 3. I don't belong here/I shouldn't be here. 50 4. Something is wrong with me (my brain) 100 5a. Everyone thinks I'm an idiot ↓ 100 5b. I should not be in this ↓profession ↓ 70 5c. I failed to find something I'm good at. ↓ 70 6. I'm worthless 60 Although freezing in social situations is fairly common, it can be incredibly challenging and painful for those who experience it. Cody said: Sometimes they try to help, or may switch to someone else. It sucks, and everyone feels awkward. The hangover can last a few hours or a day, and keeps me up at night. Over time, some emotions get worse, especiall

Ask David, Rhonda and Matt Assertiveness, Suppressing your Feelings, and the "Miracle Cure" question Questions for today's Ask David podcast. Chris asks if I have a book about assertiveness. Brian asks: Is there anything to the theory that "suppressing emotions" is harmful or is that just Freudian mumbo jumbo? Matt asks about the "Miracle Cure" question in the Assessment of Resistance portion of a TEAM therapy session. Rhonda began with a lovely endorsement and a cool reminder of the classic book, Robinson Crusoe, who created cognitive therapy (the double column technique) when he was stranded on a deserted island! I believe I wrote about it in one of my books, possibly Feeling Good. It's pretty cool! You will hear Matt playing the role of the "evil" thoughts, like, "I am stranded alone on a deserted island," and Rhonda will play the role of the "good" thoughts, like, "Yes, but my life was spared, and all of my shipmates died." Here's what it looks like in the novel: Evil. Good. I am cast upon a horrible, desolate island, void of all hope of recovery. But I am alive; and not drowned, as all my ship's company were. I am singled out and separated, as it were, from all the world, to be miserable. But I am singled out, too, from all the ship's crew, to be spared from death; and He that miraculously saved me from death can deliver me from this condition. I am divided from mankind—a solitaire; one banished from human society. But I am not starved, and perishing on a barren place, affording no sustenance. I have no clothes to cover me. But I am in a hot climate, where, if I had clothes, I could hardly wear them. I am without any defence, or means to resist any violence of man or beast. But I am cast on an island where I see no wild beasts to hurt me, as I saw on the coast of Africa; and what if I had been shipwrecked there? I have no soul to speak to or relieve me. But God wonderfully sent the ship in near enough to the shore, that I have got out as many necessary things as will either supply my wants or enable me to supply myself, even as long as I live. I know this novel is a couple hundred years old, so it certainly deserves nomination of the earliest cognitive therapy! Now, for the answers to today's Ask David questions. Keep in mind that these answers were written BEFORE today's recording, so the actual live answers will differ in some regards from the written answers below. 1. Chris asks if I have a book about assertiveness. Hi Dr. Burns, I hope you're doing well. Do you have a book on assertiveness training? I've used your books to help me with my hidden "should" statements, which has enabled me to be less angry or anxious whenever someone treats me less than satisfactorily. While this has helped immensely, I realize it's still in my interest to reduce the behavior I disagree with. For example, my sibling scheduled an early morning shift after I had a long day of work. Because they can't drive, they expect me to take them to work, which means I'll only get about 5 hours of sleep; this in itself isn't a bad thing... except this is the 3rd time in a row they've done this. After using your techniques, I'm less angry and anxious, but I still want to address the behavior to reduce the likelihood that they do something like this again, which is why I'm reaching out. Thanks for your help. Kind regards, Chris David's Reply Sure. I like my own book, Feeling Good Together, and have often recommended Manuel Smith's When I Say NO I Feel Guilty. There is a LOT to be said about assertiveness training, including the fact that it doesn't always work! I can give a great personal account of that! Sometimes, or always, skillful listening is also effective. Assertiveness without listening makes it sound like only your own feelings are important, which is obviously pretty self-centered. One of the most helpful things to me is the difference between healthy and unhealthy anger, and how to express tough messages in a loving, respectful way. Can discuss more on the show. For example, what are the problems with the assertiveness movement? And where can it be helpful? And what mistakes do unassertive individuals make when trying to be more assertive? Do they sometimes overdo it? Warmly, david 2. Brian asks: Is there anything to the theory that "suppressing emotions" is harmful or is that just Freudian mumbo jumbo? Thanks!! David's reply. Thanks, Brian. Great question! You can listen to the podcasts on the Hidden Emotion Technique, or read about it in my book, When Panic Attacks. Will make this an Ask David question if that's okay! 3. Matt asks about the "Miracle Cure" question in the Assessment of Resistance portion of a TEAM therapy session. Hi David, I've noticed that when I ask the 'miracle cure' question or 'magic wand' question, I'll sometimes get a response that isn't all that useful and I might waste time trying to figure out what the person is really asking for. An example might be, 'I want to be able to support and understa

Incredible Voices from the Past! Plus: David's Amazing Summer Intensive Returns August 8 - 11, 2024 Today, David and Rhonda are joined by Dr. Jill Levitt, the Director of Clinical Training at the Feeling Good Institute in Mountain View, California, and two incredible voices from the past: Dr. Karen Radella, a clinical psychologist who volunteered to do personal work at the 2013 summer intensive at the South San Francisco Conference Center, and Jacqueline Ong, LCSW, who volunteered to do personal work at the 2019 summer intensive. That was the last summer intensive, due primarily to the Covid pandemic. Karen Radella, PhD But here's some fantastic news. The intensive returns again this summer, from August 8 to 11, 2024, at the same location. And Karen and Jacqueline give testimonial today, along with Rhonda, to the magic of the intensive, by describing the phenomenal impact of the personal work they did years ago, and the tremendous impact that work has had on their personal and professional lives. Both Karen and Jacqueline had been suffering from the devastating emotional impact of severe personal trauma for many years. Nine years earlier, when Karen's daughter was 12, she asked Karen if she could go out to play after dinner. She'd done this for years, but Karen had the thought that it was late and cold outside, but gave in and let her daughter go out to play. Minutes later, some neighborhood boys snuck up on her and shot her in the mouth with a high-powered pellet rifle that blew out one of her teeth and did considerable damage to her mouth which triggered PTSD and required many dental surgeries to correct. Both Karen and her daughter had been suffering emotionally for the nine years since that incident. Karen was telling herself that she was a bad mom, that she "shouldn't have" let her go out to play on that particular night, and that her daughter's horrific trauma was her fault. She was also convinced that other people, including the 100+ in the audience that evening, would be judging her as harshly as she was judging herself, and her feelings of fear and despair were palpable at the start of her live work. Karen described the techniques that were so helpful to her in her fantastic recovery that evening during her two hour session with Jill and David, including the Survey Technique, which she said was the "coolest experience of my entire life." She was also helped by other techniques, including Explain the Distortions, the Double Standard Technique, and the Externalization of Voices. Jacqueline had suffered a different but equally severe traumatic event of a personal nature, but also disclosed it and worked it through with great courage in front of an audience of the same size in 2019. Like Karen, she experienced a complete elimination of her symptoms in the 2 hour session with Jill and David. She describe the keys to her suffering and recovery involved perfectionism (the need to be flawless) and perceived perfectionism (a term David coined that refers to the belief that others expect us to be perfect in order to be loved and respected.) Jacqueline emphasized that "failing as fast as you can" is one of the keys to the rapid recovery we so often see in TEAM. Instead of meeting once a week for an hour, which sets you up for very slow progress with relapses between sessions, you use technique after technique in one session until you find the one that works. Of course, following "recovery," your negative thoughts will return over and over throughout your life, because no one is entitled to be—or would even want to be—happy all the time. But once you've experienced your own enlightenment, you know the tools that work for you, so you get better and better at heading off the relapses at the pass. Jacqueline and Karen both said they'd heard that the personal work at an intensive can be life-changing, but they "wouldn't have believed it" until they experienced it. Rhonda said, "I saw both live demonstrations. My first intensive was also the 2013 intensive when Karen did her personal work and saw Jackie's work at the 2019 intensive. I cried my eyes out with both of you at those intensives. After watching David and Jill's personal work with Karen at the 2013 intensive, I decided that TEAM was the therapeutic method I wanted to learn, and that's why I've dedicated my life to learning, practicing and teaching TEAM." David, Jill and Rhonda hope YOU can attend the magical intensive this year. To learn more, you can just go to www.CBTintensive.com. This year you can attend in person OR online, since the program will be live-streamed. In the past, David has done all the teaching, but this year, David and Jill will do their dynamic "tag team" teaching made famous by their weekly free training group at Stanford. It is now online and is free for therapists around the world. It is Tuesdays from 5 to 7 PM west coast time. If you are interested in joining, contact Ed Walton, [email protected]. You could also join Rhonda's W

Ask David, Rhonda and Matt More on Insomnia; Porn Addiction Guilt; Rage Questions for today James asks for help with insomnia. Arjun Asks: How can I stop blaming myself for my porn addiction as a teen? Stephan asks: How do you treat feelings of rage? And what if you are simply very angry, but you don't have any thoughts? James asks for help with insomnia, Hi Dr. Burns, I enjoy your newsletter and have experienced moments of clarity with your book. However, my current struggle is that I have developed terrible sleep anxiety. I feel nervous tension in my stomach and trembling limbs as nighttime approaches. Some nights I can put these feelings aside and dose off and others I just cannot stop dwelling on the negative body sensations and it does not allow me to sleep. I wonder if you can offer some advice on how to get over this fear and accompanying sensations. Best, James David's reply Thanks, James. Sorry you're struggling with trouble sleeping. Yes, a Daily Mood Log can help, to find out what you are telling yourself that makes you so anxious about not sleeping. Also, the Hidden Emotion Technique may be important to find out if there's a problem in your life that's bugging you. There are also the typical sleep hygiene tips that can be useful for some folks, too! You can find these with an internet search. Can I use this as an Ask David question for a podcast, with your first name or a fake name? Best, david Arjun Asks: How can I stop blaming myself for my porn addiction as a teen? Hi Rhonda, I Really appreciate the work that you guys do and I listen to most of the feeling good podcasts. I'm 27 and have struggled with depression and anxiety since my teens. I'm currently in therapy with a TEAM certified professional from India, but I'm still grappling with feelings of being stuck in my past. During my pre-teen years, I battled a porn addiction for about a year, which has left me with ongoing feelings of anxiety, guilt, and depression. Despite trying various therapies, I haven't found relief. I keep fixating on the thought: "I shouldn't have indulged in porn addiction in the past. It's led me to develop anxiety and depression." How do I debunk this thought, reduce its hold on me, and cope with the regret it brings? It feels like I'm trapped in my past. and constantly blaming myself for that one mistake. because that indulgence in porn really did change my life. I wasn't the same as before. and never could go back to being who I was. How do I put the lie to this thought? Any methods you'd recommend putting in the recovery circle? Your insights would be invaluable in helping me move forward. Thank you, Arjun David's reply: The key concept is that the problem is perfectionism, plus the beating up on yourself in the here and now, and not the behavior or misbehavior in your past. In the live podcast, we can discuss the importance of T = Testing (with DML), E = Empathy and A = Assessment of Resistance, and M = Methods, like explain the distortions, Perfectionism / Self-Blame CBA, D. Standard, EOR, EOV, etc. etc. The issue, as I see it, is that you are looking for a technique to help you accept yourself, but in reality, it is a decision for you to make. The choice is to accept yourself with compassion or continue to beat up on yourself. There are many really GOOD reasons to beat up on yourself, and we can perhaps outline some on the podcast. You would then have to explain why you'd really want to accept yourself, given all the good reasons to keep beating up on yourself, and given all the positive things your self-criticisms show about you. Also, I will try to remember to tell one of my favorite Buddhist stories that relates to this problem. Stephan asks: How do treat feelings of rage? And what if you are simply very angry, but you don't have any thoughts? Hello Mr. Burns, I hope this email finds you in good spirits. I've just begun your book "Feeling Good" and I have just reached the point where you begin to speak about cognitive distortions and how to get over your thinking. I've been doing your exercise on the days that my thoughts are heavily saturated in my mind and I've realized something within doing this exercise. A lot of my thoughts do focus on the cognitive distortions that you've outlined in your book, but the other 75% of my thoughts focus on pure trauma of past situations and experiences that channels pure hate, anger and rage that pours out of my thoughts about the past situations. For example, one situation was someone purely scamming and taking advantage of me for years. And while doing your exercise, my hate and rage for that situation really comes out to where I wrote down "F*** that stupid a** b***** I hope she continues through her life being scammed as the fraud she is". A lot of my thoughts surround things like this with situation that I've been in. Or another example "This stupid a** girl gonna be married and divorced five times before I get married once And I went the wrong path. Ha." Most of

Featured photo is Dr. Jacob Towery Report on the 2nd Annual Social Anxiety Marathon Finding Humans Less Scary 2.0 Led by Jacob Towery, MD (above) and Michael Luo, MD (below) Today, Drs. Jacob Towery and Michael Luo report on the second annual "Finding Humans Less Scary" 2-day marathon in March of this year. As you all know, I am partial to offering valuable experiences for therapists and the general public for free, and my website (feelinggood.com) and life are focused pretty strongly on this goal, although I realize it isn't always possible since we all have to support ourselves and our families. That's why Rhonda and I are so proud of our colleagues, Jacob and Michel, who have now completed their second annual social anxiety marathon, which was open to therapists and the general public alike—in fact anyone struggling with shyness, public speaking anxiety, and other forms of social anxiety. And the total cost of admission both years had been a simple, $20 tax-deductible contribution to one of the charities listed on the FHLS website. That's pretty darn cool, since the leaders are among the world's top experts in the treatment of social anxiety, and there were, in addition, numerous highly trained TEAM therapists providing small group supervision and mentoring as well! They described a number of highlights from the event, including group exercises, both within the auditorium and also outside, on the streets of Palo Alto, doing exercises designed to help participants overcome fears and build feelings of confidence and self-esteem, including, but not limited to: Smile and Hello Practice Talk Show Host Rejection Practice Shame Attacking Exercises Feared Fantasy The Vulnerability Ladder Primary vs Secondary Characteristics Self-Compassion Enthusiastic Verbal Consent Internalizing a Compliment Flirtation Training Cost-Benefit Analysis of Maintaining Social Anxiety Exposure (public speaking on stage) And many more Michael explained that the program was sold out, and that participants came from a wide variety of backgrounds, and many had life-change experiences. Many provided testimonials on what the experience meant to them, including: "I grew as a person and experienced a dramatic increase in vulnerability and genuineness in my interactions with others." "My son attended Jacob Towery's two-day social anxiety workshop, Finding Humans Less Scary, and found it life changing. He asked me to come along for moral support, which meant I witnessed the transformation in real time. I have never seen anything like it in my life! Quite literally, one person went into the conference room that morning and a different person came out at the end of the day. He was elated. He met amazing people and had transformational conversations. He walked down the street hooting like a bird. He looked and acted like he had thrown off some old moldy coat. "Day two seemed to deepen and solidify the gains. On our drive home he taught me what he had learned (I got some trickle down wisdom!) and he was able to trace how the roots of his social anxiety got started and grew. He reflected on the fact that some people in the room were nearly 70, and that he felt lucky to be learning this stuff at 23. "I can highly recommend this experience to other people who are struggling with social anxiety and want to try a novel approach to breaking the pattern." I'm of the belief that, in a sense, we're all one. That means that you can't bring joy to another person without bringing joy to yourself. And Jacob and Michael both seemed to be on a high from their efforts to touch so many people. If you're also excited, make sure you register next year well ahead of time so you, too, can have this life-transforming experience, which is (almost) totally free! Thank you for listening today! Rhonda and David

393 Marina Dyck on TEAM for Insomnia Today we feature Marina Dyck, a TEAM-Certified Clinical Counselor in private practices in Swift Current, Saskatchewan, Canada. She works with individuals and families struggling with trauma, anxiety, depression, and relationship issues. She combines the latest research in neuroscience, powered by TEAM-CBT, and what she calls the "whole person" approach. Marina describes her innovative TEAM-CBT treatment for patients with trouble sleeping. Many of them toss and turn at night, unable to turn off their anxious and agitated brains, so they ruminate over and over about problems that are bugging them. Sound familiar? Here's David's quick, step by step overview of Marina's treatment approach, which is based on the steps of TEAM and the Daily Mood Log. Step 1. Let's imagine you're the patient (or the shrink), so you start with a brief description of the Upsetting Event at the top of the Daily Mood Log. It could be something as simple as "Lying in bed for several hours, unable to get to sleep because I keep ruminating about a report I have not finished for work," or some other problem. Step 2. Identify your negative feelings and estimate how intense each one is on a scale from 0 (not at all) to 100 (the worst.) For example, you may be feeling: Sad, down: 80% Anxious, panicky: 95% Guilty, ashamed: 70% Inadequate, incompetent, inferior: 90% Alone: 100% Discouraged: 80% Frustrated: 95% Angry, annoyed: 100% Step 3: Record your negative thoughts and how strongly you believe each one from 0% to 100%. For example, you may be telling yourself: I have to get to sleep! 100% If I don't get to sleep, I'll never be able to function tomorrow. 90% I should have completed my report for my boss today. 100% I should get out of bed and work on it. 90% There must be something wrong with me. 100% etc. etc. Step 4. Identify the distortions in these thoughts, like All-or-Nothing Thinking, Fortune-Telling, Should Statements, Emotional Reasoning, Magnification, and more. Now, if you're a shrink, after you've empathized, do the A = Paradoxical Agenda Setting or Assessment of Resistance. If you're a general citizen, you can do Positive Reframing. In other words, instead of trying to make your negative thoughts and feeling disappear entirely by pushing the Magic Button, you can ask two questions about each negative thought (NT) or feeling: How might this NT or feeling be helping me? What does this NT or feeling show about me and my core values that's positive and awesome? Example. In the current example you are 95% anxious and panicky about your report for work as well as the fact that you can't relax and fall asleep. Could there be some positives in your anxiety and panic? For example, these feelings might show Your intense commitment to your work. They may be a reflection of your high standards. Your anxiety, while uncomfortable, has probably motivated you to work hard and achieve a great deal. Your anxiety may protect you from danger and keep you focused on what you have to do to succeed and survive. Your anxiety could be an expression of your respect for your boss and for the company you're working for. Your desire to do a good job is probably a reflection of one of your core values as a human being. You could make similar lists for other feelings as well, like feeling down, guilty, discouraged, angry, and so forth. At that point, you can set your goals for every negative feeling. For example, you might decide that 15% or 20% might be enough anxiety and panic, and that 15% shame would be enough, and so forth. You can record your goals for each negative feeling in the goal column of your Daily Mood Log. This is much easier than if you try to reduce them all to zero by pressing the Magic Button. And even if you could, then all of the positives you listed would go down the drain, right along with your negative thoughts and feelings. Instead, you can aim to reduce them to some lower level that would allow you to relax while still maintaining your core personal values. Now we're ready for the M = Methods portion of the TEAM session. You will enjoy this portion of the podcast. Marina led Rhonda in three classic TEAM methods: The Paradoxical Double Standard Technique, the Externalization of Voices, and something Marina calls Distraction Training, which is actually a mix of Image Substitution, self-hypnosis, and relaxation training. Essentially, you focus on something positive and relaxing, as opposed to ruminating about all you have to do. This approach will come to life when you listen to the podcast, and I think you will agree that it IS innovative and significantly different and from 99% of what is currently sold as "insomnia treatment!" Marina emphasizes that you, the client, will have to agree to spend 15 to 20 minutes per day doing written work with the Daily Mood Log, or all bets are off. In addition, I would like to add that you and your shrink (or you and your patient) will have to find effective ways

392 The Empty Nest Cure Featuring Jill Levitt, PhD Plus BIG NEWS! The Magical Annual Intensive Returns this Summer at the South San Francisco Conference Center August 9 -13, 2024 You can Review the Exciting Details Below Or click this link! Today we are proud to feature our beloved Dr. Jill Levitt. Jill is the Director of Clinical Training at the Feeling Good Institute in Mountain View, California, and co-leader of my Tuesday evening psychotherapy training group at Stanford. She is a dear friend, and one of the world's top psychotherapists and psychotherapy teachers. Today, Jill joins us to discuss the so-called "Empty Nest" syndrome. According to Wikipedia, this is the "feeling of grief and loneliness parents may feel when their children move out of the family home, such as to live on their own or to pursue a higher education." Jill emailed Rhonda and me to explain why she thought a podcast on this topic might be of some value. She wrote, Recently, I was working with two different women around the same age who were having similar feelings of guilt and shame about the choices they made around parenting versus working. Jane is a 60 year old high level executive with two boys who was super successful and is now retired. She is telling herself, " I did not do enough for my boys. I should have worked less. I should have spent more time with them. I was selfish, and worked because I enjoyed it. I should have done more for them. I'm a terrible mother. Stephanie, in contrast, is a 60 year old stay-at-home mom of four adult kids, and now that her last kid has left for college, she is telling herself: I should have had a career. I have done nothing with my life. I am a smart woman so I should have done more. I am inferior compared to other women who have contributed to society in some way. Jane and Stephanie both struggled with feelings of guilt, shame, sadness and inferiority, and they were both telling themselves that they should have made different choices. I'm sure your life is very different from their lives, but you may have also looked in to the past and beaten up on yourself for what you should or shouldn't have done. Or, you may be beating up on yourself right now with shoulds, telling yourself that you should be better, or smarter or more successful or popular than you are. In fact, according to the late Dr. Albert Ellis, these "Should Statements" are responsible for most of the suffering in the world, and there are several different types, including: Self-Directed Shoulds, like "I shouldn't be so klutzy and shy in social situations. These self-directed shoulds trigger feelings of depression, anxiety, inadequacy, inferiority, guilt, shame and loneliness, to name just a few. Other-Directed Shoulds, like "So and so shouldn't be such a jerk!" Or, "You have no right to feel the way you do!" These other-directed shoulds trigger feelings of anger, blame, resentment, irritation, and rage, and can easily escalate into violence, and even war. I'm sure you can see that both women were struggling with Self-Directed Shoulds. What can you do about these shoulds and the unhappiness they trigger? Jill explains how both women experienced rapid recovery when she used simple TEAM methods systematically, including empathy and Positive Reframing as well as other basic techniques like the Double Standard Technique and the Externalization of Voices, and more. I, David, then described a woman he treated who fell into a depression when her two daughters went off to college. And she was perplexed, because she'd always had a super loving relationship with them, just as she'd had with her own mother when she was growing up. When I explored this with her, a Hidden Emotion suddenly emerged, as you'll hear on the podcast, and that also led to a complete recovery in just two sessions. Then Jill had a sudden "eureka" moment and realized that the Hidden emotion phenomenon was also central to the anxiety that one of her two patients was experiencing. One of the neat things I (David) really like about TEAM is that we don't treat people with formulas for "disorders" or "syndromes." These three woman all had the same "Empty Nest Syndrome," but the causes and the cures for all of them were unique, as you'll understand when you listen to this podcast. Our 400th podcast is coming up soon, and we want to thank all of you in advance for your support and encouragement over the past several years, which we all DEEPLY appreciate! We'll be joined by a number of our podcast stars from the past 100 shows, as well as our beloved founder, Dr. Fabrice Nye! And we have one VERY special event coming up this summer that might interest you if you're a shrink. I (David) have done very few workshops over the past five years because of the pandemic as well as the intensive demands of developing our Feeling Great App which will be available soon. The most fantastic work of the year was always the summer intensive at the South San Francisco Conference Center. Well,

Evolution of TEAM from CBT Porn Compulsive Liars Angry Patients Who Resist Where's the App? and More! Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda, Matt and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers! Today's live discussion was especially fun and lively, so make sure you listen to the actual live podcast. Questions for this Ask David Podcast Stan asks if any of my early methods have been abandoned by newer and more effective methods as CBT evolved into TEAM. Stan asks if mild porn is harmful or helpful. Rima ask how you can deal with compulsive liars. Pretika asks what to do with patients who angrily resist positive reframing. Anonymous asks several questions about the Feeling Great App. 1. Stan asks about new approaches in TEAM for habits and addictions, as well the evolution of TEAM, as compared with the much earlier classical CBT. 2. Stan also asks if mild porno is helpful or harmful. Hi David. I read in the eBook (I think it was) that you have radically changed your approach and have many new methods for Habits and Addictions. I actually have many of your books such as: Feeling Good Feeling Good Handbook When Panic Attacks Intimate Connections Feeling Good together Feeling Great eBook I wonder if you could please tell us in one of your Ask David podcasts which methods described in your earlier books you no longer recommend, because they have been superseded by more effective ones described in Feeling Great for example. I am sure there must be a lot of material that is still valid in those earlier books and which is not mentioned in Feeling Great. It would be great to know which ones you no longer recommend for the general public. I also want to ask you about Porn Addiction. Do you think occasional mild porn use is harmful or beneficial? I read in a BBC article that porn probably isn't harmful for most men, and can even be positive for couples. For example, some couples start to engage in oral sex after seeing it on the internet. Porn seems a bit like alcohol, if you abuse it it will be bad for your health but if you don't go for the strong stuff and don't over use it, it could be OK. I think some people might misinterpret your references to porn addiction as being any kind and intensity of porn use. Maybe these people feel anxious and shameful for using it as a result. I would welcome your clarification on this issue. Finally, even though I know you have heard it thousands, or hundreds of thousands of times, your work is having a really positive effect on my life. I am truly grateful for all that you do. Thank you, David. Warm regards Stan David's Reply Hi Stan, I can turn this into a couple Ask David questions for the podcast if you like. There have been many upgrades of the therapy ideas and techniques over the years, as we develop greater understanding of how people change, and what works and what tends not to work. In addition, I would say that we develop new methods and ideas on a weekly basis. The TEAM models lends itself very nicely to evolution, perhaps one of the strong points. I can speak in more detail on the podcast, but here are two ideas. First, I have come to appreciate more and more that all change in emotions comes from a reduction in belief in the negative thoughts that trigger negative feelings with few, if any, exceptions. In addition, any reduction in belief in negative thoughts will case an immediate reduction in the negative feelings that thought causes. This insight angers many people who don't really "get" it, so I don't push it. I find that people sometimes do not take kindly to statements that challenge their sacred beliefs. A simple example would be jogging, or aerobic exercise. Some people believe on faith or personal experience that exercise has a mood elevating effect due to release of endogenous "endorphins" in the brain, and many even claim that exercise is the most effective antidepressant known. While some people do experience a mood lift after strenuous exercise, I believe this is due to the change in their thoughts, telling themselves and believing that this is going to be good for the health and outlook. So that thought can have potent effects on mood. I can describe some experiments on exercise and mood. Second, I have tilted much further in the direction of appreciating the existence and power of resistance in all emotional and behavioral problems, and the often magical power of the new resistance-melting techniques I've developed in opening the door to the possibility of rapid and dramatic change. I'm also very aware of the therapy wars, predicated on the belief that our group as THE answer and your group consists of fools! And typically, one or both of those who are arguing have never measured anything in their patients on a session by

Self-Acceptance, People who Resist, Secrets of Dynamic Job Interviews, Five Secrets with your Boss, Do Cognitive Distortions Cause Transgenderism? Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers! Questions for the this Ask David Podcast Rizwan suggests a new method for self-acceptance. Anonymous asks how to convince someone that depression is NOT due to a chemical imbalance in the brain. My father does not believe that you can change the way you FEEL by changing the way you THINK! Marc asks about tips for job interviews, as well as how to respond during periodic performance reviews at work. Brian asks if transgenderism could be the result of distorted thoughts. 1. Rizwan asks I have a question about the Acceptance Paradox that came to my mind during our Tuesday training group on 19 Dec, 23. As homework, will it be useful to ask clients to make a list of things which they have already accepted in life and made peace with? At the next stage, in the session, would it be useful if the therapist asks them, "why did you accept and make peace with those things? "Can you use the same criteria to accept other things in your lives which you are not accepting now?" Sincerely, Rizwan David's take Yes, you can certainly try that and let us know how it works out? I do lots of spontaneous and "new" things in almost every therapy session. Some things work out, and others do not. That way, I learn from my clinical work. One thing to be aware of is that your proposed approach might overlap with "helping," when a paradoxical approach might have more "punch" / impact, After all, the Acceptance Paradox is arguably more of a decision, than a skill. But try, even with yourself if you like, and let us know what you discover. TEAM constantly evolves, and you can be an important part of that process! Best, david 2. Anonymous asks how to convince someone that depression is not due to a chemical imbalance in the brain and that you can change the way you FEEL by changing the way you THINK? Hi David I love listening to your podcasts. And now I am seeing differences in my life but not my father who has been depressed for around 40 years. He is on medicines and has an extreme belief that it's on the basis of chemical imbalance. He is a pharmacist by profession, and loves to learn about how chemical changes mood swings. I am not able to convince him to read your books. He just take sleeping pills every single and sleeps all day. He is learning something about neuroplasticity which is actually the case that happens in cbt. But he think it's some kind of thought changing therapy which cannot change the chemical in our brain. Please help David. I would love you to answer this. Regards, Anonymous David's Response Hi, I once gave the keynote address at a research conference at the Harvard Medical School. When the department chairman introduced me, he something like, "Dr. David Burns is going to show us how you can change brain chemistry with CBT, and without drugs!" It was pretty cool! That's one dimension. And we could add more evidence and research findings to support our side of the argument. But on another level, we see the underlying issue of trying to convince someone who is taking an adversarial position and content with their own thinking and beliefs, and determined to argue no matter what evidence you present. In my experience, spending time trying to convince them is almost always a losing cause. All you do is engage in a frustrating philosophical debate, at least that's my thinking! The podcasts on the theme of "How to Help and How NOT to Help" might be useful, in case you are looking for help with your relationship with your father. Your love and concern for him is huge and very touching! Okay to use in an Ask David? I will not use your first name! Best, david 3. Marc asks for tips on job interviewing. Hi David, I hope you are keeping well. I am wondering if you have any tips / strategies/resources that you recommend for an upcoming job interview? Also, you once told a story of someone who worked in the tech industry that you counselled, and you recommended some questions for him to ask in periodic performance reviews. Does this ring a bell at all? I've had trouble remembering/locating this Podcast. Stay well, Marc David replies Hi Marc, Yes, we can discuss the secrets of successful job interview on a podcast. I have LOTS of tips, actually, and we can perhaps do a podcast on this. We could also focus on how to respond to your supervisor during performance reviews, and I DO have an amazing story about that as well; it was the fellow who had been fired six times in two years. Thanks for reminding me. I might have given him the name of Rameesh, but not sure! Best, Da

Featured Photo is Dr. Amy Huberman The Amy Story, Part 2: The Joys of Doing the Laundry! Amy and her exuberant son, Sasha, and wife, Alena Last week you heard Part 1 of the Amy session, which included T = Testing, E = Empathy, and A = Assessment of Resistance. Today, you will hear Part 2 of Amy's exciting journey from perfectionism to JOY. M = Methods We used a variety of Methods to help Amy challenge her negative thoughts, starting with the first, "I'm failing my patients." We started with Identify and Explain the Distortions, then went to the Double Standard Technique, and ended up with the Externalization of Voices. As a reminder, you can see Amy's Daily Mood Log at the start of her session here.. As an exercise, see how many distortions, or thinking errors, you can find in her first Negative Thought, "I'm failing my patients," using the list of cognitive distortions on the bottom of her Daily Mood Log. You'll find the list of the ten cognitive distortions if you click here. After you've identified each distortion, see if you can explain two things about it: Why is this distortion in Amy's thought unrealistic and misleading? Why might it be incredibly unfair and hurtful? You'll find my list of the distortions in this thought at the end of the show notes. But don't look until you've made your list! These techniques we used were effective , as you'll hear on the podcast, especially the Externalization of Voices. You'll hear us doing role-reversals with Amy, and the method that "won the day" was the CAT, or Counter-Attack Technique, combined with the Acceptance Paradox. The Acceptance Paradox involves finding truth in a negative thought with a sense of peace or even humor. The CAT involves confronting the hostile voice in your head and tell it to go fly a kite, or other gentle but firm message You'll enjoy seeing some striking changes in Amy, as her tears and feelings of intense self-doubt are suddenly transformed into joy and laughter. Those changes created strong feelings of joy for Jill and me as well. We both have incredibly fondness and admiration for Amy, and feel great joy as well when she feels joy. Here are Amy's final scores at the end of the session. Emotions % Now % Goal % After Sad, blue, depressed, down, unhappy 80 25 0 Anxious, worried, panicky, nervous, frightened 80 20 0 Guilty, remorseful, bad, ashamed 90 5 0 Worthless, inadequate, defective, incompetent 100 15 5 Lonely, unloved, unwanted, rejected, alone Embarrassed, foolish, humiliated, self-conscious Hopeless, discouraged, pessimistic, despairing 90 5 0 Frustrated, stuck, thwarted, defeated 80 5 5 Angry, mad, resentful, annoyed, irritated, upset, furious Other The Joyous Dr. Amy! Sudden and dramatic change is pretty trippy, but it isn't much good if it doesn't last. And it won't! Negative thoughts and feelings will always return, because no one can be happy all the time. That's why some relapse prevention training and ongoing practice and refinement of what you've learned can be vitally important. In our follow-up session with Amy one week later she said she'd felt way better during the week, but did, in fact, have some relapses and had to challenge her negative thoughts again. She'd been helped a lot by the idea that it was okay to fail, to seek consultation, and learn, and that failing with patients gave us endless opportunities to learn and grow as therapists. And it was also okay not to have to listen so intently to the attempts of the negative self to put her down. In fact, our misery almost never results from our failures, but from telling ourselves that we "shouldn't" ever fail, and from punishing ourselves mercilessly when we do. One of her most exciting statements in our follow-up session was that she discovered that even something as humble as putting the dirty clothes into the washing machine could be a joyous experience without that negative voice in her brain constantly hollering at her that she wasn't good enough! Teaching points It was hard, at first, for Amy to "see" how distorted and unfair her negative thoughts were. She is an extremely intelligent, accomplished, and beloved colleague, and yet most of us cannot "see" or really "grasp" that we can be pretty mean to when we're feeling down and anxious. I have often said that feeling anxious and depressed is a lot like being in a deep hypnotic trance, telling yourself and believing things that just aren't true. For example, Amy is doing beautiful work with the great majority of her patients, and is doing the exact same thing with the patients who are responding beautifully as she is with the two who are stuck. So, when she tells herself she's a failure, she's clearly involved in All-or-Nothing Thinking. In other words, she's thinking that if she's not perfect, she's a complete failure and a fraud. She also seems to have many Hidden Shoulds (e.g. I SHOULD be able to help every single patient quickly) and Mental Filtering (focusing only on the negatives) and Discounting the

Featured Photo is Dr. Amy Huberman The Amy Story Part 1: True Confessions of a "Fraud" and a "Failure" Part 2: The Joys of Doing the Laundry Amy and her exuberant son, Sasha, and husband, Poppy Today's podcast, and next week's podcast, include a single, two-hour session with Amy Huberman, MD. Amy is a psychiatrist in private practice in Baltimore, MD. She also serves on the volunteer faculty at the Johns Hopkins University School of Medicine. Amy specializes in brief, intensive psychotherapy to help people overcome struggles with anxiety, OCD, and trauma, but today comes to us to get some help with her own anxiety. Often doing our own work can be a vitally important part of our training and growth as mental health professionals. Amy has been upset because she is stuck with two of her patients, and she's telling herself that she's a "fraud" and a "failure." Although her life is undoubtedly very different from yours, the root cause of her problem might be very similar to the source of your unhappiness, especially if you sometimes get down in the dumps and tell yourself that you're just not good enough. My co-therapist for this session is Jill Levitt, Ph.D. co-founder and Director of Clinical Training at the Feeling Good Institute in Mt. View California. Jill also serves on the Adjunct Faculty at the Stanford Medical School and is co-leader of my weekly TEAM Therapy training group at Stanford, Tuesdays from 5-7:00 pm pst. If you are interested in joining David and Jill's Tuesday group, please contact Ed Walton, [email protected]. That group is now virtual and therapists from the Bay Area and around the world are welcome to attend. It is free of charge. Rhonda Barovsky also runs a free weekly training group with Richard Lam, on Wednesdays, from 9-11:00 am pst, which is also free of charge. If you are interested in joining the Wednesday group, please contact Ana Teresa Silva, [email protected]. Because the groups are virtual, they are open to therapists from around the world. Amy has been a member of our Tuesday training group, and is a highly skilled, certified TEAM therapist. Like nearly all the mental health professionals who come for training every Tuesday, Amy has incredibly high standards and is sometimes harshly self-critical when she feels she is not living up to them. At the same time, those high standards can be strongly motivating, and this can create strong feelings of ambivalence when it's time to change. Sound familiar? If you're struggling with perfectionism, you might want to check out these two podcasts! Part 1. The True Confessions of a "Fraud" and a "Failure" Amy opened by saying she was anxious and telling herself: I'm about to reveal my weaknesses and my inner self—This is something I've never done before in such a public setting. . . I also have to confess that I'm struggling with social anxiety right now. I'm afraid that my patients might see this and think, "I don't want to work with her! I want to work with a competent psychiatrist." I Included that because I am hoping you will appreciate Amy's incredible courage and gift of sharing her true inner self today! Amy described the problem that's been bothering her for several weeks. Although she specializes in the short-term treatment of anxiety, she has been struggling with two patients with OCD symptoms who have been stuck and not making significant progress for a long time. This has triggered feelings of shame and intense anxiety which have invaded Amy's every moment when she's NOT seeing patients, and has even prevented her from getting restful sleep at night. She keeps ruminating and beating up on herself. You can see Amy's Daily Mood Log Amy here.. As you can see, she was feeling intensely sad, panicky and ashamed, and rated these three feelings as 80% on a scale from 0 (not at all) to 100 (the most severe). She was also feeling worthless and defective which she rated at 100%, as well as hopeless (90%) and stuck (80%). As you know, feelings do not result from the events in our lives (in Amy's case, the fact that two of her patients were stuck), but rather from her thoughts, or interpretations, of those events. You can see on her Daily Mood Log that she was being intensely self-critical, telling herself that she was failing her patients, that she should refund their money, that she was not competent to practice psychotherapy and should find a new career, that she "should" know how to get them unstuck, and more, and finally that she was a fraud and a failure. Her belief in all of these thoughts was super high, ranging from 80% to 100%. And if you've ever felt down or inadequate, I'm sure you recognize the same types of thoughts in your own thinking, telling yourself that you're a failure, or not good enough, and so forth. During the session, Jill and David went through the TEAM acronym: T = Testing We measured her negative feelings at the start of the session so we could measure them again at the end to see how we did. E = Empa

Why Do We Resist Accepting Ourselves Other People, and the World? The Five Most Common Reasons! Rhonda and David are joined in today's podcast by Dr. Matt May, a super popular and loved guest on our show, to discuss the resistance findings in David's recent survey on acceptance and resistance. The following is a summary of some of the statistical findings, but the actual podcast dialogue was wide ranging and tremendously engaging, and won't require a lot of statistical smarts! We also discussed the vitally important difference between healthy and unhealthy acceptance. Healthy acceptance is accompanied by feelings of joy, lightness, and liberation. Unhealth acceptance is accompanied by feelings of unhappiness and despair. Unhealthy acceptance is characterized by Should Statements and self-punishment for your failures and shortcomings. Healthy acceptance is an expression of self-love. The group brought the five most common reasons to life with engaging stories. Why should you accept yourself? We are not saying that you "should," and it's really a decision. However, the statistical models the I (David) developed indicated that healthy acceptance can trigger a 49% reduction in negative feelings and a 39% boost in positive feelings, which is tremendous. Matt told an inspiring story about two strategy for training the dolphins at SeaWorld. One strategy involved trying to shape the behavior of the dolphins with little shocks, in much the same way that some people train horses. Sadly, the dolphins went to the bottom of the pool and appeared depressed, not moving much. It was a complete failure. Then they tried a radically different strategy--they gave a new group of dolphins fish to reward them for doing the things the trainers wanted them to do. This strategy was tremendously successful. So, the question is whether you want to shape your own life with frequent shoulds and self-criticisms, which can have the effect of electric shocks every time you fail or screw up or fall short of your goals, or whether you want to shape your life with love and rewards. Some of us have discovered that acceptance is way more fun and vastly more effective! Quick Bottom Line The typical survey respondent endorsed 1/3 of the 12 Resistance Scale items, and seemed to believed that Acceptance would be foolish and lead to a life of misery and mediocrity. The actual causal impact of the Non-Acceptance and Resistance scales on positive and negative feelings was massive and appeared to be in the exact opposite direction. Findings The respondents in the Resistance survey endorsed an average of 33.8%. (+/- 0.1%) of the items, ranging from 0 to all 12. The most commonly endorsed was, "Acceptance is easy for rich and famous, but hard if you're struggling just to pay the bills." 47% (+/- 2%) endorsed this item. The least endorsed was, "If I beat up on myself, people will love me more," although 25% (+/- 1%) of the people endorsed this item, so it was fairly popular. The high scores on the resistance scale items is also pretty consistent with my experiences over the years—the people in the study, and the people I've worked with, have expressed MANY reasons to beat up on themselves. You can see the list of the 12 Resistance Scale items below. I have bolded the five most often endorsed. As you can see, many people surveyed believed that acceptance is fine for people who are rich and famous, but terribly painful and foolish for people who struggle with real problems. Many respondents were convinced that acceptance leads to pain, robs you of motivation and does not make sense in a the world that's falling apart. If I accept my flaws and shortcomings, I'll end up with a second-rate life. If I accept my flaws and shortcomings, I'll lose all my motivation to learn If I beat up on myself and work my ass off, people will love and admire me. It would be tremendously painful to accept my flaws and shortcomings. That would be like giving up and having to live with a heavy load of inadequacies. Life has many real disappointments and losses. I don't want to feel happy and chipper by "accepting" all those negatives when the world is falling apart all around me. That just doesn't make sense! I haven't achieved many of my goals in life. I think it would be kind of pathetic to suddenly accept myself and feel enormous joy that I haven't really earned or deserved. I've often fallen short, and I've made a lot of mistakes in my life. Are you saying that I should be happy about that? Hell NO! I am never going to accept myself as just another average or below-average person. That would be awful! If I accept my flaws, failures, and shortcomings, I'll just be like everyone else. I won't be special, and I won't have the chance to become special. If I admit that I often fail and screw up, people will think less of me. If I've done things that have hurt others or if I've violated my moral values, then I deserve to suffer. Acceptance is fine and easy for people who've enjoyed

Accept this Sh__? Hell No! Rhonda and David are joined in today's podcast by two dear friends, Dr. Matt May, a popular regular on our show, and Matt Pierce, a co-founder of the soon-to-be-released Feeling Great App Brief bio sketch of Matt Pierce goes here, should you wish to include it in the show notes. Matt,. A pic would also be great, but not required. People get tired of the same pics each week, so a fresh face to illustrate this episode would be cool! You've probably heard about acceptance. It's a popular buzzword in the mental health space these days. In fact, some experts claim that it's THE key to happiness and enlightenment. It's NOT, but it can be incredibly helpful. I wanted to learn more about Acceptance and put some numbers on it's effectiveness, or lack of effectiveness, so I recently sent an invitation to the 45,000 people on my mailing lists to complete a new survey on acceptance and resistance. More than 1,000 quickly responded, which was great. I hoped the data could provide some answers questions like these: What is acceptance? How interested are we in accepting themselves, other people, and the world? Many people, and perhaps most of us, strenuously resist acceptance. Why? What are the things that we have the most trouble accepting about ourselves and others? Is all the hype about acceptance justified? Does it actually have meaningful effects on how we feel? Can money buy happiness? And if so, how much, exactly, does it cost? Why are single people more depressed and unhappy than people with partners? And if so, is it because of the lack of a loving partner? Or was there some other reason? Thanks for listening, David, Rhonda and Matt

Do we have a "Self"? Or "Personality"? What's the best way to combat Should Statements? Is TEAM effective without a therapist? What's the Difference between Positive Reframing and Positive Thoughts? Note: The answers below were written by David prior to the podcast, just to give some structure to the discussion. Keep in mind that the actual live discussion by Rhonda, Matt and David will often go in different directions with different information and opinions. So, please listen to the podcast for the more complete answers! Questions for today's Ask David Podcast: Stefan asks if we have a "self" or a "personality." Slash wants to know how to combat a "Should Statement." Magellan asks about the effectiveness of TEAM without the guidance of a therapist. Werner asks about the differences between Positive Reframing and the Positive Thoughts you record on the Daily Mood Log. 1. Stefan asks if we have a "self" or a "personality." What is the so-called "Great Death" of the "self," referred to in Buddhism? Hi David, I really love your work, both the books and the podcast you've created. Lots of great tools there. I think your down-to-earth approach is effective and great in de-mythologizing mental health care. Still, one thing has been bugging me about your approach: the fact that you quite casually seem to discount the existence of the self. As a theologian I understand this position. In discounting the self as a construct, you'll open the way to less resistance and more acceptance. I studied both Christianity and some Buddhism, and in that tradition the self is essentially something to let go of as an illusion. I think you called this the death of the ego, and it's common in many mystical currents both within and without the major religious traditions. However, by embracing this tradition in a therapeutic setting, I think there's a great risk to gloss over long-held implicit beliefs or patterns in the construction of a personality that might hold people back from reaching their full potential. More specifically, I'm talking about schemas or Lifetraps (in the terminology of Jeffrey E. Young and Janet S. Klosko). I know Aaron Beck supports their work to address these "chronic self-defeating personality patterns" that are usually considered the be part of the self. What's your take on their work? Kind regards, Stefan David's reply Hi Stefan, Personality, like "self" is not a "thing," but just the observations that different people have different behavioral patterns. So, some are more outgoing, for example, while others are more introverted and shy and insecure. The only meaning of "self" is the context in which the word appears. So, "behave yourself" simply means that you are misbehaving and need to stop! Can you come to the Sunday hike is a question. It does not need the add on, "and do you plan to bring you 'self.'" The only meaning of any word is the context, and many uses in the English language, or any language. Nouns do not always refer to "things." Words are just sounds that come out of our mouths. I don't go into this much because few people "get it." Thanks so much, Stefan. Warmly, david PS The above is my take on Wittgenstein's Philosophical investigations, published after he died in 1950. . Second PS I had a random and fairly weak thought, but here it is. When doing my daily "slogging" a while back, I was going through a pleasant and familiar path and noticing how beautiful everything was, and had the thought, "This land is so valuable and expensive, and I'm SO GLAD I don't have to own it. It would involve a nightmare of paper work, taxes and all kinds of worries. But I can just enjoy it without any of those burdens of ownership. Then I thought of the "self," and what a heavy burden it is to "have one," and worry about whether or not it is "good enough," or "inferior," and so forth. Selves tend to be a bit overweight, and heavy to carry around. And how much more fun, beautiful, and rewarding life is without having to have a "self" to worry about. Rhonda found this helpful after a time feeling confused about the "self," and Matt added this: "Right, and if we own the 'land' one day, and it changes, the next moment, is it the same 'land'? Do we still own it?" Matt's "Self" Thoughts Wittgenstein is one of my favorite philosophers due to the elegance of his solution to philosophical problems, which is to recognize that they are not, in fact, 'problems'. Instead of trying to answer the question, 'is there a self', 'do I have a self', he would point out that these questions are meaningless and can't be answered. One way to bring these questions into a form that could be useful and answerable, is to define the terms. What is the 'self', and what can it do? How would I know, if I had a 'self'? If the definition was in the form of a testable hypothesis, we'd be a step closer to arriving at a meaningful answer. In some cases, this answer is incredibly meaningful, in terms of our mental state and relationships. Let's t

Can You Treat ADHD with TEAM? Does Humor Play a Role in Therapy? What's the Difference between Rejection Practice and Shame-Attacking Exercises? Featuring Dr. Matthew May Note: Not all of the information covered here is in the podcast, and much of what we discuss in the podcast is not covered here. Questions for the next two Ask David Podcasts: Rich asks how you treat ADHD in TEAM. Hwa-Chi Qiu Alvarez asks about the use of humor in therapy. Rima asks about the differences between Rejection Practice and Shame-Attacking Exercises. Rich asks: How do you treat ADHD? From Richard: How about a podcast concerning ADHD? I feel that applying TEAM would work. No? I mean "disorders" arise from distortions…so what does a distraction "disorder" arise from? Thanks for all you do David, Rich David's reply: Hi Rich, I don't treat "disorders," I treat individuals at specific moments when they're struggling and wanting help! Hope that helps. As an aside, if you or a friend, colleague, or patient have ADHD and you can describe a specific moment when that person was struggling, I would love to hear about it! Then you'll see how TEAM works it's magic by focusing on individuals, and not "problems" or "disorders," etc. TEAM is a "fractal psychotherapy." I will explain! Warmly, david Matt's Take: Thanks for the question, Rich! I love what David is saying, about treating the individual, not the diagnosis. There are a lot of things that can interfere with focus and attention, such as. medical problems, sleep difficulties, toxin exposure, substance misuse, and relationship problems. In addition, depression and anxiety can interfere with concentration and contribute to ADHD symptoms. Below, I've listed many of the distracting thoughts that my clients have had. Along with a list of some good things about being Distracted. Hope you enjoy! Matt's A – Z List of Distracting Thoughts: I don't feel like doing this This is boring and no fun I never get to do what I want It's not fair I'll do it later There's plenty of time Best not to rush things I might be missing out on something interesting or important I'll check my phone one more time, real quick, and then get right back to work This time will be different. Seriously. I mean it. Actually, I'm feeling too tired to concentrate I'll just take a quick, 5-minute nap I'll get to work when I feel more rested and motivated I've had a hard day and deserve a little break and some fun Tomorrow's going to be really hard, so I need to rest up I just *can't* concentrate, at all There's something seriously wrong with me I lack willpower / I have no ambition I shouldn't have to do this There's no point doing this I'll never be able to do this I need to be doing important, interesting things It would be really exciting and fun to … x, y, z, instead I need to tidy up a bit before starting this big project I don't know where to get started / don't want to mess up I'll be too distracted if I don't take care of this one thing, first Matt's A – Z List of GOOD Reasons to be Distracted I can be spontaneous, have fun and be present, in-the-moment I won't miss out on something interesting and important I won't waste my life doing boring stuff that leads nowhere I'll focus on what makes me happy I won't let other people control me or make my decisions for me I like to feel powerful and in-charge; I call the shots This is my time, nobody controls me It's calming to know that I'm in-control I want to treat myself with respect I want to be free, not shackled It's important to take breaks I want to maintain a good work-life balance It's fun and exciting to be a bit of a 'rebel' I'm my own unique person, doing things my way I just want to 'go with the flow', it's easier I want to be safe, protected me from failure. I can't really fail if I don't give it my all I can get instant relief from the pressure anxiety when I outsource this task to 'future me' I deserve to do what I want, when I want to; I'm sticking up for me I can reject others' advice and feel superior I don't know where to start I can have more time to plan I'll be less likely to mess up if I consider my approach carefully I don't want to do an average job, this needs to be amazing I can prepare, talk, plan and complain; that's more interesting and fun than doing I don't have to face how dull and boring some parts of life can be I can daydream about a better life On the live podcast, Matt and Rhonda gave examples of individuals diagnosed with "ADHD" who all needed completely different and highly individualized treatment, which is what TEAM is all about. Matt described treating a boy with ADHD who would get anxious in class when he was called on to read out loud. He was afraid he'd get nervous and make mistakes, and the other students would judge him. The technique that helped him was the Feared Fantasy. Matt also described a fellow with ADHD who had trouble keeping appointments and getting places on time. He was helped by the technique I have called "Little

Transgender Issues Featuring Dr. Robin Mathy Emily Dickinson, from Amherst, Massachusetts, was one of the greatest American 19th century poets, and after hearing one of our Amherst professors explain her life and work, I fell in love with her incredible poetry. When she attended Mt. Holyoke College as a freshman, she was obligated to sign up as a "Christian," a "Non-Christian with hope," or a "Non-Christian without hope." She was the only student who had ever signed up as a "Non-Christian without hope," and she was given one semester to change her registration category. When she refused, she was asked to leave, and spent the rest of her life living in Amherst, baking cookies for children and writing her fabulous poems, which were sometimes included in her cookie packages. Her poetry was all about loss, which was much the story of her life. However, she was not self-pitying, which is part of what makes her poetry so sad and magical. Emily Dickinson always dreamed of visiting the west, but never got the chance to travel much beyond the outskirts of Amherst. She once wrote, To make a prairie, It takes one clover, and a bee. One clover and a bee. And reverie. The reverie alone will do, if bees are few. Tears come to my eyes every time I think about that poem! When I was a student at Amherst, we used to visit her grave, and I once actually knocked on the door of the house where she once lived. I explained I was a huge fan and actually got the chance to look around. I actually found a poem scribbled on a scrap of paper on a window ledge. Today we interview Dr. Robin Mathy, who describes herself as "A human who hopes." Robin is a well-published expert on LGBTQ issues, with a specialization in transgender research and political activism based on science to debunk hateful myths about sexuality. She is also a new member of our Tuesday training group at Stanford! In addition to studying to become a TEAM therapist, Robin is a Doctor of Social Work student at Tulane University. She is a researcher and activist who has published four books and more than 50 peer-reviewed articles or book chapters. She is a beloved member of David and Jill's Tuesday TEAM CBT group. Rhonda kicked off today's podcast by reading two very moving endorsements from people who heard part 1 of the live work with Jessica, "Living with Regrets," which we had published just prior to our interview with Robin. Then Rhonda kicked off our dialogue with Robin by asking if there are any special treatment considerations when you are working with trans individuals. Robin said that there really aren't—TEAM-CBT is already highly personalized and individualized, so we let the patient set the agenda. Robin emphasized the importance, of course, of being warm, affirming, and supportive. In addition, do not assume that the patient is there because of gender identity issues, or automatically refer them to a support group on that topic, because the patient's issue may be radically different, and that would amount to stereotyping your patient. I asked Robin for a simplified introduction to LGBTQ, including what these terms actually mean. That's because I have to admit I never had any good sexual diversity training during my medical school or psychiatry residency, and I suspect that some of our podcast fans, perhaps many, would also appreciate a little enlightenment based on science. Robin pointed out that transgender has to do with identity issues: what is your sense of self? Do you see yourself more as a woman or a man? And sometimes, this will be quite different from the gender you were assigned at birth. So, for example, you may be assigned as a boy at birth, but your sense of who you are may be a girl, when you are young, and a woman as you develop during puberty. In this case, you would be a trans-gender woman. To be respectful, you should refer to a transgender woman as she or her. And, of course, if you were assigned as a girl at birth, but your sense of who you are is a boy/man, you would be a transgender man, referred to as he / him. Some transgender people are nonbinary, meaning they do not want to be referred to as either a man or a woman, and they do not want to be referred to with either binary pronoun. To be respectful and sensitive, you should always ask someone what pronouns they prefer. In contrast, the terms, LGBQ, do not refer to gender identity, but rather to sexual attraction. So, a lesbian is a woman who is sexually or romantically attracted to women, and a gay man is attracted to men, and so forth. The term, "cis," refers to your gender that was assigned at birth. According to the National Center for Transgender Equality, When a person begins to live according to their gender identity, rather than the gender they were thought to be when they were born, this time period is called gender transition. Deciding to transition can take a lot of reflection. . . . Possible steps in a gender transition may or may not include changing your clothing, appear

Overcoming Loneliness Part 2-- A Master Class on the Feared Fantasy Technique Featuring Dr. Orly Marmur This is the second of a two-part series on loneliness, featuring the courageous personal work of Dr. Orly Marmur with Drs. David Burns and Jill Levitt as co-therapists. After Orly shared her story, we worked on helping her learn to use the Five Secrets, especially the Disarming Technique and Inquiry, to develop closer relationships with others. Jill described the philosophy of this approach as learning to be "interested" in others—encouraging them to talk about themselves—rather than trying to be "interesting" or "impressive," which is usually a losing battle. We also worked with the Feared Fantasy technique to help Orly deal with her fear of rejection. Essentially, we explained that we would enter an Alice-in-Wonderland Nightmare World where there were two weird rules:. If you think people are judging you or looking down on you, they really are! In this Nightmare World, people are not polite but get right in your face and tell you all the negative thoughts they're having about you. We asked Orly to describe the worst criticisms she thought her friends might have about her. Here's the list: We're not really interested in you. You don't really say or create anything interesting. You are by yourself. We have families. You're not funny enough. You're not fun enough. You're too intellectual. You're too political. You're a liability. Orly bravely took the role of herself to kick things off, and Jill and David played the role of the "friends from hell," and verbalized these criticisms to Orly. At first Orly struggled to respond effectively to the critical statements. She got stuck defending herself at times, and forgot to express interest in the critic and the specific criticisms. David and Jill modeled more effective responses, using the Five Secrets of Effective Communication, including The Disarming Technique (finding truth in the criticisms), Inquiry (ask for more information with a spirit of curiosity) Thought and Feeling Empathy (acknowledging how the critic was thinking and feeling) "I Feel" Statements (sharing feelings like sadness, shame, and loneliness in an open, respectful way) and Stroking (expressing positive regard for the critic, even in the heat of battle). Orly did a fantastic job, as you'll hear on the podcast, and we did some role reversals to refine certain responses. The goal of the Feared Fantasy is not so much to prepare for rejection in the real world, since very few people would ever say these things in such a harsh and open way. The Feared Fantasy "Monster" actually exists primarily in your own mind. But since most of us never think about the thing we fear, we don't realize or discover that the monster has no teeth. That is to say that by engaging with your greatest interpersonal fears, you discover that if someone were to attack you with over the top vague criticisms, you would survive, and it would reveal something terrible about the other person, not about you! The Feared Fantasy Technique brings this to life in a dramatic, emotional, and vivid way. At the end of the session there was a dramatic reduction in all of Orly's scores on the Emotions Table of her Dailly Mood log. Her Unhappiness dropped from 40 to 0 Anxiety dropped from 100 to 5 Shame went from 85 to 0 Worthlessness dropped from 95 to 0 Loneliness fell from 100 to 10 Self-consciousness fell from 8 to 5 Hopelessness fell from 100 to 5 Stuck and defeated fell from 100 to 0 Resentment fell from 90 to 0 Disappointed in myself fell from 100 to 0 As you can see, there was a dramatic reduction in all of her scores. We asked Orly what the most important healing elements during the session were. What techniques were that were most helpful. Orly said that the empathy from Jill and David was really important as she felt heard and accepted. The Feared Fantasy Technique also made a huge difference, as it taught her what she wanted, which was to feel intense feelings without doing anything about them. Orly felt that this is the continuation of earlier work that made her realize that she struggles with Emotophobia (which means "the fear of feeling your emotions), and she wanted to increase her capacity to simply feel. Rhonda, Jill, and David want to give a shout out and virtual hug to Orly for a most fantastic session and learning opportunity for all of us. Teaching Points Here are a few teaching points for therapists as well as the general public. The secret of meaningful relationships is to be interested in others instead of trying to be "interesting" or impressive. You do not need to add more accomplishments to the list in order to feel close and loved by others. The Disarming and Inquiry Techniques (which are parts of the Five Secrets of Effective Communication) are extremely important in calming troubled relationships, if used skillfully, because they open the door for the other person to be heard and validated, and hopefully inte

Overcoming Loneliness Part 1-- How to Develop Loving Relationships Featuring Dr. Orly Marmur This is the first of a two-part series on loneliness, featuring the courageous personal work of Dr. Orly Marmur with Drs. David Burns and Jill Levitt as co-therapists. Orly is a clinical psychologist from Southern California and member of our Tuesday TEAM-CBT training group at Stanford. She loves to hike, and recently went on a 25 mile solo hike from the North to the South Rim of the Grand Canyon, an arduous hike that she planned for a long time She happened to be hiking on October 7, 2023, the day of the Hamas invasion of Israel. The hike was a huge victory for Orly, but when she arrived at the top of the South Rim, her cell phone was instantly bombarded with news and emails about the Hamas invasion and brutal murder, beheading, and rape of many innocent Israeli citizens. For the next several days, Orly's mind was flooded with flashbacks of her life, growing up in Israel when the country was still young, and living through four wars. Her father and brothers were in one war together, and her brother was wounded, but survived and recovered. Orly felt guilt and shame because she was not there to help. She said that she wanted to go to Israel to help her brother with his farm, but was conflicted because she did not want to abandon her clinical practice in Southern California. She explained: I grew up with the people who started the State of Israel. Those were idealistic, heroic times. My grandmother left Europe when she was 17 and settled in Israel. The focus was on building. We learned to be heroic. A few days later, in the Tuesday group, David noticed that I was feeling down and lonely unable to focus and "checked out." I had a hard time feeling my feelings. I had shut down. I began being flooded with memories of sexual molestation at my grandparents' house when I was a girl in Israel. I remember standing next to a tree, and feeling like I was "different" from the other kids, I started feeling sad and guilty about losing so many relationships over the years. I've alienated so many people, and now I want to accept responsibility for that. When my daughter was 1 year old, I became friends with other parents at the day care center. We became like an extended family as our kids grew up, getting together on Fridays for dinner, celebrating holidays together and being there for each other. However, during the pandemic, I began to feel rejected by them. And sometimes there were individual rejections. We had often camped out together over the years, but all of a sudden, I was not invited. I was the only single person. The rest of the group are couples. Over the years, I was told a few times that, at times, my presence makes things difficult. Since then, I've been invited to some but not other functions of our group. I haven't felt like people are interested in me, or like me. I also want to feel my feelings and develop a sense of empathy for others and greater pride in myself—after all, I DID survive. I became very politically active with others interested in supporting Israel after the October 7th invasion. I was hoping to feel close to people, but it didn't work because I still felt alone. I had hoped they'd be impressed with my political activism, but it didn't help. My problem was not the war, but me. I'm hoping today you can help me to feel my feelings again! I realize that I tend to jump to action rather than feel my feelings. I think that it has to do with my upbringing and the circumstances and culture that I came from. Next week you will hear the exciting conclusion to the work with Orly, and a follow-up several weeks later. Orly's Daily Mood Log. End of Part 1 Thanks for listening today! Rhonda, Jill, Orly, and David

The Anxious Child— Three Common Errors Parents Make, and How to Avoid Them! Featuring Dr. Taylor Chesney Today we interview Dr. Taylor Chesney who is the Director of the New York office of the Feeling Good Institute. She specializes in the treatment of children and teens, and today will tell us about the three biggest errors parents make in dealing with anxious kids. Dr. Chesney has been a guest on several of our podcasts in the past (episodes 107 and 263, and Corona Casts 4 and 6) and is a terrific teacher and therapist. She recently taught a 12 week course for therapists working with teens and children (ages 6 to 18) and their parents and brings us some of the highlights today. She always begins treatment by interviewing the child and the parents and pinpoints what they want help with. Then she assesses how hard they are willing to work to bring about that change. The goals may be quite different for the child and the parents. It's crucial to develop a meaningful therapeutic contract with the children, as well as the parents, as opposed to thinking your role is to "fix" the child for the parents. If the child is less than 11 years old, she meets with the parents first. If the child is 12 and up, she meets with the child first. Either way, she empathizes with the child and encourage them to tell their side of the problem. During or after empathizing, she does Positive Reframing, to show the child what their negative feelings, like depression and anxiety, show about them that's positive and awesome. For example, if you're sad about not being invited to a birthday party, it shows that you value friendships, and that you care a lot about other people. If the child is anxious, she will teach them how their anxiety can be helpful. For example, if the child is a good athlete or student, anxiety can be an important motivating force in their success. But sometimes we might get too anxious and feel intensely anxious about something that is not actually dangerous. Then you might experience your anxiety as trouble eating, a belly ache, trouble sleeping, or some other symptom that gets in the way of your optimal functioning. The most important question with parents and children is usually: "Do you want to learn some tools and skills to help you change the way you feel?" She also teaches children and teens what different kinds of emotions are, and the kinds of thoughts that trigger them. For example, if you feel anxious, you're probably telling yourself that you're in danger and that something bad is about to happen. If you feel guilty, you're probably telling yourself that you've done something bad, or that you hurt someone you love; and if you're feeling angry you may be telling yourself that someone is trying to hurt you or take advantage of you. Taylor brings the core cognitive therapy ideas to life with examples that children can understand. Here's how she explains the idea, taught by Epictetus nearly 2,000 years ago, that our feelings do not result from what happens to us, but from our thoughts about what's happening. Let's say that you got a 90 on a test. How would you feel? You might feel overjoyed if you studied hard and felt like you did a good job and got a wonderful grade. However, if you felt like you had to get a 95 to raise your semester grade in the class to an A, and you even skipped going to the prom to study extra hard, you might feel sad, ashamed, frustrated, angry, and disappointed, telling yourself that you "failed." Same grade, but two radically different emotional reactions, depending on how you think about your grade. Conclusion: it's not what happens, but what you tell yourself, that triggers all of your positive and negative feelings. Taylor said that anxiety is incredibly common in her clinic population and that surveys indicate that a whopping 25% of children have an anxiety disorder. She teaches her patients that anxiety in children, teens, and adults results from giving in to the urge to escape from a frightening or uncomfortable situation instead of facing your fears and discovering that the monster has no teeth. For example, Taylor was in the ocean with her 9 year old son, and there were jellyfish in the ocean. Her son was terrified and wanted to get out of the water and back to the shore. Taylor asked him what he was telling himself, and he said he was thinking that the jellyfish were bad. She also told him, "It's okay to be afraid and to be careful and avoid the jelly fish, but you can also choose to stay in the ocean. Then we can have some fun together playing in the water." He decided to stay and have fun and felt proud of himself! She described Three Common Mistakes parents make in dealing with an anxious child. Error #1: The Quiet Out Trap She explained that we love our children, and don't want them to suffer, so we may give them an easy way out. For example, if your child is afraid to go to the party when you are dropping them off, you might say, "If you don't want to go to the p

Personal Work with Dr. Tom Gedman-- Overcoming Performance Anxiety The Triumphant Conclusion Last week you heard Part 2 of our personal work with Dr. Tom Gedman, which included T = Testing and E = Empathy. This week you will hear the dramatic and inspiring conclusion of the session, including A = Assessment of Resistance and M = Methods. Dr. Tom's beloved pal Start of Part 2 A = Assessment of Resistance We began with the Invitation Step, asking Dr. Gedman what he hoped to accomplish in today's session. His list included: Develop some clarity on the direction of my business. Become more authentic in my video recordings promoting my clinical work. Increase in self-confidence. Feel accepted by David and Rhonda. My ability to push ahead during recordings instead of stopping and backing down because it isn't "good enough." Dr. Gedman said that he'd gladly push the Magic Button to make his negative thoughts and feelings instantly disappear, but agreed to look at some of the positives in them first by asking these types of questions of each negative thought or feeling. Is there some truth in this negative thought? Could this negative thought or feeling be appropriate or even healthy, given my circumstances? How might this negative thought or feeling be helping me? What does this negative thought or feeling show about me and my core values that's positive and awesome? Could there be some negative consequences of giving up this negative thought or feeling? The Positives in My Negatives Negative thought: "I can't be authentic on videos. I look like such s smug phony." I want to be other-centered, and focused on how I might be able to relieve the emotional struggles and health problems of my patients. I value being authentic and genuine. I want to help people who resonate with my message. I don't want to hide. I want to be open with my flaws. I value honesty and integrity. I value humility. I value compassion. Negative feeling: sadness I care a great deal about my dream. I don't want to fail and let my family down. Negative feeling: shame Motivates me to work harder Shows my love for my family. I'm aware that I'm letting down the very people I want to help. Negative feeling: inferior, inadequate Show that I respect and admire the many people who have superior skills at talking live in front of a camera. Shows that I'm aware of what others have accomplished. Shows I don't feel superior to others. The idea behind the Positive Reframing is to help the patients see that their negative thoughts and feelings are not the expression of what's "wrong" with them, but what's right with them. This paradoxically reduces the resistance to change and opens the door to the possibility of rapid recovery. You can see Dr. Gedman's goals for each of the negative feelings on his Daily Mood Log if you click here. As you can see, instead of trying to eliminate his negative thoughts and feelings by pushing the Magic Button, he has decided to dial them down to lower levels with the Magic Dial. Of course, these are only goals. We will need methods to challenge and smash his negative thoughts so we can reduce his negative feelings. M = Methods Rhonda, Tom, and David used a variety of methods to work on several negative thoughts Tom wanted to work on first, including numbers 1, 2, and 4 from Tom's Daily Mood Log.. I can't be authentic. I look like a smug phony. 100% I waste so much time on my videos. I should be quicker. This should be easier. 100% David and Rhonda will judge me for what I'm doing. 80% We used several methods including Explain the Distortions, Survey Technique, Externalization of Voices (with Self-Defense, Acceptance Paradox, Counter-Attack Technique,) and more You can see Dr. Gedman's end-of-session scores on his nine negative feelings on his Daily Mood Log if you click here. As you can see, eight of the feelings fell all the way to zero, and his feelings of inadequacy fell from 100 all the way to 5. Toward the end of the session, we discussed Tom's medical and psychological philosophy, which might appeal to some of our podcast fans, especially if you live in England. First, he uses TEAM-CBT in individual two-hour sessions to help help people who are struggling with feelings of depression and anxiety. He finds this work thrilling because you can often see amazing changes within a single session, just like we saw in Tom's work today. Dr. Gedman also hopes to develop TEAM-CBT groups as well. This can be difficult because you need many referrals, but in my experience, TEAM groups can be incredibly effective, and cost-effective as well. In addition, Tom also has a Functional Medical Practice which focuses on developing healthy nutritional and eating habits, consistent exercise, limiting the intake of toxins, developing loving relationships via the Five Secrets of Effective Communication, and enhancing spirituality. If you would like to contact Dr. Gedman and learn more about his clinical practice, he can be reached at www.DrTomGedm

Personal Work with Dr. Tom Gedman-- Overcoming Performance Anxiety Have you ever struggled with Performance Anxiety? That can include public speaking anxiety, as well as anxiety when having to perform in an athletic or musical event, or speak on the radio, TV, or internet , etc. This is one of the most common forms of anxiety that we see in mental health professionals, as well, of course, in general citizens, including children, teens and adults. Today you will hear Part 1 of the live work with Dr. Tom Gedman, a British physician struggling with intense performance anxiety, including the initial T = Testing and E = Empathy. Next week, you'll hear Part 2 of the session as David and Rhonda do the A = Assessment of Resistance and M = Methods portions of the work with Dr. Gedman. You may recall Dr. Gedman from our previous podcast (# 348). Recently, Dr. Gedman has wanted to promote his new programs on health and mental health in brief videos he plans to publish on social media sites, but finds himself crippled by negative thoughts that make him freeze up in front of the camera, like these: I'm not good at this. 100% I can't be authentic. 100$ I'll look like a robot! 100% Tom practices in England as a family practice doctor, but has decided to work part time for the national health service while he establishes his clinical practice because he is only permitted to spend 10 minutes with each patient. He has developed a love affair and expertise with TEAM-CBT, and wants the freedom to practices in the way he wants, offering two-hour individual and group sessions, where he emphasizes the integration of physical with mental health. But this means having to advertise his clinical practice to solicit patients, and this is a bit of a treadmill because of the rapid changes he sees in so many of his patients. Hence, his urgent need to overcome his public speaking / performance anxiety. I have a soft spot in my heart for anyone who's struggle with these types of anxious thoughts and feelings, because I have encountered them on many occasions in my professional career when I had to present my work in conferences, or even when attending receptions that included other mental health professionals. In fact, I am the "voice" on the Feeling Great App that I've been developing over the past several years, and it took me some time to get comfortable with the recordings, since I told myself that I "had to sound natural, spontaneous, and inspiring." Of course those internal and external demands caused the exact opposite—feelings of tension, insecurity, pressure, and intense self-doubt, resulting in "robotness" as opposed to spontaneity! Yikes! It was a dreadful battle for a while! So, I KNOW how Tom has been feeling. And our beloved Rhonda has been there, too, especially when she took over from Dr. Fabrice Nye as host of the Feeling Good Podcast that you're listening to right now. If you recall, she was feeling pretty darn insecure! (See Podcasts # 142 and 143.) Perhaps you've also struggled with social or public speaking anxiety, and felt insecure, panicky, frustrated, or ashamed? Have you? Even in our weekly training group at Stanford for mental health professionals, these feelings are rampant and nearly universal. Part 1 of the work with Tom T = Testing Tom brought a partially completed Daily Mood Log to today's session. You can review it if you CLICK HERE. As you can see, he was feeling nine different categories of negative feelings, all intensely, with estimates ranging from 70 to 100. This is why T = Testing is necessary for all mental health professionals, regardless of your so-called "school" of therapy. People, like Tom, may look attractive and filled with enthusiasm and joy on the outside, and still be experiencing EXTREME levels of distress inside. The T = Testing vasty improves your accuracy in understanding how your patients are feeling. It also makes you accountable, which can be sobering, because we will again ask Tom how he's feeling at the end of the session. The improvement, or lack of improvement, will tell us EXACTLY how effective, or ineffective, we were today in our work with Tom. This is a great bonus for therapists who are courageous enough to use my Brief Mood Survey at the stat and end of every session, with every patient, because your patients become your best teachers, by far. But it's also a threat, because the numbers don't lie, and you'll also be confronted by your ineffectiveness with many of your patients / clients. Sadly, a great many therapists would prefer not knowing the truth! E = Empathy Although Tom had previously defeated these anxiety-provoking thoughts and reached a state of relative enlightenment and joy, the thoughts have come creeping back into his psyche. That's one of the things about anxiety. Once you've beaten it, you have to keep up the assault with frequent, ongoing exposure, or the anxiety will once again invade your brain and body. But the good news is that the methods that helped

Rhonda Describes the GRIP Program and Interviews GRIP Graduate, Shakur Ross The Guiding Rage Into Power (GRIP) Training Institute serves incarcerated men and women in California. Their mission is to create personal and systemic change to turn violence and suffering into opportunities for learning and healing. I (Rhonda) was introduced to the GRIP program when two of my dearest friends, Steve Zimmerman and Vicki Peet, invited me to a yearly celebration of the GRIP Training institute. I was blown away by who I met and what I learned that I wanted to share it with the Feeling Good Podcast listeners. Thank you, David, for letting me deviate from our typical subjects. The GRIP program is a different subject for the Feeling Good Podcast, because it is not about TEAM-CBT. What the GRIP Program and TEAM-CBT have in common is that they are both evidence-based programs that incorporate CBT theory and methods into their treatment methodology. But the main thing they have in common is that people who engage in these two therapies experience profound, enlightening changes in their lives. From their program: "The GRIP program is an evidence-based methodology developed over 25 years of work with 1000's of incarcerated people and many victim/survivors. Rooted in Restorative Justice principles, the program's trauma informed model integrates cutting-edge neuroscience research. Students engage in a yearlong, in-depth journey to comprehend the origins of their violence and develop skills to track and manage strong impulses rather than acting out in harmful ways. They transform destructive beliefs and behaviors into an attitude of emotional intelligence that prevents revictimization." The GRIP Training Institute was started in 2011. As of October 2020, nine years after running its first group, 915 students have graduated. Of the 915 graduates, 369 were released from prison. Only 1 graduate in nine years returned to prison, which is a recidivism rate of 0.3%, which is very impressive considering the recidivism rate for California is between 44-46%. Many, if not all of the graduates, say that GRIP saved their lives. Something many people who have benefitted from TEAM-CBT echo. At the GRIP celebration, I was standing in line waiting for the buffet. A man got in line behind me. It was confusing where the line ended, which was not directly behind me. In another circumstance I might have mentioned to him that the line ended somewhere else, but he was kind of scary looking, big, buff with obvious prison tattoos on his neck so I didn't say anything. But the line moved slowly and I was curious so I asked him what his connection to GRIP was. He told me he was a graduate of the program and then politely asked me the same question. It has been my experience that often people love to talk about themselves more than they are interested in other people so I was immediately impressed that he was as interested in me as I was in him. When I told him I was a therapist, he asked me what kind of therapy I practiced. I explained TEAM-CBT, and he was super interested! He told me he loved CBT, and had learned a lot about himself through that kind of therapy because GRIP incorporated it in their program. I asked him about his experience in GRIP and his tough exterior transformed right in front of me as he talked about how GRIP saved his life. I talked to several other men (so far only men have graduated from the GRIP program because the services have only recently been brought to a women's prison), and had the same experience. I met our guest on this podcast, Shakur Ross, who kindly agreed to share his journey of transformation with us. GRIP graduates continue to do the work and live as Peacemakers. Shakur works for GRIP and returns to San Quentin and other prisons to provide the same lessons that he received. The podcast starts with an interview with Kim Moore, the Executive Director of the GRIP Training Institute, who explains some of the key concepts of the program. Thanks for listening today! Rhonda

Jessica Malvicino Live Work With Jessica-- Living with Regrets Rhonda and I recently did live work at a TEAM-CBT intensive in Mexico City. Our "patient" was a 40 year old mental health professional named Jessica with many years of unhappiness because of a decision she made when she was just 17. Perhaps you've also looked back on your life and thought, "If only I would have . . . " done something I didn't do," as well as, "I wish I hadn't done X, when I was young." Last week you heard the initial Testing and Empathy portions of the session with Jessica. Today you'll hear the Assessment of Resistance, Methods, and final Testing.. Part 2 of the Jessica Session A = Assessment of Resistance Jessica said her goal for the session was learning to accept life and move on, and not have such constant feelings of emptiness, with so many "I should have" thoughts running through her brain. Although Jessica, like most people, said she'd press the Magic Button to make all of her negative thoughts and feelings disappear, we decided to do some Positive Reframing first, to see if there were some positives hiding in her negative feelings. We asked the following questions about a number of her negative feelings and thoughts: Why might this thought or feeling be appropriate and healthy? Why might this thought or feeling be helpful to you? Why does this thought or feeling show about you and your core values that's positive and awesome. ? As you probably know, the goal of there are two goals for this paradoxical exercise: First, we want to bring the patient's subconscious resistance to conscious awareness. Second, we want her to see that her struggling and suffering is NOT the result of what's WRONG with her, but rather, what's RIGHT with her. The moment that people really "see" and "get" this, there's often a sharp and sudden reduction in feelings of shame, and a strong burst of motivation to crush the negative thoughts at the heart of her misery. Here are some of the Positives we listed: SADNESS My sadness shows my passion and love of dancing. It shows my dedication to the idea of having a fulfilling career. It shows that I'm a very loving person. ANXIETY, WORRY, NERVOUSNESS These feelings show that I'm responsible motivate me to complete tasks help me avoid procrastination make me vigilant and protect me from danger SHAME These feeling show that I'm concerned about others I'm human I want to please others with my career I admire my mom and want to make her proud I want her to admire me I'm humble I want to feel close to others ANGER These feelings show that I'm a caring and passionate person I have character I have a moral compass I'm feisty and strong I'm accountable My anger also empowers me After listing these and other positives, Jessica decided to use the Magic Dial to reduce her negative feelings to lower levels, but not necessarily all the way to zero, as you can see in the goal column on her emotions table: Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, unhappy 90 20 Foolish 100 0 Anxious, worried, nervous 90 10 Discouraged 97 5 Bad, ashamed 95 0 Frustrated, stuck, defeated 100 5 Inadequate 90 0 Angry, mad, resentful, annoyed 95 10 Lonely 92 5 Other Then we went on to M = Methods These were some of the negative thoughts that Jessica wanted to challenge, along with the percent she initially believed each of them: I'm a failure. 90% My mom is to blame for not understanding the career path that I wanted. 90% I was an idiot for not following my dreams. 100% Nothing will truly fulfill my professional career. 100% I have to "settle" for my professional career now.100% She had many others ad well. We used a variety of techniques to challenge and crush these thoughts, including the Externalization of Voices with Self-Defense, the Acceptance Paradox, and the CAT (Counter-Attack Technique), and used frequent role reversals to help Jessica get to "huge" wins when she was in the role of her positive thoughts. Here you can see Jessica's scores in the "% After" column. As you can see, her scores were extraordinarily low, which is terrific. Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, unhappy 90 20 0 Foolish 100 0 3 Anxious, worried, nervous 90 10 0 Discouraged 97 5 0 Bad, ashamed 95 0 0 Frustrated, stuck, defeated 100 5 10 Inadequate 90 0 0 Angry, mad, resentful, annoyed 95 10 5 Lonely 92 5 0 Other Typically, such drastic and sudden reductions in negative feelings not only indicate "recovery," but the experience of feelings of joy and enlightenment. At the end we asked Jessica two questions: Are the scores valid, or is she just trying to please us? If they are valid, what were the most healing and helpful aspects of the session? As you listen to the end of the live session, you'll find out what she said! Rhonda and I hope you enjoyed the session with Jessica. We believe that live work with real people, and not role players who are pretending to be in therapy, is invaluable,

Live Work With Jessica-- Living with Regrets Rhonda and I recently did live work at a TEAM-CBT intensive in Mexico City. Our "patient" was a 40 year old mental health professional named Jessica with many years of unhappiness because of a decision she made when she was just 17. Perhaps you've also looked back on your life and thought, "If only I would have . . . " done something I didn't do," as well as, "I wish I hadn't done X, when I was young." Today you'll hear the initial Testing and Empathy portions of the session, and next week you'll hear the Assessment of Resistance, Methods, and final Testing.. Part 1 T = Initial Testing DAVID WILL SUMMARIZE SCORES ON BMS AND DML You can also see her scores on the emotions table of her Daily Mood Log here. Emotions % Now % Goal % After Emotions % Now % Goal % After Sad, depressed, unhappy 90 Foolish 100 Anxious, worried, nervous 90 Discouraged 97 Bad, ashamed 95 Frustrated, stuck, defeated 100 Inadequate 90 Angry, mad, resentful, annoyed 95 Lonely 92 Other As you can see, these negative feelings were all incredibly intense. E = Empathy Jessica, who grew up in Florida, explained that she started ballet dancing at the age of 3, and when she was 17, she won a prestigious full scholarship to study and have the chance to join a world renowned ballet company. Jessica was incredibly excited, but her mom did not see ballet as a "true career." In addition, her mother was quite protective, which was not uncommon in the Cuban community, and told Jessica she could only accept the scholarship if she agreed to live with her grandparents in New York. Jessica angrily rebelled and turned down the offer. Although she continued to dance professionally until her first daughter was born 14 years ago, she battled with feelings of anger and regret the entire time, while also blaming her mother for her. unhappiness. She eventually got a bachelor's degree in journalism, and worked in television for a period of time. Then she got a master's degree in counseling, and found that she loves clinical work and helping people. However, she continued to live with feelings of regret and anger directed at her mom from age 17 to her current age of 40, for a total of 23 years, and explained that she frequently "takes it out" on her mom during periods of irritability. She also has feelings of grief about what she's lost when she see her young niece dancing ballet beautifully now. This statement brought tears to her eyes. Jessica described all the sacrifices she'd made when growing up in order to become a top dancer, including periods of bulimia to maintain the thinness that her teachers always stressed. She explained that "everyone did it—they weighted us frequently and would grill us if we were even a little bit overweight. . ." and this was all in order to fulfill her ultimate dream of becoming a world class ballerina, a dream that vanished. Jessica gave Rhonda and David an A on Empathy, and said that the self-disclosure felt uncomfortable, but helpful. Next week, you'll hear the inspiring conclusion of the work with Jessica!

Today's special guest, Brittany. Podcast 375. I'm Struggling! Ask David Live: a New Podcast Twist We start today's podcast with a visit from Dr. Jacob Towery. You might recall that one year ago he offered an amazing and (almost) totally free two-day workshop for shrinks and the general public on overcoming social anxiety. Roughly 90 people attended, and it was a huge success. The only "cost" was a $20 contribution to a charity of your choice, including Doctors Without Borders and several others. Dr. Jacob Towery This year, Dr. Towery will be repeating this incredible program on March 16 and 17, 2024, which will be on a Saturday and Sunday, in Palo Alto. Once again, the title will be "Finding Humans Less Scary." Jacob and Michael Luo will lead the program and will be assisted by 10 - 20 expert therapists who will lead the break-out groups. Last year, people described the program as "transformative" and "life-changing." Social anxiety can have a significant impact on your life, so you owe it to yourself to attend if you or a loved one has struggled with any of the five common forms of social anxiety:Shy Bladder Syndrome Shyness in social situations Public Speaking Anxiety Performance Anxiety Test Anxiety You'll learn and practice tons of awesome anxiety-busting techniques, including Smile and Hello Practice, Flirting Training, Rejection Practice, Talk Show Host, Shame-Attacking Exercises, and much more. Social anxiety rarely exists alone, but is nearly always associated with other mood problems, such as loneliness, shame, depression, and substance misuse with alcohol and benzodiazepine pills to try to combat the symptoms, to name just a few. How do you sign up? It's easy! Just go to FindingHumansLessScary.com If you attend, let us know how it worked out for you, what you learned, and how you grew. Thanks so much, Jacob, for making this kind of world-class experience available to everyone who's looking for some help, and some wild, life-changing and zany fun in March! Brittany, an enthusiastic podcast fan, asked for help with a conflict with her husband. She wrote: Hi Dr. Burns, I'm struggling a bit. My husband reads a ton of articles and feels that the media has been portraying a lot of the current events incorrectly, especially the horrifying Israel/Palestine conflict. He is extremely frustrated by this and has become depressed because none of his friends or family seems to want to talk about it. He says he feels alone & isolated. I have never been much into politics, abd I don't know enough to have a real opinion on things to say who is right. I try to be a good listener to whatever he says. For example, I may say "yeah, that sounds really frustrating," and then I agree with what he says. But I'm obviously doing a bad job at the empathy because he says the support he gets from me is not satisfactory at all. Sometimes I feel like a parrot, just repeating back what he says. I think you had an example before on an Ask David where you showed how to empathize with someone who says how awful everyone is and how awful all the liberals are. Something like that. But I can't find it. When I empathize my husband says I just don't get it and nobody is doing anything to help these innocent people who are being attacked, and he says that I am not doing anything either. I'm at a loss on how to reply? Maybe you could do an example on an Ask David. Sorry for the long message. - Brittany Hi Brittany, Sorry you're struggling, this is a common but important problem. Yes, we can and will do that. Can you give me an example of something he says to you, and exactly what you say next? You can use the attached Relationship Journal I you like. Try to complete steps 1 and 2 at least, and mail back to me ASAP. Lots of people with this problem these days, so could be great ASK D question. Weren't you on the show live once a few years back? I know you've sent us some great questions. I'm thinking MAYBE you could join and practice with us, using your example. Do you have / have you read my book, Feeling Good Together? Best, david It turned out that Brittany was eager and willing to join us live on today's podcast . This is kind of an experimental podcast where we not only respond to a great question by one of our fans, but actually invite that person to get our "expert" help in real time and live on a podcast. You can let us know if you like this format. To get us started, Brittany sent us an example of a Relationship Journal she had prepared. I thought this was really well done, and gave her revised version a grade of A-, which is way better than most people can do. I sent her an email saying that she could probably add more acknowledgement of his feelings and her feelings, like feeling alone and hurt and a bit lonely, and also a bit more Stroking, like "I want you to know how much I love you, and how special you are to me. And that's why it's so had for me to realize that I've really been letting you down." We practiced with Brittany u

Featured photo is Mina as a child (more pics below!) 374 Anger, Part 2 You Have Always Hated Me! In the Anger Part 1 podcast (371 on November 20), Rhonda, Matt and David discussed the fact that when you're feeling angry, there's always an inner dialogue—this is what you're saying to yourself, the way you're thinking about the situation—and an outer dialogue—this is what you're saying to the other person. In Part 1, we focused on the inner dialogue and described the cognitive distortions that nearly always fill your mind with anger-provoking inner chatter about the 'awfulness" of the person you're mad at. Those distortions include All-or-Nothing Thinking, Overgeneralization, Labeling, Mental Filtering, Discounting the Positive, Mind-Reading, Fortune Telling, Emotional Reasoning, Other-Directed Should Statements, and Other-Blame. That's a lot—in fact, all but Self-Blame. And sometimes, when you're ticked off, you might also be blaming yourself, and feel mad at yourself at the same time. Matt suggested I add these comments on Self-Blame or it's absence:: Another possible addition would be when you identify the absence of Self Blame when we're angry. For me, it's been easier to think of that as a positive distortion, because you are blind to, or ignoring, your own role in the problem. In other words, when I'm blaming someone else, it's me thinking my poop smells great and tit's all the other person's fault.. I've wondered if we fool ourselves like this because of the desire to have a special and perfect "self," which we then defend. Because nobody's perfect, our "ideal self," as opposed to our "real self," is just a pleasant, but potentially destructive, fantasy. Still, we try to preserve and project the fantasy that we are free of blame and the innocent victim of the other person's "badness," , and we imagine there we have a perfect "self" to defend. Or, as you've said, at times, David, "anger is often just a protective shell to hide and protect our more tender and genuine feelings." We also discussed the addictive aspect of anger, since you probably feel morally superior to the "bad" person you're ticked off at when you're mad, and this makes it fairly unappealing to change the way you're thinking and feeling. Your anger also protects you from the risk of being vulnerable and open and genuine. Today we discuss the Outer Dialogue, and how to express angry feelings to another person, as well as how to respond to their expressions of anger. The main concept is that you can express anger in a healthy way, by sharing your anger respectfully, or you can act out your anger aggressively, by attacking the other person. That's a critically important decision! Toward the start of today's podcast, Rhonda, Matt and David listed some of the distinctions between healthy and unhealthy anger. The following is just a partial list of some of the differences: Healthy Anger Unhealthy Anger You treat the other person with respect, even if you're angry. You want to put the other person down. Your goal is to get closer to the other person. You want to get revenge or hurt or humiliate the other person. You hope to improve the relationship. You want to reject or distance yourself from the other person. You want to understand the other person's mindset and find the truth in what they're saying, even if it sounds 'off' or 'disturbing' or offensive. You want to prove that the other person is 'wrong' and persuade them that you are 'right'. You want to understand and accept the other person. You insist on trying to change the other person. You express yourself thoughtfully. You express yourself impulsively. You come from a mindset of humility, curiosity, and flexibility. You come from a position of moral superiority, judgement, and rigidity. You are patient. You are pushy and demanding. Optimism that things can improve and that there's a great potential for a more meaningful and loving connection. Hopelessness and feelings of certainty that things cannot improve. Open to what I've done wrong and how I've hurt you. Focus on what you've done wrong and how you've hurt me. I-Thou mindset. I-It mindset. You're vulnerable and open to your hurt feelings. You put up a wall of toughness and try to hide your vulnerable true feelings.. You look for positive motives, if possible, and don't assume that you actually understand how the other person is thinking and feeling.. You attribute malignant motives to the other person and imagine that you can read their mind and know exactly why they feel the way they do. You accept and comprehend the idea that you can feel intensely angry with someone and love them at the same time.. You may believe that anger and love are dichotomies, and that conflict and anger, in some way, are the 'opposite' of love or respect.. To bring some dynamics and personality to today's podcast, Mina, who's made a number of noteworthy appearances on the podcast, agreed to describe what she learned on a recent Sunday hike. (I've starte

Why Therapy Fails One of the most common reasons patients contact me is to find out why the therapy isn't working. They may be TEAM-CBT patients or patients of therapists using other approaches. Therapists also ask for consultations on the same problem--why am I stuck with this or that patient who isn't making progress? In the Feeling Good App, my colleagues and I have been looking into this as well. Most app users report excellent and often rapid results, but some get stuck, in just the same way they might get stuck in treatment with a therapist. I have tried to organize my thinking on this topic, because if you can diagnose the cause of therapeutic failure, you can nearly always find a solution. Of course, the app is not a treatment device, but a wellness device, but the same principles apply. So today, Rhonda, Matt and I discuss a couple reasons why therapists and patients alike sometimes get stuck. Matt described a patient who was misdiagnosed with a psychotic disorder who turned out to have sleep apnea. When the proposer diagnosis was made and treated, the patent suddenly recovered. Rhonda described a patient who jumped from topic to topic and always brought up a new problem before completing work on the previous problem. This problem was solved when Rhonda explained the importance of sticking to one problem for several sessions, until the problem was resolved. The patient then began to make progress. David described a depressed woman from Florida who was stuck in treatment, and not making progress, and then the therapist said "I just can't help you," This hurt and confused the patient who wrote to me. There were essentially two problems--the patients depression what brought her to therapy in the first place, and her unresolved hurt feelings when the therapist "gave up" on her. This problem reflected many failed relationships is the patient's life. This was resolved when the patient took the initiative to schedule a session to talk about the conflict more openly with excellent results. In addition, the patient had heard that she "should" accept herself, but didn't know how to accept her constant self-critical troughs and intensely negative feelings. I suggested she make a list of the benefits of her negative thoughts and feelings, as well as the many positive things they showed about her and her core values as a human being. She came up with an extremely impressive and long list! For example, her criticisms showed her high standards, her humility, her dedication to her work, her accountability, and much more. In addition, she'd achieved a great deal because of her relentless self-criticisms. I asked her why in the world she'd want to accept herself, given all those positive characteristics She decided NOT to accept herself, and was delighted with her decision. She said she felt profound relief! An unusual, but awesome, path to acceptance! In other words, she ACCEPTED her "non-acceptance." I hope you find today's podcast interesting and helpful. Of course, ultimately therapy is part science and part human relationship art. That's why Rhonda and I offer free weekly training groups for therapists who wish to develop their therapeutic skills. The groups are on zoom so therapists from around the world are welcome. Matt offers a consultation group (free to Stanford psychiatric residents) every other Tuesday for therapists who want help with difficult, challenging cases. To learn more, you'll find details and contact information at the end of the show notes. When Therapy Doesn't Work-- And How to Get Unstuck (for Therapists and Patients) By David Burns, MD Here's are some of the most common reasons why therapy might fail or appear to be stuck / without progress. Some of them will be of interest primarily to clinicians, while others will be of interest to clinicians and patients alike. And many of these reasons will also apply to individuals using the Feeling Good App who are stuck in their attempts to change the way they think and feel. But what does "stuck" actually mean? The definition, of course, is subjective. I believe that a substantial or complete elimination of depression and anxiety can typically be achieved in five sessions with a skilled TEAM therapist. I use two-hour sessions, and can usually see dramatic change in a single session, although follow-ups may be needed for Relapse Prevention Training or other problems the patients might want help with. In my experience, the treatment of relationship problems and habits and addictions usually takes much longer than the treatment of anxiety or depression. The techniques to treat relationship problems and habits and addictions actually work just as fast as the techniques to treat depression and anxiety, but the resistance can be far more intense. For example, someone may be ambivalent about leaving a troubled relationship or giving up a favored habit for many months or years before making a decision to move in a new direction. And, of course, the treatm

At Last! An Outcome Study! One of the wonderful things about TEAM-CBT is the dramatic and rapid changes we see in so many of our patients. But we've had a huge problem-no published outcome studies. And that has definitely limited the general acceptance and recognition of TEAM-CBT. Today, that era has come to an end, thanks to Dr. Elise Munoz, who joins our beloved Feeling Good Podcast to discuss a remarkable outcome study conducted at her Feeling Good Psychotherapy clinic in New York City. She wanted to evaluate the effectiveness of TEAM-CBT with teens and young adults. Dr. Munoz is the Founder and Lead Therapist at Feeling Good Psychotherapy and Adjunct Assistant Professor at New York University. She is also a Level 4 Certified TEAM-CBT Therapist & Trainer, and specializes in the treatment of anxiety, depression and life transitions. Elise conducted a "naturalistic" study of data from 116 teenagers and young adults aged 13 -24 years of age who were treated by 15 therapists between 2017 and 2022. In a "naturalistic" study, you simply analyze all the data from your patients to evaluate the effectiveness of the treatment. This is in contrast to a "controlled outcome study" where patients are randomly assigned to two treatments to see which treatment delivers the best results. Elise conducted the research study as part of her work for a Doctorate in Clinical Social Work at the University of Pennsylvania in Philadelphia. "The results," she says, "were encouraging." That's perhaps a humble description of her findings. David and Rhonda might say that the results were pretty awesome! Elise told us that although the average number of treatment sessions was 27, most of the patients made maximal gains after just 10 weeks (2.5 months) of treatment, and many achieved maximal improvement by the 5th session. Specifically, by the tenth session. 80% of the patients scored in the "subclinical" range on the depression scale of my Brief Mood Survey (with scores of 0 to 4) and 87% scored in the subclinical range on the anxiety scale (scores from 0 to 4) . These scales range from 0 (no symptoms) to 20 (extremely severe.) Prior to the study, only 30% were in the subclinical range. According to Elise, the rapid improvement suggested that most patients will not need long-term treatment, although some will need more time to incorporate their gains following their initial improvement, and many will want to remain in treatment to deal with other problems, such as relationship issues that are so important in this (or any) age range. Prior to the study, Elise trained the therapists in a weekend TEAM-CBT "boot camp," along with two hours per week of group training and 1 hour per week of individual consultation/supervision. My own view (David) is that learning TEAM-CBT is very challenging, requiring a minimum of one to two years of intensive training. However, the fact that therapists can get excellent results with a relatively small amount of training is encouraging. One of the key components of TEAM is T = Testing. We test every patient at the start and end of every therapy session, asking, "How are you feeling right now?" This provides the therapist with a kind of emotional X-ray machine that allows you to see the precise degree of improvement, or lack of improvement, at every session in multiple dimensions. Therapists can use the information to fine-tune the treatment on an ongoing basis. Many other research studies have demonstrated that session by session monitoring of symptoms, consisting of measurement and feedback, significantly improves outcomes in mental health treatment. (please contact Elise for a list of research studies you can look up online). Research indicates that roughly half of adolescents and young adults will suffer from some mental health problem. Therefore, it is essential to provide accessible, effective treatments to prevent the development of long-term mental health problems. We salute Elise for going the extra mile to evaluate the effectiveness of the treatment and to identify the therapists who get the best results. This requires courage and also allows our field to move forward based on real data rather than subjective impressions. Dr. Munoz's fascinating work adds to the body of evidence supporting the effectiveness of TEAM-CBT. and also sets a commendable example of dedication to improving mental health outcomes through research and ongoing professional development in a private practice environment. The famous and idealistic "Boulder Model" of the "scientist / practitioner" is highly touted in graduate school graining programs for mental health practitioners, but is rarely practiced in real life. Dr. Munoz shows that the integration of science with clinical treatment in community settings is not only possible, but extremely important. Dr. Munoz's research also indicates that the TEAM model offers an exciting path to improved mental health for teens and young adults!

Anger, Part 1 You suck! Screw you! Jay asks: Are you EVER going to do a podcast on anger? Dr. Burns, Also are you EVER going to do a podcast on Anger with Rhonda and Matt? You have done many podcasts on depression, anxiety, interpersonal relationships YET there is not one podcast addressing anger. Given the world we live in right now maybe it's time to address Anger from a TEAM-CBT perspective and give it the attention you have given anxiety and depression. All the Best, Jay In today's podcast, Rhonda and David address this important but neglected topic that is perhaps more important than ever in today's angry and violent world. David began by pointing out that in the feeling Good App, anger improved as much as six other negative feeling clusters, with fairly dramatic reductions in just a few days. This was completely unexpected and exciting, and has been replicated in numerous beta tests. Maybe there IS a small glimmer of hope in this troubled, angry world! David pointed out that anger is addictive Depression is not addictive because in depression you are thinking I am no good, and you have negative and painful distortions about yourself. Anger, in contrast, is addictive because you are directing the distortions at other people, telling yourself that they are no good, and they will never change, and so forth. These distortions directed at others trigger feelings of moral superiority and those feelings are intensely addictive. Any group that is at war tends to feel morally superior and sees the "other" as scum, the enemy, and these distortions give you justification for hurting and killing them and feeling good about what you are doing. What makes the treatment of anger fairly challenging is that most angry people are not looking for help. Distortions directed at others are key in conflicts with friends and loved ones as well as racial and religious hatred, and war and violence. How do you treat a patient who is angry? You always start with T = Testing. David's research on therapist accuracy indicates that therapist accuracy is recognizing anger in their patients is incredibly poor. If you want to assess and deal with patient anger, the Brief Mood Survey at the start and end of every session can be invaluable, and the Evaluation of Therapy session at the end can also help. E = Empathy comes next. However, empathizing with someone who is angry can be challenging because they are often provocative, or want the therapist to align with them in their belief that the person they are angry with is to blame. We want the client to feel accepted, and have a warm relationship with their therapist so the therapist can easily get sucked into the patient's blaming mind-set. David calls this "reverse hypnosis," and this can sabotage the chance for effective treatment. Empathy can be challenging if the anger is directed at the therapist, or if the client is saying they are so angry they want to hurt someone. That can be ethically challenging because of the Tarasoff duties to warn the victim and notify the police. That is tough because the client can get upset with the therapist. A = Assessment of Resistance comes next, starting with the Straightforward or Paradoxical Invitation. With someone who is angry, we nearly always use the Paradoxical Invitation. Here's an example: You have been talking about person X, and I can see you are pretty fed up with her. You said, you've tried everything and nothing works, and she won't change. I have a lot of tools that could be very helpful if you want to do work on the relationship and turn it around. But I did not hear you saying that, and I am assuming that is NOT what you want. Don't get me wrong, if you want to work on this relationship, I'd love to do that so you can develop a closer relationship, but at the same time, there's no law that says you have to get along or like everyone. I'm assuming you DON'T want to work on your relationship with X, but want to make sure I'm understanding you. Am I reading your right? M = Methods Two invaluable tools are the Straightforward or Paradoxical Cost-Benefit Analysis for anger, blame, or for the relationship. Anger CBA What are the Advantages and Disadvantages of feeling intense anger at the other person. Blame CBA What are the Advantages and Disadvantages of blaming the other person for the problem. Relationship CBA What are the advantages and disadvantages of having a relationship with this person? David provided this example of a Paradoxical Anger CBA. A man was hospitalized involuntarily in Philadelphia who was brought in by the police. He was working at Savings and Loan company with disgruntled customers. A customer came in who was whining and complaining. The patient was a large and powerful man, and he got so angry at the whining customer that he picked him up and threw him against the wall. They called the police who arrested the man, but he seemed psychotic, or in a manic state, so they brought him, instead, to the hospital. He was

Ask David The fear of ghosts; the truth about nutritional supplements; the fear of fear; how does anxiety treatment work? And more. Today, David and Rhonda answer six cool questions submitted by podcast listeners like you! Joseph asks: How would you use exposure to confront your fear of ghosts? Salim asks: What herbs and supplements will help me become more zen and relaxed? Peter asks: How do you stop fearing the fear and discomfort of anxiety? Jillian asks: How does cognitive therapy work to help reduce anxiety? Sanjay asks: How do you give up wants, needs, and desires? Dana asks for help with the Disarming Technique. In the following, David's reply was David's email response to the person prior to the podcast, just suggesting some directions we might take on the podcast. The Rhonda comments were based on notes she took during the live podcast. For the full answers, make sure you listen to the podcast! Joseph asks: How would you use exposure to confront your fear of ghosts? Hi David and Rhonda, Thank you again for your wonderful replies and the amazing podcast. If you would humor me, I have another question -- I know David talked about exposure therapy in overcoming fears, but I wonder how this could apply to some fears like the fear of ghosts where it is caused by an over-active imagination (in which case, what should one be exposed to?) Regards Joseph David's reply Cognitive flooding would be one approach. Will give details on podcast. Thanks! David Rhonda's notes Find out what is happening in the person's life, and treat that specific problem. Maybe someone developed a fear of ghosts after the death of a loved one, so the idea of being around death or dead things may also cause intense anxiety. Going to a cemetery may be part of their exposure. Other examples of exposure for overcoming the fear of ghosts could be: Approaching a scary, abandoned house Watching a scary movie about ghosts Fear of darkness may accompany fear of ghosts so staying in the dark may be part of your exposure. Fear of sleeping alone may also accompany fear of ghosts so sleeping alone in your home may be part of your exposure. Salim asks: What herbs and supplements will help me become more zen and relaxed? Hello Mr. David D Burns, I want to tell you that i loved "Feeling Good", your book helped me a lot in improving my life, I have a question, can you recommend herbs or supplements that help me be more Zen and more relaxed? I would be eternally grateful. 🙏. Thank you so much. Salim David's reply. Hi Salim, I don't believe in the efficacy of herbs etc. except for their placebo effect. However, the written exercises in the book, like writing down your negative thoughts, can help a lot. You'll find lots of free resources on my website. At the same time, the use of herbs and supplements is kind of a "cult" thing, and as you know, cult followers don't like to have their views challenged! And our field of mental health is, to my way of thinking, a mine field of cults! Thanks! David Burns, MD Peter asks: How do you stop fearing the fear and discomfort of anxiety? David's Reply Exposure! However, I don't "throw" methods at symptoms, but rather work systematically with the TEAM approach, and always incorporate four models in my work with every anxious patient: The cognitive, motivational, exposure, and hidden emotion models. You can learn more about this in the free anxiety class on my website! You'll find it right on the homepage for www.feelinggood.com. Thanks, David Rhonda added You don't stop fearing the fear and discomfort of anxiety before doing an exposure. You do all of the work necessary using the three other models of treating anxiety (see the anxiety question directly below this one) and then you dive into the exposure, embracing the discomfort until it's reduced or gone. Jillian asks: How does cognitive therapy work to help reduce anxiety? Hi David, I have questions about how using your methods helps people. I'm someone that uses an acceptance method for my anxiety with success and throughout this journey I've really been able to catch my mind trying to focus on the negative and trying to spiral into ruminating. With negative thoughts, how do your methods actually help, does it start to change the way you think or make you automatically think in more of a positive way (eventually without having to "challenge" each thought?) Do you have to believe the challenges to your negative thoughts in order for it to work? What if you believe the original negative thoughts more? Do you actually start viewing things in a more positive light? Kinds regards, Jillian David's Reply Hi Jillian, I can make this an Ask David question for my weekly podcast if you like. You can find the answers, too, in the free anxiety class on my website and in my book, When Panic Attacks. Thanks1 Essentially, and I've covered this in detail in a podcast, cognitive techniques can be very helpful in reducing anxiety, but they are only one strategy among many. I act

369 The Invisible Racism We All Deny, Featuring Drs. Manuel Sierra and Matthew May Today we're joined by Drs. Manuel Sierra and Matthew May on the sensitive topic of racism. Manuel Sierra MD is a child and adolescent psychiatrist practicing in Idaho, one of the places where he grew up (he also spent time in Oregon). He was a classmate of Matt May during his residency training days at Stanford, and they remain close friends today. Rhonda begins today's podcast with this mail we received from Guillermo, one of our favorite podcast fans: Guillermo asks: How do you respond to family or friends who make racist comments? Hello, Dr Burns Not sure if you have addressed this in any of the podcasts (I don't recall it being a topic) but: I was recently in a group chat with some cousins, and I read some really disappointing racist comments about a particular group. Many people ignored it (as I did) and a couple AGREED with the comments. How can we balance not judging not just any people but our longtime friends and family about overtly racist actions/comments and the thinking that it is not the event but our thoughts that create our emotions? I don't care about "judging them" (in the sense that I don't think it is my place to "change" their views) but just hearing/reading comments like this bothers me when they come from people close to me. When I see it on tv or the internet, I don't get affected because I feel it is beyond my control. I don't believe they will change their views so do I just remove them from my life? I apologize, the topic is too wide, but I've been thinking about this. Sincerely grateful for all you do, Guillermo Manuel kicked off our answer to Guillermo by saying that he has been personally familiar with racism within families and communities, and says that he and Matt have talked about this topic "a lot." He explained that: Although I am proud of my Mexican-American heritage, I was born and grew up in Oregon and Idaho, where I'm currently practicing. I encountered considerable racial bias when I was a kid, and later in life as well. I clearly cannot speak for all Mexican-American people, I can only speak for myself and what I've personally experienced, and I am extremely aware of how difficult the current times are. My grandparents didn't teach my mom Spanish. She was a single mom, and we lived in a small town in Idaho. I also have family through marriage who live on Native American lands. In grade school I began hearing jokes about Mexican Americans, and this was very awkward, painful, for me. I also got ridiculed for not speaking Spanish. Even my grandfather asked me, "why aren't you speaking Spanish?" There were also gangs where the racial bias got worse and frequently turned violent. After learning more about Manuel's experiences, we modeled various ways of talking to a friend or family member who has made hurtful racist comments. Manuel cautioned that it might be best to do provide the feedback individually, and not in public, so as not to shame the person. In addition, this can reduce the chance for social posturing and responding in an adversarial way. Matt agreed and emphasized the importance of combining your "I Feel" Statement with Stroking. For example, you might say something like this, assuming the racial slur comment came from a relative or person you like, Jim, as you know, you're one of my favorite people, but I want you to know that when you said X, Y and Z, it really upset me, because it sounded like a put down to people who are (Mexican, Jewish, Moslem, gay, or whatever). I (David) like this approach because it sounds respectful and direct, but not judgmental or condemning. Rhonda modeled an excellent alternative response which included this type of add-on: "And I'm going to request that you not say that again in my presence. " I (David) would prefer not to add the directive statement at the end, which could, in theory, rankle some individuals with coercion sensitivity, because it might sound scolding. However, that's just my take on it, and it's not some kind of gospel truth. If you want to push your assertiveness and stick up for yourself, it might be effective, and was effective recently for Rhonda because the relative she said this to stopped making similar racial comments in her presence. I would suggest ending any kind of response to the person who made a racial slur with Inquiry, asking them about their racial feelings as well as the fact that you are criticizing them. Do they feel hurt, angry, anxious, or put down? You might also ask something along these lines--Have they always had negative feelings about this or that racial or religious group? Manuel described an experience in medical school when an attending doctor was supervising a group of medical students in how to do a particular medical procedure quickly, and said this to him, "You can be like a Mexican jumping bean!" Then Manuel asked himself, "Should I say something?" Which of course incurs the risk of retaliat

A Strange Paradox-- The Incredible Impact of Compassion + Accountability Featuring Adam Holman, LCSW We want to remind our listeners about the upcoming Mexico City TEAM intensive from November 6 – 9, 2023, organized by Level 5 TEAM therapist, Victoria Chicural, and Level 4 TEAM therapist Silvina Bucci. The Intensive will be held in a beautiful part of Mexico City (Sante Fe) at the Hotel Camino Real. There will be lots of opportunities to practice every aspect of TEAM-CBT along with many excellent, internationally renown TEAM-CBT trainers. I (David) will do a keynote address on Day 1, On Day 2 Rhonda and I will do a live TEAM demonstration with a volunteer attending the conference. On Day 3 everyone will have the opportunity to practice the TEAM model from start to finish. And on Day 4 Leigh Harrington and I will answer questions about the TEAM treatment model. This promises to be an Intensive not to be missed! To learn more and register, please visit their website: https://teamcbt.mx, Today we are joined by Adam Holman, LCSW, whose podcast 288 on April 22, 2022 was a big hit. He shared his strategies for working with kids with video game addictions, and his no-nonsense, patient-focused approach made good sense and resonated with many of our podcast fans. Today, he talks about what he calls a "Strange Paradox," which is: If you treat people like they're fragile, they act and behave like someone who's fragile. If, in contrast, you hold them accountable, with compassion, they will discover their strengths. He began by commenting on hearing David talk about how therapists often get hypnotized by our clients without realizing it. When that happens, we buy into the clients' beliefs that they're helpless and hopeless. And, I (David) might add, worthless. When that happens, we start to treat them as if the beliefs are true, further proving to them that they're helpless, hopeless, and worthless. This became incredibly evident after Adam had a unusual encounter with a child while on a hike with his partner near Prescott, Arizona. The child was shrieking in terror at the top of his lungs. As they got approached the child, they saw that he was paralyzed by fear of a swarm of flies near his head. They also realized that his family had already walked past, and were about 45-seconds down the trail, hoping that he would become brave and walk through the flies and catch up with them. But that clearly wasn't happening. Adam walked past the flies and stood next to him before saying, "I know you're scared, that's okay. I just walked past the flies and it's safe. You can walk through." Then, the boy immediately stopped crying and walked past the flies on his own. The boy willingly chose to walk past them the moment that his suffering was acknowledged. He heard the message that there was nothing wrong with him or the fear that he was feeling. In other words, the acknowledgement of his fear send the message: "It IS scary, and you can do it. You're capable of doing scary things." And he immediately found his courage and became capable. Adam continued: My partner and I began thinking about the suffering that the boy had experienced in that moment, and how little he needed in order to become strong and courageous. We felt close to the boy, and talked about our own suffering, and our parents' suffering that was passed on to us. We cried for three hours that day and began to think about all the suffering in the world. It felt incredibly relieving, I felt so connected to all of the people in my life, and naturally began thinking more about the suffering experienced by my clients. I realized that with many of them, I've just given in to listening without holding them accountable. I had been standing next to them, but I was treating them as if they could not walk past the flies. . . . I loved your podcast on stories from the 60's, especially your experience when you were crying for hours when driving through the Nevada desert. All the same kinds of feelings bubbled up in me. I saw that his parents were just doing what they'd learned to do; to try to discourage the uncomfortable feelings by walking away from them. Unknowingly, this was sending the message that he isn't strong enough and that he is weak for feeling so fearful. Like many of us, they had learned that it's not okay to suffer, that experiencing feelings like fear is not acceptable. This, ironically triggers more suffering because you learn to avoid and fear your negative feelings, and you don't gain the courage to sit with your painful feelings and the feelings of others You can say (to the little boy), it's okay that you're suffering and afraid, and that's not a problem. I related to that boy. My dad was very critical, and would berate me for feeling anything other than happiness. Feelings like fear or sadness were signs of weakness, and eventually I stopped realizing that I was even feeling them. Then my feelings came out in the form of a lot of anxiety that I was avoiding,

TEAM for Troubled Couples A New Twist! Today we are joined by a favorite guest, the brilliant Thai-An Truong. Thai-An is a Licensed Professional Counselor (LPC) and Alcohol and Drug Counselor (LADC). She is the first Certified TEAM-CBT Therapist and Trainer in Oklahoma. She has found TEAM-CBT to be life-changing professionally and personally and is passionate about training other therapists in this "awesome approach." In her private practice, Thai-An specializes in the treatment of trauma and OCD. To learn more about her TEAM-CBT Trainings, visit www.teamcbttraining.com Thai-An has been featured on many Feeling Good Podcasts focusing on Depression and social anxiety (Live demonstration, 187) Postpartum Depression and Anxiety ( 218) How to Get Laid (Ep. 264) OCD ( 283) Grief (Ep 344) Now Thai-An adds an important dimension to the TEAM Interpersonal Model—working with trouble couples, as opposed to working with individuals with troubled relationships. She also describes a new way to use Positive Reframing to reduce patient resistance to giving up David's famous list of "Common Communication Errors," and she adds five new errors to the list. At the start of the podcast, Thai-An described a woman who complained that her husband often "shuts down" when they are communicating about a sensitive topic, and she wondered why. Thai-An decided to invite him to join the session so his wife could find out why. This really opened things up, and the wife discovered that her husband shut down because he was feeling inadequate when she pointed out all the things that were wrong with the house, and he was taking her comments as criticism. However, the more he shut down, the more she complained, and this pushed him away even further since her criticisms intensified his feelings of inadequacy. Thai-An then used Positive Reframing to help her see why he shut down. One of Thai-An's new ideas was to use Positive Reframing to cast our list of "errors" on the "Bad Communication Checklist" in a positive light, just as we do with the negative thoughts and feelings of people who are using the Daily Mood Log. By siding with the patient's resistance and listing all the good reasons NOT to change, nearly all patients paradoxically let down their guard and powerful urges to oppose change. Instead, they open up and become receptive to the many methods for challenging distorted thoughts. Thai-An has observed the same phenomena with troubled couples. When they see the GOOD reasons to why they or their partners use dysfunctional ways of communicating, they paradoxically let down their guard and become more willing to use the Five Secrets of Effective Communication. She says: Positive reframing started to open them up to each other, and helped them see each other in a more positive light. At the same time, they discovered that they shared the same values. Voicing the good reasons to maintain the communication errors as well as the cost of change (e.g., it'll be hard work, I'll have to focus on changing myself, it'll be vulnerable) allowed each partner to melt away their resistance to change. David comment: This is an excellent example of a "double paradox." Once again, instead of trying to "help," which often triggers intense resistance, the therapist sides with the resistance, and this paradoxically triggers strong motivation to change! Thai-An reminded us that it's important to go through the TEAM structure before moving forward with tools to help the couple change. For testing, she asks both partners to complete the version of David's Brief Mood Survey that includes the Relationship Satisfaction Scale, and asks both to complete the Evaluation of Therapy Session at the end. She makes sure both partners rate her empathy toward them at 20/20 (perfect scores) before proceeding to the next steps. During the Assessment of Resistance, she begins to work with David's Relationship Journal to get a specific moment in time of conflict. Then when they do Steps 3 and 4, where they identify their own communication errors and their impact on their partners, she does positive reframing of the bad communication errors, which you can see here, along with five new errors that Thai-An has listed below. The Bad Communication Checklist* Instructions. Review what you wrote down in Step 2 of the Relationship Journal. How many of the following communication errors can you spot? Communication Error (ü) Communication Error (ü) 1. Truth – You insist you're "right" and the other person is "wrong." 10. Diversion – You change the subject or list past grievances. 2. Blame – You imply the problem is the other person's fault. 11. Self-Blame – You act as if you're awful and terrible. 3. Defensiveness – You argue and refuse to admit any imperfection. 12. Hopelessness – You claim you've tried everything and nothing works. 4. Martyrdom – You imply that you're an innocent victim. 13. Demandingness – You complain when people aren't as you expect. 5. Put-Down – You imply that the o

AI and Psychotherapy— Doomsday or Revolution? Featuring Drs. Jason Pyle and Matthew May Today we feature Jason Pyle, MD, PhD and our beloved Matthew May, MD on a controversial, exciting and possibly anxiety-provoking podcast on the future of AI in psychotherapy and mental health. Will AI shrinks replace humans in a doomsday scenario for shrinks? Or will AI serve shrinks and patients in a revolutionary way that sees the dawning of a new age of psychotherapy? You are all familiar with Matt, due to his frequent and highly praised appearances on our Ask David segments, but Jason Pyle, MD, PhD, will probably be new to you. Jason joined the Evolve Foundation as Managing Director in 2022 to focus his work on the mass mental health crisis and the rampant diseases of despair, which afflict tens of millions of Americans. The Evolve Foundation is a private foundation dedicated to the advancement of human consciousness. Evolve is active in philanthropy and venture investments in the mental health fields. Jason is an accomplished biotechnology executive with over twenty years of executive management and technology development experience. He is committed to developing healthcare technologies and bringing science-backed healing to the most important problems of our generation. Jason is a veteran who served as a US Ranger, and earned an Engineering degree from the University of Arizona. He received both his MD and PhD in Neurosciences from the Stanford University School of Medicine, where he met Matt May and they became close friends. At the start of today's podcast, Matt and Jason reflected on their long friendship, starting as classmates at the Stanford Medical School 20 years ago. The following questions were submitted by Jason, Matt, and David prior to the start of today's podcast. Jason's Questions: How important is the role of therapist rapport with patients? If it is important, how might AI accomplish or fail to accomplish this? Given the limitations of AI, what parts or pieces of the therapeutic process might it best serve? One of AI's potentially best features is that it can interact with a person anytime/anyplace, how could this be useful to augment the current therapeutic paradigm? We talk a lot about patients using AI, but how could therapists use it to better serve their needs? Matt's Questions about AI: What is AI? How does it work? If therapists strengths tend to be their weaknesses and vice-versa, what might we expect to be the strengths and weaknesses of an AI therapist? How do these expectations match up with what David is seeing in the data? Is AI safe? Can it be made to be safe? What would be the best case scenario for AI, in therapy? David's question about AI: Will AI replace human therapists? Jason kicked off the discussion with a brief description of AI and machine learning, and outlined four potential roles for AI in psychiatry and psychology: An AI therapist full replaces the human therapist An AI helper augments human therapist, acting as a 24 / 7 therapist helper in a myriad of ways involving ongoing support for patients between therapy sessions and support for patients during crises. AI helps the therapist with rudimentary tasks like record-keeping, recording, and summarizing sessions. AI can study transcripts of therapy sessions for research purposes, rating what procedures were done as well as degree of adherence to the therapeutic methods, and the skill of the therapist. The ensuing dialogue was illuminating and exciting. In fact, I got so engrossed that I stopped taking notes, so you'll have to give it a listen to find out. However, one thing that was interesting and unexpected was highlighting the strengths and weaknesses of AI. For example, a patient with social anxiety might benefit greatly from armchair work, focusing on ways to combat distorted negative thoughts, but will still have to interact strangers in social situations to conquer this type of fear. David and Matt nearly always go with the patient out into the world for interpersonal exposure exercises, and find that the presence and trust and "push" from the human therapist can be invaluable and necessary. It is not at all clear that an AI therapist working via a smart phone could have the same effect, but that might require an experiment to find out. Jumping to conclusions without data is rarely safe or accurate! Maybe an AI "helper" could be very helpful to individuals with social anxiety! Jason raised the question of whether AI could replicate the trust and warmth and rapport of a human therapist, and whether the warmth and rapport of the therapeutic relationship was necessary to a good therapeutic outcome. I (David) summarized some of the findings with our Feeling Good App showing that app users actually rated the "Digital David" in the app substantially higher on warmth and understanding that the people in their lives. And now that we are incorporating AI into the Feeling Good App, the quality of the empathy / rapport from ou

Where Do Feelings Come From? Getting Unstuck from Apathy Ancient Stoic Philosophers--and More! Ask David Questions for Today Bystad: Why is it so helpful to write down your negative thoughts when you're upset? Anyinio: Do we have to have a thought every time we have an emotion? What if I see a car coming fast and about to hit me? Would I have to have a fast automatic thought? Raghav: How can I get unstuck from apathy? Anita: What are the necessary and sufficient conditions for emotional distress as well as escape from emotional distress? Louisa: Can you tell us some more about the ancient and modern Stoic philosophers who influenced the development of CBT and TEM-CBT? Answers to today's questions. The following answers were written before the podcast. The information on the podcast may be quite different in some cases, and will typically provide much more information than the brief answers below. David Bystad asks: Why is it so helpful to write down your negative thoughts when you're upset? Dear David! I have practiced the paradoxical approach where I just write down my thougts / worries without challenging them. I think I learned that approach from your great book «When Panic Attacks». This is something that really works for me, especially for worries. It is almost like I «get the worries out of my head». Can you talk about this approach in your lovely podcast, why is it so effective for some people?? Best regards from Martin David's reply Great question. Will address it the next time we record an Ask David podcast! Anyinio asks: Do you ALWAYS have a thought before you can experience an emotion / feeling? David's response The word "thought" is just a form of shorthand for perception. Perception can take many forms. When you see a car about to hit you, you already HAVE a negative and alarming thought! If you like, you can check out the railroad track story in my Feeling Good Handbook. It is a story about a man who became euphoric after his car was hit by a train going 60 MPH because of his thoughts about it! When a deer spots a pack of howling wolves, it runs in terror. It does not have a "thought" in English, but it DOES have the perception of being in imminent danger, and it DOES experience intense, sudden fear. However, the deer did NOT feel fear / anxiety until s/he SAW and correctly interpreted the pack of wolves. Thanks, best, david Raghav asks: How can I get unstuck from apathy? Hi Dr. Burns, I hope you're doing well and thank you so much for all of your incredible work! It has really helped me pull myself out of some of the deepest depressions and anxieties I've had. I wanted to ask for your help with a problem I've been facing recently: I seem to get stuck in depressive cycles at times where I don't want to do a DML even though I know it will make me feel better. When I start doing the positive reframing, it helps melt away this resistance, but I still mope around for a while before I start the positive reframing. My thoughts during this time are generally "There's no point to getting better," "Doing a DML is like forcing myself to cheer up," "I should care about getting better more than I do right now," and "There's no meaning to life." How would you recommend I go about dealing with this apathetic state? I would greatly appreciate any help in this matter! Thanks, Raghav David's reply: You could perhaps list: All the really GOOD reasons NOT to do a DML. What the procrastination / avoidance shows about you and your core values that positive and awesome. How the avoidance helps you. Something along those lines. I might make this an Ask David question if that's okay with you. Could use your first name only, or a fake name if you prefer. Thanks! Good question, as so many can relate to it! Best, david Raghav's response to David Here's the answers I came up with: Good Reasons NOT to do a DML Doing a DML might be difficult and take a long time. I might not be able to answer some of my thoughts. Even if I do a DML, I might not be able to change my mood. Even if I change my mood, there's no point in being happy. There's no sense of meaning in doing a DML. It feels inauthentic to try to change my mood. Even if I do a DML now, I will return to this state again. Doing a DML is like forcing myself to cheer up and I don't want to be forced to do anything. I want to be able to get better without doing a DML. I might have to confront really negative and distressing thoughts. Core Values it shows about me I care about doing things successfully — I don't want to half-ass it. I want to put my best foot forward when doing tasks — i.e. not do them when I'm tired. I want to be self-reliant and be able to solve all my problems myself. I care about being able to change my mood. I care about having meaning in life. I care about being authentic to my emotional states — I can honor my apathetic/bored side. I can sit with my sadness and apathy rather than trying to escape it. I care about having lasting solutions rather than

Self-Esteem, Self-Confidence, and Self-Acceptance What's the Difference? What's More Important? Questions for today's Ask David podcast David asks: What's the difference between self-confidence, self-esteem, and self-acceptance? Guillermo asks: How do you help people who are not asking for help or don't even know they need help with depression? The answers to today's questions in these show notes were written before the podcast. The information on the podcast may be quite different and will typically provide much more information than the brief answers below. David David asks: What's the difference between self-confidence, self-esteem, and self-acceptance? Hello David, The mental health world seems to like or argue about the meaning of terms like self-confidence, self-esteem, and self-acceptance? What's the difference between them, and which one is the best thing to have? David's response: Great question, David. I think of self-confidence as the conviction that you're probably going to win because you're very good at something. Self-esteem, in contrast, is the decision to love yourself whether you win or lose. Between those two, I'd say that self-confidence is more fun, but self-esteem is more important. But where does self-acceptance fit in? That's the big buzz word these days, although the concept has been around for ages. We'll have to ask the experts today to find out where it fits in! I'm a bit confused at the moment! Guillermo asks: How do you help people who don't know that they need help with depression? Hello, Dr Burns I was curious as to how you would help someone who isn't aware (or capable to know--but not in a medical sense) that they need help. You've said before that the worst thing you can do is try to help (especially when no one asked for help), but how have you handled in the past cases when someone isn't aware that they need help for depression? Seems like it would be very tough without the person being motivated. As always, thank you for all you do, Guillermo Campos Rhonda, Matt, and David will reply on the podcast. David and Rhonda are grateful that Matt can join us often on the podcast.

Shoulds and More with our Beloved Fabrice! Three little words that will make your life miserable are "shoulds," "wants," and "needs," says Dr. Fabrice Nye, the father / creator of the Feeling Good Podcast several years ago. But for the purpose of this episode, we'll add a fourth word, "Musts," which was popularized by Dr. Albert Ellis, who referred to it as "Musterbation." Fabrice says that, "Shoulds are a trap. . . . There's no such thing as a should, except for the laws of nature. For example, if I drop my pen, it "should" fall to the floor because of the effects of gravity. And sure enough, it does! "But when I say, 'I should get an A on my upcoming exam,' i may just be setting myself up for frustration. That's because there's no laws of the universe saying that people will always get As on their exams. "Similarly, if I say it SHOULDN'T be raining today, I'm involved in fiction, not reality. The clouds don't obey our whims, they are just obeying the laws that govern the weather." Fabrice explained that when you apply shoulds to some past event, telling yourself that your shouldn't have made some mistake, you just make yourself guilty because it sounds like you're scolding yourself. Again, you're living in some fictitious reality where things are always the way you want them to be, because it's impossible to change the past Fabrice reminded us that the Anglo-Saxon origin of the word, "should," is "scolde." So when you "should" on yourself, you're actually scolding yourself. Fabrice also explained that the concept of "needs" can also get us into emotional hot water, since we sometimes tell us that we "need" things that we may want but don't really "need." So, if you tell yourself that someone "needs" to do something for you, you are simply applying pressure to the situation. For example, you might want or prefer for the person to be on time for appointments or planned activities, but you don't "need" them to be on time. Similarly, you might want to find someone to love, or someone to love you, but you don't "need" love, according to Fabrice. . . . and David agrees! It has been shown in research studies that infants and young children need love to grow and develop in a healthy way, but love is not an adult human need. According to the Buddhists, "needs" are not real. They're just cravings, or intense desires that we've elevated to some godly state. Of course, there ARE things that we really do "need." For example, we "need" to breathe to stay alive, and we "need" to have gas in the car if we want to drive to San Francisco. Those things are needed to fulfill a particular goal. So the key to an actual need is adding the phrase, "...in order to..." Fabrice also described some "want" traps. For example, you may sit at your computer cruising the internet or playing digital games, all the while telling yourself "I really want to get to work on my paper," or taxes, or whatever. But in point of fact, you DON'T want to get to work on the thing you're putting off. You WANT to be doing exactly what you are doing. Fabrice explains that we "trick ourselves into thinking we want something (like doing our taxes) when we really want to be doing something else (watching TV, playing computer games.) So, once again, we are telling ourselves stories that don't map onto reality." Our real "wants" are the result of an unconscious cost-benefit analysis we make in our head, where the choice that comes out on top is our real want. It's only when I really start doing my taxes that I'll know this is what I want to be doing (probably because the urgency of the matter made the cost-benefit analysis tip in that direction). David was trying to see if this concept of "wants" can be helpful in therapy but had trouble seeing how this might help someone who's procrastinating. Fabrice explained it like this: First, we need to realize that we are doing what we want in the moment; so, it's a choice. Next, we can make our cost-benefit analysis conscious and see that we're only considering short-term factors (e.g., it's a lot more comfortable right now to be watching TV than doing taxes). Finally, we can develop some empathy for our future self (the one who will be pulling an all-nighter three weeks from now, or who will have to pay late fees) to reevaluate our cost-benefit analysis with more complete data. Fabrice also explained that procrastination can sometimes be difficult to treat because it's an addiction. Rhonda also commented on the use of these concepts in therapy. Fabrice concluded the podcast by saying that he watches out for those three little words in his own thinking: "should, need, or want." Thanks for listening today. Fabrice, Rhonda, and David